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CDC Telebriefing on Vital Signs Report on Binge Drinking among Women and Girls

Tuesday, January 8, 2013 at Noon. ET

OPERATOR: Welcome and thank you for standing by. At this time, all participants are in a listen-only mode. During the question and answer session of today's call, you may ask a question by pressing star 1. Today's conference is being recorded. At this time, I'll turn the call over to Mr. Tom Skinner.  You may begin, sir. 

TOM SKINNER: Thank you, Shirley, and thank you for joining us today on this telebriefing on a Vital Signs report on binge drinking among women and girls.  With us today is the Director of the CDC, Dr. Thomas Frieden, who will provide some opening remarks.  And when we get to your questions, we'll be joined by Dr. Robert Brewer, from our alcohol program in the National Center for Chronic Disease Prevention Health Promotion.  So I'll turn it over to Dr.  Frieden for some brief remarks, and then we'll get to your questions. 

THOMAS FRIEDEN:  Good afternoon, everyone.  And thanks for joining us.  I'm Tom Frieden, Director of the Centers for Disease Control and Prevention.  Although binge drinking is even more of a problem among men and boys, binge drinking is an important and under recognized women's health issue. Today, this Vital Signs focuses on this, because there are serious risks associated with binge drinking, and some of those are specific to women and girls.  There are about 23,000 deaths in women and girls each year due to drinking too much alcohol.  Most of those deaths are from binge drinking.  For women, binge drinking is defined as consuming four or more drinks on an occasion.  Binge drinking is the most common and most dangerous pattern of excess alcohol consumption.  In fact, about 50% of all of the alcohol consumed by adults and about 90% of all of the alcohol consumed by kids is consumed during a binge drink.  Binge drinking can have serious health risks for women and girls.  Women and girls' bodies respond differently to alcohol than men's.  In fact, women metabolize or process alcohol in a different way.  Women tend to be smaller, and therefore, are more susceptible to the harms of drinking at lower levels of drinking.  Risks include breast cancer, heart disease, sexually-transmitted diseases and many other health problems.  Binge drinking can also lead to unintentional pregnancy and women who do not intend to become pregnant may not realize that they're pregnant until later in their pregnancy when they can't get preventive care.  It is not safe to drink at any time during pregnancy. In fact, if women drink while pregnant, they risk exposing their developing baby to high levels of alcohol, and that can lead to sudden infant death syndrome, as well as fetal alcohol spectrum disorders.  However, about 14 million U.S. adult women, one in eight, binge drink.  As do about one in five high school girls.  In fact, the rate of drinking among high school girls is nearly as high as the rate of drinking among high school boys, and as we have previously reported, while the rate of drinking among high school boys fell considerably in recent decades, it has remained relatively constant among high school girls, which is why there is hardly any difference at this point between boys and girls and drinking.  Women who binge drink also tend to do so frequently, about three times a month, and in substantial quantities, about six drinks per binge, which increases the risk of harm to themselves and to others.  Binge drinking is most common among women age 18 to 34 and among high school girls.  About half of high school girls who drink alcohol report binge drinking and among high school seniors, about 62% of girls who report drinking, binge.  Binge drinking is also more common among white women and Hispanics and among women with household incomes above $75,000 per year.  Fortunately, the community guide or Guide to Community Preventative Services has a number of effective strategies that communities can choose from to prevent binge drinking.  Health care providers have an important role to play in reducing binge drinking.  They can talk to all patients, including pregnant women, about their alcohol consumption and advise those who drink to do so less.  Those who drink too much, rather, to do so less.  Finally, each of us can choose not to binge drink.  If you do choose to drink, the U.S. dietary guidelines recommend drinking in moderation, which is defined as up to one drink a day for women or up to two drinks a day for men.  Underage youth and women who are pregnant should not drink at all.  It's possible working together to implement effective measures, support women in making wise choices and reduce binge drinking and the many harms associated with it. 

TOM SKINNER: Okay.  Shirley, I think we're ready for questions, please. 

OPERATOR: Thank you.  We will now begin the question and answer session.  If you would like to ask a question, please press star 1.  Please unmute your line and state your name clearly.  To withdraw your request, you may press star 2.  Again, star 1 to ask a question.  And one moment, please, for our first question.  One moment, please.  Our first question comes from John Roberts with Fox News Channel.  You may ask your question. 

