Driving under the influence of alcohol or drugs among adolescents: The role of urban and rural environments

•Exposure to DUIAD and especially RDUIAD is common among Spanish adolescents.•Living in a rural area is independently associated with DUIAD and RDUIAD.•Improving public transportation in rural areas is needed to reduce them.

This study aimed to describe driving under the influence of alcohol or drugs (DUIAD) and riding in a vehicle with a driver under the influence of alcohol or drugs (RDUIAD) and their associated factors among rural and urban adolescents in Spain. We performed a cross-sectional study including 2067 students from Barcelona and a rural area 60 km north of this city. The prevalences of ever DUIAD and RDUIAD were 17% and 41% among 17–18 year-old adolescents. DUIAD was more common in boys. Living in the rural area was independently associated with these behaviours. Exposure to these behaviours is common among Spanish adolescents, especially in rural areas.