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This multilevel study examined whether state-level variations existed in the prevalence of regular alcohol use in the US after controlling for individual characteristics, evaluating the contribution of both individual socio-economic status, and state economic and alcohol policy in explaining alcohol use behavior using data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions and data from the U.S. Census and National Institute of Alcohol Abuse and Alcoholism State Policy System. When controlled for individual-level variables, state poverty level, Sunday alcohol sales, states with higher per capita ethanol sales were associated with individual alcohol use. Over and above the individual characteristics, state-level predictors explained a considerable proportion of state variance and had an impact on individuals’ propensities to use alcohol regularly. This implies that both individual characteristics and state conditions were independently associated with alcohol use behavior. Our results showed that state socio-economic conditions and state alcohol policy were as important as individual-level characteristics in explaining alcohol use in the U.S. Policies aimed at reducing alcohol use may be more effective if they address both situational and individual factors.

Clustering Alcohol Use Behavior: State Socioeconomic Conditions, Alcohol Policy and Individual Regular Alcohol Use in the US