By Melissa PatrickKentucky Health News
Kentucky has a relatively small percentage of drinkers compared to the rest of the nation, but it appears it is leading the nation in the increases in the percentage of people who are drinking any alcohol, drinking heavily and binge drinking, especially among women, according to a new
analysis of county-level drinking patterns in the U.S.
The study took a look at any drinking, heavy drinking and binge drinking at a state and county level and found that Kentucky leads the nation in the percentage of increase in all three categories. Kentucky showed a 17.6 percent increase in any drinking, compared to no national increase; a 60.8 percent increase in heavy drinking, compared to 17.2 percent nationally; and a 29 percent increase in binge drinking, compared to 8.9 percent nationwide, between 2005 and 2012.
"It is surprising that there has been such a big increase in Kentucky in more people drinking," Ty Borders, professor of health management and policy at the
University of Kentucky, said in an interview. "I'm not sure why that would be, especially because it was the only state that had this really big increase in drinking and risky drinking. ... It just really doesn't make sense."
Borders was perplexed at these outcomes, especially for the "any drinking" category, saying that because there is a greater percentage of persons who are members of religious affiliations that forbid drinking in the Southeast, people in this region tend to drink less. He expressed more confidence in the state and national estimates than the county-level estimates because of the often low response rates generated by the Behavioral Risk Factor Surveillance System on which the county estimates are based, but he said, "This is the best we have at the county level." The system is a continuous national poll by the federal
Centers for Disease Control and Prevention.
Allen Brenzel, medical director for the state
Department for Behavioral Health, Developmental and Intellectual Disabilities, emphasized in an interview that while Kentucky is well below the national alcohol abuse averages, this report shows an "alarming trend, regarding women particularly."
�It really does show that we need to be careful to not become so preoccupied with prescription drug abuse and opiate abuse,� he said. �We need to realize that alcohol is still a major issue when we see trends like this, we need to rebuild our education, prevention and treatment efforts.�
Borders agreed. "If you think about the overall burden on the health of the population, alcohol is still the top in terms of the effect it has on our health status and other downstream factors such as loss work productivity and also health-care costs," he said. "A lot of attention has been focused on obesity and illicit drug use, but alcohol misuse really remains a very big public health concern and it should be at the forefront of issues that we are discussing."
Brenzel said that while the BRFSS data is �more intended to be used across states and across regions of the country,� which makes it �a little bit challenging to break it down specifically� to counties, this data does show a statewide �absolute increase from the 2005 levels.�
He also said that this report conflicted slightly with a recent state report that shows a consistent decline in alcohol use and abuse in both boys and girls during the same time period. �Typically, what we see is that trends in children are usually reflected later in trends in adults,� he said.
Brenzel offered several possible reasons for the increases found in the report, but said it would take a while to �drill down� the specifics. He suggested one thing to investigate regarding the increases shown in women is whether it has become more socially acceptable in Kentucky for women to drink, especially with the increased marketing of liquor to women.
He suggested that the increased number of Kentuckians who are in the active military might have influenced the increases shown in this study, saying studies have shown that if a family has someone actively in the military, it tends to have higher drinking rates. He also noted that the socioeconomic strains that occurred between 2005 and 2012 could have also influenced these increases.
The study, "Drinking patterns in U.S. counties from 2002 to 2012," by the Institute on Health Metrics and Evaluation at the
University of Washington, was published in the
American Journal of Public Health and is the first study to track trends in alcohol use at the county level.
It defined "any drinking" as one drink in the past 30 days, "heavy drinking" as more than one drink a day for women and two drinks per day for men, and "binge drinking" as at least five drinks for men and four for women on a single occasion during the previous 30 days.
The data are adjusted for age, and the county figures reflect statistical modeling to compensate for small sample sizes. Click
here for an interactive map of the data, which shows the possible ranges of percentages, reflecting the poll's error margin.
Drinking in KentuckyThe study found that nationwide, Kentucky showed the greatest increase in drinking, with a 17.6 percent (possible range of 10.6 to 25) increase between 2005 and 2012. No other state was even close; Tennessee ranked second at 11.3 percent and Louisiana was third at 9.8 percent. Nationally, there was no percentage increase in drinking during this time frame.
