Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-29 (of 29 Records) |
Query Trace: Esser MB[original query] |
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Prescription opioid misuse and use of alcohol and other substances among high school students - Youth Risk Behavior Survey, United States, 2019
Jones CM , Clayton HB , Deputy NP , Roehler DR , Ko JY , Esser MB , Brookmeyer KA , Hertz MF . MMWR Suppl 2020 69 (1) 38-46 Adolescence is an important period of risk for substance use initiation and substance use-related adverse outcomes. To examine youth substance use trends and patterns, CDC analyzed data from the 2009-2019 Youth Risk Behavior Survey. This report presents estimated prevalence of current (i.e., previous 30-days) marijuana use, prescription opioid misuse, alcohol use, and binge drinking and lifetime prevalence of marijuana, synthetic marijuana, cocaine, methamphetamine, heroin, injection drug use, and prescription opioid misuse among U.S. high school students. Logistic regression and Joinpoint analyses were used to assess 2009-2019 trends. Prevalence of current and lifetime substance use by demographics, frequency of use, and prevalence of co-occurrence of selected substances among students reporting current prescription opioid misuse are estimated using 2019 data. Multivariable logistic regression analysis was used to determine demographic and substance use correlates of current prescription opioid misuse. Current alcohol, lifetime cocaine, methamphetamine, heroin, and injection drug use decreased during 2009-2019. Lifetime use of synthetic marijuana (also called synthetic cannabinoids) decreased during 2015-2019. Lifetime marijuana use increased during 2009-2013 and then decreased during 2013-2019. In 2019, 29.2% reported current alcohol use, 21.7% current marijuana use, 13.7% current binge drinking, and 7.2% current prescription opioid misuse. Substance use varied by sex, race/ethnicity, grade, and sexual minority status (lesbian, gay, or bisexual). Use of other substances, particularly current use of alcohol (59.4%) and marijuana (43.5%), was common among students currently misusing prescription opioids. Findings highlight opportunities for expanding evidence-based prevention policies, programs, and practices that aim to reduce risk factors and strengthen protective factors related to youth substance use, in conjunction with ongoing initiatives for combating the opioid crisis. |
Reducing alcohol use to prevent cancer deaths: Estimated effects among U.S. Adults
Esser MB , Sherk A , Liu Y , Henley SJ , Naimi TS . Am J Prev Med 2024 66 (4) 725-729 Introduction: The Dietary Guidelines for Americans, 2020–2025 recommends non-drinking or no more than 2 drinks for men or 1 drink for women in a day. However, even at lower levels, alcohol use increases the risk for certain cancers. This study estimated mean annual alcohol-attributable cancer deaths and the number of cancer deaths that could potentially be prevented if all U.S. adults who drank in excess of the Dietary Guidelines had instead consumed alcohol to correspond with typical consumption of those who drink within the recommended limits. Methods: Among U.S. residents aged ≥20 years, mean annual alcohol-attributable cancer deaths during 2020–2021 that could have been prevented with hypothetical reductions in alcohol use were estimated. Mean daily alcohol consumption prevalence estimates from the 2020–2021 Behavioral Risk Factor Surveillance System, adjusted to per capita alcohol sales to address underreporting of drinking, were applied to relative risks to calculate population-attributable fractions for cancers that can occur from drinking alcohol. Analyses were conducted during February–April 2023. Results: In the U.S., an estimated 20,216 cancer deaths were alcohol-attributable/year during 2020–2021 (men: 14,562 [72.0%]; women: 5,654 [28.0%]). Approximately 16,800 deaths (83% of alcohol-attributable cancer deaths, 2.8% of all cancer deaths) could have been prevented/year if adults who drank alcohol in excess of the Dietary Guidelines had instead reduced their consumption to ≤2 drinks/day for men or ≤1 drink/day for women. Approximately 650 additional deaths could have been prevented annually if men consumed 1 drink/day, instead of 2. Conclusions: Implementing evidence-based alcohol policies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to decrease drinking could reduce alcohol-attributable cancers, complementing clinical interventions. © 2023 |
Alcohol and other substance use before and during the COVID-19 pandemic among high school students - Youth Risk Behavior Survey, United States, 2021
Hoots BE , Li J , Hertz MF , Esser MB , Rico A , Zavala EY , Jones CM . MMWR Suppl 2023 72 (1) 84-92 Adolescence is a critical phase of development and is frequently a period of initiating and engaging in risky behaviors, including alcohol and other substance use. The COVID-19 pandemic and associated stressors might have affected adolescent involvement in these behaviors. To examine substance use patterns and understand how substance use among high school students changed before and during the COVID-19 pandemic, CDC analyzed data from the nationally representative Youth Risk Behavior Survey. This report presents estimated prevalences among high school students of current (i.e., previous 30 days) alcohol use, marijuana use, binge drinking, and prescription opioid misuse and lifetime alcohol, marijuana, synthetic marijuana, inhalants, ecstasy, cocaine, methamphetamine, heroin, and injection drug use and prescription opioid misuse. Trends during 2009-2021 were assessed using logistic regression and joinpoint regression analyses. Changes in substance use from 2019 to 2021 were assessed using prevalence differences and prevalence ratios, stratified by demographic characteristics. Prevalence of substance use measures by sexual identity and current co-occurring substance use were estimated using 2021 data. Substance use prevalence declined during 2009-2021. From 2019 to 2021, the prevalence of current alcohol use, marijuana use, and binge drinking and lifetime use of alcohol, marijuana, and cocaine and prescription opioid misuse decreased; lifetime inhalant use increased. In 2021, substance use varied by sex, race and ethnicity, and sexual identity. Approximately one third of students (29%) reported current use of alcohol or marijuana or prescription opioid misuse; among those reporting current substance use, approximately 34% used two or more substances. Widespread implementation of tailored evidence-based policies, programs, and practices likely to reduce risk factors for adolescent substance use and promote protective factors might further decrease substance use among U.S. high school students and is urgently needed in the context of the changing marketplaces for alcohol beverage products and other drugs (e.g., release of high-alcohol beverage products and increased availability of counterfeit pills containing fentanyl). |