JOHN ROBERTS: Good afternoon, Dr.  Frieden, Dr. Brewer.  Dr. Frieden, you mentioned 23,000 deaths every year.  You said most of those are from binge drinking.  Can you give us some sort of ballpark number?  The report actually said more than half.  So I’m looking— if you can give us kind of a ballpark number.  And also you said that when you compare this to binge drinking among males, in high school, the number of boys who binge drink is coming down.  Do you know— it used to be that twice as many males than females binge drink.  And I’m wondering what that ratio is now. 

THOMAS FRIEDEN: Among adults, it's still about twice as many men as women binge drink, although it's a serious problem with one in eight women binge drinking.  But in girls and boys, the rates are almost the same.  Very similar levels.  In terms of binge drinking and the burden of binge drinking, one thing that's very important to understand is that the overwhelming majority of people who binge drink are not alcoholic.  Nevertheless, they may have serious harms from binge drinking.  Binge drinking is both the most common and most harmful pattern of drinking.  Dr. Brewer may want to comment further on binge drinking and the proportion of illness that it causes. 

ROBERT BREWER: Sure.  This is Dr. Robert Brewer.  And in response to your question about the proportion of the deaths among women and girls that are due to binge drinking, we would estimate that it's about half.  So right in the order of around 12,000 or so of those deaths would be due to binge drinking.  And particularly to what we would call acute events, injuries.  That would include motor vehicle crashes, interpersonal violence, suicide, et cetera.  So binge drinking is a major contributor to preventable death among women and girls. 

JOHN ROBERTS:  Great.  Thank you, gentlemen. 

OPERATOR: Thank you. 

TOM SKINNER: Next question, Shirley. 

OPERATOR: Thank you.  Next question comes from Evan Brown with Fox News Radio.  You may ask your question. 

EVAN BROWN: Good morning, Dr. Frieden.  You mentioned that binge drinking could lead to STDs and unwanted pregnancy.  But that's obviously not an automatic thing.  I mean, doesn't that skip a step somewhere? 

THOMAS FRIEDEN: Binge drinking increases the risk of a wide range of harms.  Those include getting hurt in a car crash, those include getting hurt in a violent episode, and those include engaging in behaviors that you may well regret the next morning and may have long-term negative consequences, whether that's a sexually-transmitted infection, HIV, or unintended pregnancy. 

EVAN BROWN: Great, thank you. 

OPERATOR: Thank you.  Again, if you have a question, press star 1.  Our next question comes from David Beasley with Reuters News Service.  You may ask your question. 

DAVID BEASLEY: Yes.  Could you talk a bit about why you're choosing to profile women today?  In other words, these are not new numbers, correct?  In other words, it's basically your effort to raise awareness that perhaps women are overlooked when discussing this problem, or --

THOMAS FRIEDEN: One of the issues -- this is Dr. Frieden.  One of the issues that's really struck us is that binge drinking is an unrecognized or under recognized women's health issue.  That there is a growing recognition of binge drinking as a problem among men and boys.  But there isn't that same recognition about the level of the problem among girls and women.  So that was one reason for this approach.  Dr. Brewer? 

ROBERT BREWER: I think the other point -- I completely agree with Dr.  Frieden.  I think the other point to recognize is that while binge drinking is not a new problem for women and girls, it is an unrecognized problem, largely, among women and girls.  And there are some special concerns related to binge drinking among women and girls.  Dr. Frieden highlighted some of those points in his opening remarks.  But just to repeat them, women and girls metabolize or process alcohol differently than men and boys.  As a result of that, they may have a higher blood alcohol level at the same level of alcohol consumption.  That greatly increases their risk of not only short term health effects, injuries and such, but also longer-term problems, such as breast cancer, which is not widely recognized by a lot of people.  So they're both immediate problems and longer-term problems associated with binge drinking, which remains a serious problem for women and girls. 

DAVID BEASLEY: In your opinion, is it increasing faster among women overall than it is men?  In other words, we talked about how it was dropping in some categories of men.  But it is actually going up among women, or --

ROBERT BREWER: Actually, if you look at what has happened with the proportion, what we would call the prevalence of binge drinking among women, it really hasn't changed very much over a 15-plus year period.  It's gone up a little bit, because frankly, we've gotten better at measuring it.  We're using a definition of binge drinking that better captures some of the special risks that women have when they drink too much.  That's the greater than four drinks or four or more drinks, definition that we talked about before.  Using that definition has resulted in a somewhat increase in prevalence over time.  But there is another important point here that I think we ought to emphasize, which is that most women and girls who do engage in binge drinking tend to do so frequently, an average of three times a month, and tend to consume upwards of six drinks per binge drinking occasion, which is obviously well above that four-drink threshold that we talked about.  So it hasn't -- the prevalence of binge drinking, the proportion of women and girls who report this behavior hasn't changed very much, but those who do engage in it quite frequently and at high levels. 

