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Background: Prior research attributed youth alcohol consumption to the attitudes and drinking patterns among adults. Yet at a population level, few have examined the relationship between state-level adult binge drinking prevalence and youth drinking behaviors, or whether tax policy plays a role in this relationship., Methods: We analyzed 6 biennial surveys (1999 to 2009) of individual-level youth alcohol use and related behaviors from state-based Youth Risk Behavior Surveys and corresponding years of state-level adult binge drinking prevalence from the Behavioral Risk Factor Surveillance System. We employed logistic regression with generalized estimating equations method to assess the extent to which state adult binge drinking predicted individual-level youth drinking outcomes and examined the role of alcohol taxes in that relationship., Results: Population-aggregate analyses based on 194 state-year strata showed a positive correlation between state adult binge drinking and youth binge drinking (Pearson r = 0.40, p < 0.01). For individual-level youth drinking outcomes, a 5 percentage point increase in binge drinking prevalence among adults was associated with a 12% relative increase in the odds of alcohol use (adjusted OR = 1.12, 95% CI: 1.08, 1.16). Taxes were strongly inversely related with adult and youth drinking measures, and the effect of tax on youth drinking was attenuated after controlling for adult binge drinking., Conclusions: Both tax and adult binge drinking are strong predictors of youth drinking. Tax may affect youth drinking through its effect on adult alcohol consumption. Implementing effective alcohol policies to reduce excessive drinking in the general population is an important strategy to reduce youth drinking., (Copyright © 2013 by the Research Society on Alcoholism.)

Aims: Many observational studies suggest that increased drinking frequency is associated with reduced mortality among those with low-dose alcohol consumption. The purpose of this paper was to examine whether frequent drinkers consume lower-risk amounts during drinking days or have favorable risk factor profiles compared with those who drink less frequently, and discuss implications for the larger debate about the limitations of non-randomized studies about 'moderate' drinking and the development of low-risk drinking guidelines., Methods: Data from the 2008 Behavioral Risk Factor Surveillance System survey were used to characterize alcohol consumption characteristics and their relationship with risk factors among adult drinking men who consumed an average of fewer than two drinks per day and adult drinking adult women who consumed an average of less than one drink per day., Results: Those who drank relatively infrequently (14 or fewer days per month) consumed more during drinking days, were more likely to exceed the US Dietary Guidelines drinking limits (41.0% versus 9.7%) and had a larger proportion of drinking days that included binge drinking (13.4% versus 4.3%). Infrequent drinkers also had a higher prevalence of 13 of 15 risk factors assessed. Findings from analyses of those aged ≥40 years were similar., Conclusions: Among those with low average alcohol consumption, infrequent drinkers drink more during drinking days and have unfavorable risk factors profiles compared with more frequent drinkers, suggesting that confounding may contribute to favorable associations with 'moderate' average alcohol consumption and increased drinking frequency observed in non-randomized studies., (© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.)

Background: Public policy can limit alcohol consumption and its associated harm, but no direct comparison of the relative efficacy of alcohol control policies exists for the U.S., Purpose: To identify alcohol control policies and develop quantitative ratings of their efficacy and strength of evidence., Methods: In 2010, a Delphi panel of ten U.S. alcohol policy experts identified and rated the efficacy of alcohol control policies for reducing binge drinking and alcohol-impaired driving among both the general population and youth, and the strength of evidence informing the efficacy of each policy. The policies were nominated on the basis of scientific evidence and potential for public health impact. Analysis was conducted in 2010-2012., Results: Panelists identified and rated 47 policies. Policies limiting price received the highest ratings, with alcohol taxes receiving the highest ratings for all four outcomes. Highly rated policies for reducing binge drinking and alcohol-impaired driving in the general population also were rated highly among youth, although several policies were rated more highly for youth compared with the general population. Policy efficacy ratings for the general population and youth were positively correlated for reducing both binge drinking (r=0.50) and alcohol-impaired driving (r=0.45). The correlation between efficacy ratings for reducing binge drinking and alcohol-impaired driving was strong for the general population (r=0.88) and for youth (r=0.85). Efficacy ratings were positively correlated with strength-of-evidence ratings., Conclusions: Comparative policy ratings can help characterize the alcohol policy environment, inform policy discussions, and identify future research needs., (Copyright © 2013 American Journal of Preventive Medicine. All rights reserved.)

Background: Little is known about brand-specific alcohol consumption among underage youth, as existing information is collected at the level of alcoholic beverage type. This study identifies the alcohol brands consumed by a nationally representative sample of underage youth in the United States., Methods: We obtained a national sample of 1,032 underage youth, aged 13 to 20, using a pre-recruited Internet panel maintained by Knowledge Networks. Youth aged 18 to 20 were recruited directly from the panel via email invitation. Teens aged 13 to 17 were identified by asking adult panelists to identify a member of their household. The survey assessed the past 30-day consumption of 898 brands of alcohol among 16 alcoholic beverage types, including the frequency and amount of each brand consumed in the past 30 days. Market share for a given brand was calculated by dividing the total number of drinks for that brand in the past 30 days across the entire sample by the total number of drinks for all identified brands., Results: The alcohol brands with highest prevalence of past 30-day consumption were Bud Light (27.9%, 95% confidence interval [CI] 23.3 to 32.4%), Smirnoff malt beverages (17.0%, 95% CI 12.9 to 21.1%), and Budweiser (14.6%, 95% CI 11.0 to 18.3%). Brand market share was concentrated in a relatively small number of brands, with the top 25 brands accounting for nearly half of all market shares., Conclusions: Underage youth alcohol consumption, although spread out over several alcoholic beverage types, is concentrated among a relatively small number of alcohol brands. This finding has important implications for alcohol research, practice, and policy., (Copyright © 2013 by the Research Society on Alcoholism.)

Objectives: Our goal was to provide current estimates of alcohol-attributable cancer mortality and years of potential life lost (YPLL) in the United States., Methods: We used 2 methods to calculate population-attributable fractions. We based relative risks on meta-analyses published since 2000, and adult alcohol consumption on data from the 2009 Alcohol Epidemiologic Data System, 2009 Behavioral Risk Factor Surveillance System, and 2009-2010 National Alcohol Survey., Results: Alcohol consumption resulted in an estimated 18,200 to 21,300 cancer deaths, or 3.2% to 3.7% of all US cancer deaths. The majority of alcohol-attributable female cancer deaths were from breast cancer (56% to 66%), whereas upper airway and esophageal cancer deaths were more common among men (53% to 71%). Alcohol-attributable cancers resulted in 17.0 to 19.1 YPLL for each death. Daily consumption of up to 20 grams of alcohol (≤ 1.5 drinks) accounted for 26% to 35% of alcohol-attributable cancer deaths., Conclusions: Alcohol remains a major contributor to cancer mortality and YPLL. Higher consumption increases risk but there is no safe threshold for alcohol and cancer risk. Reducing alcohol consumption is an important and underemphasized cancer prevention strategy.

