Patterns of alcohol, tobacco and cannabis use and related harm in city, regional and remote areas of Australia

Abstract

Background

Prevalence of substance use and related harms differs across geographic locations, with prevalence increasing with remoteness. This paper builds on previous research, investigating patterns of problematic use by remoteness.

Methods

Analysis of the National Drug Strategy Household Survey (NDSHS) data from 2007 by geographic location (in accordance with the Australian Standard Geographical Classification (ASGC) remoteness index).

Results

Problematic cannabis use was predicted by demographics; older males with less education were more likely to report problematic cannabis use regardless of location. Younger, less educated males in inner regional and remote areas were more likely to report risky alcohol consumption for short term harms, while older, less educated males in outer regional and remote areas were more likely to report daily drinking. People from remote areas were significantly more likely to report driving under the influence of alcohol.

Conclusions

It is clear that men with lower levels of education were significantly more likely to report problematic alcohol and cannabis use patterns. An additional level of risk is associated with living in inner regional and remote areas, particularly in relation to risky drinking. Findings suggest a complex relationship between remoteness and substance use which requires further investigation.

Introduction

The United Nations Office on Drugs and Crime (UNODC) estimates 3.3–6.1% of the global population aged 15–64 years has used an illicit drug in the past year (United Nations Office on Drugs & Crime, 2011); the World Health Organization (WHO) estimates that, in 2005, 6.13 litres of pure alcohol was consumed by every person aged 15 years or older (World Health Organization, 2011). Both reports indicate there is variation in consumption between countries; higher levels of alcohol consumption are seen in countries such as Argentina, Australia and New Zealand (World Health Organization, 2011).

Research also shows within-country variance. Studies in the United States have shown that adolescents living in rural communities report higher levels of alcohol and tobacco use than adolescents in urban communities (Hanson et al., 2009). Although there is some indication this difference may extend to illicit substance use (Lambert, Gale, & Hartley, 2008), other studies have shown higher rates among urban adolescents (Hanson et al., 2009). Research from Victoria, Australia has found adolescents in regional and rural areas report high-risk alcohol consumption compared to those in urban areas (Livingston, Laslett, & Dietze, 2008). Geographical differences cease to exist for tobacco consumption among adolescents and those in urban areas report higher levels of illicit substance use, with the exception of cannabis (Australian Institute of Health & Welfare, 2008).

Rural communities also show greater harm from substance use. A research review in Australia has shown that rural communities show substantially greater harm from alcohol consumption than urban populations (Miller, Coomber, Staiger, Zinkiewicz, & Toumbourou, 2010). Hospitalisation rates are generally higher; up to 24.7% of men living in rural or remote areas experience hospitalisations due to alcohol-related disease (such as cirrhosis of the liver) and alcohol-related injury (such as road injuries) as compared to 17.6% of men living in metropolitan areas. The trend is the same for women (Hanlan, Jonas, Laslett, Dietze, & Rumbold, 2000).

Exploring differences in patterns of substance use and related harm between urban, regional and rural locations is not new. However, these differences are often discerned using prevalence measures, which include those who may have only used a substance once over a period of time. It is important to explore patterns of problematic substance use, which are more likely to confer harm. Using data collected from a nationally-representative population survey, the current paper seeks to identify differences between urban, regional and rural populations regarding problematic substance use, and harm and highlight areas requiring further investigation.