Excessive alcohol use* is associated with disease, injury, and poor pregnancy outcomes and is responsible for approximately 95,000 deaths in the United States each year (1). Binge drinking (five or more drinks on at least one occasion for men or four or more drinks for women) is the most common and costly pattern of excessive alcohol use (2). CDC analyzed data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) to estimate past 30-day binge drinking prevalence, frequency, and intensity (number of drinks per occasion), overall and by select characteristics and state. The overall unadjusted prevalence of binge drinking during the past 30 days was 16.6%, representing an estimated 38.5 million U.S. adults aged ≥18 years; prevalence was highest (26.0%) among those aged 25-34 years. The age-standardized binge drinking prevalence was higher among men (22.5%) than among women (12.6%), increased with income, and was highest among non-Hispanic White adults and adults in the Midwest Census region. State-level age-standardized binge drinking prevalence ranged from 10.5% (Utah) to 25.8% (Wisconsin). Among adults who reported binge drinking, 25.0% did so at least weekly, on average, and 25.0% consumed at least eight drinks on an occasion. To reduce binge drinking, the Community Preventive Services Task Force recommends increasing alcohol taxes and implementing strategies that strengthen regulations to reduce alcohol availability.(†) The U.S. Preventive Services Task Force recommends clinicians screen adults for alcohol misuse in primary care settings and provide counseling as needed.(§).

CONTEXT: Excessive alcohol use is responsible for 88 000 deaths in the United States annually and cost the United States $249 billion in 2010. There is strong scientific evidence that regulating alcohol outlet density is an effective intervention for reducing excessive alcohol consumption and related harms, but there is no standard method for measuring this exposure. PROGRAM: We overview the strategies available for measuring outlet density, discuss their advantages and disadvantages, and provide examples of how they can be applied in practice. IMPLEMENTATION: The 3 main approaches for measuring density are container-based (eg, number of outlets in a county), distance-based (eg, average distance between a college and outlets), and spatial access-based (eg, weighted distance between town center and outlets). EVALUATION: While container-based measures are the simplest to calculate and most intuitive, distance-based or spatial access-based measures are unconstrained by geopolitical boundaries and allow for assessment of clustering (an amplifier of certain alcohol-related harms). Spatial access-based measures can also be adjusted for population size/demographics but are the most resource-intensive to produce. DISCUSSION: Alcohol outlet density varies widely across and between locations and over time, which is why it is important to measure it. Routine public health surveillance of alcohol outlet density is important to identify problem areas and detect emerging ones. Distance- or spatial access-based measures of alcohol outlet density are more resource-intensive than container-based measures but provide a much more accurate assessment of exposure to alcohol outlets and can be used to assess clustering, which is particularly important when assessing the relationship between density and alcohol-related harms, such as violent crime.

CONTEXT: Excessive alcohol use is responsible for 88 000 deaths in the United States annually and cost the United States $249 billion in 2010. There is strong scientific evidence that regulating alcohol outlet density is an effective intervention for reducing excessive alcohol consumption and related harms, but there is no standard method for measuring this exposure. PROGRAM: We overview the strategies available for measuring outlet density, discuss their advantages and disadvantages, and provide examples of how they can be applied in practice. IMPLEMENTATION: The 3 main approaches for measuring density are container-based (eg, number of outlets in a county), distance-based (eg, average distance between a college and outlets), and spatial access-based (eg, weighted distance between town center and outlets). EVALUATION: While container-based measures are the simplest to calculate and most intuitive, distance-based or spatial access-based measures are unconstrained by geopolitical boundaries and allow for assessment of clustering (an amplifier of certain alcohol-related harms). Spatial access-based measures can also be adjusted for population size/demographics but are the most resource-intensive to produce. DISCUSSION: Alcohol outlet density varies widely across and between locations and over time, which is why it is important to measure it. Routine public health surveillance of alcohol outlet density is important to identify problem areas and detect emerging ones. Distance- or spatial access-based measures of alcohol outlet density are more resource-intensive than container-based measures but provide a much more accurate assessment of exposure to alcohol outlets and can be used to assess clustering, which is particularly important when assessing the relationship between density and alcohol-related harms, such as violent crime.

Excessive alcohol use accounted for an average of one in 10 deaths among working-age adults (aged 20-64 years) in the United States each year during 2006-2010, and cost the United States $223.5 billion in 2006. Binge drinking, defined as consuming four or more drinks for women or five or more drinks for men on an occasion, was responsible for more than half of these deaths and three fourths of the economic costs. Binge drinking also is responsible for many health and social problems, including alcohol poisoning. Yet, approximately 38 million U.S. adults report binge drinking an average of four times per month, and consume an average of eight drinks per binge episode. Most binge drinkers (90%) are not alcohol dependent.