Consideration of an upper-bound continuous maximum drinks measure for adolescent binge and high-intensity drinking prevalence

Background The degree to which binge and high-intensity drinking prevalence estimates vary from fixed threshold frequency and continuous maximum drinks measures is unknown. The current study compared prevalence estimates for adolescent binge and high-intensity drinking (5+ drinks, 10+ drinks, respectively) and sex-specific thresholds using fixed threshold frequency and continuous maximum drinks measures. Methods Data were obtained from 7911 respondents participating in the 2018 and 2019 nationally representative Monitoring the Future 12th-grade surveys. Comparisons of frequency prevalence (e.g., any occasions of 5+ drinking using the frequency measure) versus maximum drinks prevalence (e.g., reporting 5 or more drinks using the maximum number of drinks measure) were made using all respondents and then separately within males and females. Results Among the sample overall and within sex, binge drinking estimates from the 5+ frequency prevalence and 5+ maximum drinks prevalence measures evidenced overlapping confidence intervals (estimates were slightly higher for frequency prevalence); similar results were observed for high-intensity drinking 10+ frequency prevalence and 10+ maximum drinks prevalence. For example, among the sample overall, 5+ frequency prevalence was 11.4% [95% CI 10.3, 12.6]; 5+ maximum drinks prevalence was 10.7% [9.6, 11.8]; 10+ frequency prevalence was 5.1% [4.4, 5.8]; and 10+ maximum drinks prevalence was 4.1% [3.5, 4.7]. Using sex-specific thresholds (i.e., 4+ drinks for females and 5+ drinks for males), binge frequency and maximum drinks levels also had overlapping confidence intervals. Binge drinking prevalence estimates for females were approximately 1.5 times higher using sex-specific (4+) versus universal (5+) thresholds. Conclusions In this nationally representative sample of 12th-grade students, prevalence levels for 5+ and 10+ drinking did not differ significantly when using frequency versus maximum drinks measures. Among females, binge drinking prevalence was higher using sex-specific versus universal thresholds. Both the frequency and maximum drinks measures provided comparable estimates of binge and high-intensity drinking prevalence among older adolescents.