Substance abuse and its consequences in Indiana: Does level of urbanization affect outcomes

Background: Substance abuse is a public health concern in both the United States and Indiana. Indiana's adult smoking prevalence (24%) is the fifth highest in the nation. Heavy drinking rates are significantly higher among 18- to 24-year-old Hoosiers than their U.S. counterparts. In addition, the use of methamphetamines, pain relievers, and sedatives/tranquilizers among Indiana's treatment population increased significantly from 2000 to 2005. Studies suggest that urbanization and its accompanying demographic, economic, and social characteristics affect the type and severity of health problems in a community. Objective: The purpose of this study was to examine whether substance abuse and the resulting consequences are affected by the level of urbanization in Indiana. Methods: Indiana counties were given an “urbanicity score” (1 = urban; 2 = mixed urban; 3 = mixed rural, 4 = rural) depending on their level of urbanization. Secondary data sources, including the Treatment Episode Data Set (TEDS), Uniform Crime Reports (UCR); State Treatment Needs Assessment Project (STNAP); and School Suspensions and Expulsions involving Alcohol, Drugs, or Weapons Data were analyzed, comparing substance abuse and consequences across counties by their level of urbanization. Results: Significant differences (p < 0.05) by level of urbanization were found for alcohol abuse rates among adults ages 18 and older, for rates of reported substance use among Indiana's treatment population, and for drug possession arrest rates. However, urbanicity did not seem to affect rates for school suspensions and expulsions due to alcohol, drugs, or weapons.