Aims: This study aims to compare the average price of liquor in the United States between retail alcohol outlets in states that have a monopoly ('control' states) with those that do not ('licence' states)., Design: A cross-sectional study of brand-specific alcohol prices in the United States., Setting: We determined the average prices in February 2012 of 74 brands of liquor among the 13 control states that maintain a monopoly on liquor sales at the retail level and among a sample of 50 license-state liquor stores, using their online-available prices., Measurements: We calculated average prices for 74 brands of liquor by control versus license state. We used a random-effects regression model to estimate differences between control and license state prices-overall and by alcoholic beverage type. We also compared prices between the 13 control states., Findings: The overall mean price for the 74 brands was $27.79 in the license states [95% confidence interval (CI): $25.26-30.32] and $29.82 in the control states (95% CI: $26.98-32.66). Based on the random-effects linear regression model, the average liquor price was approximately $2 lower (6.9% lower) in license states., Conclusions: In the United States monopoly of alcohol retail outlets appears to be associated with slightly higher liquor prices., (© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.)

The authors investigated the relationship between state excise taxes and liquor prices in 8 states, using 2012 data for 45 brands. The authors made 6042 price observations among 177 liquor stores with online prices. Using a hierarchical model, the authors examined the relationship between excise taxes and product prices. State excise taxes were significantly related to liquor prices, with an estimated pass-through rate of 0.93. The proportion of price accounted for by excise taxes averaged 7.0%. The authors find that excise taxes do increase the price of alcohol, but states are not taking advantage of this opportunity to reduce alcohol-related morbidity and mortality.

Background: Low alcohol prices are a potent risk factor for excessive drinking, underage drinking, and adverse alcohol-attributable outcomes. Presently, there is little reported information on alcohol prices in the U.S., in particular as it relates to the costs of potentially beneficial amounts of alcohol., Purpose: To determine the minimum financial outlay necessary to purchase individual brands of alcohol using online alcohol price data from January through March 2012., Methods: The smallest container size and the minimum price at which that size beverage could be purchased in the U.S. in 2012 were determined for 898 brands of alcohol, across 17 different alcoholic beverage types. The analyses were conducted in March 2012., Results: The majority of alcoholic beverage categories contain brands that can be purchased in the U.S. for very low minimum financial outlays., Conclusions: In the U.S., a wide variety of alcohol brands, across many types of alcohol, are available at very low prices. Given that both alcohol use and abuse are responsive to price, particularly among adolescents, the prevalence of low alcohol prices is concerning. Surveillance of alcohol prices and minimum pricing policies should be considered in the U.S. as part of a public health strategy to reduce excessive alcohol consumption and related harms., (Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

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)., (Published by Elsevier Inc.)

Background: Excessive alcohol consumption causes 79,000 deaths annually in the U.S., shortening the lives of those who die from it by approximately 30 years. Although alcohol taxation is an effective measure to reduce excessive consumption and related harm, some argue that increasing alcohol taxes places an unfair economic burden on "responsible" drinkers and socially disadvantaged people., Purpose: To examine the impact of a hypothetic tax increase based on alcohol consumption and sociodemographic characteristics of current drinkers, individually and in aggregate., Methods: Data from the 2008 Behavioral Risk Factor Surveillance System survey were analyzed from 2010 to 2011 to determine the net financial impact of a hypothetic 25-cent-per-drink tax increase on current drinkers in the U.S. Higher-risk drinkers were defined as those whose past-30-day consumption included binge drinking, heavy drinking, drinking in excess of the U.S. Dietary Guidelines, and alcohol-impaired driving., Results: Of U.S. adults who consumed alcohol in the past 30 days, 50.4% (or approximately 25% of the total U.S. population) were classified as higher-risk drinkers. The tax increase would result in a 9.2% reduction in alcohol consumption, including an 11.4% reduction in heavy drinking. Compared with lower-risk drinkers, higher-risk drinkers would pay 4.7 times more in net increased annual per capita taxes, and 82.7% of the net increased annual aggregate taxes. Lower-risk drinkers would pay less than $30 in net increased taxes annually. In aggregate, groups who paid the most in net tax increases included those who were white, male, aged 21-50 years, earning ≥$50,000 per year, employed, and had a college degree., Conclusions: A 25-cent-per-drink alcohol tax increase would reduce excessive drinking, and higher-risk drinkers would pay the substantial majority of the net tax increase., (Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

This study is the first investigation to explore the alcohol brand preferences of underage youth via a national survey. The authors conducted a pilot study of a new, Internet-based alcohol brand survey with 108 youth aged 16 to 20 years who were recruited from an existing panel and had consumed alcohol in the past month. The authors ascertained respondents' consumption of each of 380 alcohol brands during the past 30 days, including which brands of alcohol were consumed during heavy drinking episodes. The findings suggest that, despite the wide variety of alcohol brands consumed by older adolescents in this study, the volume of alcohol consumed is concentrated among a relatively small number of brands. Accurate measurements of alcohol brand preferences will enable important new research into the factors that influence youth drinking behavior. This study establishes the feasibility and validity of a new methodology to determine patterns of brand-specific alcohol consumption among underage drinkers.

