key: cord-0024268-mt45p0kn authors: Bohm, Michele K.; Liu, Yong; Esser, Marissa B.; Mesnick, Jessica B.; Lu, Hua; Pan, Yi; Greenlund, Kurt J. title: Binge Drinking Among Adults, by Select Characteristics and State — United States, 2018 date: 2021-10-15 journal: MMWR Morb Mortal Wkly Rep DOI: 10.15585/mmwr.mm7041a2 sha: f98ad167fe25b4087f1b2e70878d70b5a56b4132 doc_id: 24268 cord_uid: mt45p0kn nan respondents aged ≥18 years in the 2018 BRFSS to estimate past 30-day binge drinking prevalence, frequency, and intensity. Binge drinking prevalence and frequency were assessed with the question, "Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 (4 for women) or more drinks on an occasion?" § § Intensity was assessed with the question, "During the past 30 days, what is the largest number of drinks you had on any occasion?" (3). Unadjusted and age-standardized (to the 2000 U.S. standard population) binge drinking prevalence and 95% confidence intervals (CIs) were estimated overall. Age-standardized prevalence was also estimated by respondents' sociodemographic characteristics (except prevalence by age group), including sex, race/ethnicity, income, marital status, veteran status, education, region, county urbanization level, ¶ ¶ and state. State-level prevalence estimates and 95% CIs were grouped into tertiles to identify geographic patterns. Because of the highly right-skewed distribution of the data, similar measures of binge drinking frequency and intensity among adults reporting binge drinking were estimated with medians and variances derived using Taylor series linearization. The means and 75th and 90th percentiles for frequency and intensity were also calculated to further characterize the distributions of these measures. Statistically significant differences between medians were defined as p<0.05 using pairwise tests and nonoverlapping CIs. All analyses were performed using SAS-callable SUDAAN (version 11.0.3; RTI International), and sampling weights were applied to account for complex sampling design, including nonresponse bias and noncoverage errors, and to improve representation of the adult U.S. population in different states. In 2018, the overall nationwide unadjusted binge drinking prevalence among U.S. adults was 16.6% (95% CI = 16.3%-16.8%), representing an estimated 38.5 million adults ( Among adults who reported binge drinking, the median frequency was 1.7 (mean = 4.6) binge drinking occasions during the past 30 days, and the median intensity was 5.5 (mean = 7.2) drinks on an occasion. ( Table 2 ). The upper frequency quartile was >4.0 (95% CI = 3.9-4.1) binge drinking occasions in the past 30 days and the upper intensity quartile was >7.7 (95% CI = 7.6-7.8) drinks on an occasion. Median binge drinking frequency and intensity were significantly higher among men (1.9 occasions and 5.9 drinks, respectively) than among women (1.4 occasions and 4.5 drinks, respectively), and decreased with education level. Median binge drinking intensity was highest among adults aged 18-24 years and decreased with age. Median binge drinking frequency among states ranged from 1.5 occasions (eight states) to 2.1 occasions (Mississippi) in the past 30 days; median binge-drinking intensity on an occasion ranged from 5.2 drinks (New Jersey, District of Columbia, and Connecticut) to 6.4 drinks (West Virginia). During 2018, one in six U.S. adults reported binge drinking during the past 30 days, increasing their risk for many preventable adverse health outcomes. Among those who binge drank, one half did so at least twice per month; one half of men consumed at least six drinks and one half of women consumed at least five drinks on a binge occasion. These median values are lower than the mean values for binge drinking frequency and intensity, but better represent how often adults who binge drink typically do so and how many drinks they usually consume. DC 18.6%-25.8% 16.1%-18.5% 10.5%-16.0% Abbreviation: DC = District of Columbia. * Respondents who reported consuming five or more alcoholic drinks (men) or four or more alcoholic drinks (women) on at least one occasion in the past 30 days. † State prevalence estimates are divided into tertiles. The higher values for the 90th percentiles for frequency (9.5 occasions in the past 30 days) and intensity (11.5 drinks on an occasion) indicate that a small proportion of adults binge drink very frequently, consume large quantities of alcohol, or both, which is consistent with previous findings (4) . Binge drinking prevalence decreased from 18.9% in 2011 to 18.0% in 2017 (5). This report found binge drinking prevalence was 17.4% in 2018, indicating that binge drinking remained common. Alcohol consumption patterns might have since changed, including during the COVID-19 pandemic. Collectively, all three measures (prevalence, frequency, and