Social and economic consequences of rural alcohol use.

One-quarter of the population of the United States lives in nonmetropolitan or rural areas (U.S. Congress 1990). These areas are notable for their rich diversity and varied lifestyles. From farming communities in the Midwest, to agricultural areas of the Mississippi Delta, Native American reservations, Appalachian and Ozark Highlands, and western oil-based boom towns, rural communities vary greatly in socioeconomic characteristics, ethnic and minority mix, and availability of health and social services. At the same time, rural communities share a number of characteristics: they are defined by the low population density; most are severely limited in access to professional health, mental health, and substance abuse resources; and rural economies are often volatile in nature with increased dependence on agricultural, extractive, and service industries (Gesler et al. 1992). Higher rates of poverty and substandard housing in rural areas in general and lower educational attainment of rural residents increase the chances that families from these regions will suffer the negative consequences of such health risk behaviors as problem drinking (Meade 1992).