Reason for Ranking
Excessive drinking is a risk factor for a number of adverse health outcomes, such as alcohol poisoning, hypertension, acute myocardial infarction, sexually transmitted infections, unintended pregnancy, fetal alcohol syndrome, sudden infant death syndrome, suicide, interpersonal violence, and motor vehicle crashes. Approximately 80,000 deaths are attributed annually to excessive drinking. Excessive drinking is the third leading lifestyle-related cause of death in the United States.
Measurement Strengths and Limitations
A study evaluating the reliability and validity of the self-reported BRFSS measures found the reliability (repeatability) of the BRFSS alcohol consumption data to be high. Validity (accurate representation) was found to be moderate but sufficient given the difficulty in assessing the validity of people’s reports of their own alcohol use.
Using self-reported survey data to assess excessive drinking has limitations. First, excessive drinking is often underreported in surveys because of recall bias, social desirability response bias, and non-response bias. Second, BRFSS changed the definition of excessive drinking for women in 2006; this means that there will be a higher prevalence in recent years compared to prior years for women. Third, the measure does not include youth drinking prevalence. Some US states and counties administer a Youth Behavioral Risk Surveillance Survey, but there is not adequate coverage or consistent enough methodology to aggregate the results to represent all counties across the country. Binge drinking accounts for 90% of alcohol consumption for youth ages 12-17. Having a measure that includes youth binge drinking would be beneficial for understanding youth drinking patterns in different counties.
Please note that changes in the method CDC used to create this measure in 2016, 2017, and 2018 means that new estimates should not be compared with earlier years. To see more about these changes, look in the Data Source tab.