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Press Briefing Transcript

CDC Telebriefing on Vital Signs Report: Binge Drinking

Tuesday, January 10, 2012 – 12:30pm ET

OPERATOR: Welcome.  Thank you for standing by.  At this time, all participants are in a listen-only mode.  During the question and answer session, press star one to ask a question.  Today's conference is being recorded.  At this time, I turn the call over to Mr. Llelwyn Grant.  You may begin, sir. 

LLELWYN GRANT: Good afternoon, everyone.  My name is Llelwyn Grant and I am the branch chief of CDC's News Media Branch.  I wish to thank you all for joining us for today's telebriefing for CDC's Vital Signs report on binge drinking.  Here today to discuss the binge drinking study is Dr. Ursula, spelled u-r-s-u-l-a Bauer, b-a-u-e-r.  Dr. Bauer is the CDC's director of the National Center for Chronic Disease Prevention and Health Promotion.  Following her remarks, she will be joined by Dr. Robert Brewer, the lead for CDC's alcohol program, to address any questions thaw may have following the remarks.  At this time, I would like to turn it over to Dr. Bauer. 

URSALA BAUER: Hi, good afternoon.  This is Dr. Ursula Bauer with the National Center for Chronic Disease Prevention and Health Promotion.  Thank you all for joining us today.  Excessive alcohol consumption, including binge drinking, accounts for an average of 80,000 deaths and 2.3 million years of life lost in the united states each year and costs the U.S. an estimated $223 billion dollars in 2006 or about $1.90 per drink.  Binge drinking is responsible for over half of deaths, two-thirds of the years of potential life lost and three-quarters of the economic costs that are due to excessive drinking.  Binge drinking is defined as consuming four or more drinks on an occasion for a woman and five or more drinks on an occasion for a man.  This level of consumption usually leads to acute impairment and is, therefore, strongly associated with alcohol impaired driving, risky sexual behavior and interpersonal violence.  Over time, it can also increase the risk of other serious health problems, including cancer, heart disease and liver failure.  Most binge drinkers are not alcohol dependent or alcoholics.  Despite the serious health impacts, binge drinking remains a common and a largely unrecognized public health problem.  Today, we're reporting that an estimated 38 million or about one in six U.S. adults binge drank in 2010.  Binge drinkers also reported doing so on an average of four times a month, or almost once a week.  And the largest number of drinks per binge was an average of eight, far exceeding the drinking levels that are used to define this behavior.  This report also highlights how widespread the problem of binge drinking really is and how it affects some groups who are generally considered to be less likely to engage in this behavior.  For example, binge drinking is most common among 18 to 34-year-olds, but binge drinkers age 65 years and older report binge drinking most often, an average of five to six times a month.  Binge drinking is most often reported by people with incomes above $75,000 a year.  But binge drinkers with incomes less than $25,000 a year consumed the largest average number of drinks when they do binge.  Up to eight or nine drinks per episode.  In some states where fewer people binge drink, like Louisiana and Mississippi, New Mexico, South Carolina and Utah, binge drinkers report consuming more drinks when they do binge.  Fortunately, there are a number of effective strategies for preventing excessive drinking, including binge drinking that are recommended by the guide to community preventive services.  We need to work together to implement these strategies so we can reduce binge drinking and the many health and social harms that are related to it.  I want to thank you for your time and your interest and we'll now open it up for questions.  Shirley, Dr. Brewer and I will take questions. 

OPERATOR: Thank you.  We now will begin the question and answer session.  If you would like to ask a question, please press star one and regard your name clearly.  Again, press star one to ask a question.  One moment for our first question.  Our first question comes from Mike Stobbe with Associated Press.  You may ask your question. 

MIKE STOBBE: Hi.  Thank you for taking my call.  I wanted to ask you about that -- one of the last statistics you mentioned, doctor, the one about the number of drinks, I think you said eight on average and then, of course, we saw nine and in the age group 18 to 24.  First of all, I just want to clarify, is that the average number of drinks for all episodes or did you say it's the average number for the worst episode?  I wonder if you could clarify that number.  And then I wanted to ask you, even if you're stating the obvious, is nine worse than five or four?  And why is it worse? 