Deaths from excessive alcohol use - United States, 2016-2021
Esser MB , Sherk A , Liu Y , Naimi TS . MMWR Morb Mortal Wkly Rep 2024 73 (8) 154-161 Deaths from causes fully attributable to alcohol use have increased during the past 2 decades in the United States, particularly from 2019 to 2020, concurrent with the onset of the COVID-19 pandemic. However, previous studies of trends have not assessed underlying causes of deaths that are partially attributable to alcohol use, such as injuries or certain types of cancer. CDC's Alcohol-Related Disease Impact application was used to estimate the average annual number and age-standardized rate of deaths from excessive alcohol use in the United States based on 58 alcohol-related causes of death during three periods (2016-2017, 2018-2019, and 2020-2021). Average annual number of deaths from excessive alcohol use increased 29.3%, from 137,927 during 2016-2017 to 178,307 during 2020-2021; age-standardized alcohol-related death rates increased from 38.1 to 47.6 per 100,000 population. During this time, deaths from excessive alcohol use among males increased 26.8%, from 94,362 per year to 119,606, and among females increased 34.7%, from 43,565 per year to 58,701. Implementation of evidence-based policies that reduce the availability and accessibility of alcohol and increase its price (e.g., policies that reduce the number and concentration of places selling alcohol and increase alcohol taxes) could reduce excessive alcohol use and alcohol-related deaths. |
Estimating the effects of hypothetical alcohol minimum unit pricing policies on alcohol use and deaths: A state example
Bertin L , Leung G , Bohm MK , LeClercq J , Skillen EL , Esser MB . J Stud Alcohol Drugs 2024 85 (1) 120-132 OBJECTIVE: Alcohol minimum unit pricing (MUP) policies establish a floor price beneath which alcohol cannot be sold. The potential effectiveness of MUP policies for reducing alcohol-attributable deaths in the United States has not been quantitatively assessed. Therefore, this study estimated the effects of two hypothetical distilled spirits MUP policies on alcohol sales, consumption, and alcohol-attributable deaths in one state. METHOD: The International Model of Alcohol Harms and Policies tool was used to estimate the effects of two hypothetical MUP per standard drink policies (40-cent and 45-cent) pertaining to distilled spirits products at off-premises alcohol outlets in Michigan during 2020. Prevalence estimates on drinking patterns among Michigan adults were calculated by sex and age group. Prices per standard drink and sales of 9,747 spirits products were analyzed using National Alcohol Beverage Control Association data. Analyses accounted for other alcoholic beverage type sales using cross-price elasticities. RESULTS: Increasing the MUP of the 3.5% of spirits with the lowest prices per standard drink to 40 cents could reduce total alcohol per capita consumption in Michigan by 2.6% and prevent 232 (5.3%) alcohol-attributable deaths annually. A 45-cent MUP would affect 8.0% of the spirits and reduce total alcohol per capita consumption by 3.9%, preventing 354 (8.1%) deaths. CONCLUSIONS: Modestly increasing the prices of the lowest-priced spirits with an MUP policy in a single state could save hundreds of lives annually. This suggests that alcohol MUP policies could be an effective strategy for improving public health in the United States, consistent with the World Health Organization's recommendation. |
Associations between parental drinking and alcohol use among their adolescent children: Findings from a national survey of United States parent-child dyads
Bohm MK , Esser MB . J Adolesc Health 2023 73 (5) 961-964 PURPOSE: Underage drinking is common and costly. This study examined associations between parent and child drinking using recent United States national survey data. METHODS: We analyzed responses of 740 parent-child dyads from 2020 SummerStyles and YouthStyles surveys. Parents and their adolescent children answered questions about past 30-day alcohol use. We estimated prevalence of adolescent drinking and explored differences by sociodemographics. A multivariable logistic regression model assessed whether parents' drinking behaviors were associated with drinking among their children. RESULTS: Overall, 6.6% of adolescents drank alcohol, with no significant differences by sociodemographics. Adolescents whose parents drank frequently (≥5 days/month), or binge drank, had significantly higher odds of drinking than adolescents whose parents did not drink or did not binge drink, respectively. DISCUSSION: Parents could drink less to reduce the likelihood of drinking among their children. Implementation of effective population-level strategies (e.g., increasing alcohol taxes, regulating alcohol sales) can reduce excessive drinking among both adults and adolescents. |
U.S. adolescents’ exposure to alcohol marketing: Self-reported exposure on the internet and traditional media
Zhang L , Esser MB . AJPM Focus 2024 Introduction: Youth exposure to alcohol marketing is a risk factor for underage drinking. In the U.S., research documents the impact of youth exposure to alcohol marketing through traditional media (e.g., TV, radio) on underage drinking, with less known about digital alcohol marketing exposure. This study aims to examine adolescents’ self-reported exposure to alcohol marketing on various types of media, including the internet, by their demographic characteristics. Methods: Data were from the 2021 YouthStyles survey administered by Porter Novelli. Adolescents aged 12–17 years (N=833) completed this national online survey. Two multivariable logistic regression models were conducted in October 2022–April 2023 to examine exposure to alcohol marketing on 2 categories of media (watching TV, streaming videos, or going to the movies or browsing the internet). Models included race/ethnicity, age, gender, and past-week number of hours using the media category being assessed. Results: More than half of the U.S. adolescents reported being sometimes or often exposed to alcohol marketing. Hispanic adolescents had approximately 1.6 greater adjusted odds than non-Hispanic White adolescents of reporting sometimes or often being exposed to alcohol marketing while watching TV, streaming videos, or going to the movies and while browsing the internet. As adolescents’ age increased, self-reported alcohol marketing exposure also increased for both media categories assessed. Conclusions: Monitoring alcohol marketing exposure, including exposure on the internet, can inform efforts for reducing racial/ethnic disparities in underage drinking risk factors. © 2024 |
