Underage drinking can lead to risky or harmful behaviors that include unintentional and unprotected sex, physical and sexual assault, traffic and other injuries, suicide, homicide, and overdoses. Binge drinking among adults is defined as five drinks consumed during two hours by adult men and four drinks by adult women – typically producing a blood alcohol level (BAL) of ≥0.08%. Adolescents can reach a similar BAL after consuming fewer drinks. This paper explored whether and how different levels of adolescent drinking affected associations with health-risk behaviors.

Study authors analyzed past-month drinking and past-month or past-year health-risk behaviors from the 2015 Youth Risk Behavior Survey, respondents to which included 4,646 female students and 4,722 male students in grades 8 through 12. The associations between different drinking levels and selected risk behaviors were adjusted for age, gender, race/ethnicity, and drinking frequency.

Bingeing at twice or more of the age/gender-specific binge thresholds by high-school students (including seniors, 10th graders, and 8th graders) was a strong predictor of numerous health-risk behaviors. Seven percent of respondents binged twice or more, nine percent binged less than twice the age/gender-specific thresholds, and 14 percent drank less than the binge thresholds. Significantly higher percentages of binge drinkers at twice or more of the threshold reported illegal drug and tobacco use, risky sexual and traffic behaviors, physical fights, suicide, less school-night sleep, and poorer school grades. The authors recommended that alcohol-misuse screening should ask adolescents about the maximum number of drinks that they consume per occasion and the frequency of such consumption. They also recommended that surveillance surveys investigate which interventions can reduce both consumption beyond binge thresholds and related health-risk behaviors.