Context: Dram shop liability holds the owner or server(s) at a bar, restaurant, or other location where a patron, adult or underage, consumed his or her last alcoholic beverage responsible for harms subsequently inflicted by the patron on others. Liability in a state can be established by case law or statute. Overservice laws prohibit the sale of alcoholic beverages to intoxicated patrons drinking in on-premises retail alcohol outlets (i.e., premises where the alcohol is consumed where purchased); enhanced enforcement of these laws is intended to ensure compliance by premises personnel. Both of these interventions are ultimately designed to promote responsible beverage service by reducing sales to intoxicated patrons, underage youth, or both. This review assesses the effectiveness of dram shop liability and the enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms., Evidence Acquisition: Studies assessing alcohol-related harms in states adopting dram shop laws were evaluated, as were studies assessing alcohol-related harms in regions with enhanced overservice enforcement. Methods previously developed for systematic reviews for the Guide to Community Preventive Services were used., Evidence Synthesis: Eleven studies assessed the association of state dram shop liability with various outcomes, including all-cause motor vehicle crash deaths, alcohol-related motor vehicle crash deaths (the most common outcome assessed in the studies reviewed), alcohol consumption, and other alcohol-related harms. There was a median reduction of 6.4% (range of values 3.7% to 11.3% reduction) in alcohol-related motor vehicle fatalities associated with the presence of dram shop liability in jurisdictions where premises are licensed. Other alcohol-related outcomes also showed a reduction. Only two studies assessed the effects of enhanced enforcement initiatives on alcohol-related outcomes; findings were inconsistent, some indicating benefit and others none., Conclusions: According to Community Guide rules of evidence, the number and consistency of findings indicate strong evidence of the effectiveness of dram shop laws in reducing alcohol-related harms. It will be important to assess the possible effects of legal modifications to dram shop proceedings, such as the imposition of statutes of limitation, increased evidentiary requirements, and caps on recoverable amounts. According to Community Guide rules of evidence, evidence is insufficient to determine the effectiveness of enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms., (Published by Elsevier Inc.)

Background: Very little is known about the types of alcoholic beverages preferred by youth in the U.S. and the relationship between beverage preference and demographic and behavioral characteristics of these youth., Purpose: To determine the type of alcoholic beverages consumed by adolescent drinkers and how it varies by drinking patterns., Methods: In 2010, an analysis was performed using 2007 data from the Youth Risk Behavior Survey (YRBS) conducted among public school students in eight states that included a question on the type of alcohol usually consumed. Analysis was restricted to the 7723 youth who reported consuming at least one drink of alcohol in the past 30 days. Beverage type preferences were analyzed by demographic factors, drinking patterns, and other health-risk behaviors. Logistic regression analyses were conducted to examine the correlates of type-specific alcohol consumption., Results: Liquor was the strongly preferred alcoholic beverage of choice (43.8%), followed by beer (19.2%) and malt beverages (17.4%), with a very low preference for wine (3.7%) or wine coolers (3.4%). A higher preference for liquor or beer was observed among older youth, among those with a riskier pattern of alcohol consumption (e.g., greater frequency of consumption, binge drinking, or drinking and driving), and among youth who engaged in other risk behaviors., Conclusions: Riskier patterns of drinking and other health-risk behaviors are associated with an increased preference for hard liquor and beer. Improved surveillance of alcoholic beverage preferences among youth will enable a better understanding of the factors related to youth drinking, allowing the development of more effective interventions., (Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.)

Background: Binge drinking accounts for more than half of the 79,000 deaths due to excessive drinking in the U.S. each year. In 2006, the Behavioral Risk Factor Surveillance System (BRFSS) lowered the threshold for defining binge drinking among women from ≥5 drinks to ≥4 drinks per occasion, in accordance with national recommendations., Purpose: To assess changes in binge-drinking prevalence among women., Methods: The relative and absolute change in binge drinking among U.S. adult women was assessed using pooled BRFSS data from the 2 years before (2004-2005) and after (2006-2007) the implementation of the new gender-specific definition. Analyses were conducted in 2008-2009., Results: Binge-drinking prevalence among women increased 2.6 percentage points (from 7.3% in 2004-2005 to 9.9% in 2006-2007), a 35.6% relative increase. The percentage of women who reported consuming exactly 4 drinks in 2006 (3.6%) was similar to the increase in the prevalence of binge drinking among women that was observed from 2005 to 2006 (absolute change=2.9 percentage points)., Conclusions: The new gender-specific definition of binge drinking significantly increased the identification of women drinking at dangerous levels. The change in prevalence among women was primarily due to the change in the definition and not to actual changes in drinking behavior. The new gender-specific definition of binge drinking can increase the usefulness of this measure for public health surveillance and support the planning and implementation of effective prevention strategies (e.g., increasing alcohol excise taxes)., (Published by Elsevier Inc.)

Local, state, and national policies that limit the hours that alcoholic beverages may be available for sale might be a means of reducing excessive alcohol consumption and related harms. The methods of the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of such policies. All of the studies included in this review assessed the effects of increasing hours of sale in on-premises settings (in which alcoholic beverages are consumed where purchased) in high-income nations. None of the studies was conducted in the U.S. The review team's initial assessment of this evidence suggested that changes of less than 2 hours were unlikely to significantly affect excessive alcohol consumption and related harms; to explore this hypothesis, studies assessing the effects of changing hours of sale by less than 2 hours and by 2 or more hours were assessed separately. There was sufficient evidence in ten qualifying studies to conclude that increasing hours of sale by 2 or more hours increases alcohol-related harms. Thus, disallowing extensions of hours of alcohol sales by 2 or more should be expected to prevent alcohol-related harms, while policies decreasing hours of sale by 2 hours or more at on-premises alcohol outlets may be an effective strategy for preventing alcohol-related harms. The evidence from six qualifying studies was insufficient to determine whether increasing hours of sale by less than 2 hours increases excessive alcohol consumption and related harms., (Published by Elsevier Inc.)

Local, state, and national laws and policies that limit the days of the week on which alcoholic beverages may be sold may be a means of reducing excessive alcohol consumption and related harms. The methods of the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness for preventing excessive alcohol consumption and related harms of laws and policies maintaining or reducing the days when alcoholic beverages may be sold. Outcomes assessed in 14 studies that met qualifying criteria were excessive alcohol consumption and alcohol-related harms, including motor vehicle injuries and deaths, violence-related and other injuries, and health conditions. Qualifying studies assessed the effects of changes in days of sale in both on-premises settings (at which alcoholic beverages are consumed where purchased) and off-premises settings (at which alcoholic beverages may not be consumed where purchased). Eleven studies assessed the effects of adding days of sale, and three studies assessed the effects of imposing a ban on sales on a given weekend day. The evidence from these studies indicated that increasing days of sale leads to increases in excessive alcohol consumption and alcohol-related harms and that reducing the number of days that alcoholic beverages are sold generally decreases alcohol-related harms. Based on these findings, when the expansion of days of sale is being considered, laws and policies maintaining the number of days of the week that alcoholic beverages are sold at on- and off-premises outlets in local, state, and national jurisdictions are effective public health strategies for preventing excessive alcohol consumption and related harms., (Published by Elsevier Inc.)