Estimating alcohol-attributable injury deaths: A comparison of epidemiological methods
Naimi TS , Sherk A , Esser MB , Zhao J . Addiction 2023 118 (12) 2466-2476 BACKGROUND AND AIMS: Injuries often involve alcohol, but determining the proportion caused by alcohol is difficult. Several approaches have been used to determine the causal role of alcohol, but these methods have not been compared directly with one another. Such a comparison would be useful for understanding the strengths and comparability of different approaches. This study compared estimates of average annual alcohol-attributable deaths in the United States from injuries during 2015-19 using a blood alcohol concentration (BAC) method compared with a population attributable fraction (PAF) approach. METHODS: For the BAC method, we used a direct method involving the proportion of decedents with a high blood alcohol concentration (BAC; e.g. ≥ 0.10%). For the PAF approach, we compared the use of unadjusted survey data with average consumption data adjusted using alcohol sales data to account for underreporting and also accounting for the underreporting of binge drinking. Survey data were from the Behavioral Risk Factor Surveillance System and mortality data were from the National Vital Statistics System. RESULTS: The number of alcohol-attributable injury deaths using the direct method (48 516 deaths annually) was similar to that using PAF methods (47 879 deaths annually), but only when alcohol use measures were adjusted using alcohol sales data. Furthermore, estimates were similar for cause-specific categories of deaths, including non-motor vehicle unintentional injuries and motor vehicle crashes. Among PAF methods, excessive drinking accounted for 38.3% of injury deaths using unadjusted survey data, but 64.8% of injury deaths using adjusted data. CONCLUSIONS: Estimates of alcohol-attributable injury deaths from a direct method and from a population attributable fraction method that adjusts for alcohol use based on alcohol sales data appear to be comparable. |
Estimated deaths attributable to excessive alcohol use among US adults aged 20 to 64 years, 2015 to 2019
Esser MB , Leung G , Sherk A , Bohm MK , Liu Y , Lu H , Naimi TS . JAMA Netw Open 2022 5 (11) e2239485 IMPORTANCE: Alcohol consumption is a leading preventable cause of death in the US, and death rates from fully alcohol-attributable causes (eg, alcoholic liver disease) have increased in the past decade, including among adults aged 20 to 64 years. However, a comprehensive assessment of alcohol-attributable deaths among this population, including from partially alcohol-attributable causes, is lacking. OBJECTIVE: To estimate the mean annual number of deaths from excessive alcohol use relative to total deaths among adults aged 20 to 64 years overall; by sex, age group, and state; and as a proportion of total deaths. DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study of mean annual alcohol-attributable deaths among US residents between January 1, 2015, and December 31, 2019, used population-attributable fractions. Data were analyzed from January 6, 2021, to May 2, 2022. EXPOSURES: Mean daily alcohol consumption among the 2 089 287 respondents to the 2015-2019 Behavioral Risk Factor Surveillance System was adjusted using national per capita alcohol sales to correct for underreporting. Adjusted mean daily alcohol consumption prevalence estimates were applied to relative risks to generate alcohol-attributable fractions for chronic partially alcohol-attributable conditions. Alcohol-attributable fractions based on blood alcohol concentrations were used to assess acute partially alcohol-attributable deaths. MAIN OUTCOMES AND MEASURES: Alcohol-attributable deaths for 58 causes of death, as defined in the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact application. Mortality data were from the National Vital Statistics System. RESULTS: During the 2015-2019 study period, of 694 660 mean deaths per year among adults aged 20 to 64 years (men: 432 575 [66.3%]; women: 262 085 [37.7%]), an estimated 12.9% (89 697 per year) were attributable to excessive alcohol consumption. This percentage was higher among men (15.0%) than women (9.4%). By state, alcohol-attributable deaths ranged from 9.3% of total deaths in Mississippi to 21.7% in New Mexico. Among adults aged 20 to 49 years, alcohol-attributable deaths (44 981 mean annual deaths) accounted for an estimated 20.3% of total deaths. CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that an estimated 1 in 8 total deaths among US adults aged 20 to 64 years were attributable to excessive alcohol use, including 1 in 5 deaths among adults aged 20 to 49 years. The number of premature deaths could be reduced with increased implementation of evidenced-based, population-level alcohol policies, such as increasing alcohol taxes or regulating alcohol outlet density. |
Alcohol consumption and 15 causes of fatal injuries: A systematic review and meta-analysis
Alpert HR , Slater ME , Yoon YH , Chen CM , Winstanley N , Esser MB . Am J Prev Med 2022 63 (2) 286-300 INTRODUCTION: The proportion of fatal nontraffic injuries that involve high levels of alcohol use or alcohol intoxication was assessed by cause of injury to generate alcohol-attributable fractions. Updated alcohol-attributable fractions can contribute to improved estimates of the public health impact of excessive alcohol use. METHODS: Peer-reviewed and gray literature for 1995-2019 on 15 causes of fatal nontraffic injuries in the U.S., Canada, or Mexico were systematically reviewed, and state data systems were queried for available estimates of fatalities with recorded blood alcohol concentration levels and proportions of decedents with blood alcohol concentrations 0.10 g/dL by cause of injury. For each injury cause, alcohol-attributable fractions across studies were synthesized by meta-analysis of single proportions using generalized linear mixed models. RESULTS: In total, 60 published studies and 40 additional population-level data points from 6 state data systems were included. The meta-analyzed alcohol-attributable fractions by cause of injury are as follows: air-space transport (0.03), aspiration (0.24), child maltreatment (0.09), drowning (0.31), fall injuries (0.37), fire injuries (0.34), firearm injuries (0.24), homicide (0.29), hypothermia (0.29), motor vehicle nontraffic crashes (0.42), occupational and machine injuries (0.08), other road vehicle crashes (railroad trespasser injuries) (0.63), poisoning (not alcohol) (0.20), suicide (0.21), and water transport (0.27), yielding an overall median alcohol-attributable fraction of 0.27. DISCUSSION: Excessive alcohol use is associated with substantial proportions of violent and nonviolent injury deaths. These findings can improve the data used for estimating alcohol-attributable injury deaths and inform the planning and implementation of evidence-based strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to prevent them. |
