Prevalence of HIV Risk Behaviors Between Binge Drinkers and Non-binge Drinkers Aged 18- to 64-Years in US, 2008

Xiao-Jun Wen; Lina Balluz; Machell Town

J Community Health. 2012;37(1):72-79.

Abstract and Introduction

Abstract

Using data from the 2008 Behavioral Risk Factor Surveillance System on 281,303 adults aged 18–64 years in the United States, we examined the relationship between HIV risk behaviors and binge drinking of alcoholic beverages and the frequency of binge drinking among a subgroup of 41,073 respondents who were acknowledged binge drinkers (bingers), based on reported drinking behavior in the year preceding survey. Our findings show that the weighted prevalence of HIV risk behaviors (including injection drug use, exchange of sex for money/drugs, and anal sex without a condom) among binge bingers [7.0%, 95% confidence interval (95% CI): 6.4–7.6%] is twice that among nonbingers (2.9%, 95% CI: 2.7–3.0%). The highest prevalence of HIV risk behaviors is among the bingers aged 18–20 years (14%, 95% CI: 11.2–18.2%). After adjusting for covariates, bingers are 1.77 (95% CI: 1.58–2.00) times more likely than nonbingers to report HIV risk behaviors. Risk increases in bingers with the number of episodes. Compared with bingers reporting 1–2 binge episodes in the month proceeding survey, the adjusted odds of reporting HIV risk behaviors among bingers are 1.27 (1.08–1.49), 1.68 (1.35–2.10), 1.67 (1.08–2.57), and 1.70 (1.34–2.16), respectively for bingers with 3–4, 5–6, 7–8, and ≥9 episodes in the same period. Our results suggest that HIV risk behaviors are strongly linked with binge drinking and its frequency. Effective measures to prevent binge drinking are essential to HIV prevention, especially among youth aged 18–20 years.

Introduction

Injection drug use, exchange of sex for money or drugs, and anal sex without a condom are some of the well-known risk behaviors that lead to HIV infections.^[1–7] It is also well known that alcohol use including binge drinking are linked to high-risk sexual behaviors.^[8–17]

Binge drinking is the practice of consuming an excessive quantity of alcoholic beverages defined as 5 or more drinks for men, or 4 or more drinks for women within an episode of about 2 h.^[18] It is a prevalent form of excessive alcohol abuse in the United States (US), where approximately 92% of adults aged 18 or older who drink excessively reported binge drinking.^[19] In the general population of US, 17% of adults^[20] reported excessive drinking during the 30 days preceding survey. The impact among full-time college students is staggering. In 2001, for example, 599,000 (10.5%) full-time 4-year college students were injured because of drinking, 696,000 (12%) were hit or assaulted by another drinking college student, and 97,000 (2%) were victims of alcohol-related sexual assault or date rape.^[21] According to national surveys,^[19] binge drinking is associated with many health problems including unintentional injuries (e.g., car crashes, falls, burns, drowning), intentional injuries (e.g., firearm injuries, sexual assault, domestic violence), alcohol poisoning, sexually transmitted diseases, unintended pregnancy, children born with Fetal Alcohol Spectrum Disorders, high blood pressure, stroke, and other cardiovascular diseases, liver disease, neurological damage, sexual dysfunction, and poor control of diabetes.

Studies have demonstrated the excessive alcohol use including binge drinking is associated with sexual risk behavior and HIV infection.^{[13,15,22–24]} Despite the large amount of data^{[13,15,22–24]} supporting the linkage between excessive alcohol use/abuses and HIV risk behaviors, large scale population-based studies on the HIV risk behaviors among the US binge-drinking population have been lacking. In particular, we need national data on the linkage of binge drinking and HIV risk behaviors by demographic characteristics. We propose that this information gap must be filled in order to plan and implement effective intervention programs to reduce HIV risk behaviors and binge drinking as well in the US.