ROBERT BREWER: Mike, this is Dr. Robert Brewer calling.  Good to hear from you.  First of all, what we're reporting here are really three different measures of binge drinking.  This is a little different than what we reported in our vital signs last year.  In addition to reporting the proportion of adults, what we referred to as prevalent who engage in binge drinking were what you referred to in binge drinking frequently and what you referred to is intensity.  That is the amount consumed.  There are different ways to get to binge drinking.  The way we assessed it in this particular study is by looking at the largest amount of drinks consumed within a 30-day period.  We analyzed the findings from that particular question in the survey among people who also self-reported binge drinking.  So that was the basis for our coming up with the estimate of an average of eight drinks consumed or binge intensity of eight.  Now, as to whether or not that represents typical level of drinking, when binge drinking, we didn't specifically assess that in this study.  But I can tell you from other studies that we have been involved in and have reported on, that that level of consumption, eight, is consistent with what people have typically reported with binge drinking episodes.  I think we would conclude that that level of consumption is a reasonable measure of typical binge drinking intensity.  Now, to get to your second point, which is effectively, does it matter how much people drink, yes, the short answer to that, as you had guessed is, indeed, it masters a great deal.  That has been best demonstrated when you look at problems that are more immediately associated with binge drinking, things like risk of involvement in motor vehicle crashes, thing is like risk of involvement in other injury outcomes.  Indeed, there have been a number of studies that have shown as the number of drinks that are consumed within a short period of time goes up; the risk of those adverse outcomes goes up substantially.  And it isn't just by a factor of one or two.  It's by a much greater factor.  So I think the important take on this message and why we've talked about this study is showing that binge drinking is perhaps a bigger problem than people have realized is it isn't just a question of whether people are engaging in binge drinking or not, which is four or more drinks per occasion for a woman and five or more drinks per occasion for a man, it's also how frequently they're engaging in that behavior and how much they drink when they do, Clearly we have a lot of work to do to bring down both the frequency and intensity of binge drinking in addition to prevalence. 

MIKE STOBBE: May I ask one more question? 

ROBERT BREWER: certainly. 

MIKE STOBBE: Is there a -- I know the way the statistics are cut, there's certain groups that tend to be doing binge drinking a little more commonly.  Is there a prototypical binge drinker?  Is it a rich, white, male college student or is there a certain group of people that seems to be really driving this? 

ROBERT BREWER: Mike, again, very good question.  I think it is safe to say that binge drinking is most common among males, particularly 18 to 34-year-olds and surprisingly, in the minds of a lot of people, folks who have higher household incomes.  Certainly binge drinking is a problem with college students.  Binge drinking is a problem with high school students.  Binge drinking is a problem with active duty military.  Binge drinking is a problem with medical students, believe it or not.  And we have published on all of those groups.  In fact, binge drinking is a widespread problem in the population.  To drive that point home, I think it's worth nothing when you look at the frequency of binge drinking; the highest frequency of binge drinking is actually among those age 65 and older.  They have more episodes and more times that they report for binge drinking.  They actually report more episodes of binge drinking than two younger people.  So, again, I think it's perhaps tempting on the one hand, but perhaps a bit overly simplistic to try to isolate binge drinking to just particular sections of the population.  In fact, it's a widespread problem across the entire population, which is why we think we need to look at community-based solutions to address it.  Thank you. 

LLELWYN GRANT: Shirley, we're ready for our next question. 

OPERATOR: thank you.  Our next question comes from Timothy Martin with Wall Street Journal. You may ask your question. 

TIMOTHY MARTIN: Hello.  Thanks for taking my call.  From the report itself and from the topic, it says that binge drinking is a bigger problem than we had thought.  I was wondering, did you guys -- could you address what you had thought binge drinking, what levels it was at?  And I think Dr. Brewer had mentioned this in his previous response.  But you just talk about some of the surprises that might have come out from the data. 

