Previous work on Russian roulette has focused on data from large cities. It is unclear if the epidemiological patterns based on large cities will replicate for the nation as a whole, and if the influence of minority status will be moderated by urban context. The present investigation fills these gaps by providing descriptive epidemiological data on Russian roulette for 17 states, and testing a hypothesis on urbanism as a moderator of the race-Russian roulette relationship. Data were taken from the National Violent Death Reporting System (2003-2006). They refer to 71 Russian roulette cases and a matched control group of 284 males who committed suicide by a gunshot wound to the head. Russian roulette suicides were more apt to be of minority status, younger, had a lower incidence of mental health problems, and were more likely to be utilizing alcohol than the controls. Differentiating the sample into larger and smaller urban areas, it was found that the risk of Russian roulette for African Americans was higher in larger urban areas. Epidemiological patterns in previous research on large city samples are largely replicated. The moderating influence of urban context is related to differential opportunity structures for risk-taking behavior.