Abstract

Aims

High-intensity drinking (HID), extreme drinking considerably above the level of heavy episodic drinking (HED), is associated with long-term health and social consequences. There is limited understanding of HID beyond young adulthood. This study aims to identify concurrent risk factors for HID, comparing age differences among all adults.

Methods

Multinomial logistic and linear regression modeling was performed using a nationally-representative sample of adults (analytic n = 7956) from the 2015 and 2020 National Alcohol Surveys. The outcomes were any HID of 8–11 drinks and 12+ drinks for men, and 8+ drinks for women, and corresponding frequencies. Concurrent risk factors included coping motive, sensation seeking, simultaneous use of alcohol and cannabis (SAC), and drinking at a bar or party. Analyses were stratified by age (18–29 vs. older) and sex.

Results

For younger men, sensation-seeking was significantly associated with HID (vs. no HED) at both levels and frequency of HID 8–11 drinks, while drinking to cope was only significant for 12+ drinks. For older men, drinking to cope was a consistent predictor for both HID level and its frequency, but sensation-seeking was not significant. Both coping and sensation-seeking were significantly associated with any HID for all women, while coping was significant for HID frequency for younger women. Frequent drinking at bars and parties were associated with greater odds of HID for all adults. With HED as referent, similar patterns of (though fewer significant) associations were observed.

Conclusions

Younger and older adults share similar risk factors for HID, with coping more consistent for older men.

Introduction

Negative health and social consequences associated with heavy episodic drinking (HED) are well-established. The risks associated with high-intensity drinking (HID), extreme drinking considerably above the level of HED, are even greater. HID, for example, is more likely than HED to be associated with negative consequences such as drinking and driving and alcohol-related emergency room visits (Hingson et al. 2017) and alcohol-induced blackouts (Merrill et al. 2019).

Although HED and HID tend to decline after young adulthood, they continue among some older individuals (Linden-Carmichael et al. 2017a), adversely affecting them. HED among mid-to-older adults (Breslow et al. 2017; Hingson et al. 2017; Grucza et al. 2018) and alcohol-related morbidity and mortality (Keyes et al. 2019) have all been rising in the United States (US). An analysis of the 2012–13 National Epidemiologic Survey on Alcohol and Related Conditions data found that a sizable segment (20%) of US adults drinkers ages 18–64 drank at high-intensity levels (Linden-Carmichael et al. 2017a). Given the aging population and the potential burden on the health care system due to this extreme alcohol use, further HID research among mid-to-older adults is warranted.

Studies using national samples have reported high risks for AUD associated with HID among adults. A study found that among those ages 18–64, high-intensity drinkers at all ages had over three times greater odds for meeting AUD criteria than HED-only drinkers (Linden-Carmichael et al. 2017b); one longitudinal study reported that HID at age 29/30 had over twice the odds for having AUD symptoms as binge drinkers (Patrick et al. 2021). Given that much of the current HID literature is based on younger populations including adolescents, college students, and other young adults (Linden-Carmichael and Lanza 2018; Patrick and Terry-McElrath 2021) and that heavy-drinking adolescents and emerging adults with higher alcohol consumption are less likely to respond to interventions (Bonar et al. 2022), it is imperative to better understand HID among mid-to-older adults for developing interventions. Few studies have focused on risk factors of adult HID.

Given the paucity of research on HID among older adults, we drew upon past HID studies focusing on young people in selecting risk factors to consider. This body of literature has posited HID as situationally influenced by immediate drinking contexts such as being at a party, party characteristics (e.g. large size, presence of heavy drinkers), and drinking at a bar (Merrill et al. 2021; Cox et al. 2022). Simultaneous use of alcohol and cannabis (SAC) is another contextual factor identified in the literature (Patrick et al. 2017b). As one of the most proximal risk factors for drinking (Cooper 1994), drinking motives (e.g. coping, enhancement) have also been central to prior young adult HID studies (White et al. 2016; Terry-McElrath et al. 2017; Patrick et al. 2017a; Patrick and Terry-McElrath 2021). We extend this research by examining the associations of HID for young and older adults by drinking locations, drinking to cope, and simultaneous use of alcohol and cannabis, as well as sensation seeking as a key personality trait and risk for extreme drinking.

Location has an important contextual influence on drinking (Kairouz and Greenfield 2007). While public locations (e.g. bars) and private places (e.g. homes) can be conducive to HED (Stanesby et al. 2019), drinking at bars and parties were more prominent predictors of HED among young adults (Braitman et al. 2017) and adults (Stanesby et al. 2019), as well as HID among young adults. Bars and parties provide social and logistical contexts where alcoholic beverages are readily available and heavy drinking is tolerated or encouraged (Cox et al. 2022), which elevate HID (Greenfield et al. 2011).