Estimating alcohol-attributable liver disease mortality: A comparison of methods
Sherk A , Esser MB , Stockwell T , Naimi TS . Drug Alcohol Rev 2022 41 (5) 1245-1253 INTRODUCTION: Alcohol is a leading contributor to liver disease, however, estimating the proportion of liver disease deaths attributable to alcohol use can be methodologically challenging. METHODS: We compared three approaches for estimating alcohol-attributable liver disease deaths (AALDD), using the USA as an example. One involved summing deaths from alcoholic liver disease and a proportion from unspecified cirrhosis (direct method); two used population attributable fraction (PAF) methodology, including one that adjusted for per capita alcohol sales. For PAFs, the 2011-2015 Behavioral Risk Factor Surveillance System and per capita sales from the Alcohol Epidemiologic Data System were used to derive alcohol consumption prevalence estimates at various levels (excessive alcohol use was defined by medium and high consumption levels). Prevalence estimates were used with relative risks from two meta-analyses, and PAFs were applied to the 2011-2015 average annual number of deaths from alcoholic cirrhosis and unspecified cirrhosis (using National Vital Statistics System data) to estimate AALDD. RESULTS: The number of AALDD was higher using the direct method (28 345 annually) than the PAF methods, but similar when alcohol prevalence was adjusted using per capita sales and all alcohol consumption levels were considered (e.g. 25 145 AALDD). Using the PAF method, disaggregating non-drinkers into lifetime abstainers and former drinkers to incorporate relative risks for former drinkers yielded higher AALDD estimates (e.g. 27 686) than methods with all non-drinkers combined. DISCUSSION AND CONCLUSIONS: Using PAF methods that adjust for per capita sales and model risks for former drinkers yield more complete and possibly more valid AALDD estimates. |
Trends in emergency department visits related to acute alcohol consumption before and during the COVID-19 pandemic in the United States, 2018-2020.
Esser MB , Idaikkadar N , Kite-Powell A , Thomas C , Greenlund KJ . Drug Alcohol Depend Rep 2022 3 100049 BACKGROUND: : Excessive drinking accounts for more than 95,000 deaths annually in the United States. Coronavirus disease 2019 (COVID-19) pandemic-related factors (e.g., social, economic, policy) may have affected alcohol consumption. Emergency department (ED) visits involving acute alcohol consumption (referred to as "alcohol-related") are a useful indicator for assessing changes in alcohol-related harms. METHODS: : The 2018-2020 National Syndromic Surveillance Program data, which include nonfatal ED visits from facilities in 49 states and Washington, DC, were analyzed. Trends in the number of alcohol-related ED visits among people ≥15 years, and weekly alcohol-related ED visit rates (per 10,000 total visits) overall, by demographic characteristics, and quarter (Q) were assessed. Quarterly rates for 2018 and 2019 were averaged to increase baseline data stability. RESULTS: : Alcohol-related visits accounted for 1.6% of 60,474,770 total visits (2018), 1.7% of 61,564,380 total visits (2019), and 1.8% of 52,174,507 total visits (2020). The number of alcohol-related ED visits generally increased during the first eight months of 2018 and 2019. However, it sharply declined at the onset of the COVID-19 pandemic in mid-March-mid-April 2020, before resuming pre-pandemic patterns. Alcohol-related ED visits per 10,000 were higher during quarters in 2020 than corresponding quarters in 2018-2019 (Q1: +7.3%, Q2: +23.8%, Q3: +9.7%, Q4: +6.5%). CONCLUSIONS: : Alcohol-related ED visit rates per 10,000 total visits increased during 2020 versus 2018-2019, with the greatest percentage difference in the second quarter. Fewer people sought ED care in 2020 than 2018-2019 but alcohol-related visits declined to a lesser extent than total visits. |
Improving estimates of alcohol-attributable deaths in the United States: Impact of adjusting for the underreporting of alcohol consumption
Esser MB , Sherk A , Subbaraman MS , Martinez P , Karriker-Jaffe KJ , Sacks JJ , Naimi TS . J Stud Alcohol Drugs 2022 83 (1) 134-144 OBJECTIVE: Self-reported alcohol consumption in U.S. public health surveys covers only 30%-60% of per capita alcohol sales, based on tax and shipment data. To estimate alcohol-attributable harms using alcohol-attributable fractions, accurate measures of total population consumption and the distribution of this drinking are needed. This study compared methodological approaches of adjusting self-reported survey data on alcohol consumption to better reflect sales and assessed the impact of these adjustments on the distribution of average daily consumption (ADC) levels and the number of alcohol-attributable deaths. METHOD: Prevalence estimates of ADC levels (i.e., low, medium, and high) among U.S. adults who responded to the 2011-2015 Behavioral Risk Factor Surveillance System (BRFSS; N = 2,198,089) were estimated using six methods. BRFSS ADC estimates were adjusted using the National Alcohol Survey, per capita alcohol sales data (from the Alcohol Epidemiologic Data System), or both. Prevalence estimates for the six methods were used to estimate average annual alcohol-attributable deaths, using a population-attributable fraction approach. RESULTS: Self-reported ADC in the BRFSS accounted for 31.3% coverage of per capita alcohol sales without adjustments, 36.1% using indexed-BRFSS data, and 44.3% with National Alcohol Survey adjustments. Per capita sales adjustments decreased low ADC prevalence estimates and increased medium and high ADC prevalence estimates. Estimated alcohol-attributable deaths ranged from approximately 91,200 per year (BRFSS unadjusted; Method 1) to 125,200 per year (100% of per capita sales adjustment; Method 6). CONCLUSIONS: Adjusting ADC to reflect total U.S. alcohol consumption (e.g., adjusting to 73% of per capita sales) has implications for assessing the impact of excessive drinking on health outcomes, including alcohol-attributable death estimates. |
Prospective Analysis of Minimum Pricing Policies to Reduce Excessive Alcohol Use and Related Harms in U.S. States
