Brief report
Impact of a New Gender-Specific Definition for Binge Drinking on Prevalence Estimates for Women

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Background

Binge drinking accounts for more than half of the 79,000 deaths due to excessive drinking in the U.S. each year. In 2006, the Behavioral Risk Factor Surveillance System (BRFSS) lowered the threshold for defining binge drinking among women from ≥5 drinks to ≥4 drinks per occasion, in accordance with national recommendations.

Purpose

To assess changes in binge-drinking prevalence among women.

Methods

The relative and absolute change in binge drinking among U.S. adult women was assessed using pooled BRFSS data from the 2 years before (2004–2005) and after (2006–2007) the implementation of the new gender-specific definition. Analyses were conducted in 2008–2009.

Results

Binge-drinking prevalence among women increased 2.6 percentage points (from 7.3% in 2004–2005 to 9.9% in 2006–2007), a 35.6% relative increase. The percentage of women who reported consuming exactly 4 drinks in 2006 (3.6%) was similar to the increase in the prevalence of binge drinking among women that was observed from 2005 to 2006 (absolute change=2.9 percentage points).

Conclusions

The new gender-specific definition of binge drinking significantly increased the identification of women drinking at dangerous levels. The change in prevalence among women was primarily due to the change in the definition and not to actual changes in drinking behavior. The new gender-specific definition of binge drinking can increase the usefulness of this measure for public health surveillance and support the planning and implementation of effective prevention strategies (e.g., increasing alcohol excise taxes).

Introduction

Binge drinking is responsible for more than half of the estimated 79,000 deaths and two thirds of the 2.3 million years of potential life lost annually due to excessive alcohol use in the U.S.1 It is also a risk factor for many health and social problems.2 Since the Monitoring the Future Study3 began using a 5-drink measure for high school students in 1975, most national surveys have defined binge drinking as consuming 5 or more drinks on an occasion (or in a row) for both women and men.4, 5 The Harvard School of Public Health College Alcohol Study used a gender-specific measure of ≥5 drinks for men, and ≥4 drinks for women, because of gender differences in the risk of alcohol-related harms at these levels.6, 7, 8 The use of a 4-drink threshold for defining binge drinking in women is justified also because women generally have a smaller stature than men and because of physiologic differences that affect the absorption and distribution of alcohol (e.g., women absorb alcohol more rapidly than men).9

Recognizing these differences, in 2004 the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Advisory Council endorsed the use of a 4-drink threshold for defining binge drinking in women.10 The National Epidemiologic Survey on Alcohol and Related Conditions Survey also began using 4 drinks to define binge drinking among women that year,11 and the Behavioral Risk Factor Surveillance System (BRFSS) did so in 2006. The present study assessed the impact of the new definition on BRFSS estimates of binge drinking among women and examined whether any changes in prevalence were attributable to the new definition or to actual changes in drinking behavior of women.

Section snippets

Methods

Data for the present study came from the 2004–2007 BRFSS (more details available at www.cdc.gov/brfss).12 The number of respondents ranged from 303,822 in 2004 to 430,912 in 2007, and median state response rates ranged from 50.6% to 52.7%. Data analyses were conducted in 2008–2009 using SAS-callable SUDAAN. All data were weighted to produce population-based national estimates.

Current drinkers were defined as those who reported consumption of alcohol in the past 30 days. To assess binge

Results

There were no significant changes in binge-drinking prevalence from 2004 to 2005, or from 2006 to 2007 among men and women (Table 1). Therefore, data were pooled for 2004–2005 and 2006–2007 and the two time periods compared. Binge-drinking prevalence for women increased from 7.3% to 9.9% (absolute increase=2.6%; relative increase=35.6%) during this time, whereas no increase was seen in binge drinking among men (Table 2).

The largest absolute increases in prevalence among women were generally

Discussion

Lowering the BRFSS threshold for defining binge drinking among women from ≥5 drinks to ≥4 drinks per occasion, in accordance with national standards,10 increased the absolute prevalence of this behavior among U.S. women by approximately 3 percentage points, which corresponded to a one-third relative prevalence increase. Given the evidence and rationale for lowering the threshold in the first place, the new binge-drinking definition improves the ability of the BRFSS to identify women drinking at

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