Drinking motives have been consistently related to alcohol consumption and related problems (Kuntsche et al. 2005, 2006). Among young adults, social and/or enhancement motives have been associated with HID (Patrick and Terry-McElrath 2021; Bonar et al. 2022; Patrick et al. 2022), and enhancement and coping motives with HID-related negative consequences (Patrick and Terry-McElrath 2021). Another study found that college students who engaged in extreme drinking had greater social, enhancement, and coping motives than non-HED and HED (White et al. 2016). Our focus here is on coping motives. Drinking to cope is linked to HED and alcohol problems (Cooper et al. 1995; Wardell et al. 2020). While drinking primarily for social reasons may constitute a normative behavior, drinking to cope may lead to adverse long-term consequences. This is because the problems that foster negative effects may never be adequately addressed, and reliance on alcohol to cope may contribute to further deterioration and to increased psychological dependence on alcohol to meet one's needs (Cooper et al. 1995; Kuntsche et al. 2005). Indeed, drinking to alleviate mood symptoms in adults is associated with the development of alcohol dependence and its persistence (Crum et al. 2013). Continued binge drinking between ages 22 and 30 was most strongly correlated with using alcohol to get away from problems, with no moderation by sex or other demographic characteristics (Patrick and Schulenberg 2011). Examining whether drinking to cope persists as a risk factor for HID in adulthood is important for informing interventions addressing HID in adulthood.

Sensation seeking is among the most investigated dispositional traits that consistently shows strong associations with HED (Oberlin et al. 2021). While coping motives is closely aligned with internalizing factors such as anxiety and depression (Cooper et al. 2016), sensation seeking captures the dispositional preference involving a psychological process to seek novel and intense experiences including extreme drinking (Cooper et al. 1995). While sensation seeking is not a contextual factor, the modification of behaviors linked to personality traits may be beneficial for prevention and treatment of HED and HID (Adan et al. 2017). Interestingly, sensation seeking was associated with increased risk for HID among underage drinkers, but not for those ages 21–24 (Bonar et al. 2022). It might be meaningful to examine whether this pattern of reduced influence of sensation seeking holds for mid-to-older adults.

Cannabis is the most commonly used drug among, particularly among heavy-drinking young adults (Lee et al. 2022). Adults who use both alcohol and cannabis often use them at the same time (Subbaraman and Kerr 2015). Young adults tend to drink more alcohol when they also use cannabis, compared to alcohol alone, and research has found this pattern continuing among adults (Subbaraman and Kerr 2015) and across the adult lifespan (Tucker et al. 2023) and more prevalent among men than women (Gunn et al. 2022). Prior research has found SAC associated with HID in adolescents in the US (Patrick et al. 2017b), and such a relationship may hold for adults as well.

A major focus of this study is to evaluate whether contextual risk factors differ between younger adults ages 18–29 versus mid-to-older adults, that is, whether key correlates for HID among young adults hold for other adults. Our broad hypotheses are that drinking to cope, sensation-seeking, drinking at bars and parties, and SAC will be positively associated with HID, and that these risk factors differ between younger and older adults. This study is the first step towards exploring whether age- and sex-specific intervention approaches are needed to address HID. Given the documented sex differences in drinking patterns (Wilsnack et al. 2009) we also examine these relationships separately for men and women. Perhaps with the exception of drinking to cope, which appear to become more prominent among men after college years (Kuntsche et al. 2006), literature is sparse on sex differences in the relationships, and thus we do not formulate directional hypotheses concerning sex differences in these relationships.

Methods

Data

Using pooled 2015 and 2020 National Alcohol Survey (NAS) data, our analysis was limited to respondents who reported any past 12-month drinking (64.7% of the sample; analytic n = 8174). The ages in our sample range from 30–96, with >97% of the sample < 80 years. The NAS is a population-representative survey of randomly selected adults aged 18+ approximately every 5 years since 1979 (Kerr et al. 2018). Both recent waves of the NAS included computer-assisted telephone interviews, using a dual-frame sampling design with a two-stage stratified, random digit dialing (RDD) samples of adults from landline telephone households and cell phone users. In the 2015 NAS, approximately 60% of completed interviews were conducted via landline and 40% via cell phone. The NAS 2020 survey used two probability samples including a RDD landline and cell phone telephone sample (most responding by cell phone) and an address-based sample (ABS), supplemented with a nonprobability pre-recruited web panel sample. Black and Hispanic adults were over-sampled in NAS 2015 and in the ABS and web panel samples in NAS 2020. Surveys were conducted in English or Spanish. The American Association for Public Opinion Research cooperation rate was 43.4% for NAS 2015 and 42.2% for NAS 2020. The Institutional Review Board of the Public Health Institute approved survey procedures and analysis.

Measures

Our drinking outcomes were based upon maximum quantity consumed, a valuable measure of drinking patterns (Greenfield et al. 2006). Using categorical responses to the question, ‘During the last 12 months, what is the largest number of drinks you had on any single day?’, we constructed HID measures of HID 8–11 drinks and HID 12+ drinks for men, and a single measure of HID 8+ drinks for women, the latter because the number of women who had 12+ drinks was too small for advanced modeling. Other drinking categories were HED (4–7/5–7 drinks for women/men) and no HED (less than 4/5 drinks for women/men).