Background: Binge drinking (consuming five or more drinks during a drinking occasion) is responsible for more than half of the 79,000 annual deaths due to excessive drinking in the U.S. Although studies show a strong dose-response relationship between the intensity of binge drinking (i.e., the number of drinks consumed per binge episode) and adverse outcomes, there are no population-based studies assessing this measure., Purpose: This study aims to analyze population-based data from a module of questions on binge drinking among U.S. adults to assess the number of drinks consumed by binge drinkers and the associated independent risk factors for consuming more drinks., Methods: Data were analyzed from 14,143 adult binge drinkers who responded to the Behavioral Risk Factor Surveillance System binge drinking module in 2003 and 2004. Total drinks were calculated by summing the total number of beer, wine, and liquor-containing drinks consumed during a respondents' most recent binge drinking episode., Results: Binge drinkers consumed an average of 8.0 drinks (median 6) during their most recent binge drinking episode; 70.0% of binge drinkers consumed six or more drinks, and 38.4% consumed eight or more drinks. Men consumed more drinks during their last binge episode than women (M = 8.3 vs 7.0, median = 7 vs 6), and those aged 18-34 years consumed more drinks than those aged >34 years for both men and women. Independent risk factors for consuming eight or more drinks included being male; being aged <35 years; being other than white race/ethnicity; having less education; not being married; binge drinking three or more times in the past 30 days; and drinking mostly beer., Conclusions: Most adult binge drinkers drink in excess of the five-drink threshold defining this risky behavior. The intensity of binge drinking should be monitored regularly by health agencies to improve surveillance and to better assess the impact of interventions designed to reduce binge drinking and its consequences., (Published by Elsevier Inc.)

A systematic review of the literature to assess the effectiveness of alcohol tax policy interventions for reducing excessive alcohol consumption and related harms was conducted for the Guide to Community Preventive Services (Community Guide). Seventy-two papers or technical reports, which were published prior to July 2005, met specified quality criteria, and included evaluation outcomes relevant to public health (e.g., binge drinking, alcohol-related crash fatalities), were included in the final review. Nearly all studies, including those with different study designs, found that there was an inverse relationship between the tax or price of alcohol and indices of excessive drinking or alcohol-related health outcomes. Among studies restricted to underage populations, most found that increased taxes were also significantly associated with reduced consumption and alcohol-related harms. According to Community Guide rules of evidence, these results constitute strong evidence that raising alcohol excise taxes is an effective strategy for reducing excessive alcohol consumption and related harms. The impact of a potential tax increase is expected to be proportional to its magnitude and to be modified by such factors as disposable income and the demand elasticity for alcohol among various population groups., (Published by Elsevier Inc.)

The density of alcohol outlets in communities may be regulated to reduce excessive alcohol consumption and related harms. Studies directly assessing the control of outlet density as a means of controlling excessive alcohol consumption and related harms do not exist, but assessments of related phenomena are indicative. To assess the effects of outlet density on alcohol-related harms, primary evidence was used from interrupted time-series studies of outlet density; studies of the privatization of alcohol sales, alcohol bans, and changes in license arrangements-all of which affected outlet density. Most of the studies included in this review found that greater outlet density is associated with increased alcohol consumption and related harms, including medical harms, injury, crime, and violence. Primary evidence was supported by secondary evidence from correlational studies. The regulation of alcohol outlet density may be a useful public health tool for the reduction of excessive alcohol consumption and related harms.

Background: Although binge drinking is strongly associated with alcohol-impaired driving, little is known about the prevalence of or risk factors for driving after binge drinking., Purpose: The purpose of this study was to assess the prevalence of, and risk factors for, driving during or shortly after a specific binge drinking episode., Methods: The data were analyzed in 2007 and 2008 from 14,085 adults from 13 states in 2003 and 14 states in 2004 who reported binge drinking and answered an additional series of questions about binge drinking behaviors as part of the Behavioral Risk Factor Surveillance System survey. Binge drinking was defined as the consumption of five or more drinks during a drinking occasion., Results: Overall, 11.9% of binge drinkers drove during or within 2 hours of their most recent binge drinking episode. Those drinking in licensed establishments (bars, clubs, and restaurants) accounted for 54.3% of these driving episodes. Significant independent risk factors for driving after binge drinking included male gender (AOR = 1.75); being aged 35-54 or > or = 55 years compared to 18-34 years (AOR = 1.58 and 2.37, respectively); and drinking in bars or clubs compared to drinking in the respondent's home (AOR = 7.81). Drivers who drank most of their alcohol in licensed establishments consumed an average of 8.1 drinks, and 25.7% of them consumed > or = 10 drinks., Conclusions: Because binge drinking and subsequent driving were common in establishments licensed to sell alcohol, and because licensing is conditional on responsible beverage service practices (i.e., not selling to intoxicated people), efforts to prevent impaired driving should focus on enforcing responsible beverage service in licensed establishments.

Background: Binge drinking (drinking on a single occasion >or=5 drinks for men or >or=4 drinks for women) is a common risk behavior among U.S. adults that is associated with many adverse health and social consequences. However, little is known about binge drinking among active-duty military personnel (ADMP). The objectives of this study were to quantify episodes of binge drinking, to characterize ADMP who binge-drink, and to examine the relationship between binge drinking and related harms., Methods: The prevalence of binge drinking and related harms was assessed from responses to the 2005 Department of Defense Survey of Health Related Behaviors Among Military Personnel (n=16,037), an anonymous, self-administered survey. The data were analyzed in 2007 after the release of the public-use data., Results: In 2005, a total of 43.2% of ADMP reported past-month binge drinking, resulting in 29.7 episodes per person per year. In all, 67.1% of binge episodes were reported by personnel aged 17-25 years (46.7% of ADMP), and 25.1% of these episodes were reported by underage youth (aged 17-20 years). Heavy drinkers (19.8% of ADMP) were responsible for 71.5% of the binge-drinking episodes and had the highest number of annual per-capita episodes of binge drinking (112.6 episodes). Compared to nonbinge drinkers, binge drinkers were more likely to report alcohol-related harms, including job performance problems (AOR=6.5; 95% CI=4.65, 9.15); alcohol-impaired driving (AOR=4.9; 95% CI=3.68, 6.49); and criminal justice problems (AOR=6.2; 95% CI=4.00, 9.72)., Conclusions: Binge drinking is common among ADMP and is strongly associated with adverse health and social consequences. Effective interventions (e.g., the enforcement and retainment of the minimum legal drinking age) to prevent binge drinking should be implemented across the military and in conjunction with military communities to discourage binge drinking.