LeClercq J , Bernard S , Mucciaccio F , Esser MB . J Stud Alcohol Drugs 2021 82 (6) 710-719 OBJECTIVE: Increasing the price of alcohol is an effective strategy for reducing excessive consumption and alcohol-related harms. Limited research is available on how the establishment of a minimum price for alcoholic beverages might be an effective strategy to reduce this health risk behavior and what impact that might have in the United States. This study describes alcohol minimum pricing (MP) policy options for consideration in the United States, assesses implementation feasibility and effectiveness, and discusses implications for implementation. METHOD: Three alcohol pricing policy options for reducing excessive drinking were compared in this prospective analysis: alcohol taxation (status quo in states), minimum unit pricing (MUP) by unit of alcohol (e.g., 0.6 oz. [14 g] of pure alcohol), and MP by specified amount of an alcoholic beverage type (e.g., liter of beer). For each policy, five implementation-related domains were analyzed: political feasibility, public acceptability, implementation cost, health equity, and legal feasibility. Effectiveness was also evaluated based on literature. RESULTS: Alcohol MP policies, particularly MUP, could be feasible to implement and cost-efficient for reducing excessive alcohol consumption and related harms in the United States. MP policies are likely to have modest public acceptability in the United States. Although the political feasibility of MP policies is uncertain and would likely vary across states, international research suggests that MP might be a feasible pricing strategy that can be used in conjunction with alcohol taxes. CONCLUSIONS: Alcohol MP can be part of a comprehensive approach for reducing excessive drinking and related harms; however, factors such as state-level differences in alcohol control regulation may influence policy implementation. |
Current Marijuana Use and Alcohol Consumption Among Adults Following the Legalization of Nonmedical Retail Marijuana Sales - Colorado, 2015-2019
Crawford KA , Gardner JA , Meyer EA , Hall KE , Gary DS , Esser MB . MMWR Morb Mortal Wkly Rep 2021 70 (43) 1505-1508 In Colorado, excessive alcohol use* contributed to $5 billion in economic costs in 2010 (1) and >1,800 deaths annually during 2011-2015 (2). The most common pattern of excessive drinking is binge drinking (consumption of four or more drinks on an occasion for women or five or more drinks for men) (3), which is associated with increased likelihood of using other substances, including marijuana (4). Retail (i.e., nonmedical) marijuana sales began in Colorado on January 1, 2014. The Colorado Department of Public Health and Environment (CDPHE) and CDC used data from Colorado's 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS) to examine current use of marijuana (including hashish) by drinking patterns among 45,991 persons aged ≥18 years who responded to questions about alcohol and marijuana use. The age-standardized, weighted prevalence of current marijuana use among persons who reported binge drinking (34.4%) was significantly higher than the prevalence among current non-binge drinkers (14.8%) and nondrinkers (9.9%). Evidence-based strategies recommended by the Community Preventive Services Task Force to reduce excessive alcohol use and tobacco use (e.g., increasing prices or reducing access) can reduce alcohol- and tobacco-related harms. Similar strategies might be effective in reducing marijuana use and its potential harms as well. |
Binge Drinking Among Adults, by Select Characteristics and State - United States, 2018
Bohm MK , Liu Y , Esser MB , Mesnick JB , Lu H , Pan Y , Greenlund KJ . MMWR Morb Mortal Wkly Rep 2021 70 (41) 1441-1446 Excessive alcohol use* is associated with disease, injury, and poor pregnancy outcomes and is responsible for approximately 95,000 deaths in the United States each year (1). Binge drinking (five or more drinks on at least one occasion for men or four or more drinks for women) is the most common and costly pattern of excessive alcohol use (2). CDC analyzed data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) to estimate past 30-day binge drinking prevalence, frequency, and intensity (number of drinks per occasion), overall and by select characteristics and state. The overall unadjusted prevalence of binge drinking during the past 30 days was 16.6%, representing an estimated 38.5 million U.S. adults aged ≥18 years; prevalence was highest (26.0%) among those aged 25-34 years. The age-standardized binge drinking prevalence was higher among men (22.5%) than among women (12.6%), increased with income, and was highest among non-Hispanic White adults and adults in the Midwest Census region. State-level age-standardized binge drinking prevalence ranged from 10.5% (Utah) to 25.8% (Wisconsin). Among adults who reported binge drinking, 25.0% did so at least weekly, on average, and 25.0% consumed at least eight drinks on an occasion. To reduce binge drinking, the Community Preventive Services Task Force recommends increasing alcohol taxes and implementing strategies that strengthen regulations to reduce alcohol availability.(†) The U.S. Preventive Services Task Force recommends clinicians screen adults for alcohol misuse in primary care settings and provide counseling as needed.(§). |
Alcohol testing and alcohol involvement among violent deaths by state, 2014-2016
Greene N , Tomedi LE , Cox ME , Mello E , Esser MB . Prev Med 2021 148 106527 Blood alcohol concentration (BAC) testing rates vary across states, potentially biasing estimates of alcohol involvement in violent deaths. The National Violent Death Reporting System (NVDRS) collects information on violent deaths, including decedents' BACs. This study assessed characteristics of violent deaths by BAC testing status, and the proportion of decedents with a positive BAC or BAC ≥ 0.08 g/dL. NVDRS data from 2014 to 2016 (2014: 18 states; 2015: 27 states; 2016: 32 states) were analyzed to assess BAC testing (tested, not tested, unknown/missing) by state, decedent characteristics, and death investigation system (e.g., state medical examiner, coroners), in 2019. The proportion of violent deaths with a BAC > 0.0 or ≥ 0.08 g/dL was also assessed. Among 95,390 violent death decedents, 57.1% had a BAC test (range: 9.5% in Georgia to 95.8% in Utah), 2.3% were not tested, and 40.6% had an unknown/missing BAC testing status (range: 1.3% in Alaska to 78.0% in Georgia). Decedents who were 21-44 years, American Indian/Alaska Native or Hispanic, died by poisoning, died by undetermined intent, or were investigated by a state medical examiner were most likely to receive BAC testing. Among the violent deaths with a reported BAC, 41.1% had a positive BAC and 27.7% had a BAC ≥ 0.08 g/dL. About 2 in 5 violent deaths were missing data on alcohol testing. Increased testing and reporting of alcohol among violent deaths could inform the development and use of evidence-based prevention strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) for reducing violent deaths. |