From a methodological perspective, alcohol use is a general term for a variety of usage patterns, such as chronic heavy drinking and binge drinking. The measurements of alcohol use can be complicated and they can be analyzed from several aspects. For example, binge drinking is by nature extreme-intensity alcohol use, binge drinking can still be measured by the intensity of each episode and by the frequency of episodes during a certain time frame, as well. The association of alcohol use with HIV risk behaviors has been well established by numerous studies using a variety of measurements of alcohol use/abuse, e.g. by intensity, frequency, or length of time of alcohol use; however, the association of the frequency of binge drinking episodes with the HIV risk behaviors has not been fully examined. We believe that understanding such association is essential to development of effective HIV prevention programs that target binge drinkers.

The objectives of our study were to examine the difference(s), if any, in HIV risk behaviors of 18- to 64-year-old binge drinkers versus nonbingers in the US general population, and to assess the association between HIV risk behaviors in bingers and the frequency of binge drinking episodes during the 30 days preceding survey.

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J Community Health. 2012;37(1):72-79. © 2012 Springer
Springer Science+Business Media

Abstract and Introduction
Methods
Results
Discussion
References

Table 1. Characteristics of Binge and non-binge drinkers among US adults aged 18–64 years
	Binge drinkers n = 41,073		Non-binge drinkers n = 240,230
	n	% (95% CI)	n	% (95% CI)
Age group, years
18–20	976	6.6 (7.3–10.0)	4,850	6.9 (7.3–10.0)
21–24	2,242	13.9 (6.0–7.2)	5,616	6.9 (7.2–9.7)
25–34	8,277	28.9 (28.0–29.9)	30,298	20.6 (20.2–20.9)
35–44	10,673	23.3 (22.6–24.1)	49,966	22.9 (22.5–23.8)
45–54	11,536	18.4 (17.8–19.1)	70,884	23.8 (23.5–24.1)
55–64	7,369	8.9 (8.5–9.3)	78,616	19.0 (18.7–19.2)
Sex
Men	23,300	67.1 (66.2–68.0)	85,345	46.2 (45.8–46.6)
Women	17,773	32.9 (32.0–33.8)	154,885	53.8 (53.4–54.2)
Race/ethnicity
White/nonHispanic	33,264	71.5 (70.5–72.6)	181,877	65.0 (64.6–65.4)
Black/nonHispanic	2,307	7.5 (6.9–8.1)	21,906	10.8 (10.5–11.1)
Hispanic	2,823	15.4 (14.5–16.4)	19,714	16.7 (16.4–17.1)
Asian American/Pacific Islander	572	1.6 (1.4–2.0)	5,414	3.9 (3.7–4.2)
Other	1,887	3.9 (3.5–4.4)	9,477	3.5 (3.4–3.7)
Education
Did not graduate from high school	2,711	9.6 (8.9–10.3)	19,105	10.8 (10.5–11.1)
High school diploma	11,951	28.5 (27.6–29.4)	65,704	27.4 (27.0–27.8)
Attended college or technical school	11,760	28.5 (27.6–29.4)	65,978	26.9 (26.5–27.2)
College degree or higher	14,628	33.4 (32.5 34.3)	89,170	35.0 (34.6–35.5)
Marital status
Married	22,517	52.0 (51.0–53.0)	147,072	62.4 (62.1–62.9)
Previously married	10,144	18.0 (17.3–18.7)	58,028	17.1 (16.8–17.4)
Never married	8,353	30.0 (29.0–31.1)	34,471	20.5 (20.1–20.9)
Smoking status
Current smoker—smokes every day	10,407	24.6 (23.8–25.5)	31,791	12.4 (12.2–12.7)
Current smoker—smokes some days	3,832	11.4 (10.7–12.1)	10,566	4.6 (4.4–4.8)
Former smoker	11,043	22.9 (22.1–23.7)	58,473	20.3 (20.0–20.6)
Never smoked	15,671	41.2 (40.2–42.2)	138,741	62.7 (62.3–63.1)
No. of binge drinking
1–2	14,728	30.8 (29.9–31.7)
3–4	14,352	33.6 (32.7–34.6)
5–6	7,255	20.3 (19.5–21.2)
7–8	1,403	4.4 (3.9–4.8)
9 or more	3,335	11.0 (10.3–11.7)

Source: Behavioral Risk Factor Surveillance System, 2008
n unweighted sample size and it varies variable-by-variable, because of the missing value, % weighted percentage, CI confidence interval

