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CDC Vital Signs: Binge Drinking Among High School Students and Adults — United States, 2009

Tuesday, October 5, 2010 – 12:00pm ET

*Please note this is a rough transcript that has not yet been edited*

Operator: Good morning, everyone. Thank you all for calling and welcome to today's conference call. At this time your lines have been placed on listen only for today's conference. During the answer portion only you will be prompted to press star 1 on your touchtone phone. Please say your name slowly and clearly so I may introduce you for your question. I will now turn the conference over to Mr. Tom Skinner, senior public affairs officer for CDC. Mr. Skinner, you may proceed.

Tom Skinner: Thank you, Jill. Thank you all for joining us today for this briefing on the release of CDC's Vital Signs report on binge drinking among high school students and adults, United States 2009. CDC Vital Signs is a new report that appears on the first Tuesday of each month as part of CDC's Morbidity and Mortality Weekly Report. It's designed to provide the latest information and data on key health indicators which impact health here in the U.S. This is the fourth Vital Signs report from the CDC. Joining me today is CDC Director Dr. Thomas Frieden spelled f-r-i-e-d-e-n and Dr. Bob Brewer spelled b-r-e-w-e-r, who is from CDC's National Center for Chronic Disease Prevention and Health Promotion. Both will give a brief opening remark and then we will open the lines up to take your questions. So I'll turn it over to Dr. Frieden.

Tom Frieden: Good afternoon, everyone. Vital Signs is a new CDC product that provides information on really what are some of the major health problems of the country and what is their status. Binge drinking is a very large health and social problem. Alcohol causes a wide range of problems and today's report indicates that binge drinking is common among adults and high school students and not just among the groups that we think of as high risk. One in six adults, one in four high school students and one in three high school seniors binge drink. In fact, among people who drink, one-third of adults and two-thirds of high school kids binge drink. Ninety percent of the alcohol consumed by high school kids is consumed in the course of binge drinking and more than half of the alcohol consumed by adults is consumed in the course of binge drinking. Binge drinking is defined as four or more drinks for women and five or more drinks for men. Binge drinking causes a very wide range of health and social harm, fatal motor vehicle crashes, maltreatment, liver disease, cancer, high blood pressure, infections and sexually transmitted diseases, higher risk of contracting and spreading HIV. Unintended pregnancy and it has many effects on the next generation through low-birth weight, birth defect and sudden infant death syndrome. The final point I would like to make is that binge drinking as a problem has been largely unrecognized. Most people who binge drink are not alcoholic. On average, people who binge drink do so about once a week and may consume about eight drinks or more, and it may be because binge drinking hasn't been widely recognized as a problem that it has not decreased in the past 15 years in this country. I'll now turn it over to Bob Brewer, our expert at CDC on alcohol policy.

Bob Brewer: Thank you, Dr. Frieden. As Dr. Frieden noted, binge drinking is a common pattern of alcohol consumption, and I would say a leading cause of preventable death and other health and social problems. Indeed, we estimate that about half of the 79,000 deaths that are due to excessive drinking in the United States can be attributed to binge drinking as can about two-thirds of the 2.3 million years of potential life lost due to excessive drinking in the United States. In our study we looked at data from a telephone survey of over 400,000 U.S. adults age 18 years and over and a survey of over 16,000 high school students both of which were completed in 2009. Based on our findings from these surveys we estimate that at least 15% of U.S. adults or 33 million men and women reported binge drinking one or more times in the past month. Binge drinking also included those 18 to 34 years of age, one in four of whom reported binge drinking and those with household incomes of 75,000 or more. About one in five of whom reported binge drinking. Unfortunately, though, when comparing our survey findings from those in prior years we found binge drinking among young adults hasn't declined over the past 15 years. Furthermore, one in three adults who drink reported binge drinking over the past month. We found that one in four high school students reported binge drinking one or more times in the past month in 2009 and most high school students who drink reported binge drinking as Dr. Frieden noted. These findings emphasize that binge drinking remains a huge public health problem among adults and youth in the United States. Thank you very much.

Tom Skinner: Okay, Jill. I think we're red for questions, please.

Operator: Thank you. At this time if you would like to ask a question, please press star 1 on your touchtone phone. Be sure to record your name and affiliation slowly and clearly so that I may introduce you into conference. Please stand by for our questions. Thank you. Our first question comes from Daniel DeNoon with WebMD. Sir, your line is open.

Dan DeNoon: I think I'm with WebMD. You all are with CDC. I need help putting this in perspective. So four or more drinks once in awhile doesn't seem like a terrible problem, but you're talking about eight or more drinks for many of these binge drinking. Can you give me perspective on what kind of drinking this is and why this is more than just somebody going out and getting high once in a while.

Bob Brewer: Sure. First of all, I should say, we don't recommend binge drinking at any level by anybody at any time. Any binge drinking is associated with an increased risk and the problems that Dr. Frieden noted previously including motor vehicle clashes and sexually transmitted diseases, et cetera. You are correct that in fact, among those who report binge drinking during the past 30 days which is the time period that we looked at in both of these surveys, the average number of drinks consumed per binge drinking occasion is on the order of eight. It's where it could be closer to ten and is somewhat lower than those who are older, but unfortunately, most people who binge drink do drink at levels who are substantially greater than the four-drink threshold that we use for women and the five-drink threshold that we use for men.

