Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 1035-1036 (doi:10.1542/10.1542/peds.2007-0468)

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LETTER TO THE EDITOR

Is the Binge-Drinking Glass Half Full or Half Empty?: In Reply

Jacqueline W. Miller, MD
Timothy S. Naimi, MD, MPH
Robert D. Brewer, MD, MSPH
Centers for Disease Control and Prevention
Atlanta, GA 30333

In response to Dr Turner, underage drinking remains common and dangerous. Alcohol is a leading preventable cause of death among young adults and contributes to the 3 leading causes of death among adolescents.¹ In addition, youth drinking and binge drinking contribute to a number of social problems, including unintended pregnancy, violence, sexually transmitted infections, altered brain development, and subsequent alcohol problems in adulthood.^2,3 Although rates of underage drinking have declined slightly among male high school students during the past decade, it is hard to take solace from our study when almost half of all US high school students drank alcohol during the previous 30 days and approximately two thirds of those individuals binge drank, typically on multiple occasions.

Although binge drinking is an extremely dangerous pattern of alcohol consumption, our report and other studies have shown that any alcohol consumption among youth is riskier than no consumption. For example, we found that high school students who drank but did not binge drink were 2 to 4 times more likely than nondrinkers to ride with a drinking driver, be sexually active, smoke cigarettes, and get into a fight. In addition, because respondents in adult population-based surveys tend to underreport how much they drink, it is also likely that some students who reported drinking at less-than-binge levels may have been misclassified because of potential reporting bias.^4,5 Furthermore, youth generally weigh less than adults and, therefore, are more likely to attain impairment-level blood alcohol concentrations when drinking fewer than 5 drinks. Finally, underage drinkers are far more likely than adult drinkers to suffer alcohol-related harms (eg, motor vehicle crashes) at blood alcohol concentrations below 0.08%.⁶

Dr Turner's glass-half-full paradigm reflects an approach called social norms theory, which postulates that educating adolescents or college students about normative behavior (ie, emphasizing that many people do not drink) will "pressure" them to behave in less risky ways. Although this approach has been endorsed by some educators, there are at least 3 concerns. First, according to the Guide to Community Preventive Services,⁷ there is insufficient evidence to determine whether social norming is effective in reducing alcohol-related outcomes among youth (eg, drinking and driving). Second, social norming programs are aimed primarily at individuals and do not address important societal determinants of youth drinking behavior, such as adult alcohol misuse and the larger alcohol-policy environment.^2,8 Third, programs that have a large focus on social norming may have the unintended consequence of minimizing the public's appreciation for the problem of underage drinking, thus eroding support for other interventions that are known to be effective and that require a strong public commitment.^7,9

Social attitudes about the acceptability of underage drinking do need to change, but minimizing the problem will only increase our complacency about solving it. The time has come to match the scope and intensity of the underage drinking problem with robust, population-based intervention policies recommended by the Institute of Medicine, including increased alcohol excise taxes, adequate enforcement of minimum legal drinking age laws, and additional reductions in alcohol marketing to youth-oriented audiences.² We also need to recognize the strong relationship between binge drinking by adults and binge drinking by youth and implement effective strategies (eg, limiting alcohol-outlet density) to prevent binge drinking in the general population.¹⁰ Absent such policy changes, the impact of future clinical and educational efforts to reduce underage and binge drinking and to change social attitudes regarding this behavior will be limited.

REFERENCES

1. Centers for Disease Control and Prevention. Web-based injury statistics query and reporting system. Available at: www.cdc.gov/ncipc/wisqars. Accessed July 26, 2005
2. Bonnie RJ, O'Connell ME, eds. Reducing Underage Drinking: A Collective Responsibility. Washington, DC: National Academies Press; 2004
3. Naimi TS, Lipscomb LE, Brewer RD, Colley Gilbert B. Binge drinking in the preconception period and the risk of unintended pregnancy: implications for women and their children. Pediatrics. 2003;111 (5 pt 2):1136–1141
4. Feunekes GI, van't Veer P, van Staveren WA, Kok FJ. Alcohol intake assessment: the sober facts. Am J Epidemiol. 1999;150 :105 –112[Abstract/Free Full Text]
5. Midanik LT. The validity of self-reported alcohol consumption and alcohol problems: a literature review. Br J Addict. 1988;77 :357 –382[CrossRef]
6. Zador PL, Krawchuk SA, Voas RB. Alcohol-related relative risk of driver fatalities and driver involvement in fatal crashes in relation to driver age and gender: an update using 1996 data. J Stud Alcohol. 2000;61 :387 –395[Web of Science][Medline]
7. Elder RW, Nichols JL, Shults RA, et al. Effectiveness of school-based programs for reducing drinking and driving and riding with drinking drivers. Am J Prev Med. 2005;28 (5S):288–304
8. Babor TF, Caetano R, Casswell S, et al. Alcohol: No Ordinary Commodity—Research and Public Policy. New York, NY: Oxford University Press; 2003
9. Wechsler H, Seibring M, Liu I, Ahl M. Colleges respond to student binge drinking: reducing student demand or limiting access [published correction appears in J Am Coll Health. 2004;52:286]. J Am Coll Health. 2004;52 :159 –68[Web of Science][Medline]
10. Nelson TF, Naimi TS, Brewer RD, Wechsler H. The state sets the rate: the relationship among state-specific college binge drinking, state binge drinking rates, and selected state alcohol control policies. Am J Public Health. 2005;95 :441 –446[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Miller, J. W. Articles by Brewer, R. D. Search for Related Content PubMed Articles by Miller, J. W. Articles by Brewer, R. D. Related Collections Adolescent Medicine Social Bookmarking                         What's this?