Binge drinking, other substance use, and concurrent use in the U.S., 2016-2018
Esser MB , Pickens CM , Guy GPJr , Evans ME . Am J Prev Med 2021 60 (2) 169-178 INTRODUCTION: The use of multiple substances heightens the risk of overdose. Multiple substances, including alcohol, are commonly found among people who experience overdose-related mortality. However, the associations between alcohol use and the use of a range of other substances are often not assessed. Therefore, this study examines the associations between drinking patterns (e.g., binge drinking) and other substance use in the U.S., the concurrent use of alcohol and prescription drug misuse, and how other substance use varies by binge-drinking frequency. METHODS: Past 30-day alcohol and other substance use data from the 2016-2018 National Survey on Drug Use and Health were analyzed in 2020 among 169,486 U.S. respondents aged ≥12 years. RESULTS: The prevalence of other substance use ranged from 6.0% (nondrinkers) to 24.1% (binge drinkers). Among people who used substances, 22.2% of binge drinkers reported using substances in 2 additional substance categories. Binge drinking was associated with 4.2 (95% CI=3.9, 4.4) greater adjusted odds of other substance use than nondrinking. Binge drinkers were twice as likely to report concurrent prescription drug misuse while drinking as nonbinge drinkers. The prevalence of substance use increased with binge-drinking frequency. CONCLUSIONS: Binge drinking was associated with other substance use and concurrent prescription drug misuse while drinking. These findings can guide the implementation of a comprehensive approach to prevent binge drinking, substance misuse, and overdoses. This might include population-level strategies recommended by the Community Preventive Services Task Force to prevent binge drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density). |
Variability in antemortem and postmortem blood alcohol concentration levels among fatally injured adults
Greene N , Esser MB , Vesselinov R , Auman KM , Kerns TJ , Lauerman MH . Am J Drug Alcohol Abuse 2020 47 (1) 1-8 Background: Excessive alcohol use is a risk factor for injury-related deaths. Postmortem blood samples are commonly used to approximate antemortem blood alcohol concentration (BAC) levels. Objectives: To assess differences between antemortem and postmortem BACs among fatally injured adults admitted to one shock trauma center (STC). Method: Fifty-two adult decedents (45 male, 7 female) admitted to a STC in Baltimore, Maryland during 2006-2016 were included. STC records were matched with records from Maryland's Office of the Chief Medical Examiner (OCME). The antemortem and postmortem BAC distributions were compared. After stratifying by antemortem BACs <0.10 versus ≥0.10 g/dL, differences in postmortem and antemortem BACs were plotted as a function of length of hospital stay. Results: Among the 52 decedents, 22 died from transportation-related injuries, 20 died by homicide or intentional assault, and 10 died from other injuries. The median BAC antemortem was 0.10 g/dL and postmortem was 0.06 g/dL. Thirty-one (59.6%) decedents had antemortem BACs ≥0.08 g/dL versus 22 (42.3%) decedents using postmortem BACs. Postmortem BACs were lower than the antemortem BACs for 42 decedents, by an average of 0.07 g/dL. Postmortem BACs were higher than the antemortem BACs for 10 decedents, by an average of 0.06 g/dL. Conclusion: Postmortem BACs were generally lower than antemortem BACs for the fatally injured decedents in this study, though not consistently. More routine antemortem BAC testing, when possible, would improve the surveillance of alcohol involvement in injuries. The findings emphasize the usefulness of routine testing and recording of BACs in acute care facilities. |
Deaths and years of potential life lost from excessive alcohol use - United States, 2011-2015
Esser MB , Sherk A , Liu Y , Naimi TS , Stockwell T , Stahre M , Kanny D , Landen M , Saitz R , Brewer RD . MMWR Morb Mortal Wkly Rep 2020 69 (39) 1428-1433 Excessive alcohol use is a leading cause of preventable death in the United States (1) and costs associated with it, such as those from losses in workplace productivity, health care expenditures, and criminal justice, were $249 billion in 2010 (2). CDC used the Alcohol-Related Disease Impact (ARDI) application* to estimate national and state average annual alcohol-attributable deaths and years of potential life lost (YPLL) during 2011-2015, including deaths from one's own excessive drinking (e.g., liver disease) and from others' drinking (e.g., passengers killed in alcohol-related motor vehicle crashes). This study found an average of 95,158 alcohol-attributable deaths (261 deaths per day) and 2.8 million YPLL (29 years of life lost per death, on average) in the United States each year. Of all alcohol-attributable deaths, 51,078 (53.7%) were caused by chronic conditions, and 52,921 (55.6%) involved adults aged 35-64 years. Age-adjusted alcohol-attributable deaths per 100,000 population ranged from 20.8 in New York to 53.1 in New Mexico. YPLL per 100,000 population ranged from 631.9 in New York to 1,683.5 in New Mexico. Implementation of effective strategies for preventing excessive drinking, including those recommended by the Community Preventive Services Task Force (e.g., increasing alcohol taxes and regulating the number and concentration of alcohol outlets), could reduce alcohol-attributable deaths and YPLL.(†). |
Distribution of drinks consumed by U.S. adults by average daily alcohol consumption: A comparison of 2 nationwide surveys