Kentucky women led the nation in increased drinking, at 21.9 percent, with Tennessee women at 17 percent. Kentucky men also led the nation in this category with an increase of 14.6 percent, followed by Louisiana at 9 percent and Tennessee at 7.3 percent.
In 2012, 43.1 percent of Kentuckians drank at least one drink per month, including 36 percent of women and 50.4 percent of men. Nationwide, 56 percent of Americans have at least one drink a month.
Heavy drinking in Kentucky
Kentucky also showed the nation's largest increase in heavy drinking, up 60.8 percent (possible range 39 to 89.5) between 2005 and 2012. Once again, no other state was close. South Dakota came in at 46.5 percent, Nebraska 45 percent, Kansas 44.5 percent and Washington, D.C., 42.2 percent. Nationally, the increase in heavy drinking was 17.2 percent.
Kentucky's increase was driven largely by women, who showed a 68.2 percent increase in heavy drinking. Nebraska (63.8 percent) and Oklahoma's (60.1 percent) women had the next largest increases in this category. Kentucky men also led the nation in this category with a 57.6 percent increase in heavy drinking, followed by Washington, D.C., at 52.1 percent. Other states were nowhere close to these numbers.
In 2012, 7.2 percent of Kentuckians self-reported as heavy drinkers, including 4.6 percent of women and 10 percent of men. Nationwide, 8.2 percent of Americans identify as a heavy drinker.
Heavy drinking is a risk factor for long-term health effects like cancers, liver damage and heart disease, according to the study.
Binge drinking in KentuckyKentucky also led the nation in increased binge drinking, up 29 percent (possible range 17.9 to 42.7) between 2005 and 2012, compared to 8.9 percent nationally. Washington, D.C, up 21.4 percent, and Maryland, up 20.8 percent, were next in the rankings for increased binge drinking.
This increase in Kentucky was also driven by women, with 51.4 percent more of them binge drinking between 2005 and 2012, compared to 17.5 percent nationally. This was far ahead of the next two state leading this category, Maryland women at 34.7 percent and Vermont women at 32.3 percent. Men in Kentucky increased their binge drinking by 20.7 percent, followed by Washington, D.C., at 17.9 percent and Kansas at 17.6 percent. Other states were not close.
In 2012, 15.1 percent of Kentuckians self-reported as binge drinkers, compared to 18.3 percent nationally, including 9.5 percent of Kentucky women and 21 percent of Kentucky men.
Binge drinking is commonly linked to higher risk for serious bodily harm like car crashes, injuries and alcohol poisoning and acute organ damage, says the study.
Nationwide, women showed a much faster escalation in binge drinking than men, with rates rising 17.5 percent between 2005 and 2012; men, on the other hand, saw rates of binge drinking increase 4.9 percent, according to the release.
�We are seeing some very alarming trends in alcohol overconsumption, especially among women,� Dr. Ali Mokdad, a lead author of the study and professor at the Institute for Health Metrics and Evaluation, said in a press release. �We also can�t ignore the fact that in many U.S. counties a quarter of the people, or more, are binge drinkers.�
County data
This report is the first to track trends in alcohol use at the county level, and while the confidence level for the county data are lower than the state data, the report found that every Kentucky county experienced increases in rates of drinking since 2005, with Lawrence County recording the largest increase in drinking at 43.5 percent (possible range 21.4 to 67.8).
Kenton County posted the highest levels of heavy drinking in 2012 (13.1 percent, with a possible range of 10.2 to 16.4), and Bracken County experienced the fastest rise in heavy drinking between 2005 and 2012, increasing 94 percent (possible range 42 to 188.8).
Pike County experienced the largest increase in binge drinking for women, climbing 90 percent (possible range 45.9 to 166.6), says the release.
Campbell County had the highest percentage of binge-drinking residents (27.3 percent with a possible range of 23.9 to 31.8), and Lawrence County recorded the fastest increase in rates of binge drinking, rising 52.8 from 2005 to 2012 (possible range 24 to 88.8).
Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky. 