HID frequency was assessed by the number of days in the past 12 months when the respondent engaged in HID, calculated by using midpoints of six categorical responses: (nearly) every day, 3–4 times a week, once/twice a week, 1–3 times a month, less than once a month, once in the past year, and never. Natural logs of the continuous variables were used in our analyses because of skewed distributions with long tails at higher levels.

Drinking to cope was assessed by ‘drinking to forget about worries/problems’ in the past year with Likert-type scale responses (1 = strongly disagree and 4 = strongly agree).

Frequency of drinking at a bar or party each was assessed using an ordinal variable with the categories of monthly or less frequently, at least once a week to every 2–3 weeks, and everyday/nearly everyday, and never.

Past year SAC (using cannabis and alcohol together sometimes or usually) (Subbaraman and Kerr 2015) was based on the combinations of current drinking, cannabis use (use of cannabis, hash, pot, or ‘weed’), and frequency of SAC (‘How often did you use alcohol and cannabis at the same time? Was it usually, sometimes, or never?’).

Sensation-seeking was the sum of three items, ‘I like to test myself every now and then by doing something a little chancy,’ ‘I like to try new things just for the excitement,’ and ‘I like to experience new and different sensations,’ all assessed on a 4-point scale (not at all/a little/some/quite a lot). The Cronbach’s alpha in our sample was .82.

Our measure for gender is biological sex assigned at birth, female or male. More detailed information on gender identity status was available only in the 2020 NAS, and our use of pooled 2015–2020 data for greater statistical power precluded the consideration of gender identity. Models adjusted for age, race/ethnicity (White, Black, Hispanic, Asian, Native American/Alaska Native, and others), family income (more than median income vs. median income or less), education (high school diploma/equivalency, some college education, and 4-year college/advanced degree vs. less than high school diploma), marital/cohabitation status (separated/divorced/widowed/never married vs. married/cohabitating), the number of cannabis use days (using the number-of-day midpoints of the categories ranging from (nearly) every day to never), and survey year (2015 vs. 2020).

Analyses

Analyses were conducted using STATA version 17. We first performed bivariate chi-squared and ANOVA tests to examine differences in demographic characteristics and drinking-related variables among adults with different drinking levels. A series of multinomial regression models stratified by age (18–29 years vs. >30) and sex were used to examine associations between risk factors (drinking frequencies at bars and parties, drinking to cope, sensation-seeking, and SAC frequencies) with HED (4–7/5–7 drinks for women/men) and HID (8–11 and 12+ drinks for men, and 8+ drinks for women), first using no HED as reference category and then using HED as referent. We also performed linear regression modeling using logged HID frequencies as the outcomes, also stratifying on age and sex. We accounted for the complex survey design and post-stratification adjustments and sample weights.

Results

Table 1 shows the demographic profiles and distributions of drinking-related variables by HED/HID levels. Prevalence of HID was higher among men than women and among 18–29 age group than 30+ older group. There was no clear association between income and either HID level. Prevalence of drinking 8–11 drinks was the highest among those with 4-year-college/advance degree, while that of HID 12+ drinks was the highest among those with no high school diploma. Prevalence of HID 8–11 drinks was the highest among American Indian/Native Alaskan and White adults, and 12+ drinks was the highest among White adults. The average values of drinking to cope and sensation-seeking increased with each level of greater drinking intensity, as did the average frequency of cannabis use. Prevalence of HID 12+ drinks was the highest among those who reported ‘(nearly) everyday’ SAC, but that HID 8–11 drinks was the highest among those who reported SAC ‘weekly to every 2–3 weeks.’ Prevalence of both HID levels was the highest among those who drank at bars or parties ‘(nearly) everyday,’ followed by those who did ‘at least weekly.’

Table 1

Demographic and drinking-related characteristics of US adult drinkers, 2015 and 2020 National Alcohol Surveys (N = 7956)

