Ralph W. Hingson’s research while affiliated with National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health and other places

This study uses mortality data from the National Center for Health Statistics to assess whether alcohol-related deaths increased during the COVID-19 pandemic.

Background Alcohol consumption, alcohol‐related emergency department visits, and hospitalizations have all increased in the last 2 decades, particularly among women and people middle‐aged and older. The purpose of this study was to explore data from death certificates to assess whether parallel changes in alcohol‐related mortality occurred in the United States in recent years. Methods U.S. mortality data from the National Center for Health Statistics were analyzed to estimate the annual number and rate of alcohol‐related deaths by age, sex, race, and ethnicity between 1999 and 2017 among people aged 16+. Mortality data contained details from all death certificates filed nationally. For each death, an underlying cause and up to 20 multiple or contributing causes were indicated. Deaths were identified as alcohol‐related if an alcohol‐induced cause was listed as either an underlying or multiple cause. Joinpoint analyses were performed to assess temporal trends. Results The number of alcohol‐related deaths per year among people aged 16+ doubled from 35,914 to 72,558, and the rate increased 50.9% from 16.9 to 25.5 per 100,000. Nearly 1 million alcohol‐related deaths (944,880) were recorded between 1999 and 2017. In 2017, 2.6% of roughly 2.8 million deaths in the United States involved alcohol. Nearly half of alcohol‐related deaths resulted from liver disease (30.7%; 22,245) or overdoses on alcohol alone or with other drugs (17.9%; 12,954). Rates of alcohol‐related deaths were highest among males, people in age‐groups spanning 45 to 74 years, and among non‐Hispanic (NH) American Indians or Alaska Natives. Rates increased for all age‐groups except 16 to 20 and 75+ and for all racial and ethnic groups except for initial decreases among Hispanic males and NH Blacks followed by increases. The largest annual increase occurred among NH White females. Rates of acute alcohol‐related deaths increased more for people aged 55 to 64, but rates of chronic alcohol‐related deaths, which accounted for the majority of alcohol‐related deaths, increased more for younger adults aged 25 to 34. Conclusions Death certificates suggest that alcohol‐related mortality increased in the United States between 1999 and 2017. Given previous reports that death certificates often fail to indicate the contribution of alcohol, the scope of alcohol‐related mortality in the United States is likely higher than suggested from death certificates alone. Findings confirm an increasing burden of alcohol on public health and support the need for improving surveillance of alcohol‐involved mortality.

Objective: To study the longitudinal associations of 12th-grade binge drinking with driving while impaired (DWI), riding with an impaired driver (RWI), blackouts, extreme binge drinking, and risky driving (self-reported Checkpoints Risky Driving Scale) among emerging adults up to 4 years after leaving high school. Methods: The data were all 7 waves (W 1 to W 7 of the NEXT Generation Health Study; a US nationally representative study (N = 2785) with a probability cohort of 10th-graders (mean age = 16.2 years; SE = 0.03) starting in the 2009-2010 year. Binary and ordinal logistic regressions were used for the analysis. Results: Binge drinking prevalence in W1 to W3 was 27.2%, 23.8%, and 26.8%, respectively. Twelfth-grade binge drinking was associated with a higher likelihood of DWI, RWI, blackouts, and risky driving in W4 to W7 and extreme binge drinking in W7. Adolescents who binged ≥3 times in high school were more likely to DWI, RWI, blackout (W4 to W7), be involved in extreme binge drinking (W7), and report riskier driving several years after high school. In some waves, parental practices appeared to have enduring effects in protecting against DWI, RWI, and blackouts. Conclusions: Twelfth-grade binge drinking is a robust predictor of early adulthood DWI, RWI, blackout, extreme binge drinking, and risky driving. Our study suggests that ongoing parental practices could be protective against DWI, RWI, and blackouts once adolescents transition from high school into early adulthood. Prevention programs that incorporate binge drinking-focused screening and bolster parental practices may reduce the likelihood of later major alcohol-related health-risk behaviors and consequences in emerging adults.

Background: Underage binge drinking is a serious health concern that is likely influenced by the neighbourhood environment. However, longitudinal evidence has been limited and few studies have examined time-varying neighbourhood factors and demographic subgroup variation. Methods: We investigated neighbourhood influences and binge drinking in a national cohort of US 10th grade students at four times (2010-2014; n = 2745). We estimated odds ratios (OR) for past 30-day binge drinking associated with neighbourhood disadvantage, personal and property crime (quartiles), and number of liquor, beer and wine stores within 5 km, and then evaluated whether neighbourhood associations differ by age, sex and race/ethnicity. Results: Neighbourhood disadvantage was associated with binge drinking before 18 [OR = 1.54; 95% confidence interval (1.14, 2.08)], but not after 18 years of age. Property crime in neighbourhoods was associated with a higher odds of binge drinking [OR = 1.54 (0.96, 2.45)], an association that was stronger in early adulthood [4th vs 1st quartile: OR = 1.77 (1.04, 3.03)] and among Whites [4th vs 1st quartile: OR = 2.46 (1.03, 5.90)]. Higher density of liquor stores predicted binge drinking among Blacks [1-10 stores vs none: OR = 4.31 (1.50, 12.36)] whereas higher density of beer/wine stores predicted binge drinking among Whites [one vs none for beer: OR = 2.21 (1.06, 4.60); for wine: OR = 2.04 (1.04, 4.03)]. Conclusions: Neighbourhood conditions, particularly those related to economic circumstances, crime and alcohol outlet density, were related to binge drinking among young adults, but associations varied across age and individual characteristics.