ROBERT BREWER: We certainly had a sense that binge drinking is common.  And we have reported that previously.  Once again, unfortunately, we're affirming that it's about 38 million U.S. adults who report binge drinking on one or more occasions.  So it's a large number of people and I have to say in that regard -- and I will come to your question here in just a second -- that we know this to be a substantial underestimate of what actual binge drinking is because people tend to underreport their drinking behavior.  We've actually looked at that, comparing self-reports to alcohol sales, for example, and found that we're capturing a maybe 30 percent of presumed consumption based on sales.  So this is a big problem that we're underestimating.  Now, to your question about why we then -- to the extent to which we were surprised by our findings, I think that the difference here between what we're reporting and this report and what we have reported previously is that we really looked more specifically at the frequency, the number of episodes of binge drinking reported by various groups and then also, again, this concept of intensity, the amount consumed per binge, on average.  And what we found was that indeed the frequency of binge drinking is very high and the amount consumed on average -- and, again, this is based on looking at the largest number of drinks consumed -- was also very high.  I think what was surprising here that we had not reported previously were some of the differences across states.  I think sometimes people can be lulled into a false sense of security. If it doesn't look like there's a large portion of adults who are binge drinking compared to some other states that maybe they really don't have to worry about the problem so much.  What, in fact, we found, and I will certainly say was a surprising finding to us, is that a number of states that have a relatively low prevalence of binge drinking, that is a proportion of adults that report ever engaging in this behavior over the past 30 days, a number of those states, when you looked at the amount that was consumed by the binge drinkers, we found that the number of drinks was very high.  So I think the important take on there is that you can have high risk groups in the population consuming a large number of drinks, even though overall it may look like binge drinking is not such a problem.  That's why we are trying to highlight the fact that it's a bigger problem than what was generally realized. 

TIMOTHY MARTIN: To what extent was this, the case to the extent that now you've measured it, you've asked the questions and you have data looking at it.  I'm just wondering, has this always been the case and now we just have a number associated with it?  Thank you. 

ROBERT BREWER: I think that's a fair point.  We're not necessarily meaning to imply that the number of episodes of binge drinking or the number of drink consumed per binge has gone up substantially over the last few years.  I think we're trying to provide a more committee and nuance picture of the issue of binge drinking to highlight the huge public health impact that it has and the significant impact that it constitutes for population health.  Now, I will tell you that based on other studies that we have done where we have looked at the estimates of the total number of binge drinking episodes in the United States, we do have strong information indicating that a number of binge drinking episodes increased quite substantially during the 1990s, of about 29 percent, about 1.2 billion episodes to about 1.5 billion he episodes.  So there has been historically a substantial increase in binge drinking episodes.  But that is not what we were assessing here.  Thank you. 

OPERATOR: Our next question comes from Kathleen Doheny, with WebMD.  You may ask your question. 

KATHLEEN DOHENY: Thank you good morning, two quick questions.  Has the recession affected binge drinking at all, if you know?  And what do you do if you know a binge drinker? 

ROBERT BREWER: We really didn't look at the effect of changes in the economy on binge drinking.  Unfortunately, though, I think one would have to conclude since we're looking at 2010 data here that we really haven't seen an appreciable impact of the economy and the higher jobless rate and so forth on binge drinking rates.  Unfortunately, it's continued to truck along at a pretty high rate. 

KATHLEEN DOHENY: Regardless of how the economy is doing, you're saying? 

ROBERT BREWER: Regardless of how the economy is doing, yes.  That's been reflected in other statistics that have been reported through other surveys and based on alcohol sales, as well.  In terms of what to do about binge drinking, and you said specifically, what to do if you know someone who is binge drinking, is that, right? 

KATHLEEN DOHENY: Right.  Because I'm assuming that binge drinkers are in denial, right? 

ROBERT BREWER: Well, actually, I think we ought to talk about that one a little bit.  When you use a term like denial, that's often a term that is associated to people who are alcohol dependent and who are suffering from the disease of alcoholism.  As Dr. Bauer pointed out in fact, most people who are binge drinking are not alcohol dependent.  To attach a figure to that based on various surveys, it's over 80% of binge drinkers who are not alcohol dependent.  So it isn't really a situation where you're talking about denial in the classic way that you would if you're talking about somebody who has a medical problem and doesn't want to acknowledge it for whatever reason.  I think what we're talking about is a risk behavior that is quite widespread in the population and, frankly, where I think a lot of people have the impression that maybe it's not such a bad thing to do.  I think that a lot of people feel encouraged to do binge drinking, particularly at certain times of the year such as the holidays that just passed us by.  If you ask me what I think you should do, what you should do if you're dealing with someone who is a binge drinker, advise them not to do it. Advise them that the risks of binge drinking are very high, both in the short-term and the long-term and I think there are other things that we need to do as a society that help to reinforce that message, as well. 

KATHLEEN DOHENY: Thank you. 

LLELWYN GRANT: Next question, Shirley. 

OPERATOR: Thank you.  Janice Lloyd with USA Today, you may ask your question. 