All (n; %)No HEDaHEDb8–11 drinks12+ drinksp
Gender5071 (63.3)1871 (27.5)650 (6.1)364 (3.1)***
 Male3358 (49.9)55.721.813.19.4
 Female4598 (50.1)63.327.56.13.1
Age***
 18–291461 (2.7)39.132.616.711.7
 30–391612 (2.8)48.431.111.49.2
 40–491315 (16.9)57.326.51.55.7
 50–591434 (17.7)67.621.57.73.3
 60 or older2134 (23.9)8.313.22.71.5
Education*
 No high school diploma284 (5.1)56.122.98.012.5
 High school graduation/diploma1409 (22.5)63.121.59.65.7
 Some college2485 (36.9)59.325.08.96.9
 4-year college/advanced degree3778 (35.5)57.926.510.65.0
Family incomen.s.
 Below median income4229 (53.2)60.123.89.46.8
 Above median income3727 (46.8)58.925.79.95.6
Race/ethnicity*
 White4380 (68.9)58.324.51.26.9
 Black1492 (10.6)67.821.07.24.0
 Hispanic1586 (14.3)58.526.69.35.6
 Asian/Pacific Islander281 (3.2)62.126.27.83.9
 American Indian/Alaska Native97 (1.6)58.328.11.43.3
 Others120 (1.4)61.83.23.84.3
Marital/cohabitation statusn.s.
 Divorced/separated/widowed/never married3417 (4.0)57.625.21.07.2
 Married/cohabitating4539 (6.0)6.724.39.35.6
Drinking to cope1.75 (.01)1.62 (.01)1.94 (.03)2.03 (.05)2.34 (.06)***
Sensation seeking (mean; SE)6.40 (.03)6.08 (.04)6.95 (.09)7.47 (.14)8.06 (.16)***
Cannabis use days/past year (mean; SE)13.70 (.48)9.93 (.76)17.36 (1.82)29.35 (3.23)43.77 (4.84)***
Simultaneous use of alcohol and cannabis***
 Never7013 (87.8)64.523.77.94.0
 Monthly or less554 (6.5)25.634.519.620.3
 Weekly to every 2–3 weeks280 (4.5)24.727.925.422.0
 (Nearly) everyday109 (1.3)17.526.421.834.3
Bar use frequency***
Never3054 (37.5)76.315.05.33.5
 At least yearly2885 (36.4)6.027.88.14.1
 At least monthly1498 (19.4)37.836.815.99.6
 At least weekly472 (6.1)31.525.922.52.2
 (Nearly) everyday47 (.6)16.87.023.652.6
Party frequency***
 Never1925 (24.8)77.215.34.72.8
 At least yearly4572 (56.8)6.025.99.44.7
 At least monthly1254 (15.8)38.134.114.913.0
 At least weekly174 (2.3)2.227.025.926.9
 (Nearly) everyday31 (.3)8.07.338.046.7
All (n; %)No HEDaHEDb8–11 drinks12+ drinksp
Gender5071 (63.3)1871 (27.5)650 (6.1)364 (3.1)***
 Male3358 (49.9)55.721.813.19.4
 Female4598 (50.1)63.327.56.13.1
Age***
 18–291461 (2.7)39.132.616.711.7
 30–391612 (2.8)48.431.111.49.2
 40–491315 (16.9)57.326.51.55.7
 50–591434 (17.7)67.621.57.73.3
 60 or older2134 (23.9)8.313.22.71.5
Education*
 No high school diploma284 (5.1)56.122.98.012.5
 High school graduation/diploma1409 (22.5)63.121.59.65.7
 Some college2485 (36.9)59.325.08.96.9
 4-year college/advanced degree3778 (35.5)57.926.510.65.0
Family incomen.s.
 Below median income4229 (53.2)60.123.89.46.8
 Above median income3727 (46.8)58.925.79.95.6
Race/ethnicity*
 White4380 (68.9)58.324.51.26.9
 Black1492 (10.6)67.821.07.24.0
 Hispanic1586 (14.3)58.526.69.35.6
 Asian/Pacific Islander281 (3.2)62.126.27.83.9
 American Indian/Alaska Native97 (1.6)58.328.11.43.3
 Others120 (1.4)61.83.23.84.3
Marital/cohabitation statusn.s.
 Divorced/separated/widowed/never married3417 (4.0)57.625.21.07.2
 Married/cohabitating4539 (6.0)6.724.39.35.6
Drinking to cope1.75 (.01)1.62 (.01)1.94 (.03)2.03 (.05)2.34 (.06)***
Sensation seeking (mean; SE)6.40 (.03)6.08 (.04)6.95 (.09)7.47 (.14)8.06 (.16)***
Cannabis use days/past year (mean; SE)13.70 (.48)9.93 (.76)17.36 (1.82)29.35 (3.23)43.77 (4.84)***
Simultaneous use of alcohol and cannabis***
 Never7013 (87.8)64.523.77.94.0
 Monthly or less554 (6.5)25.634.519.620.3
 Weekly to every 2–3 weeks280 (4.5)24.727.925.422.0
 (Nearly) everyday109 (1.3)17.526.421.834.3
Bar use frequency***
Never3054 (37.5)76.315.05.33.5
 At least yearly2885 (36.4)6.027.88.14.1
 At least monthly1498 (19.4)37.836.815.99.6
 At least weekly472 (6.1)31.525.922.52.2
 (Nearly) everyday47 (.6)16.87.023.652.6
Party frequency***
 Never1925 (24.8)77.215.34.72.8
 At least yearly4572 (56.8)6.025.99.44.7
 At least monthly1254 (15.8)38.134.114.913.0
 At least weekly174 (2.3)2.227.025.926.9
 (Nearly) everyday31 (.3)8.07.338.046.7

Unweighted n's and weighted percentages shown

***P < .001, **P < .01, *P < .05

aSex-specific no HED levels, <4/<5 drinks for women/men

bSex-specific HED levels, 4+/5+ drinks for women/men

Table 1

Demographic and drinking-related characteristics of US adult drinkers, 2015 and 2020 National Alcohol Surveys (N = 7956)

