Researchers from Nationhood Lab, the University of Illinois-Chicago, and the HealthPartners Institute found significant differences in excessive drinking across the American Nations regional cultures in a new paper published in the academic journal PLOS One
By Colin Woodard
In a finding that defies the usual geographical pattern, the largest of the U.S. regional cultures with histories of investing in social services and public goods have higher rates of excessive or “binge” drinking than than the largest individualistic regions.
Two communitarian regions identified in my American Nations model — Yankeedom and the Midlands — have the worst excessive drinking prevalence among the major regional cultures, with 18.8 percent of Yankees and 18 percent of Midlanders reporting they have engaged in binge drinking or heavy alchohol use. The three “southern” regions — Greater Appalachia, the Deep South, and Tidewater — had among the best metrics, with 16.8, 17.1 and 17.3 percent of residents reporting excessive drinking.
Two smaller regions that are usually polar opposites in health outcomes — First Nation in northern and western Alaska and the U.S. portion of Greater Polynesia in the Hawaiian Islands — had the very worst metrics in the country, with New France’s southern Louisiana enclave just behind. New Netherland, the Dutch-founded zone in and around what is now New York City, had the lowest excessive drinking rate of all, at just 16.5 percent.
The research, published earlier this month in the peer-reviewed scientific journal PLOS One, was lead by Shane A. Phillips, senior associate dean of the University of Illinois Chicago’s College of Applied Health Sciences. I joined my frequent collaborators, Phillip’s colleague, Ross Arena, and HealthPartners Institute president Nico Pronk, as co-authors. It is the 33rd peer-reviewed paper published in as many months involving Nationhood Lab
“Certain cultures and groups represented across the American Nations may have disparate health consequences as a result of excessive alcohol, ” Phillips wrote. “The American Nations model may be particularly helpful in crafting future alcohol reduction messages, interventions, and health policy recommendations.”
The study used county-level data for 2024 collected the County Health Rankings & Roadmaps (CHRR) program of the University of Wisconsin’s Population Health Institute. Binge drinking is defined, scientifically, as a woman consuming four or more drinks in a two hour period or a man consuming five. Heavy alcohol use is defined as five or more drinks a day or 15 or more a week for men, four or more a day or eight or more in a week for women.
The differences between the regions were small — the gap between the best and worst regions was just three and a half percent — but Phillips notes small differences can be significant in health outcomes, especially at the population level.
The study is open access and available online at PLOS One, the peer-reviewed medical and scientific journal published by the Public Library of Science and has an impact score of 2.5 as of 2025. I was a co-author of a paper on geographical differences in wellbeing published there in September 2025 with collaborators from the University of Toronto Mississagua’s anthropology department.
We’ve previously used American Nations model to reveal and explain the spatial patterns of a wide range of health indices, including the prevalence of diabetes, obesity, disabilities, arthritis and preventable oral health problems. Our collaboration has gained signifiant attention in the health sciences field, and I have presented our work at the National Academies, at the “grand rounds” of both Maine’s largest hospital network, MaineHealth and Minnesota’s HealthPartners, and as the keynote speaker at the 2025 annual conference of the Maine Public Health Association.
Nationhood Lab, based at the Pell Center for International Relations and Public Policy at Salve Regina University, is an interdisciplinary research, writing, testing and dissemination project focused on counteracting the authoritarian threat to American democracy and the centrifugal forces threatening the federation’s stability. The project delivers more effective tools with which to describe and defend the American liberal democratic tradition and better understand the forces undermining it.
Thanks to Nationhood Lab’s partners at Motivf, where John Liberty produced the maps you see here.
— Colin Woodard is director of Nationhood Lab at Salve Regina University’s Pell Center for International Relations and Public Policy.