JANICE LLOYD: Hi, Dr. Brewer.  Thanks for taking my questions.  I have two.  The first one just seems so obvious to me is why do you think some of these people are not alcohol dependent or alcoholics?  And the second is did you measure time of day, days of week, etcetera, and when people are doing binge drinking?

ROBERT BREWER: Okay.  Let me just clarify one thing with respect to alcohol dependence.  I don't want to have a misunderstanding here.  We're certainly not meaning to suggest that there isn't a proportion of people who report binge drinking who would meet criteria, medical diagnostic criteria for alcohol dependence.  Certainly there are.  I also want to be very careful to emphasize that we're not in any way trying to diminish the public health importance of alcohol dependence nor the need to make treatment available to those who have that condition, that is certainly not the point.  Its simply to point out that the large majority of people who are engaging in this risky drinking behavior would not actually meet the medical diagnostic criteria for the condition of alcohol dependence.  So what I think that challenges us as a society to do is to look at other ways to try to address that problem in addition to making appropriate services available for those who need them.  I'm not sure if that answers your question as to why more people are not alcohol dependent.  Was there something else there you were interested about? 

JANICE LLOYD: No.  I was just curious to hear perhaps some of these people are alcoholic and this is when they can drink and this is how they drink. 

ROBERT BREWER: Right.  And it certainly is correct to point out that the overwhelming majority of people who would meet diagnostic criteria for independence are going to report binge drinking.  What we're pointing out is really the flip side of that coin, which is that most people who are binge drinking are not meeting criteria for dependence.  

JANICE LLOYD: And then the question about time of day or time or week, did you dig down that deep? 

ROBERT BREWER: We didn't for this report.  Classically, what you typically find, and this is certainly reflected in statistics on alcohol impaired driving, which is very, very strongly associated with binge drinking, by the way, about 85% of alcohol impaired driving episodes occur among people who self report binge drinking.  Classically, you tend to find alcohol impaired driving and with it binge drinking occurring on weekends, Saturday nights, Friday nights, etcetera.  But it's not restricted to just those days.  But no, for this particular study, we actually didn't look at how binge drinking is distributed across the course of the week. 

LLELWYN GRANT: Next question, Shirley. 

OPERATOR: Thank you.  Next question comes from Patricia Neighmond, NPR.  You may ask your question.

PATRICIA NEIGHMOND: Thank you.  I just wonder a couple of things.  It's a follow-up on the question that was just asked.  What is the medical criteria for alcoholism?  I mean, is it a daily -- what is it, actually? 

ROBERT BREWER: It's actually more based on consequences and more based on people continuing to go drink despite the fact that they're experiencing adverse consequences related to their drinking.  Typically that -- those consequences appear first in the home environment, in their family relationships, but certainly can appear in the workplace and in their work productivity.  And, in fact, the reduction in work productivity associated with excessive drinking is one of the largest cost items that contributes the roughly $224 billion in economic costs that Dr. Bauer was talking about before relating to excessive alcohol use.  There's this idea of continuing to drink despite adverse consequences. 

PATRICIA NEIGHMOND: So in that sense, it's individual? 

ROBERT BREWER: and classically, people who are -- who have alcohol dependence are not able to effectively control the amount that they consume.  But there are a whole standard set of diagnostic criteria for alcohol dependence that have been spelled out.  And that are used to diagnose people that have that problem.  What we're focusing on here, though, are people who are drinking above a level that we know to be dangerous.  And, again, for women, that's four or more drinks within a short period of time.  For men, it's five or more drinks within a short period of time.  That would then constitute the definition of binge drinking that we're looking at here.  Does that answer your question? 

PATRICIA NEIGHMOND: Yeah.  So it's sort of individual really in terms of the impact of people's ability to function helpfully, at home, on the job, different people I guess would fall apart in different --

ROBERT BREWER: Yeah.  If you're talking about the diagnosis of alcohol dependence, yes that's going to be made on an individual level.  And anybody who has concerns about their drinking behavior should certainly talk to their physician or their health professional about it.  But that's not really what we're talking about here.  The levels of consumption that are used to define binge drinking are sufficiently high to typically lead to a blood alcohol concentration of 0.08 grams per deciliter and the medical terminology, 0.08 for men and women respectively.  We're talking about what would also typically be referred to as impairment level blood alcohol concentrations.  And that's not so much a -- I mean, there's some individual variability there, to be sure, but that is certainly what we have found to be a dangerous level of consumption across the entire population.  I think it's also worth pointing out, again, that what we're reporting in this vital signs is that a large proportion of the people who engage in binge drinking are actually drinking at levels that are substantially greater than that.  So I think for somebody who is consuming eight drinks, for example, within a two or three-hour period, I think there's little doubt that they are putting themselves and others at significantly greater risk for a whole host of adverse harms.  So you don't have to be alcohol dependent to experience very serious consequences from excessive alcohol consumption.  And the reality is that most people who experience those consequences are not. 