Esser MB , Sacks JJ , Sherk A , Karriker-Jaffe KJ , Greenfield TK , Pierannunzi C , Brewer RD . Am J Prev Med 2020 59 (5) 669-677 INTRODUCTION: Estimates of alcohol consumption in the Behavioral Risk Factor Surveillance System are generally lower than those in other surveys of U.S. adults. This study compares the estimates of adults' drinking patterns and the distribution of drinks consumed by average daily alcohol consumption from 2 nationwide telephone surveys. METHODS: The 2014-2015 National Alcohol Survey (n=7,067) and the 2015 Behavioral Risk Factor Surveillance System (n=408,069) were used to assess alcohol consumption among adults (≥18 years), analyzed in 2019. The weighted prevalence of binge-level drinking and the distribution of drinks consumed by average daily alcohol consumption (low, medium, high) were assessed for the previous 12 months using the National Alcohol Survey and the previous 30 days using the Behavioral Risk Factor Surveillance System, stratified by respondents' characteristics. RESULTS: The prevalence of binge-level drinking in a day was 26.1% for the National Alcohol Survey; the binge drinking prevalence was 17.4% for the Behavioral Risk Factor Surveillance System. The prevalence of high average daily alcohol consumption among current drinkers was 8.2% for the National Alcohol Survey, accounting for 51.0% of total drinks consumed, and 3.3% for the Behavioral Risk Factor Surveillance System, accounting for 27.7% of total drinks consumed. CONCLUSIONS: National Alcohol Survey yearly prevalence estimates of binge-level drinking in a day and high average daily consumption were consistently greater than Behavioral Risk Factor Surveillance System monthly binge drinking and high average daily consumption prevalence estimates. When planning and evaluating prevention strategies, the impact of different survey designs and methods on estimates of excessive drinking and related harms is important to consider. |
Alcohol use among HIV-positive women of childbearing age, United States, 2013-2014
Frazier EL , Esser MB , McKnight-Eily LR , Zhou W , Chavez PR . AIDS Care 2020 33 (8) 1-13 More than one-quarter of the adults living with diagnosed HIV infection in the US are women. Binge drinking (i.e., ≥4 alcoholic drinks per occasion for women) is associated with poor HIV treatment compliance, HIV incidence, and unplanned pregnancy. However, little is known about the prevalence of binge drinking among women of childbearing age who are living with HIV (WLWH) and health risk behaviours among those who binge drink. Using the 2013-2014 data cycles of Medical Monitoring Project, we assessed the weighted prevalence of drinking patterns by socio-demographic, clinical and reproductive characteristics of 946 WLWH. Logistic regression was used to calculate unadjusted and adjusted prevalence ratios and 95% confidence intervals. Overall, 39% of WLWH reported current drinking and 10% reported binge drinking. Compared to non-drinkers, binge drinkers were less likely to adhere to antiretroviral therapy (ART) or be virally suppressed. In multivariate analyses, binge drinking among WLWH was associated with smoking, drug use, and reduced ART adherence compared to non-drinkers, increasing the likelihood of negative clinical outcomes. WLWH may benefit from a comprehensive approach to reducing binge drinking including alcohol screening and brief interventions and evidence-based policy strategies that could potentially improve adherence to HIV treatment. |
Binge drinking by occupation groups among currently employed U.S. adults in 32 states, 2013-2016
Shockey TM , Esser MB . Subst Use Misuse 2020 55 (12) 1-12 Background: Excessive alcohol use, including binge drinking (i.e., >/=5 drinks (males); >/=4 drinks (females), per occasion during the past 30 days), is associated with work-related injuries, absenteeism, and lost productivity. Binge drinking varies by sociodemographic characteristics (e.g., age, sex, income). However, information on binge drinking by occupation is limited. Purpose: This study examined binge drinking prevalence, frequency, intensity, and total binge drinks per binge drinker by sociodemographic characteristics and occupation. Methods: Data were analyzed from 358,355 currently employed U.S. adults who resided in the 32 states that administered the Behavioral Risk Factor Surveillance System industry and occupation questions during 2013-2016. Binge drinking was evaluated using weighted and adjusted prevalence models. Results: Among currently employed adults in the 32 states, 20.8% reported binge drinking, with an average of nearly 49 times per year and an average intensity of 7.4 drinks per binge episode, resulting in 478 total binge drinks per binge drinker. The adjusted binge drinking prevalence ranged from 15.9% among community and social services workers to 26.3% among construction and extraction workers. The total annual binge drinks per binge drinker ranged from 207 drinks among community and social services workers to 749 drinks among construction and extraction workers. Conclusions: One in five employed adults binge drink, and binge drinking varied across occupation groups. Widespread use of effective community-based strategies for preventing excessive alcohol use (e.g., regulating alcohol outlet density), as well as interventions tailored to specific occupation groups, and could reduce binge drinking and improve occupational safety and health. |
Binge drinking and prescription opioid misuse in the U.S., 2012-2014
Esser MB , Guy GPJr , Zhang K , Brewer RD . Am J Prev Med 2019 57 (2) 197-208 INTRODUCTION: Prescription opioids were responsible for approximately 17,000 deaths in the U.S. in 2016. One in five prescription opioid deaths also involve alcohol. Drinkers who misuse prescription opioids (i.e., use without a prescription or use only for the experience or feeling it causes) are at a heightened risk of overdose. However, little is known about the relationship between drinking patterns and prescription opioid misuse. METHODS: Data were analyzed from 160,812 individuals (aged >/=12 years) who responded to questions about prescription opioid misuse and alcohol consumption in the 2012, 2013, or 2014 National Survey on Drug Use and Health (analyzed in 2017-2018). The prevalence of self-reported past-30-days prescription opioid misuse was assessed by sociodemographic characteristics, other substance use (i.e., cigarettes, marijuana), and drinking patterns. Multiple logistic regression analyses were used to calculate AORs. RESULTS: From 2012 to 2014, 1.6% (95% CI=1.5, 1.7) of all individuals aged >/=12 years (estimated 4.2 million) and 3.5% (95% CI=3.3, 3.8) of binge drinkers (estimated 2.2 million) reported prescription opioid misuse. Prescription opioid misuse was more common among binge drinkers than among nondrinkers (AOR=1.7, 95% CI=1.5, 1.9). Overall, the prevalence of prescription opioid misuse increased significantly with binge drinking frequency (p-value<0.001). CONCLUSIONS: More than half of the 4.2 million people who misused prescription opioids during 2012-2014 were binge drinkers, and binge drinkers had nearly twice the odds of misusing prescription opioids, compared with nondrinkers. Widespread use of evidence-based strategies for preventing binge drinking might reduce opioid misuse and overdoses involving alcohol. |
Policy approaches for regulating alcohol marketing in a global context: A public health perspective