Background: Alcohol-related motor vehicle crashes kill approximately 17,000 Americans annually and were associated with more than $51 billion in total costs in 2000. Relatively little is known about the drinking patterns of alcohol-impaired (AI) drivers in the United States., Methods: 2006 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for alcohol consumption and self-reported AI driving among U.S. adults aged > or =18 years for all states. Alcohol consumption was divided into 4 categories: binge/heavy, binge/nonheavy, nonbinge/heavy, and nonbinge/nonheavy. Binge drinking was defined as > or =5 drinks for men or > or =4 drinks for women on one or more occasions in the past month, and heavy drinking was defined as average daily consumption of >2 drinks/day (men) or >1 drink/day (women). The prevalence of AI driving was examined by drinking pattern and by demographic characteristics. Logistic regression analysis was used to assess the association between drinking patterns and AI driving., Results: Five percent of drinkers were engaged in AI driving during the past 30 days. Overall, 84% of AI drivers were binge drinkers and 88% of AI driving episodes involved binge drinkers. By drinking category, binge/nonheavy drinkers accounted for the largest percentage of AI drivers (49.4%), while binge/heavy drinkers accounted for the most episodes of AI driving (51.3%). The adjusted odds of AI driving were 20.1 (95% CI: 16.7, 24.3) for binge/heavy, 8.2 (6.9, 9.7) for binge/nonheavy, and 3.9 (2.4, 6.3) for nonbinge/heavy drinkers, respectively., Conclusions: There is a strong association between binge drinking and AI driving. Most AI drivers and almost half of all AI driving episodes involve persons who are not heavy drinkers (based on average daily consumption). Implementing effective interventions to prevent binge drinking could substantially reduce AI driving.

Introduction: Binge drinking is a leading cause of preventable death and results in employee absenteeism and lost productivity. Knowledge about the prevalence of binge drinking among employees of different occupations is limited., Methods: We assessed the prevalence of binge drinking (i.e., consuming five or more drinks per occasion during the previous 30 days) by primary occupation using data from the 2004-2005 North Dakota Behavioral Risk Factor Surveillance System. We used logistic regression to assess the association between binge drinking and primary occupation., Results: Overall, 24.1% (95% confidence interval [CI], 22.5-25.7) of North Dakota workers reported binge drinking. The prevalence was highest among farm or ranch employees (45.3%; 95% CI, 28.3-63.4), food or drink servers (33.4%; 95% CI, 23.9-44.4), and farm or ranch owners (32.5%; 95% CI, 26.3-39.4). The prevalence was lowest among health care workers (13.2%; 95% CI, 10.3-16.8). Compared with health care workers, the adjusted odds of binge drinking were highest among farm or ranch employees (adjusted odds ratio [AOR], 2.2; 95% CI, 0.9-5.5), food or drink servers (AOR, 2.1; 95% CI, 1.1-4.0), and farm or ranch owners (AOR, 1.7; 95% CI, 1.1-2.6). Health insurance coverage was lowest among employees in occupations with the highest prevalence of binge drinking., Conclusion: We found occupational differences in the prevalence of binge drinking among employees in North Dakota. Many occupational categories had a high prevalence of binge drinking. We recommend the implementation of both employer-sponsored and population-based interventions to reduce binge drinking among North Dakota workers, particularly because employees in occupations with the highest rates of binge drinking had the lowest rates of health insurance coverage.

Background: Although binge drinking (drinking five or more drinks on an occasion) is an important public health problem, little is known about which beverage types are consumed by binge drinkers. This knowledge could guide prevention efforts because beer, wine, and liquor are taxed, marketed, and distributed differently., Methods: Data from 14,150 adult binge drinkers who responded to the Behavioral Risk Factor Surveillance System binge-drinking module in 2003 and 2004 were analyzed. Information pertained to the amount of alcohol consumed during a binge drinker's most recent binge episode, including beverage-specific consumption., Results: Overall, 74.4% of binge drinkers consumed beer exclusively or predominantly, and those who consumed at least some beer accounted for 80.5% of all binge alcohol consumption. By beverage type, beer accounted for 67.1%, liquor for 21.9%, and wine accounted for 10.9% of binge drinks consumed. Beer also accounted for most of the alcohol consumed by those at highest risk of causing or incurring alcohol-related harm, including people aged 18-20 years (67.0% of drinks were beer); those with three or more binge episodes per month (70.7%); those drinking eight or more drinks per binge episode (69.9%); those binging in public places (64.4%); and those who drove during or within 2 hours of binge drinking (67.1%)., Conclusions: Beer accounted for two thirds of all alcohol consumed by binge drinkers and accounted for most alcohol consumed by those at greatest risk of causing or incurring alcohol-related harm. Lower excise taxes and relatively permissive sales and marketing practices for beer as compared with other beverage types may account for some of these findings. These findings suggest that equalizing alcohol control policies at more stringent levels would be an effective way to prevent excessive drinking.

Objectives: Underage drinking contributes to the 3 leading causes of death (unintentional injury, homicide, and suicide) among persons aged 12 to 20 years. Most adverse health effects from underage drinking stem from acute intoxication resulting from binge drinking. Although binge drinking, typically defined as consuming > or = 5 drinks on an occasion, is a common pattern of alcohol consumption among youth, few population-based studies have focused specifically on the characteristics of underage binge drinkers and their associated health risk behaviors., Methods: We analyzed data on current drinking, binge drinking, and other health risk behaviors from the 2003 National Youth Risk Behavior Survey. Prevalence estimates and 95% confidence intervals were calculated by using SAS and SUDAAN statistical software. Logistic regression was used to examine the associations between different patterns of alcohol consumption and health risk behaviors., Results: Overall, 44.9% of high school students reported drinking alcohol during the past 30 days (28.8% binge drank and 16.1% drank alcohol but did not binge drink). Although girls reported more current drinking with no binge drinking, binge-drinking rates were similar among boys and girls. Binge-drinking rates increased with age and school grade. Students who binge drank were more likely than both nondrinkers and current drinkers who did not binge to report poor school performance and involvement in other health risk behaviors such as riding with a driver who had been drinking, being currently sexually active, smoking cigarettes or cigars, being a victim of dating violence, attempting suicide, and using illicit drugs. A strong dose-response relationship was found between the frequency of binge drinking and the prevalence of other health risk behaviors., Conclusions: Binge drinking is the most common pattern of alcohol consumption among high school youth who drink alcohol and is strongly associated with a wide range of other health risk behaviors. Effective intervention strategies (eg, enforcement of the minimum legal drinking age, screening and brief intervention, and increasing alcohol taxes) should be implemented to prevent underage alcohol consumption and adverse health and social consequences resulting from this behavior.