PATRICIA NEIGHMOND: Can I ask another? 

ROBERT BREWER: Absolutely. 

PATRICIA NEIGHMOND: Just confirm for me the actual, if this is self-reporting, you said something about may reflect only 30% of the actual amount of binge drinking.  Can you -- is that -- did I hear that correctly, that --

ROBERT BREWER: Yeah. 38 million.  Let me just maybe clarify it further.  What I was actually referring to are some comparisons that we have done between what people report as the amount of alcohol they consume and what one identifies as the estimated level of alcohol consumption based on the amount of alcohol that is sold, what is sometimes called per capita alcohol consumption.  And what we know and it varies a little bit across states, but is it worth picking up maybe between 22% and 32% of what's often referred to as presumed alcohol consumption based on the sales through a self-report like the behavior risk surveillance systems.  Roughly speaking, we're probably picking up less than a third of actual alcohol consumption based on what people tell us they're consuming.  Now, it would then be fair to say what proportion of that consumption is in the form of binge drinks.  I'm talking now about per capita consumption, consumption per person.  And it turns out that about half of the alcohol consumed in this country is -- for adults is in the form of binge drinks.  For young people, for under age youth, under age 21, it's about 90% of the alcohol consumed by that age group is in the form of binge drinks.  Yes, we are, as dramatic as some of these findings are, typically in terms of the number of drinks consumed, the average number of drinks consumed by binge drinkers, it's probably in fact a good bit higher than that. 

PATRICIA NEIGHMOND: About how much higher than that, do you think? 

ROBERT BREWER: I can't say specifically for the measure of intensity.  I think the better way to put it is as I did before, which is to say that we're probably getting less than a third of actual alcohol consumption based on what people tell us. 

PATRICIA NEIGHMOND: And just one more thing.  Did you break down at all beer, wine and spirits? 

ROBERT BREWER: Yeah.  We didn't in this particular study.  We actually have looked at what we might refer to as beverage specific alcohol consumption in other studies.  It turns out that beer is the most commonly consumed beverage by adult binge drinkers and it turns out that liquor is actually the most commonly consumed type of beverage by high school students who binge drink.  But that was not actually a part of our study in this case.  We didn't have that information to look at in this study. 

LLELWYN GRANT: Shirley, we have time for just two more questions. 

OPERATOR: Rebecca Adams, CQ Healthbeat, you may ask your question. 

REBECCA ADAMS: Hi.  A lot of my questions have been answered, but I wanted to ask about the 65-year-olds who report more episodes of binge drinking.  Can you tell me anything more about the reasons why they might be doing this, whether they're being more honest in their responses or what the reasons behind that might be?  And I also had a couple of other minor questions. 

ROBERT BREWER: Sure.  I can't tell you specifically what's going on in that population.  That wasn't actually part of our study.  I think what it really reflects, though, is a larger problem that is not unique to seniors in particular.  And I think a lot of it frankly boils down to the acceptability of binge drinking and the extent to which people have been binge drinking throughout their lives and continue to do so into their older adult years, as well.  We did not specifically take a look at whether the frequency of binge drinking, the number of binge drinking episodes varies among those 65 and older by different regions.  But what we do know overall is that binge drinking tends to be very much affected by the environment in which people are making their drinking decisions.  So I think seniors are affected by that as are younger people and people throughout their lives. 

REBECCA ADAMS: And did you break things out by different geographic regions within a particular state?  For instance, I noticed that D.C. is very high, but Maryland and Virginia is not.  So do you have further data about areas within a state? 