Tom Skinner: Thank you very much. All right. Next question, please.

Operator: Our next question is from Mike Stobbe with the Associated Press. Your line is open, sir.

Mike Stobbe: Hi. Thanks for taking the call. Two questions. One, can you expand a little bit – I guess it's not a new finding, but the income. The folks who make 75,000 or more, having higher rates of binge drinking and I also had a question about the number of drinks. Were the surveys specifically asking people how many drinks they had during a binge drinking episode and how reliable do we think the numbers are? Do people recall the number of drinks well? Do they over or underestimate.

Tom Frieden: This is Dr. Frieden. The prior answer was given by Dr. Brewer. One possible reason that binge drinking, unlike many other health risks is more common as income increases is that it's not recognized as a risky health behavior and yet as Dr. Brewer emphasized, it is associated with some real problems. Fatal motor vehicle crashes, other injuries, child maltreatment as well as infectious disease risk and of course, liver disease. Another possibility is simply with more money and more disposable income people are able to afford more alcohol and do so. So those are the two leading area why you might see that somewhat unusual pattern of unhealthy, risky behavior. The first being that it's not widely recognized as unhealthy. Perhaps Dr. Brewer wants to say more about that and we'll address the methodology question.

Bob Brewer: Thanks, Mike, for your question. I completely concur with Dr. Frieden's comments. I think that really what this indicates is that as a society we haven't taken binge drinking seriously as a public health problem. If we had, we would generally expect as is true with smoking and other risk behaviors that those with higher incomes and tend also to have higher educational levels would be among the first ones to adopt healthier behaviors. I think the message that a lot of people get around alcohol consumption and binge drinking is that it's okay to drink to excess on occasion, and we wanted to dispel that myth. There are a lot of serious, health and social harms associated with binge drinking and it's a problem for both adults and for you. Your second question, I believe, had to do with whether or not we believe binge drinking tends to be over reported, underreported, is that right?

Mike Stobbe: Yeah. Uh-huh. Basically.

Bob Brewer: Basically what we know is that binge drinking and alcohol consumption in general tends to be underreported and that's not just true for the surveys that we looked at in this study. It's true overall. When we have compared, for example, reports of alcohol consumption the amount of alcohol that's sold within states, we find that we're capturing perhaps a third of the presumed alcohol consumption based on alcohol sales. So there really is a substantial underreporting of binge drinking and of alcohol consumption in general. Even though we're reporting quite high rate of binge drinking among adults and youth, I think there is good reason to believe it is significantly underreported.

Tom Skinner: Jill, next question, please.

Operator: our next question comes from Hiran Ratnayake with the Delaware News Journal. Your line is open.

Hiran Ratnayake: Thanks for taking my call. My question is on these health-related problems directly from binge drinking. I know you mentioned problems such as motor vehicles and STDs. When I think about it, I think about motor vehicle deaths from a person drinking heavily in one night can be addressed with a designated driver and STDs can be addressed with contraceptives, but are there other direct health problems that people can get from binge drinking occasionally? I know you also mentioned something about how smoking is a direct cause of lung cancer, but are there direct health problems caused just from binge drinking?

Bob Brewer: Yes. There certainly are a number of different health problems – I'm sorry, this is Dr. Robert Brewer responding. Yes, there are a number of what we would refer to as chronic diseases that are directly related to damage caused by drinking too much. Examples of that would include cirrhosis of the liver, high blood pressure. Risk of high blood pressure is bigger in people who binge drink. Strokes are more likely among people who binge drink and that is tied to high blood pressure. So there are a number of conditions that are related to the toxic effects, if you will, of excessive drinking that the binge drinking contributes to.

Tom Frieden: It is certainly also true that binge drinking is a significant risk factor for injuries, clearly drinking too much impairs judgment and reaction times that are important for driving and can increase the likely head of getting into fights and other aggressive behaviors and there are a wide range of health and social problems associated with binge drinking. Another thing I might mention that a lot of people don't think about is unintended pregnancy. That's a huge problem among the youth and beyond. Binge drinking is strongly associated with pregnancy as well.

Operator: We have another question. I would like to remind everyone on the phone to press star 1 and record your name and affiliation if you would like to ask a question. Our final question comes from Emily Walker. Ma'am, your line is open.

Emily Walker: Thanks for taking my question. To follow up on that last question asked there. So the first thing you said, cirrhosis, those are things that take a while if someone is drinking for a long time. That's something that develops. What, specifically, say a healthy person who drinks once a month, what are things that could happen if they get in a car accident or have unprotected sex. Are there immediate health effects from drinking and I have a second question, what sort of thing should the CDC be doing? What should we have with the public campaign or something of that sort?

