# Description of the geographic distribution of excessive drinking across regional cultures in the United States: Framing an important health metric according to the cultural context of the American nations

**Authors:** Shane A. Phillips, Ross Arena, Nicolaas P. Pronk, Colin Woodard

PMC · DOI: 10.1371/journal.pone.0344249 · PLOS One · 2026-03-04

## TL;DR

The paper explores how excessive drinking varies across U.S. regions and connects these patterns to historical settlement cultures.

## Contribution

It introduces the American Nations model as a framework to explain and address region-specific drinking behaviors.

## Key findings

- Excessive drinking patterns in the U.S. are region-specific and align with the American Nations model.
- The 2024 County Health Rankings data supports the regional prediction of alcohol consumption behaviors.
- Cultural context from historical settlement patterns influences current health behaviors like drinking.

## Abstract

Excessive alcohol drinking results in an increased risk for chronic diseases, and the rates of alcohol consumption have increased among U.S. adults in the past decade. The U.S. Surgeon General called for updating consumer labels to include this risk. This paper aims to understand the regional distribution of excessive drinking and how these patterns may be explained according to the American Nations model of the first U.S. settlement streams. We present data from the 2024 County Health Rankings program to demonstrate the distribution of excessive drinking, showing that excessive alcohol drinking patterns are region-specific and predicted by the American Nations model. This paper introduces the American Nations model in promoting alcohol consumption reduction messages.

## Full-text entities

- **Diseases:** obesity (MESH:D009765), stroke (MESH:D020521), food insecurity (MESH:D005517), diseases (MESH:D004194), binge drinking (MESH:D063425), physical (MESH:D059445), Excessive alcohol drinking (MESH:D000437), diabetes (MESH:D003920), cancer (MESH:D009369), insufficient sleep (MESH:D012892), alcohol-related disease (MESH:D019973), chronic disease (MESH:D002908), Excessive (MESH:D006970), death (MESH:D003643), myocardial infarction (MESH:D009203), CV disease (MESH:D002318), COVID-19 (MESH:D000086382)
- **Chemicals:** alcohol (MESH:D000438)
- **Species:** Homo sapiens (human, species) [taxon 9606]

## Full text

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## Figures

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## References

29 references — full list in the complete paper: https://tomesphere.com/paper/PMC12959701/full.md

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Source: https://tomesphere.com/paper/PMC12959701