All (n; %)No HEDaHEDb8–11 drinks12+ drinksp
Gender5071 (63.3)1871 (27.5)650 (6.1)364 (3.1)***
 Male3358 (49.9)55.721.813.19.4
 Female4598 (50.1)63.327.56.13.1
Age***
 18–291461 (2.7)39.132.616.711.7
 30–391612 (2.8)48.431.111.49.2
 40–491315 (16.9)57.326.51.55.7
 50–591434 (17.7)67.621.57.73.3
 60 or older2134 (23.9)8.313.22.71.5
Education*
 No high school diploma284 (5.1)56.122.98.012.5
 High school graduation/diploma1409 (22.5)63.121.59.65.7
 Some college2485 (36.9)59.325.08.96.9
 4-year college/advanced degree3778 (35.5)57.926.510.65.0
Family incomen.s.
 Below median income4229 (53.2)60.123.89.46.8
 Above median income3727 (46.8)58.925.79.95.6
Race/ethnicity*
 White4380 (68.9)58.324.51.26.9
 Black1492 (10.6)67.821.07.24.0
 Hispanic1586 (14.3)58.526.69.35.6
 Asian/Pacific Islander281 (3.2)62.126.27.83.9
 American Indian/Alaska Native97 (1.6)58.328.11.43.3
 Others120 (1.4)61.83.23.84.3
Marital/cohabitation statusn.s.
 Divorced/separated/widowed/never married3417 (4.0)57.625.21.07.2
 Married/cohabitating4539 (6.0)6.724.39.35.6
Drinking to cope1.75 (.01)1.62 (.01)1.94 (.03)2.03 (.05)2.34 (.06)***
Sensation seeking (mean; SE)6.40 (.03)6.08 (.04)6.95 (.09)7.47 (.14)8.06 (.16)***
Cannabis use days/past year (mean; SE)13.70 (.48)9.93 (.76)17.36 (1.82)29.35 (3.23)43.77 (4.84)***
Simultaneous use of alcohol and cannabis***
 Never7013 (87.8)64.523.77.94.0
 Monthly or less554 (6.5)25.634.519.620.3
 Weekly to every 2–3 weeks280 (4.5)24.727.925.422.0
 (Nearly) everyday109 (1.3)17.526.421.834.3
Bar use frequency***
Never3054 (37.5)76.315.05.33.5
 At least yearly2885 (36.4)6.027.88.14.1
 At least monthly1498 (19.4)37.836.815.99.6
 At least weekly472 (6.1)31.525.922.52.2
 (Nearly) everyday47 (.6)16.87.023.652.6
Party frequency***
 Never1925 (24.8)77.215.34.72.8
 At least yearly4572 (56.8)6.025.99.44.7
 At least monthly1254 (15.8)38.134.114.913.0
 At least weekly174 (2.3)2.227.025.926.9
 (Nearly) everyday31 (.3)8.07.338.046.7
All (n; %)No HEDaHEDb8–11 drinks12+ drinksp
Gender5071 (63.3)1871 (27.5)650 (6.1)364 (3.1)***
 Male3358 (49.9)55.721.813.19.4
 Female4598 (50.1)63.327.56.13.1
Age***
 18–291461 (2.7)39.132.616.711.7
 30–391612 (2.8)48.431.111.49.2
 40–491315 (16.9)57.326.51.55.7
 50–591434 (17.7)67.621.57.73.3
 60 or older2134 (23.9)8.313.22.71.5
Education*
 No high school diploma284 (5.1)56.122.98.012.5
 High school graduation/diploma1409 (22.5)63.121.59.65.7
 Some college2485 (36.9)59.325.08.96.9
 4-year college/advanced degree3778 (35.5)57.926.510.65.0
Family incomen.s.
 Below median income4229 (53.2)60.123.89.46.8
 Above median income3727 (46.8)58.925.79.95.6
Race/ethnicity*
 White4380 (68.9)58.324.51.26.9
 Black1492 (10.6)67.821.07.24.0
 Hispanic1586 (14.3)58.526.69.35.6
 Asian/Pacific Islander281 (3.2)62.126.27.83.9
 American Indian/Alaska Native97 (1.6)58.328.11.43.3
 Others120 (1.4)61.83.23.84.3
Marital/cohabitation statusn.s.
 Divorced/separated/widowed/never married3417 (4.0)57.625.21.07.2
 Married/cohabitating4539 (6.0)6.724.39.35.6
Drinking to cope1.75 (.01)1.62 (.01)1.94 (.03)2.03 (.05)2.34 (.06)***
Sensation seeking (mean; SE)6.40 (.03)6.08 (.04)6.95 (.09)7.47 (.14)8.06 (.16)***
Cannabis use days/past year (mean; SE)13.70 (.48)9.93 (.76)17.36 (1.82)29.35 (3.23)43.77 (4.84)***
Simultaneous use of alcohol and cannabis***
 Never7013 (87.8)64.523.77.94.0
 Monthly or less554 (6.5)25.634.519.620.3
 Weekly to every 2–3 weeks280 (4.5)24.727.925.422.0
 (Nearly) everyday109 (1.3)17.526.421.834.3
Bar use frequency***
Never3054 (37.5)76.315.05.33.5
 At least yearly2885 (36.4)6.027.88.14.1
 At least monthly1498 (19.4)37.836.815.99.6
 At least weekly472 (6.1)31.525.922.52.2
 (Nearly) everyday47 (.6)16.87.023.652.6
Party frequency***
 Never1925 (24.8)77.215.34.72.8
 At least yearly4572 (56.8)6.025.99.44.7
 At least monthly1254 (15.8)38.134.114.913.0
 At least weekly174 (2.3)2.227.025.926.9
 (Nearly) everyday31 (.3)8.07.338.046.7