Introduction: Excessive alcohol consumption kills approximately 75,000 people annually in the United States. Although alcohol screening among primary care patients is recommended by the U.S. Preventive Services Task Force, it is rarely performed. It is unclear whether low screening rates are due to limited access to health care, missed screening opportunities during patient visits, or both., Methods: Data came from the 2002 Behavioral Risk Factor Surveillance System, a population-based telephone survey of noninstitutionalized U.S. adults. Current health insurance status and a history of a recent medical checkup (within 2 years) were assessed in relation to alcohol consumption status. Excessive drinkers included those who reported binge drinking (consuming five or more drinks on one or more occasions in the past month), heavy drinking (consuming more than 60 drinks in the past month for men or more than 30 for women), or both., Results: The prevalence of excessive drinking among the general population (17%) was only slightly higher than the prevalence among those with current health insurance (15%) or a recent checkup (14%). Among excessive drinkers, 79% had current health insurance and 78% had a recent checkup. Although excessive drinkers were somewhat less likely to have health insurance or a recent checkup compared with nonexcessive drinkers and nondrinkers, these differences were less pronounced after stratifying by age. Excessive drinkers with the lowest rates of health insurance were young, Hispanic, less educated, and unemployed. However, most excessive drinkers who lacked insurance or a checkup were employed., Conclusion: Most excessive drinkers were insured and had a recent medical checkup, suggesting that low screening rates among excessive drinkers are mostly due to missed screening opportunities rather than a lack of screening opportunities. Systems approaches to address these missed opportunities should be aggressively implemented.

Objective: To describe the trends, costs, and complications associated with weight loss surgery (WLS)., Research Methods and Procedures: Wisconsin inpatient hospital discharge data from 1990 to 2003 were used for analysis. A WLS case was defined as anyone with a WLS-related procedure code and a primary diagnosis of morbid obesity. Charges were inflation-adjusted to 2001 constant dollars; complications were defined on the basis of readmission, extended length of stay, repeat surgical procedures, or death., Results: The number of WLSs increased from 269 in 1990 to 1992 to 1,884 in 2000 to 2002 (rate ratio = 4.6). Increases in WLSs were greatest among those 50 to 59 years of age (rate ratio = 6.4), women (rate ratio = 6.8), and blacks (rate ratio = 20.0). Between the two periods, inflation-adjusted WLS charges increased 12-fold, and the inflation-adjusted charge per procedure doubled, despite a decreased length of stay. For 2000 to 2002, 23.3% of WLS patients had either an extended length of stay or readmission within 30 days, 7.4% required a repeat surgical procedure, and 0.7% died., Discussion: In Wisconsin, the rate and costs of WLSs have increased dramatically, and the incidence of postoperative complications was high. The epidemic of obesity in the United States makes it imperative to better assess the cost-effectiveness of WLS and to improve its safety.

Objectives: Total joint replacements are important surgical interventions for treating severe arthritis of weight-bearing joints. The most common indication for total knee replacement (TKR) is osteoarthritis of the knee joint. The goals of this study were to assess the trend in rate of TKR in Wisconsin and to describe the economic impact of these surgical procedures on the health care system., Method: A population-based cross-sectional study of TKR surgeries was conducted among Wisconsin residents aged > or = 45 years. The Wisconsin inpatient hospital discharge data from 1990 through 2000 were used. Rates were age-adjusted to the 2000 U.S. population, and charges for TKR were adjusted for inflation., Results: From 1990 through 2000, the age-adjusted rate for TKR increased by 81.5% (from 162 to 294 per 100,000; p<0.001). The rate increased the most among the youngest age group (45-49 years), rate ratio 5.1 for men, 4.2 for women. The total charges for TKR increased from 69.4 million dollars to 148 million dollars (109.2% inflation-adjusted increase). Medicare received the highest proportion of charges for TKR procedures, but throughout the study period, the proportion of charges covered by private insurance increased by 39%., Conclusions: The rate and costs of TKR procedures among Wisconsin residents increased substantially from 1990 through 2000, especially among younger age groups. Changes in medical practices probably accounted for some of this increase, but these trends also may reflect an increased prevalence of osteoarthritis, which in turn may be related to dramatic increases in the number of individuals who are overweight.

Background: Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortality than nondrinkers and heavy drinkers, but there have been no randomized trials on this topic. Although most observational studies control for major cardiac risk factors, CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking., Methods: Data from the 2003 Behavioral Risk Factor Surveillance System, a population-based telephone survey of U.S. adults, was used to assess the prevalence of CVD risk factors and potential confounders among moderate drinkers and nondrinkers. Moderate drinkers were defined as men who drank an average of two drinks per day or fewer, or women who drank one drink or fewer per day., Results: After adjusting for age and gender, nondrinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors, social factors, behavioral factors, access to health care, and health-related conditions. Of the 30 CVD-associated factors or groups of factors that we assessed, 27 (90%) were significantly more prevalent among nondrinkers. Among factors with multiple categories (e.g., body weight), those in higher-risk groups were progressively more likely to be nondrinkers. Removing those with poor health status or a history of CVD did not affect the results., Conclusions: These findings suggest that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding. Given their limitations, nonrandomized studies about the health effects of moderate drinking should be interpreted with caution, particularly since excessive alcohol consumption is a leading health hazard in the United States.

Objectives: We assessed the relationship between college binge drinking, binge drinking in the general population, and selected alcohol control policies., Methods: We analyzed binge drinking rates from 2 national surveys, the Harvard School of Public Health College Alcohol Study and the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Binge drinking data were linked to a summary measure of 7 salient alcohol control policies and a rating of resources devoted to law enforcement., Results: State-level college and adult binge drinking rates were strongly correlated (Pearson correlation coefficient=0.43; P<.01). Attending college in states with the lowest binge drinking rates (adjusted odds ratio [OR]=0.63; 95% confidence interval [CI]=0.41, 0.97) and presence of more stringent alcohol control policies (adjusted OR=0.57; 95% CI=0.33, 0.97) were independent predictors of student binge drinking, after adjusting for state law enforcement and individual-, college-, and state-level covariates., Conclusions: State of residence is a predictor of binge drinking by college students. State-level alcohol control policies may help reduce binge drinking among college students and in the general population.