TOM SKINNER: Next question. 

OPERATOR: Thank you.  And the next question comes from Pam Harrison with Med Scape Psychiatry.  You may ask your question. 

PAM HARRISON: Thank you.  Just a quick clarification.  I'm looking at the prevalence of binge drinking, the different age groups.  And as you said earlier, they didn't -- the prevalence really didn't vary dramatically.  But when I got to -- you're saying over half of all high school girls who report current alcohol use also binge drink.  Doesn't that contradict the prevalence figures where the girls in high school that were about 20% of high school girls report binge drinking?  So I need to know what the 20% represents and what the over half represents. 

ROBERT BREWER: Thank you for your question.  I appreciate the chance to clarify that.  This is Dr. Brewer again.  The 20% figure among high school girls is -- prevalence of binge drinking -- is among all high school girls.  All girls who respond specifically to this survey that we use to assess drinking behavior.  50% figure is just among those girls who reported drinking at all.  Who reported having one or more drinks within the past 30 days. 


ROBERT BREWER:  Among those high school girls, about half of them reported binge drinking.  So the important point there, as Dr. Frieden has mentioned before, is that most of the drinking that is done by underage use, including underage girls, is actually in the form of binge drinking. 


ROBERT BREWER: --drinking to get drunk.  Does that clarify it, perhaps? 

PAM HARRISON:  Yes.  And there's just one other question.  There was also in the -- I know you referred frequently to the definition of binge drinking as four or more drinks on one occasion.  But in the abstract of your report, you refer to binge drinking as five or more drinks in a row during the past 30 days.  So which definition should I be using? 

ROBERT BREWER: Okay.  Well, thank you again for that question.  I appreciate the chance to clarify it.  The definition is four or more drinks on an occasion, that's within a short period of time, two or three hours, for women and girls.  That is the definition.  In this particular study, we used a survey to assess binge drinking among high school students that use the same definition for binge drinking for boys and girls.  So five or more drinks.  The results of that is that we're actually really underreporting the prevalence of binge drinking.  That is, the proportion of high school girls who reported binge drinking.  If, in fact, we had -- had used a four-drink cut point, had been able to do that with this survey, I think it is very safe to say that the prevalence of binge drinking we would have found among high school girls would have been higher.  And we know in general with these surveys that we get real underreports of alcohol consumption.  So I think you can safely assume for both women and girls that the prevalence of binge drinking we're reporting is actually quite low.  Relative to what it actually is in reality. 

TOM SKINNER:  Next question, Shirley? 

OPERATOR: Thank you.  Next question comes from Katherine Rose with “ABC News”.  You may ask your question. 

KATHERINE ROSE: Hi, thanks.  I was wondering if you guys know any data about how many women are aware of the healthy drinking limits.  You know, would many women be surprised to know that four drinks in a sitting is considered a binge alcohol episode? 

THOMAS FRIEDEN: We don't have data on that right now.  But there is a clear message for people, never four or more if you're female.  Never more than four if you're male.  It's a simple message that is a guide to not drinking at harmful levels, because binge drinking does cause a very wide range of health problems.  This is Dr. Frieden and Dr.  Brewer may want to say more. 

ROBERT BREWER: If I can pick up on that, when we're talking about binge drinking, let's be clear.  We're basically talking about a level of consumption that is going to result in a blood alcohol level of .08.  The legal limit for intoxication relative to driving in all states.  While we absolutely do not want people to engage in binge drinking, not binge drinking -- drinking at a level right below binge drinking doesn't mean that you're drinking in a low-risk fashion.  And that's why the point that Dr. Frieden made about the dietary guidelines is so important.  If you actually talk about what is a lower risk level of alcohol consumption, it's up to one drink a day for a woman.  So absolutely, we want people to avoid binge drinking for all of the reasons we have discussed.  But what we really want to try to do is to move people toward complying with lower risk guidelines for drinking, as described in the dietary guidelines.  Up to one drink a day for a woman, up to two drinks a day for a man. 

TOM SKINNER:  Next question, Shirley? 

OPERATOR: Thank you and next question comes from Mike Stobbe with the “Associated Press”, you may ask your question. 