Esser MB , Jernigan DH . Annu Rev Public Health 2018 39 385-401 Alcohol consumption is responsible for 3.3 million deaths globally or nearly 6% of all deaths. Alcohol use contributes to both communicable and noncommunicable diseases, as well as violence and injuries. The purpose of this review is to discuss, in the context of the expansion of transnational alcohol corporations and harms associated with alcohol use, policy options for regulating exposure to alcohol marketing. We first provide an overview of the public health problem of harmful alcohol consumption and describe the association between exposure to alcohol marketing and alcohol consumption. We then discuss the growth and concentration of global alcohol corporations and their marketing practices in low- and middle-income countries, as well as in higher-income societies. We review the use and effectiveness of various approaches for regulating alcohol marketing in various countries before discussing challenges and opportunities to protect public health. |
Current and binge drinking among high school students - United States, 1991-2015
Esser MB , Clayton H , Demissie Z , Kanny D , Brewer RD . MMWR Morb Mortal Wkly Rep 2017 66 (18) 474-478 Excessive drinking accounted for approximately 4,300 deaths each year among persons aged <21 years during 2006-2010,* and underage drinking cost the United States $24.3 billion in 2010 (1). CDC analyzed data from the national Youth Risk Behavior Survey (YRBS) for the years 1991-2015 to examine trends in drinking by U.S. high school students, and from the 2015 YRBS to assess the usual source of alcohol consumeddagger and binge drinking intensity (i.e., the average number of drinks consumed per binge drinking occasion). section sign During 1991-2007, the prevalence of current drinking paragraph sign among high school students declined significantly, from 50.8% (1991) to 44.7% (2007), and then significantly declined to 32.8% in 2015. The prevalence of binge drinking** increased from 31.3% in 1991 to 31.5% in 1999, and then significantly declined to 17.7% in 2015. Most high school students who drank were binge drinkers (57.8%), and 43.8% of binge drinkers consumed eight or more drinks in a row. Despite progress, current drinking and binge drinking are common among high school students, and many students who binge drink do so at high intensity (i.e., eight or more drinks in a row). Widespread use of evidence-based strategies for preventing excessive drinking (e.g., increasing alcohol taxes, regulating alcohol outlet density, and having commercial host liability laws) could help reduce underage drinking and related harms. |
Alcohol electronic screening and brief intervention: A Community Guide systematic review
Tansil KA , Esser MB , Sandhu P , Reynolds JA , Elder RW , Williamson RS , Chattopadhyay SK , Bohm MK , Brewer RD , McKnight-Eily LR , Hungerford DW , Toomey TL , Hingson RW , Fielding JE . Am J Prev Med 2016 51 (5) 801-811 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). |
Prevalence of alcohol dependence among US adult drinkers, 2009-2011
Esser MB , Hedden SL , Kanny D , Brewer RD , Gfroerer JC , Naimi TS . Prev Chronic Dis 2014 11 E206 INTRODUCTION: Excessive alcohol consumption is responsible for 88,000 deaths annually and cost the United States $223.5 billion in 2006. It is often assumed that most excessive drinkers are alcohol dependent. However, few studies have examined the prevalence of alcohol dependence among excessive drinkers. The objective of this study was to update prior estimates of the prevalence of alcohol dependence among US adult drinkers. METHODS: Data were analyzed from the 138,100 adults who responded to the National Survey on Drug Use and Health in 2009, 2010, or 2011. Drinking patterns (ie, past-year drinking, excessive drinking, and binge drinking) were assessed by sociodemographic characteristics and alcohol dependence (assessed through self-reported survey responses and defined as meeting ≥3 of 7 criteria for dependence in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS: Excessive drinking, binge drinking, and alcohol dependence were most common among men and those aged 18 to 24. Binge drinking was most common among those with annual family incomes of $75,000 or more, whereas alcohol dependence was most common among those with annual family incomes of less than $25,000. The prevalence of alcohol dependence was 10.2% among excessive drinkers, 10.5% among binge drinkers, and 1.3% among non-binge drinkers. A positive relationship was found between alcohol dependence and binge drinking frequency. CONCLUSION: Most excessive drinkers (90%) did not meet the criteria for alcohol dependence. A comprehensive approach to reducing excessive drinking that emphasizes evidence-based policy strategies and clinical preventive services could have an impact on reducing excessive drinking in addition to focusing on the implementation of addiction treatment services. |
Binge drinking intensity: a comparison of two measures
Esser MB , Kanny D , Brewer RD , Naimi TS . Am J Prev Med 2012 42 (6) 625-9 BACKGROUND: Binge drinking (≥4 drinks for women; ≥5 drinks for men, per occasion) is responsible for more than half of the estimated 80,000 U.S. deaths annually and three-quarters of the $223.5 billion in costs in 2006. Binge drinking prevalence is assessed more commonly than binge drinking intensity (i.e., number of drinks consumed per binge episode). Risk of binge drinking-related harm increases with intensity, and thus it is important to monitor. The largest number of drinks consumed is assessed in health surveys, but its usefulness for assessing binge intensity is unknown. PURPOSE: To assess the agreement between two potential measures of binge drinking intensity: the largest number of drinks consumed by binge drinkers (maximum-drinks) and the total number of drinks consumed during their most recent binge episode (drinks-per-binge). METHODS: Data were analyzed from 7909 adult binge drinkers from 14 states responding to the 2008 Behavioral Risk Factor Surveillance System (BRFSS) binge drinking module. Mean and median drinks-per-binge from that module were compared to mean and median maximum-drinks. Analyses were conducted in 2010-2011. RESULTS: Mean (8.2) and median (5.9) maximum-drinks were strongly correlated with mean (7.4) and median (5.4) drinks-per-binge (r=0.57). These measures were also strongly correlated across most sociodemographic and drinking categories overall and within states. CONCLUSIONS: The maximum-drinks consumed by binge drinkers is a practical method for assessing binge drinking intensity and thus can be used to plan and evaluate Community Guide-recommended strategies for preventing binge drinking (e.g., increasing the price of alcoholic beverages and regulating alcohol outlet density). |
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