Table 2. Comparison of the weighted prevalence of HIV risk behaviors between binge and non-binge drinkers among US adults aged 18–64 years
	Binge drinkers % (95% CI) n = 41,073	Non-binge drinkers % (95% CI) N = 240,230
HIV risk behaviours
Yes	7.0 (6.4–7.6)	2.9 (2.7–3.0)
Age group, years
18–20	14.4 (11.2–18.2)	6.0 (5.0–7.1)
21–24	13.2 (10.9–16.0)	6.7 (5.5–8.1)
25–34	8.2 (7.0–9.4)	4.0 (3.6–4.4)
35–44	4.2 (3.6–5.0)	2.6 (2.3–2.9)
45–54	3.5 (2.9–4.3)	1.7 (1.5–1.9)
55–64	2.5 (1.9–3.3)	1.0 (0.9–1.1)
Sex
Men	6.9 (6.2–7.7)	2.9 (2.6–3.1)
Women	7.2 (6.4–8.2)	2.9 (2.7–3.1)
Race/ethnicity
White/nonHispanic	5.8 (5.3–6.4)	2.3 (2.2–2.5)
Black/nonHispanic	11.5 (9.0–14.7)	4.7 (4.2–5.3)
Hispanic	9.7 (7.6–12.3)	3.8 (3.3–4.5)
Asian American/Pacific Islander	8.6 (4.1–17.2)	1.6 (1.1–2.4)
Other	10.3 (7.4–14.2)	4.5 (3.4–5.9)
Education
Did not graduate from high	12.6 (10.0–15.7)	5.0 (4.2–5.8)
High school diploma	7.8 (6.7–9.0)	3.3 (2.9–3.7)
Attended college or technical school	7.1 (6.1–8.3)	3.0 (2.7–3.3)
College degree or higher	4.9 (4.1–5.8)	2.0 (1.8–2.2)
Marital status
Married	3.6 (3.1–4.3)	1.6 (1.5–1.8)
Previously married	9.4 (8.1–10.9)	4.5 (4.1–5.0)
Never married	11.5 (10.1–13.0)	5.5 (4.9–6.1)
Smoking status
Current smoker—smokes every day	10.6 (9.3–12.1)	5.3 (4.7–5.9)
Current smoker—smokes some days	9.0 (7.0–11.5)	4.5 (3.7–5.4)
Former smoker	5.2 (4.2–6.3)	3.0 (2.6–3.4)
Never smoked	5.3 (4.5–6.2)	2.3 (2.1–2.5)
No. of binge-drinking episodes in past 30days
1–2	4.8 (4.0–5.7)
3–4	6.5 (5.6–7.5)
5–6	8.4 (7.0–10.1)
7–8	9.9 (6.6–14.6)
9 or more	11.3 (9.3–13.6)

Source: Behavioral Risk Factor Surveillance System, 2008 N unweighted sample size. It varies variable-by-variable because of the missing value, % weighted prevalence, CI confidence interval

Table 3. Association of the HIV risk behaviors with binge drinking among US adults aged 18 to 64 years
	OR (95% CI)	AOR^a (95% CI)
Binge drinker versus non-binge drinker
Non-binge drinker	1.00 (1.00–1.00)	1.00 (1.00–1.00)
Binge drinker	2.53 (2.27–2.82)^b	1.77 (1.58–2.00)^b
Binge drinking frequency in last 30days among bingers
1–2	1.00 (1.00–1.00)	1.00 (1.00–1.00)
3–4	1.75 (1.51–2.03)^c	1.27 (1.08–1.49)^c
5–6	2.86 (2.33–3.52)^c	1.68 (1.35–2.10)^c
7–8	3.14 (2.04–4.83)^c	1.67 (1.08–2.57)^c
≥9 or more	3.15 (2.53–3.93)^c	1.70 (1.34–2.16)^c

Source: Behavioral Risk Factor Surveillance System, 2008
OR crude odds ratio, AOR adjusted odds ratio, ^a Odds ratio adjusted for sex, age, race/ethnicity, education, marital status, and smoking. CI confidence interval, ^b Statistically significant when compared with non-binge drinker, ^c Statistically significant when compared with binge drinkers with 1 to 2 episodes in last 30 days

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