Unweighted n's and weighted percentages shown

***P < .001, **P < .01, *P < .05

aSex-specific no HED levels, <4/<5 drinks for women/men

bSex-specific HED levels, 4+/5+ drinks for women/men

In Table 2, multinomial regression models show the associations between hypothesized risk factors and HID levels among adult male drinkers, with no HED as reference category. For men ages 18–29 years, drinking to cope was significantly and positively associated with HID 12+ drinks, and sensation-seeking with both HID 8–11 drinks and HID 12+ drinks. As for bar frequency, only ‘at least monthly’ bar drinking was significant for HID 12+ drinks for younger men. ‘Except ‘(nearly) everyday’ partying all categories of party drinking frequency were significant for HID outcomes. For older men, drinking to cope was significant for HID (both 8–11 drinks and 12+ drinks), but sensation-seeking was not. ‘At least monthly’ SAC was significantly associated with HID 8–11 drinks and ‘weekly to every 2–3 weeks’ with HID 12+ drinks for men ages 18–29 (with the latter being the case for older men as well). For older men, SAC had a dose–response relationship with 8–11 drinks, and ‘at least monthly’ and ‘weekly to every 2–3 weeks’ were significant for 12+ drinks. ‘At least weekly’ and ‘(nearly) everyday’ bar drinking was significant for both HID outcomes for older men. All categories of party drinking frequency but ‘at least yearly’ were significant for both HID outcomes for older men.

Table 2

Contextual factors associated with any heavy episodic and high-intensity drinking for adult male drinkers: multinomial logistic regression models