intensity) address a complex pattern of binge drinking. For example, lower education and income levels were associated with lower binge drinking prevalence, but among adults who reported binge drinking, those with less than a high school diploma reported higher frequency and intensity than did college graduates. Similarly, adults in the lowest income level binge drank more frequently than did adults in the highest income level. The finding that the prevalence of binge drinking was lower in the most rural counties than in the most urban counties is consistent with earlier reports (6) . However, adults in the most rural counties who binge drank did so more frequently and at higher intensity than did adults in the most urban counties. The prevalence of binge drinking in Mississippi and in West Virginia was lower than in the United States overall, but Mississippi had the highest median frequency and West Virginia had the highest median intensity of binge drinking among all states. What is already known about this topic? Excessive alcohol use has contributed to declines in life expectancy. Binge drinking is a common and costly pattern of excessive alcohol use. What is added by this report? During 2018, one in six U.S. adults reported binge drinking during the past 30 days. Among those who binge drank, 25% did so at least weekly, on average, and 25% consumed at least eight drinks during a binge occasion. Some sociodemographic groups and states with low binge drinking prevalence reported large quantities of alcohol consumed during binge occasions. What are the implications for public health practice? An effective population health approach including regulating alcohol sales, increasing alcohol taxes, and alcohol screening and brief counseling by clinicians can help reduce binge drinking. Excessive alcohol use is associated with increasing mortality from alcoholic liver disease, which has contributed to recently observed declines in U.S. life expectancy, notably among men, young and middle-aged adults, and persons with less than a high school education and limited income living in rural areas (7) . The results of this study highlight the importance of reducing binge drinking, particularly among groups who are disproportionately affected. The findings in this report are subject to at least three limitations. First, the BRFSS response rate indicates the potential for selection bias to the extent that survey respondents differ from nonrespondents. Second, responses are self-reported and subject to recall, social desirability, and nonresponse biases, which could vary across states and groups, and lead to underestimates of binge drinking (8) . A study comparing BRFSS estimates to alcohol sales data found that although they were consistently correlated, survey data substantially underestimated consumption (9) . Finally, binge drinking intensity based on the largest number of drinks reported on any occasion in the past 30 days might overestimate intensity. A previous analysis found that among demographic groups, this measure was 0.1-1.2 drinks higher than the reported number of drinks consumed during the most recent binge, but the two measures were strongly correlated (3). However, they were not correlated among adults without a high school diploma; in 2018, intensity by education level was highest among this group. A population health approach has been shown to reduce excessive drinking, including binge drinking. The Community Preventive Services Task Force recommends the following strategies to reduce excessive drinking: increasing alcohol taxes, limiting hours and days of alcohol sales, and regulating alcohol outlet density. Fewer than one half of adults who report binge drinking to a health care provider during a medical checkup Deaths and years of potential life lost from excessive alcohol use-United States 2010 national and state costs of excessive alcohol consumption Binge drinking intensity: a comparison of two measures Distribution of drinks consumed by U.S. adults by average daily alcohol consumption: a comparison of 2 nationwide surveys Trends in total binge drinks per adult who reported binge drinking-United States Health-related behaviors by urbanrural county classification-United States Life expectancy and mortality rates in the United States Under-reporting of alcohol consumption in household surveys: a comparison of quantity-frequency, graduated-frequency and recent recall Screening for alcohol use and brief counseling of adults-13 states and the District of Columbia All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed. are advised to reduce their drinking (10). Clinicians should follow the U.S. Preventive Services Task Force recommendation to screen all adults for alcohol misuse and provide brief intervention and referral to treatment as needed.