Background: Binge drinking (defined as five or more drinks on an occasion) causes approximately half of the estimated 85,000 alcohol-related deaths in the United States each year. The Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey, and the National Survey on Drug Use and Health (NSDUH), an in-person survey, provide population-based estimates of binge drinking. Evaluating the concordance of binge drinking estimates from the BRFSS and the NSDUH is important for surveillance and for planning prevention programs., Methods: In 2003, combined data on binge drinking for 1999 and 2001 from the BRFSS (n =355,371) and the NSDUH (n =87,145) were analyzed for respondents aged >or=18 years., Results: National binge drinking estimates were 14.7% (95% confidence interval [CI]=14.5-15.2) for BRFSS and 21.6% (CI=21.2-22.0) for NSDUH. Although there was good correlation between state-specific binge drinking estimates from the two surveys (Pearson's r =0.82), the BRFSS state estimates were significantly lower (p <0.05) than the NSDUH estimates in 46 states and the District of Columbia. The demographic characteristics of binge drinkers and the wording of the binge question were similar in the two surveys. However, in 1999, NSDUH changed from paper interviews to computer-administered interviews, and incorporated an internal validity check with feedback questions to resolve inconsistent responses., Conclusions: Estimates of binge drinking from the NSDUH were consistently higher than those from the BRFSS, probably due to differences in survey methodology. Continued efforts to improve binge drinking surveillance are important for preventing this public health problem.

Background: Arthritis is the leading cause of disability in the United States. Obesity is a risk factor for arthritis, but the relationship between arthritis and weight has not been well characterized at the population level in the United States. Previous research shows that physicians often fail to advise their obese patients to lose weight., Objectives: To describe the relationship between body weight and arthritis in the United States, and to assess predictors of efforts to lose weight among obese adults with arthritis, including the impact of professional advice to lose weight., Methods: Data from the 2000 Behavioral Risk Factor Surveillance System (a population-based survey of U.S. adults) from the 35 states that collected information on weight and height, arthritis, and efforts to lose weight. Arthritis was based on self-report of doctor diagnosis or chronic joint symptoms. Main outcome measures were arthritis and efforts to lose weight among adults with arthritis., Results: Overall, 31.7% of respondents had self-reported arthritis. There was a strong relationship between body weight and arthritis. Specifically, the prevalence of arthritis was 25.9% among normal weight (18.5 to 24.9 body mass index [BMI]) adults; 32.1% among overweight (25 to 29.9 BMI) adults; and 43.5% among obese (>30 BMI) adults. This association persisted after adjusting for other factors (adjusted odds ratio [AOR] for having arthritis among obese individuals compared with healthy weight individuals, 3.6; 95% confidence interval [CI]=3.2-3.8). Among obese adults with arthritis who had a routine checkup within the past 12 months, only 43% were advised to lose weight by a health professional. However, recipients of such advice were more likely to try to lose weight than nonrecipients, and professional advice was the strongest independent predictor of weight loss efforts (AOR=2.8; 95% CI=2.5-3.1)., Conclusions: Body mass index (BMI) is an important independent risk factor for self-reported arthritis. Although physicians often fail to advise obese adults with arthritis to lose weight, adults who report receiving such advice were more likely to report weight-loss efforts. Improved awareness of the relationship between arthritis and weight might help motivate patients to lose weight, and physician advice to lose weight could contribute to the prevention and treatment of arthritis.

Background: Popular culture (movies, television shows, advertising) often portrays drinking to the point of intoxication as either humorous or associated with enjoyable social activities that enhance quality of life. This study examined the association between binge drinking (consuming five or more alcoholic drinks on one occasion) and health-related quality of life (HRQOL) among U.S. adults., Methods: Data are from the Behavioral Risk Factor Surveillance System, a continuous random-digit-dial telephone survey of adults aged >/=18 years conducted in all states. This survey included questions about alcohol consumption and HRQOL., Results: In 2001, 52% of U.S. adults were current drinkers (one or more drinks in the past 30 days). Of current drinkers, 11% were frequent binge drinkers (three or more episodes in past month) and 14% were infrequent binge drinkers (one to two episodes in past month). After adjusting for confounding factors, frequent binge drinkers were more likely than non-binge drinkers to experience >/=14 unhealthy days (physical or mental) in the past month (adjusted odds ratio [AOR]=1.39, 95% confidence interval [CI]=1.24-1.56), primarily because they had more mentally unhealthy days than non-binge drinkers (AOR=1.52, 95% CI=1.32-1.75)., Conclusions: Frequent binge drinking is associated with significantly worse HRQOL and mental distress, including stress, depression, and emotional problems. Effective interventions to prevent binge drinking should be widely adopted and may help improve quality of life.

We describe an infant with the phenotype of the "axial mesodermal dysplasia spectrum" who had the oculo-auriculo-vertebral sequence and caudal dysgenesis. Postmortem studies identified anomalies of the middle ear ossicles, and muscles, in association with microtia and atresia of the external auditory canals, but no cerebral abnormalities.

Vancomycin-intermediate Staphylococcus aureus (VISA) are an emerging problem. We observed a statistically significant inverse relationship in the MICs of vancomycin and oxacillin in S. aureus isolates from a patient undergoing hemodialysis who received 26 weeks of treatment with vancomycin during November 1999 through April 2000. All isolates were mecA positive and were indistinguishable by pulsed-field gel electrophoresis. The evolving susceptibility patterns of this strain highlight the challenges of detecting and treating VISA infections.

In recent years, the globalization of the food supply and the development of extensive food distribution networks have increased the risk of foodborne disease outbreaks involving multiple states or countries. In particular, outbreaks associated with fresh produce have emerged as an important public health concern. During July and August 1998, eight restaurant-associated outbreaks of shigellosis caused by a common strain of Shigella sonnei occurred in the United States and Canada. The outbreak strain was characterized by unique pulsed-field gel electrophoresis patterns. Epidemiologic investigation determined that the illness was associated with the ingestion of parsley at four restaurants; at the other four restaurants, the majority of the people who contracted the illness ate parsley. Isolates from patrons in two unrelated restaurant-associated enterotoxigenic Escherichia coli (ETEC) outbreaks in Minnesota shared a common serotype and pulsed-field gel electrophoresis (PFGE) pattern. Parsley was the implicated or suspected source of both ETEC outbreaks. In each of the outbreak-associated restaurants, parsley was chopped, held at room temperature, and used as an ingredient or garnish for multiple dishes. Infected food workers at several restaurants may also have contributed to the propagation of the outbreak. The sources of parsley served in outbreak-associated restaurants were traced, and a 1,600-acre farm in Baja California, Mexico, was identified as a likely source of the parsley implicated in six of the seven Shigella outbreaks and as a possible source of the parsley implicated in the two ETEC outbreaks. Global food supplies and large distribution networks demand strengthened laboratory and epidemiologic capacity to enable state and local public health agencies to conduct foodborne disease surveillance and to promote effective responses to multistate outbreaks.