ROBERT BREWER: Not in this particular study.  The data system that we used for this study, the Behavioral Risk Factor Surveillance System does not actually report out estimates of binge drinking for metropolitan areas.  And that is available through their website, actually.  We did not look at that information for this particular study.  We were just looking at the state level.  We also restricted our analysis to those states that did both surveys by landline telephone and also by cell phone.  So, in fact, there were a couple of states, South Dakota and Tennessee, and those were the only two that were not included in this study because it turned out in 2010 they did not do cell phone surveys.  But all of the other 48 states and D.C. were included in the study but we didn't look at geographic levels below the state or in the case of D.C., the district level. 

REBECCA ADAMS: And one final thing, a previous brief that you had done said drinking and driving has gone down 30% over the past five years and it said that 85% of drinking and driving episodes were reported by people who were binge drinkers.  Is there a particular silver lining that even though there may be more binge drinking then we previously knew about, that  people are controlling their driving behavior a little better than in the past? 

ROBERT BREWER: That's a very good question.  I'm certainly aware of the report you're talking about.  I think it is fair to say that we've made substantial progress in reducing alcohol impaired driving.  Through the implementation of a variety of different affective policy measures, national implementation of a 0.08 blood alcohol limit, zero tolerance for drinking and driving among underage youth, for example.  So I think there have been a number of policies that have looked at trying to uncouple the relationship, if you will, between binge drinking and driving and, therefore, reducing alcohol impaired driving.  So I think the fact that we have made progress in that area is certainly laudable.  I think as you've pointed out, though, what our findings emphasize is that we have a lot more work to do to actually address binge drinking, the pattern of consumption that is by far most strongly associated with alcohol impaired driving. 

OPERATOR: Final question comes from David Lewkowict with Fox News.  You may ask your question. 

DAVID LEWKOWICT: Thank you very much for taking the call.  I was curious whether there's any correlation that you've been able to find between alcohol advertising and this increase in binge drinking. 

ROBERT BREWER: Alcohol advertising is widely recognized as being a risk factor for initiation of under-aged drinking and for higher levels of alcohol consumption among under age youth, as well.  This particular study did included adults in the 18 to 20 age group, but we really were not specifically focused on the underage population, per se.  I do think that there's strong information, very strong scientific information documenting that youth exposure to alcohol marketing is a significant risk factor for underage drinking and for drinking at high levels, which is typical unfortunately for underage youth.  But we really couldn't say that exposure to alcohol advertising was a specific risk factor for what we're seeing and reporting on in this study. Though I do think that alcohol advertising certainly is part of the environment that influences the drinking decisions that are made by both adults and youths. 

DAVID LEWKOWICT: And do we see an increase in the levels of binge drinking, we’re talking about four times per month, etcetera, but do we see it at specific times of the year, it increasing or going down? 

ROBERT BREWER: I think there is some seasonality in binge drinking.  Classically, a lot of drinking and a lot of alcohol sales occurs around the holiday period.  Some of that is gift giving and it may or may not be entirely reflected in the amount that people are consuming during that time of year.  There are clearly some times of years when alcohol consumption levels tend to go up.  However, I think it's important to recognize binge drinking continues to be a problem throughout the year.  Often, people will engage in binge drinking frequently even during periods of time that are not expressly associated with the holidays. The Behavioral Risk Factor Surveillance System, I should point out the data source we use here also conducts surveys throughout What we're getting is basically an averaging of the binge drinking behavior of adults throughout the year. So, what we are getting is an averaging of the binge drinking behavior of adults throughout the year, throughout all 12 months.  I want to emphasize, I think I might of mentioned this with regards to another questions I answered, we didn't specifically look at seasonal variation in this study. 

DAVID LEWKOWICT: Or day of the week.  Is that correct? 

ROBERT BREWER: That's correct, yes.  We are looking at binge drinking overall across the year in 2010. 

DAVID LEWKOWICT: Thank you. 

LLELWYN GRANT: I wish to thank everyone for participating in today's telebriefing.  For more information about the vital signs report on binge drinking, please visit www.CDC.gov/vitalsigns, all one word, for more information about binge drinking and other alcohol-related data and resources, visit CDC's alcohol and public health website at www.CDC.gov/alcohol.  For information about CDC's works and saving lives, protecting people and saving money through prevention, visit our website at www.CDC.gov/24-7.  A transcript will be available later this afternoon.  For follow-up questions, please contact CDC's press office at 404-639-3286.  This concludes our media telebriefing.  Thanks again for joining us. 

OPERATOR: Thank you and this does conclude today's conference call.  At this time, you may disconnect your line. 

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