Tom Frieden: Okay. This is Dr. Frieden. Starting with the second part and I'll turn it over to Dr. Brewer for the first part. One thing we're doing through the publication of this document is shining a light as a problem because I think as we've made clear, there are many health risks from drinking if you're a woman or five or more if you're a man, and I don't think it is recognized. The first is to shine a light on this and each community needs to think of how they can best address this in their contest.

Emily Walker: Sure.

Bob Brewer: This is Dr. Brewer. As I understand your question, you're really trying to get at what are direct effects of binge drinking and once a month or so, is that what you're asking?

Emily Walker: Yeah. Yeah. People who binge drink aren't thinking they'll get in a car and have unprotected sex. So from many people's standpoints they don't think why would that be a problem?

Bob Brewer: First of all, drinking excessively and it is by far the most pattern of excessive drinking in the United States. Drinking to get drunk, it does have a cumulative effects over time. Some of the health problems like cancer and heart disease, high blood pressure, et cetera are more of a function of the cumulative damage associated with drinking too much over an extended period of time. The other major set of problems that were concerned about, the acute problems generally fall into the injury category, but include other problems that Dr. Frieden had mentioned previously such as sexually transmitted diseases. It's a matter of HIV and also another important issue, multiple sexual partners which of course, is a risk factor for HIV. So it may seem on the one hand that getting — drinking to the point of intoxication occasionally is not a major issue. But every time a person drinks to the point of intoxication they are exposing themselves and others to risks associated with excessive drinking.

Tom Skinner: Jill, we have time for maybe two more questions, please.

Operator: we have a follow-up question from Daniel DeNoon with WebMD. Sir, your line is re-opened.

Dan DeNoon: Thank you very much. I wanted to ask about the relationship between binge drinking and alcoholism. I believe, Dr. Frieden, you mentioned earlier that we're not necessarily talking about alcoholism. Can you define in a little more? Can we define what percentage of binge drinkers are alcoholics and at what point do we define alcoholism and any other relationship between a serious chronic drinking problem and binge drinking that you care to identify?

Bob Brewer: Sure. This is Dr. Brewer. First of all, let me just say that we fully recognize that alcohol dependence is also a huge public health problem and a chronic disease. However, the reality is that most people who engage in binge drinking and drinking to acute intoxication are not alcohol dependent and to put a number on that of over 80% of people are binge drinkers would not meet the diagnostic criteria for alcohol dependence. You're talking about people continuing to drink, despite the fact of social consequences associated with your drinking. They have a loss of control over their drinking so they're not able to predict the extent or outcome of a drinking occasion, and it's a very serious health problem, but the reality is, and this is something a lot of people don't appreciate. Most people who are binge drinking on occasion are not alcohol dependent. It emphasizes the need to increase people's awareness that there are substantial dangers associated with this high per-occasion alcohol consumption even if they don't meet criteria for energy dependence.

Dan DeNoon: Dr. Brewer, can you spell out some of the warning signs, perhaps it would help to tell the occasional binge drinkers of when there might be a warning sign that they are, in fact, crossing the line into alcohol dependency?

Bob Brewer: Sure. Some of the key warning signs for alcohol dependence would include a strong craving for alcohol. Continued use despite problems associated with drinking and the inability to set controls on their drinking behavior. Those are all some of the warning signs. One of the things we strongly recommend is that anybody who is concerned about their drinking talk with their physician or another health professional about it. We are very strong believers in the value of screening and counseling for excessive drinking and believe that should be a route each part of clinical encounter. This is a really serious public health problem and to not ignore it and to accept it as a tolerable behavior.

Tom Skinner: Thank you very much. Jill, we have time for one more question. We have one more question from Hiran Ratnayake. Your line is re-open, sir.

Hiran Ratnayake: Can you have — and I apologize if it sounds competitive, but do you have long-term health problems directly from occasional binge drinking. Like, can you get cirrhosis of the liver or some type of other liver problem that people typically associate and researchers typically associate with alcoholics?

Bob Brewer: From binge drinking?

Hiran Ratnayake: Yes.

Bob Brewer: This is Dr. Brewer responding. Yes, you absolutely can. It's important to recognize that most people who binge drink do so frequently and at levels that are well above the four or more drinks per occasion that we would use to define binge drinking for women or five or more drinks per occasion that would define binge drinking for men. Drinking at a high level like this, repeatedly, really in particular could be associated with a wide range of health and social problems. Both injury, risk, but also the risk of—

Hiran Ratnayake: What if you do it infrequently, sir? What if it's, like – I can see somebody drinks every night will have liver problem, but what about someone who does it on Friday nights?

Bob Brewer: I mean, there is certainly going to be variation in individual response to alcohol, but the science clearly shows that binge drinking at any level is associated with an increased risk of harm. We would not consider any level of binge drinking to be safe. In that instance similar to smoking where we would say any smoking is undesirable and any binge drinking is undesirable.

Tom Skinner: Thanks very much. Dr. Frieden and Dr. Brewer. This concludes the media briefing. If any reporter have a follow-up question they can dial the CDC press office at 404-639-3286. Thank you all very much for joining us.

Operator: This does conclude today's conference call. We thank you all for participating. Have a great afternoon.

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