Alcohol Consumption and Impact in the United States

David H. Jernigan Ph.D. Associate Professor Department of Health, Behavior and Society Johns Hopkins Bloomberg School of Public Health and Executive Director Center on Alcohol Marketing and Youth

Drinking in the U.S. Population

• Of Americans aged 12 or older (NSDUH): – Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2007 survey (51.1 percent, or 126.8 million people). – More than one fifth (23.3 percent or 57.8 million people) participated in binge drinking at least once in the 30 days prior to the survey in 2007. – In 2007, 6.9 percent (17.0 million people) reported heavy drinking (five or more drinks within two hours on five or days in the past 30 days).

Binge Drinking

*

among U.S. Adults, BRFSS, 1993-2007

Measure 1993 2001 2007 Prevalence

14.2% 14.3% 15.5%

Total Episodes

1.2 billion 1.5 billion 1.6 billion

Episodes per Person

6.3

7.4

7.2

*

Defined

as

≥5 drinks/occasion for men, ≥5 drinks/occasion for women from 1993 2005, and ≥4 drinks/occasion for women from 2006-2007.

Source: Naimi T, et al. Binge Drinking Among U.S. Adults.

JAMA

2003; 289:70 –75, and CDC Behavioral Risk Factor Surveillance System, 2007

Binge Drinking among U.S. Adults who Drink, BRFSS, 2007

Source: CDC Behavioral Risk Factor Surveillance System, 2007.

Average Drinks per Binge Episode by Age, BRFSS, 2004

Age (yrs)

18 - 24 25 - 34 35 - 44 45 - 64 65+

Average No. of Drinks per Binge

9.8

8.0

7.3

6.9

6.4

Source: Cremeens, et al. Socio-Demographic Disparities in Binge Alcohol Consumption among Adults, 14 States, United States, 2004.

Morb Mortal Wkly Rep

2009 (in press).

Total Binge Drinks by Beverage Type, BRFSS, 2003-2004

Beer 67% Liquor 22% Wine 11%

Source: Naimi T, et al. What do binge drinkers drink? Implications for alcohol control policy. American Journal of Preventive Medicine 2007;33:188-93.

Public Health Impact of Excessive Alcohol Use

• 79,000 alcohol-attributable deaths and 2.3 million YPLL per year (29 years/death) • 3 rd leading actual cause of death • $185 billion in economic costs per year • Most excessive drinkers are not alcohol dependent

Prevalence of Past-Year Alcohol Dependence, New Mexico, BRFSS, 2002

All Respondents Binge Drinkers

Source: Woerle S, et al. Prevalence of Alcohol Dependence Among Excessive Drinkers in New Mexico. Alcoholism: Clinical & Experimental Research 2007; 31:293-298.

Adult and Youth Binge Drinking

 Adult binge drinking is one of the strongest predictors of youth binge drinking (parents, states, etc.).

 Binge drinking rates in states are a strong predictor of binge drinking rates on college campuses.

 Binge drinking rates among college students were about one-third lower in the 10 states with lowest adult binge drinking rates compared to those with the highest rates.

 States with lower binge rates tended to have more stringent alcohol control policies Source: Nelson TF, et al. The State Sets the Rate: the Relationship of College Binge Drinking Rates to State Binge Drinking Rates and State Alcohol Control Policies.”

Am J Pub Hlth

2005; 95:1-6.

Youth (age 12-20) Binge Drinking in the U.S.: Much better than it would have been without community efforts, but not making the progress we should be making 25 20 15 10 5 0

Year

Males Females Source:

NSDUH 2007 (SAMHSA 2008)

Binge drinking by youth ages 14-18 (9 th 12 th grade) to 40 35 30 25 20 15 10 5 0 Males

Year

Females Total Source:

YRBS 2007 (CDC 2008)

Beverage preference of 12 th female binge drinkers grade 25,0 20,0 15,0 10,0 5,0 0,0 Liquor

Year

Beer Wine Source:

Monitoring the Future 2007

(NIDA, 2008)

Youth drinking

• In 2007, 10.7 million U.S. young people ages 12-20 (28%) reported drinking in the past month, and 7.2 million (19%) reported binge drinking. (NSDUH) • Every day, 5,000 kids under age 16 start drinking. (NSDUH) • The earlier young people begin drinking, the worse the consequences are likely to be.