MIKE STOBBE: Hi.  Thank you for taking the question.  You all said a little earlier, I believe, that the prevalence of binge drinking among high school boys and girls is about the same.  If I understood that correctly, I wanted to follow up on the Pam Harrison question, in which Dr.  Brewer responded that that survey actually put the cut point at five drinks for girls.  If that's the case, am I following correctly?  Even though you don't have numbers, it sounds likely that binge drinking is actually more common among high school girls than boys, if you had been able to measure it at the four cut point.  Is that correct? 

THOMAS FRIEDEN: We don't have a way of saying exactly what the result would be.  This is Dr. Frieden.  In the 2011 Youth Risk Behavior survey, the rate among boys was 24%.  The rate among girls was 20%.  So whether -- they're similar at the cut point of five, if respective cut points of five and four had been used, they certainly -- we would have seen no higher rate in girls, and, in fact, a higher rate than 20 -- I’m sorry, no higher rate in boys, and a higher rate than 20 in girls.  But whether that would have been as high or higher than the 24 measured in boys, we can't say. 

MIKE STOBBE: Okay.  Thanks. 

OPERATOR: Thank you.  Again, if you have a question, press star 1.  Our next question comes from Kristina Krohn with “NBC News”.  You may ask your question. 

KRISTINA KROHN:  Hi.  I wanted to ask specifically about the -- how does this result compared to previously?  My understanding is that it's really the same as far as the levels for binge drinking for women.  Just clarifying that once again.  And then is there a specific cause or trigger that women cite as far as reasons for binge drinking?  Thank you. 

THOMAS FRIEDEN: Could you repeat the first part of your question, please? 

KRISTINA KROHN:  Just reaffirming that the level of binge drinking in women hasn't actually changed.  It's been a consistent level over the last several years. 

ROBERT BREWER:  Yeah, the prevalence, as we would call it, the proportion of adult women who report binge drinking, again, consuming four or more drinks within an occasion, has not changed substantially among women.  If you were to actually look at the numbers, it has gone up.  But a lot of that has to do with the fact that we have adopted in the survey that we use to assess this behavior in adults, what's called the Behavioral Risk Factor Surveillance System, a definition that better captures the level of consumption that would lead to this .08 or a level of intoxication.  So as a result of that, the prevalence of binge drinking among adult women appears to have gone up, but that is largely due to this change in the definition which happened a few years ago.  So short answer, the proportion of adult women who have engaged in binge drinking we believe has stayed pretty constant, which, by the way, is not good news.  We want to see this proportion go down.  But, again, let's not forget, it isn't just a function of whether women are ever binge drinking.  It's also an issue of how often they're binge drinking.  We estimate about three times a month.  And the amount they're consuming when they do, which we estimate around six drinks per binge, which is a lot of alcohol. 

THOMAS FRIEDEN:  And if we can just go back to the question that Mike Stobbe from the AP asked, one question earlier, there is at least one study that looked at what reducing the threshold for defining binge drinking from five to four would do among women.  It doesn't address that among girls.  And that found that it increased it by more than a third.  So if that is -- holds for girls, you would see a slightly higher rate among girls than boys.  But there is no way to know that until we do further analysis and are able to collect the data in a different way in the future. 

TOM SKINNER: Next question, Shirley. 

OPERATOR: At this time, I’m showing no further questions. 

THOMAS FRIEDEN: Okay.  This is Dr. Frieden.  I'd like to just wrap-up with three key points.  The first is that binge drinking is a serious, under recognized problem among women and girls.  The second is that it really is a serious problem.  It has a wide range of health risks, injuries, violence, chronic disease, cancer, reproductive health, learning and memory problems and complications of pregnancy.  Alcohol has been associated with a very wide range of health problems, ranging from neurological to liver, heart, mental status, violence, social complications, and motor vehicle crashes.  And third, that there are important and effective things that all of us can do to reduce binge drinking.  Among youth, it's very important that parents play a key role in preventing youth from beginning and continuing to drink with -- in harmful patterns.  There are things that states and communities can do, and there are community guide recommendations that provide detailed approaches that are effective at reducing binge drinking and problem drinking more broadly.  Doctors and other health care workers can ask patients about drinking, and even very brief counseling can make a very big difference for a long time in preventing patients from progressing from drinking to problem drinking.  And women and girls can avoid binge drinking and if they do choose to drink, follow the U.S.  Dietary Guidelines and choose not to drink alcohol, if you're under age or if there is any chance that you could be pregnant.  So there are important things that we can do to reduce this problem.  Thanks to all of you for your attention today. 

TOM SKINNER: Thank you for joining us today.  A transcript from this telebriefing will be available from our website later this afternoon, should you need any additional information, feel free to call the CDC press office at 404-639-3286.  Thank you for joining us. 




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