Context: Binge drinking (consuming > or =5 alcoholic drinks on 1 occasion) generally results in acute impairment and has numerous adverse health consequences. Reports indicate that binge drinking may be increasing in the United States., Objectives: To quantify episodes of binge drinking among US adults in 1993-2001, to characterize adults who engage in binge drinking, and to describe state and regional differences in binge drinking., Design, Setting, and Participants: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey of adults aged 18 years or older that is conducted annually in all states. The sample size ranged from 102 263 in 1993 to 212 510 in 2001., Main Outcome Measures: Binge-drinking prevalence, episodes, and episodes per person per year., Results: Between 1993 and 2001, the total number of binge-drinking episodes among US adults increased from approximately 1.2 billion to 1.5 billion; during this time, binge-drinking episodes per person per year increased by 17% (from 6.3 to 7.4, P for trend =.03). Between 1995 and 2001, binge-drinking episodes per person per year increased by 35% (P for trend =.005). Men accounted for 81% of binge-drinking episodes in the study years. Although rates of binge-drinking episodes were highest among those aged 18 to 25 years, 69% of binge-drinking episodes during the study period occurred among those aged 26 years or older. Overall, 47% of binge-drinking episodes occurred among otherwise moderate (ie, non-heavy) drinkers, and 73% of all binge drinkers were moderate drinkers. Binge drinkers were 14 times more likely to drive while impaired by alcohol compared with non-binge drinkers. There were substantial state and regional differences in per capita binge-drinking episodes., Conclusions: Binge drinking is common among most strata of US adults, including among those aged 26 years or older. Per capita binge-drinking episodes have increased, particularly since 1995. Binge drinking is strongly associated with alcohol-impaired driving. Effective interventions to prevent the mortality and morbidity associated with binge drinking should be widely adopted, including screening patients for alcohol abuse in accordance with national guidelines.

Background: Public attitudes and expectations contribute to inappropriate antibiotic prescribing and antibiotic resistance. This study assessed knowledge, attitudes, and experiences regarding antibiotic use for respiratory infection or illness., Methods: Random-digit-dialing telephone surveys of adults and parents of children <5 years old were conducted in Wisconsin and Minnesota during 1999., Results: The survey was completed by 405 adults and 275 parents of children <5 years old. The median age was 32 years for parents and 50 years for adults. Seven percent of parents and 17% of adults believed that antibiotics are never or almost never necessary for bronchitis. More than 70% in each group believed that antibiotics are needed for green or yellow nasal drainage, and nearly half of respondents believed that they knew whether an antibiotic was needed before seeing a physician. Exposure to multiple information sources on antibiotic resistance in the past 6 months was independently associated with a knowledge score greater than or equal to the median for nine questions., Conclusions: The general public has misconceptions regarding indications for antibiotic use, and this may contribute to inappropriate prescribing. Providing multiple and varied antibiotic-related informational messages may increase knowledge of appropriate antibiotic prescribing and decrease patient demand for antibiotics., ((C)2002 American Health Foundation and Elsevier Science (USA).)

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged among patients in the general population who do not have established risk factors for MRSA. Records from 10 Minnesota health facilities were reviewed to identify cases of MRSA infection that occurred during 1996-1998 and to identify which cases were community acquired. Susceptibility testing and pulsed-field gel electrophoresis (PFGE) subtyping were performed on available isolates. A total of 354 patients (median age, 16 years) with community-acquired MRSA (CAMRSA) infection were identified. Most case patients (299 [84%]) had skin infections, and 103 (29%) were hospitalized. More than 90% of isolates were susceptible to all antimicrobial agents tested, with the exception of beta-lactams and erythromycin. Of 334 patients treated with antimicrobial agents, 282 (84%) initially were treated with agents to which their isolates were nonsusceptible. Of 174 Minnesota isolates tested, 150 (86%) belonged to 1 PFGE clonal group. CAMRSA infections were identified throughout Minnesota; although most isolates were genetically related and susceptible to multiple antimicrobials, they were generally nonsusceptible to initial empirical therapy.

Context: Until recently, methicillin-resistant Staphylococcus aureus (MRSA) infections have been acquired primarily in nosocomial settings. Four recent deaths due to MRSA infection in previously healthy children in the Midwest suggest that serious MRSA infections can be acquired in the community in rural as well as urban locations., Objectives: To document the occurrence of community-acquired MRSA infections and evaluate risk factors for community-acquired MRSA infection compared with methicillin-susceptible S aureus (MSSA) infection., Design: Retrospective cohort study with medical record review., Setting: Indian Health Service facility in a rural midwestern American Indian community., Patients: Patients whose medical records indicated laboratory-confirmed S aureus infection diagnosed during 1997., Main Outcome Measures: Proportion of MRSA infections classified as community acquired based on standardized criteria; risk factors for community-acquired MRSA infection compared with those for community-acquired MSSA infection; and relatedness of MRSA strains, determined by pulsed-field gel electrophoresis (PFGE)., Results: Of 112 S aureus isolates, 62 (55%) were MRSA and 50 (45%) were MSSA. Forty-six (74%) of the 62 MRSA infections were classified as community acquired. Risk factors for community-acquired MRSA infections were not significantly different from those for community-acquired MSSA. Pulsed-field gel electrophoresis subtyping indicated that 34 (89%) of 38 community-acquired MRSA isolates were clonally related and distinct from nosocomial MRSA isolates found in the region., Conclusions: Community-acquired MRSA may have replaced community-acquired MSSA as the dominant strain in this community. Antimicrobial susceptibility patterns and PFGE subtyping support the finding that MRSA is circulating beyond nosocomial settings in this and possibly other rural US communities.

The antiadrenergic action of adenosine was examined in open- and closed-chest preparations of anesthetized rats. The positive inotropic effects of a jugular vein infusion of either isoproterenol or epinephrine were attenuated by phenylisopropyladenosine, an adenosine A1-receptor agonist. 1,3-Dipropyl,8-cyclopentylxanthine, a specific A1-receptor antagonist, inhibited the action of phenylisopropyladenosine. The results indicate that adenosine receptor-mediated mechanisms are functional in the blood-perfused rodent heart and support the possibility of a physiological role for adenosine in modulating cardiac contractility.