Men ages 18–29 (n = 598)Men ages 30 or older (n = 2761)
HEDa8-11 drinksa12+ drinksaHEDa8–11 drinksa12+ drinksa
RRR95% CIRRR95% CIRRR95% CIRRR95% CIRRR95% CIRRR95% CI
Age (continuous)0.90*(.82–1.00)0.91(.81–1.03)0.80**(0.69–.93)0.96***(.95–.97)0.95***(.93–.96)0.95***(.93–.96)
Educationb
 High school graduation0.27(.07–1.03)2.09(.21–2.87)0.55(.09–3.39)0.77(0.35–1.70)2.00(.67–5.92)0.47(.17–1.32)
 Some college0.33(.09–1.27)3.27(.35–3.74)0.74(.12–4.62)0.88(.40–1.90)1.58(.54–4.61)0.72(.26–1.94)
 4-year college degree+0.65(.16–2.60)5.25(.54–51.04)0.82(.12–5.73)0.58(.26–1.26)1.20(.41–3.48)0.22**(.08–.64)
 >Median incomec0.83(.42–1.61)0.72(0.35–1.49)1.18(.49–2.84)1.40(.99–1.96)1.38(.88–2.15)1.29(.77–2.16)
Race/ethnicityd
 Black1.06(.47–2.41)0.35*(0.13–.92)0.26*(.08–.80)0.58*(0.35–.96)0.43*(.20–.93)0.20***(.09–.46)
 Hispanic0.94(.44–1.99)0.27**(0.10–.71)0.15***(.05–.44)0.97(.64–1.47)0.58(0.34–1.01)0.43*(.22–.82)
 Asian/Pacific Islander0.93(0.35–2.47)0.41(0.14–1.21)0.12**(.02–.59)0.55(0.18–1.64)0.29*(0.10–.79)0.36(.09–1.47)
 AmInd/NatAm0.96(.08–11.83)0.22(.02–2.04)0.97(.08–12.34)0.10*(.01–.82)0.74(0.19–2.93)0.26(.01–6.93)
 Others2.91(.44–19.20)0.01***(.00–.14)0.00***(.00–.00)0.85(0.30–2.40)0.18(.03–1.25)0.34(.04–2.76)
 Married/cohabitatinge1.19(.63 - 2.24)2.29*(1.14–4.62)2.59*(1.05–6.36)0.68*(.49–.94)0.79(.49–1.25)0.85(.52–1.40)
Drinking to cope1.11(.81–1.51)1.18(.84–1.67)1.63*(1.04–2.57)1.44***(1.19–1.73)1.61***(1.27–2.04)2.17***(1.63–2.88)
Sensation seeking1.13(.99–1.29)1.24**(1.07–1.44)1.19*(1.01–1.42)0.99(.93–1.06)0.99(.90–1.09)1.08(.98–1.19)
Marijuana use days0.99(.99–1.00)0.99(.98–1.00)0.99(.98–1.00)0.99**(.99–1.00)1.00(.99–1.00)1.00(.99–1.00)
SACf
 Monthly or less2.16(.81–5.80)3.64*(1.22–1.85)13.37***(4.31–41.47)3.56***(1.93–6.57)3.17**(1.51–6.66)7.70***(3.55–16.71)
 Weekly to every 2–3 weeks3.69(.79–17.12)4.85(.59–4.01)11.97*(1.26–113.32)9.76***(2.74–34.69)4.62*(1.04–2.49)7.99**(1.76–36.18)
 (Nearly) everyday8.84e+06***(1.29e+06–6.06e+07)2.56e+07***(2.21e+06)6.18e+08***(6.85e+07)7.43*(1.16–47.51)8.56*(1.26–58.30)7.14(.59–86.58)
Bar use frequencyf
 At least yearly1.46(.70–3.07)0.75(.30–1.87)1.15(.31–4.20)1.60*(1.09–2.36)1.33(.79–2.27)1.17(.60–2.29)
 At least monthly3.18**(1.34–7.57)2.25(.79–6.37)9.86***(2.78–34.94)2.40***(1.54–3.75)2.68**(1.48–4.88)1.63(.76–3.46)
 At least weekly0.47(.15–1.53)0.84(.23–3.02)2.16(.48–9.80)2.32*(1.22–4.40)3.13**(1.44–6.83)4.48***(2.02–9.92)
Party frequencyf
 At least yearly1.95(.93–4.09)3.35*(1.25–8.96)10.30**(2.01–52.78)1.44(.95–2.18)2.28**(1.29–4.02)1.56(.80–3.06)
 At least monthly2.62*(1.03–6.65)4.52*(1.32–15.47)23.68***(4.34–129.34)1.81*(1.06–3.09)3.34**(1.60–7.00)2.51*(1.17–5.38)
 At least weekly4.24*(1.17–15.43)5.88*(1.09–31.65)12.01*(1.27–113.68)5.71***(2.05–15.89)16.18***(5.45–48.03)13.89***(4.78–40.33)
 Survey year (2020)g1.26(.66–2.38)0.33**(.17–.67)0.41*(0.18–.94)1.00(.74–1.35)0.78(.53–1.15)0.68(.42–1.09)
Men ages 18–29 (n = 598)Men ages 30 or older (n = 2761)
HEDa8-11 drinksa12+ drinksaHEDa8–11 drinksa12+ drinksa
RRR95% CIRRR95% CIRRR95% CIRRR95% CIRRR95% CIRRR95% CI
Age (continuous)0.90*(.82–1.00)0.91(.81–1.03)0.80**(0.69–.93)0.96***(.95–.97)0.95***(.93–.96)0.95***(.93–.96)
Educationb
 High school graduation0.27(.07–1.03)2.09(.21–2.87)0.55(.09–3.39)0.77(0.35–1.70)2.00(.67–5.92)0.47(.17–1.32)
 Some college0.33(.09–1.27)3.27(.35–3.74)0.74(.12–4.62)0.88(.40–1.90)1.58(.54–4.61)0.72(.26–1.94)
 4-year college degree+0.65(.16–2.60)5.25(.54–51.04)0.82(.12–5.73)0.58(.26–1.26)1.20(.41–3.48)0.22**(.08–.64)
 >Median incomec0.83(.42–1.61)0.72(0.35–1.49)1.18(.49–2.84)1.40(.99–1.96)1.38(.88–2.15)1.29(.77–2.16)
Race/ethnicityd
 Black1.06(.47–2.41)0.35*(0.13–.92)0.26*(.08–.80)0.58*(0.35–.96)0.43*(.20–.93)0.20***(.09–.46)
 Hispanic0.94(.44–1.99)0.27**(0.10–.71)0.15***(.05–.44)0.97(.64–1.47)0.58(0.34–1.01)0.43*(.22–.82)
 Asian/Pacific Islander0.93(0.35–2.47)0.41(0.14–1.21)0.12**(.02–.59)0.55(0.18–1.64)0.29*(0.10–.79)0.36(.09–1.47)
 AmInd/NatAm0.96(.08–11.83)0.22(.02–2.04)0.97(.08–12.34)0.10*(.01–.82)0.74(0.19–2.93)0.26(.01–6.93)
 Others2.91(.44–19.20)0.01***(.00–.14)0.00***(.00–.00)0.85(0.30–2.40)0.18(.03–1.25)0.34(.04–2.76)
 Married/cohabitatinge1.19(.63 - 2.24)2.29*(1.14–4.62)2.59*(1.05–6.36)0.68*(.49–.94)0.79(.49–1.25)0.85(.52–1.40)
Drinking to cope1.11(.81–1.51)1.18(.84–1.67)1.63*(1.04–2.57)1.44***(1.19–1.73)1.61***(1.27–2.04)2.17***(1.63–2.88)
Sensation seeking1.13(.99–1.29)1.24**(1.07–1.44)1.19*(1.01–1.42)0.99(.93–1.06)0.99(.90–1.09)1.08(.98–1.19)
Marijuana use days0.99(.99–1.00)0.99(.98–1.00)0.99(.98–1.00)0.99**(.99–1.00)1.00(.99–1.00)1.00(.99–1.00)
SACf
 Monthly or less2.16(.81–5.80)3.64*(1.22–1.85)13.37***(4.31–41.47)3.56***(1.93–6.57)3.17**(1.51–6.66)7.70***(3.55–16.71)
 Weekly to every 2–3 weeks3.69(.79–17.12)4.85(.59–4.01)11.97*(1.26–113.32)9.76***(2.74–34.69)4.62*(1.04–2.49)7.99**(1.76–36.18)
 (Nearly) everyday8.84e+06***(1.29e+06–6.06e+07)2.56e+07***(2.21e+06)6.18e+08***(6.85e+07)7.43*(1.16–47.51)8.56*(1.26–58.30)7.14(.59–86.58)
Bar use frequencyf
 At least yearly1.46(.70–3.07)0.75(.30–1.87)1.15(.31–4.20)1.60*(1.09–2.36)1.33(.79–2.27)1.17(.60–2.29)
 At least monthly3.18**(1.34–7.57)2.25(.79–6.37)9.86***(2.78–34.94)2.40***(1.54–3.75)2.68**(1.48–4.88)1.63(.76–3.46)
 At least weekly0.47(.15–1.53)0.84(.23–3.02)2.16(.48–9.80)2.32*(1.22–4.40)3.13**(1.44–6.83)4.48***(2.02–9.92)
Party frequencyf
 At least yearly1.95(.93–4.09)3.35*(1.25–8.96)10.30**(2.01–52.78)1.44(.95–2.18)2.28**(1.29–4.02)1.56(.80–3.06)
 At least monthly2.62*(1.03–6.65)4.52*(1.32–15.47)23.68***(4.34–129.34)1.81*(1.06–3.09)3.34**(1.60–7.00)2.51*(1.17–5.38)
 At least weekly4.24*(1.17–15.43)5.88*(1.09–31.65)12.01*(1.27–113.68)5.71***(2.05–15.89)16.18***(5.45–48.03)13.89***(4.78–40.33)
 Survey year (2020)g1.26(.66–2.38)0.33**(.17–.67)0.41*(0.18–.94)1.00(.74–1.35)0.78(.53–1.15)0.68(.42–1.09)

