Data Source

"The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based random digit dial (RDD) telephone survey conducted annually in all states, the District of Columbia, and U.S. territories. Data obtained from the BRFSS are representative of each state’s total non-institutionalized population over 18 years of age and have included more than 400,000 annual respondents with landline telephones or cellphones since 2011. Data are weighted using iterative proportional fitting (also called "raking") methods to reflect population distributions. For the County Health Rankings, data from the BRFSS are used to measure various health behaviors and health-related quality of life (HRQoL) indicators. HRQoL measures are age-adjusted to the 2000 U.S. standard population."

Measure Methods

• "Excessive Drinking is a percentage: Excessive Drinking measures the percentage of a county’s adult population that reports binge or heavy drinking in the past 30 days."

• "Excessive Drinking estimates are age-adjusted: Age is a non-modifiable risk factor, and certain health behaviors may be associated with different age groups in the population. County Health Rankings report an age-adjusted rate to compare counties with differing age structures fairly."

• "The method for calculating Excessive Drinking has changed: Before the 2016 County Health Rankings, the CDC’s BRFSS provided the Rankings with county-level estimates that were constructed from seven years of responses from participants who used a landline phone. Beginning with the 2016 Rankings, the CDC provided single-year modeled county-level estimates that included landline and cell phone users. Beginning with the 2021 Rankings, the CDC has updated its modeling procedure for producing small-area estimates. Also, in the 2021 Rankings, this measure is now age-adjusted. All of these changes were implemented to provide users with the most accurate estimates of health in their community as possible."

• "Excessive Drinking is created using statistical modeling: Statistical modeling is used to obtain more informed and reliable estimates than survey data alone can provide. Modeling generates more stable estimates for places with small numbers of residents or survey responses. The Excessive Drinkings estimates are produced from one year of survey data and are created using complex statistical modeling. Please see their methodology for more technical information on PLACES modeling using BRFSS data. There are also drawbacks to using modeled data. The smaller the county population or sample size, the more the estimates are derived from the model and the less they are based on survey responses. Models make assumptions about statistical relationships that may not hold in all cases. Finally, there is no perfect model, and each model generally has limitations specific to their methods."

• "Measure limitations: 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 there will be a higher prevalence in recent years than in prior years. Third, the measure does not include youth drinking prevalence, where 29% of high school students drank alcohol and 11% of young people aged 12-20 years binge drank, all in the past 30 days. Having a measure that includes youth binge drinking would be beneficial for understanding youth drinking patterns in different geographical areas, such as states and communities. Some U.S. states and counties administer a Youth Behavioral Risk Surveillance Survey, but there is inadequate coverage or consistent enough methodology to aggregate the results to represent all counties nationwide."

• "Numerator: The numerator is the number of adult respondents reporting either binge drinking or heavy drinking. Binge drinking is defined as a woman consuming more than four alcoholic drinks during a single occasion or a man consuming more than five alcoholic drinks during a single occasion. Heavy drinking is defined as a woman drinking more than one drink on average per day or a man drinking more than two drinks on average per day."

• "Denominator: The denominator is the county's total number of adult respondents."

• "Can This Measure Be Used to Track Progress?: This measure could only be used to track progress after considering its substantial limitations. Methodological changes in the Behavioral Risk Factor Surveillance System, discussed above and implemented in the 2016 Rankings, make comparisons with estimates difficult before that release year. Additional changes to the methodology to create the estimates were implemented in the 2021 Rankings, making comparisons with estimates before that release year difficult. Finally, current estimates are produced using sophisticated modeling techniques, making them difficult to track progress, especially in small geographic areas. Modeled estimates have specific drawbacks about their usefulness in tracking progress in communities. Modeled data are not particularly good at incorporating the effects of local conditions, such as health promotion policies or unique population characteristics, into their estimates. Counties measuring the effects of programs and policies on the data should use great caution when using modeled estimates. To better understand and validate modeled estimates, confirming this data with additional data sources at the local level is particularly valuable."

Source: Excessive Drinking | County Health Rankings & Roadmaps

References

• Centers for Disease Control and Prevention. Sociodemographic differences in binge drinking among adults-14 states, 2004. Morbidity and Mortality Weekly Reports. 2009; 58:301-304.

• During binges, U.S. adults have 17 billion drinks a year. https://www.cdc.gov/media/releases/2018/p0316-binge-drinking.html. Published March 16, 2018. Accessed November 23, 2019.

• PLACES Project. Centers for Disease Control and Prevention. Accessed March 9, 2021. https://www.cdc.gov/places.

• Centers for Disease Control and Prevention. Alcohol and Public Health—Underage Drinking. https://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm. Updated October 6, 2021. Reviewed March 4, 2022.

• Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics. 2007; 119:76-85.