Binge Drinking: Prevention Paradox

This entry was contributed by Five Town CTC Mentor Coordinator, Marti Wolfe

Binge drinking among high school students in our Five Town Community is real, not just a problem that happens in “other” places.  We know that 18.5 % of tenth grade students reported binge drinking, consuming five or more alcoholic drinks in a row on the 2012 Communities That Care Youth Survey. Thirty-six percent (35.9) of the seniors surveyed in 2012 also reported binge drinking.  How do we prevent this injurious behavior and arm our youth with information and skills to make healthful decisions?

Prevention efforts come in all shapes and sizes.  Some are designed to address the general population, Universal Prevention, while others focus on those with greatest risk, Selective Prevention. When faced with the challenge of significantly reducing a problem behavior such as binge drinking, is it best to focus on those with greatest risk or the general population?

Researchers know that risk factors are important predictors of binge drinking. So, why not identify those individuals exposed to a high number of risk factors and target prevention efforts to this selected group? Naturally, this would reduce the incidence of binge drinking among our young people. It seems pretty simple, but the Prevention Paradox proves otherwise.

A recent University of Washington, Seattle Social Development Research Group (SDRG) Study illustrates the Prevention Paradox. Researchers followed 808 diverse Seattle public school youth since they were 10 years old, over an eight-year period.  Researchers categorized this sample population into two groups based on their exposure to risk factors as reported on annual surveys. It turned out that 87.2% of this population had a low-risk for binge drinking, and 12.8% had a high-risk for binge drinking.

When it came to measuring the binge-drinking behavior of this sample group at age 18, it became crystal clear that risk factors matter!  In the low-risk group, only 21% reported binge drinking while in the high-risk group about half reported binge drinking. So far it seems like a selective approach to reducing binge drinking is the ticket to reducing this dangerous behavior. But there is more to consider.

In total, 25% of the 18 year olds in the SDRG Sample reported binge drinking.  But, only 6.4% were from the high-risk group, about 50 students, three-quarters of those reporting binge drinking were from the low-risk group, about 152 students.  The low-risk individuals in this sample contributed the most cases of binge drinking by virtue of their being in the majority. Roses’s Theorem explains this Prevention Paradox. “A large number of people exposed to a small risk may generate many more cases than a small number exposed to high-risk” (Rose 1994:24).

The Prevention Paradox gives us a solid, science-based lens with which to see the need for Universal prevention efforts. It is important to address the most widespread risks of binge drinking community wide. These risks affect both low-risk and high-risk individuals. If we want to significantly reduce binge drinking in our community, let’s inoculate all of our young people with Universal, tested-effective prevention programming.