Public Health Impact of Underage Drinking

• Alcohol is the most widely used substance of abuse among America’s youth • 90% is consumed as binge drinks (i.e., while drinking to get drunk) • Closely tied to leading health and social problems among youth (e.g., impaired driving, violence, & risky sexual behavior) • Results in 1 of 4 deaths among males and 1 of 6 deaths among females age 15 to 20 years.

Consequences of youth drinking • Young people who begin drinking at age 14 or younger are: – four times more likely to develop alcohol dependence than those who wait until they are 21 (Grant and Dawson 1997).

– seven times more likely to be in a motor vehicle crash because of drinking (Hingson et al. 2001) – eleven times more likely to be in a physical fight after drinking (Hingson et al. 2000) – twelve times more likely to suffer from other unintentional injuries after drinking (Hingson et al. 2001) .

• Annually, approximately 5,000 people under age 21 die from alcohol related injuries resulting from underage drinking. (OSG, 2007)

Brain activity in 15 year-olds during a memory task Heavy use of alcohol during adolescence can impair brain development, causing loss of memory and other skills.

RISK FACTOR Underage & Binge Drinking POTENTIAL CONDITION Motor Vehicle Crashes Interpersonal Violence HIV, STDs Unintended Pregnancy FAS, SIDS Alcohol Dependence

Interpersonal Violence by Drinking Status, YRBS, 2003

50 40 30 % 20 10 0 Physical fight Non-drinker Dating violence Current drinker w/o binge Forced intercourse Binge drinker

Source: Miller JW, et al. Binge drinking and associated risk behaviors among high school students.

Pediatrics

2007; 119:76-85.

Binge Drinking by School Performance, YRBS, 2003

50 45 40 35 30 25 20 15 10 5 0 A B C Average Mark (grade) D or less

Source: Miller JW, et al. Binge drinking and associated risk behaviors among high school students.

Pediatrics

2007; 119:76-85.

State Question on Usual Beverage Consumption, YRBS, 2005

During the past 30 days, what type of alcohol did you usually drink?

– Beer – Malt beverages (e.g., Smirnoff Ice, Bacardi Silver, and Hard Lemonade) – Wine coolers – Wine – Liquor – Some other type – No usual type. – I did not drink alcohol in the past 30 days

Usual Beverage Consumed by Current Drinkers, YRBS, 2005

State Arkansas Nebraska New Mexico Wyoming Pooled Liquor Beer Malt Others Beverages 44.7

34.1

13.5

32.7

25.7

16.4

7.9

7.5

35.6

40.2

38.7

19.9

20.5

21.3 20.4

20.4

No usual Type 8.3

9.4

12.3 11.9

7.7 11.2

21.1 9.0 9.9

Source: Cremeens J, et al. Assessment of Source and Type of Alcohol Consumed by High School Students: Analyses from Four States.

Journal of Addiction Medicine

2009; (in press).

Adult Drinking and Underage Drinking

 Strong tie between adult drinking and youth drinking.

 Youth tend to model their behavior after adults.

 Adults are often the source of the alcohol consumed by youth.  Many alcohol control policies affect youth and adults.

Other key factors in youth drinking

• Low tax rates – State and federal levels – taxes at federal level not raised since 1991 – beer now cheaper than milk or juice • New product development – alcopops etc.

• Alcohol advertising exposure – 38% increase in youth exposure to alcohol advertising on TV, 2001-2007 – more on this tomorrow…