Introduction: Underage drinking can have profoundly negative impacts on childhood development. This study compares 4 categories of known underage drinking risk factors with alcohol consumption. The social indicators in these categories will be compared in the 10 most-at-risk (MAR) counties and the 10 least-at-risk (LAR) counties identified in Georgia.

Methods: Independent 2-tailed t-tests were conducted to compare group means among MAR and LAR counties for all identified risk factors.

Results: Significant differences were observed in all factors included in the poverty and alcohol outlet density categories.

Discussion. The findings underscore the importance of better understanding youth drinking, poverty, and alcohol outlet density. However, our findings, supported by previous individual and aggregated level research, support strategies for researchers and policy makers to more proactively respond to poverty-stricken and high-density alcohol outlet indicators. The current ecological evaluation of underage drinking risk assessed on a macrolevel offers insights into the demographic features, social structures, and cultural patterns of counties that potentially predispose youth to greater health risks specifically associated with underage drinking.