Assessing how alcohol use patterns relate to obesity among American adolescents from rural and urban areas: Five years of pooled data.

Background: Obesity is associated with locality and alcohol use; however, less is known about how the interaction of these two factors may compound the risk of obesity among adolescents.

Objectives: This study examines the relationship between alcohol use and obesity among adolescents from rural and urban areas in the United States.

Methods: Data came from a sample of American adolescents aged 12-17 years from the National Survey on Drug Use and Health (2015-2019; n = 39,489). Obesity was regressed on age, sex, race/ethnicity, income, cigarette smoking, locality, and alcohol use, with an interaction term to examine locality x alcohol use. Predicted probabilities were plotted to assess the interaction.

Results: Compared to adolescents from urban areas, those from rural areas had 1.35 times higher odds of being obese (95% CI 1.25, 1.47). Predicted probabilities indicated that the probability of being obese was higher for rural adolescents at lower levels of drinking, up to about 40 drinks in the past 12 months.

Conclusions: Findings suggest rural-urban differences at the intersection of alcohol use and obesity could depend on the frequency of use, but overall adolescents from rural areas may be more at risk.