Background and Aims A number of alcohol policies in the United States have been presumed to reduce underage youth drinking. This study characterized underage youth binge drinking trajectories into early adulthood and tested associations with the strength of the alcohol policy environment, beer excise taxes, and number of liquor stores. Design Longitudinal cohort study. Setting USA. Participants A national cohort of 10th graders in 2010 (n=2753), assessed annually from 2010‐2015. Measurements Participants reported on their 30‐day binge drinking (defined as consuming 5+ (for boys) or 4+ (for girls) drinks within 2 hours). We scored the strength of 19 state‐level policies at baseline and summarized them into an overall score and two subdomain scores. We also assessed state beer excise taxes (dollars/gallon) and linked the number of liquor stores in 1‐km to participant's geocoded address. Findings We identified five binge drinking trajectories: low‐risk (32.9%), escalating (26.1%), late‐onset (13.8%), chronic (15.1%), and decreasing (12.0%). Lower overall alcohol policy strength was associated with increased risk of being in the escalating vs. low‐risk binge drinking class (relative risk ratio, RRR = 1.4 per 1 SD in policy score; 95% CI [1.2, 1.8]). Higher beer excise taxes were associated with a reduced risk of being in the escalating class (RRR = 0.2 per 1 dollar increase; 95% CI [0.1, 0.6]). The number of liquor stores was not significantly associated with any binge drinking trajectory. Conclusions In the US, stronger state alcohol policies and higher beer excise taxes appear to be associated with lower risk of escalating alcohol consumption trajectories among underage youth.

Background Underage drinking has been associated with health‐risk behaviors: unintentional and unprotected sex; physical and sexual assault; suicide; homicide; traffic and other unintentional injuries; and overdoses. Five drinks consumed over 2 hours by adult males and 4 drinks by adult females typically produce blood alcohol levels (BALs) of ≥0.08%, which the National Institute on Alcohol Abuse and Alcoholism considers binge drinking. Being smaller, young adolescents can reach adult binge‐drinking BALs of ≥0.08% with fewer drinks. Previous research indicates boys ages 9 to 13 would reach ≥0.08% with 3 drinks, 4 drinks at ages 14 to 15, and 5 drinks at ages ≥16. For girls, ≥0.08% is reached with ≥3 drinks at ages 9 to 17 and ≥4 drinks at ages ≥18. This study explores whether, among a national sample of high school students, adolescent binge drinking at ≥twice versus <twice the age‐/gender‐specific thresholds versus nonbinge drinking heightens associations of drinking with health‐risk behaviors. Methods In 2015, the Youth Risk Behavior Survey asked a national probability sample of 15,624 high school students grades 9 to 12 (response rate 60%) about their past‐month drinking and past‐month or past‐year health‐risk behaviors. Logistic regressions with pairwise comparisons examined the association between different drinking levels and selected risk behaviors, adjusting for age, sex, race/ethnicity, and drinking frequency. Results Seven percent binged ≥twice and 9% <twice the age‐/gender‐specific thresholds, and 14% drank less than the binge thresholds. Significantly higher percentages of binge drinkers at ≥twice versus <twice the thresholds versus other drinkers reported illegal drug and tobacco use, risky sexual and traffic behaviors, physical fights, suicide, less school‐night sleep, and poorer school grades. Conclusions Adolescent alcohol misuse screening should query the maximum number of drinks consumed per occasion and frequency of such consumption. State and national surveillance surveys should include those questions to investigate which individual, family, school, community, and policy interventions reduce consumption beyond binge thresholds and related health‐risk behaviors.

Introduction Binge drinking, five or more drinks on an occasion for men and four or more for women, marks risky alcohol use. However, this dichotomous variable removes information about higher, more dangerous consumption. This paper examines predictors, consequences, and changes over a decade in drinking one to two times, two to three times, and three or more times standard gender-specific binge thresholds, labeled Levels I, II, and III. Methods In 2001–2002 and 2012–2013, respectively, 42,748 and 36,083 U.S. respondents aged ≥18 years were interviewed in person in cross-sectional waves of the National Epidemiologic Survey on Alcohol and Related Conditions (response rates, 81% and 61%). Respondents were asked their past-year maximum drink consumption per day, categorized as Levels I, II, or III. Predictors and whether Levels II and III were associated with more negative consequences were analyzed in 2012–2013 data. Results In 2001–2002, 23% of adults reported past-year binge drinking, with 15% peaking at Level I, 5% at Level II, and 3% at Level III. In 2012–2013, those percentages increased significantly to 33% binging, and 20%, 8%, and 5% binging at Levels I, II, and III, respectively. After adjusting for alcohol use disorder, the strongest predictor of Level I, II, and III binging, Level III versus I and non-binge drinkers had higher odds of past-year driving after drinking and, after drinking, experiencing physical fights, injuries, emergency department visits, arrests/detentions, and other legal problems. Conclusions Level II and III—relative to Level I—binging is associated with more negative alcohol consequences and may be increasing nationally. Research needs to explore prevention and counseling interventions.

Context: Excessive drinking is responsible for one in ten deaths among working-age adults in the U.S. annually. Alcohol screening and brief intervention is an effective but underutilized intervention for reducing excessive drinking among adults. Electronic screening and brief intervention (e-SBI) uses electronic devices to deliver key elements of alcohol screening and brief intervention, with the potential to expand population reach. Evidence acquisition: Using Community Guide methods, a systematic review of the scientific literature on the effectiveness of e-SBI for reducing excessive alcohol consumption and related harms was conducted. The search covered studies published from 1967 to October 2011. A total of 31 studies with 36 study arms met quality criteria and were included in the review. Analyses were conducted in 2012. Evidence synthesis: Twenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months. Conclusions: According to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density).