***P < .001, **P < .01, *P < .05

RRR: relative risk ratio, CI: confidence interval, SAC: Simultaneous use of alcohol and cannabis

aNo heavy episodic drinking (HED, 5–7 drinks for men) as reference category

bNo high school diploma as reference category

cMedian income or less as reference category

dWhite as reference category

eNever married/divorced/widowed as reference category

fNever as reference category

g2015 survey as reference category

Table 2

Contextual factors associated with any heavy episodic and high-intensity drinking for adult male drinkers: multinomial logistic regression models

Men ages 18–29 (n = 598)Men ages 30 or older (n = 2761)
HEDa8-11 drinksa12+ drinksaHEDa8–11 drinksa12+ drinksa
RRR95% CIRRR95% CIRRR95% CIRRR95% CIRRR95% CIRRR95% CI
Age (continuous)0.90*(.82–1.00)0.91(.81–1.03)0.80**(0.69–.93)0.96***(.95–.97)0.95***(.93–.96)0.95***(.93–.96)
Educationb
 High school graduation0.27(.07–1.03)2.09(.21–2.87)0.55(.09–3.39)0.77(0.35–1.70)2.00(.67–5.92)0.47(.17–1.32)
 Some college0.33(.09–1.27)3.27(.35–3.74)0.74(.12–4.62)0.88(.40–1.90)1.58(.54–4.61)0.72(.26–1.94)
 4-year college degree+0.65(.16–2.60)5.25(.54–51.04)0.82(.12–5.73)0.58(.26–1.26)1.20(.41–3.48)0.22**(.08–.64)
 >Median incomec0.83(.42–1.61)0.72(0.35–1.49)1.18(.49–2.84)1.40(.99–1.96)1.38(.88–2.15)1.29(.77–2.16)
Race/ethnicityd
 Black1.06(.47–2.41)0.35*(0.13–.92)0.26*(.08–.80)0.58*(0.35–.96)0.43*(.20–.93)0.20***(.09–.46)
 Hispanic0.94(.44–1.99)0.27**(0.10–.71)0.15***(.05–.44)0.97(.64–1.47)0.58(0.34–1.01)0.43*(.22–.82)
 Asian/Pacific Islander0.93(0.35–2.47)0.41(0.14–1.21)0.12**(.02–.59)0.55(0.18–1.64)0.29*(0.10–.79)0.36(.09–1.47)
 AmInd/NatAm0.96(.08–11.83)0.22(.02–2.04)0.97(.08–12.34)0.10*(.01–.82)0.74(0.19–2.93)0.26(.01–6.93)
 Others2.91(.44–19.20)0.01***(.00–.14)0.00***(.00–.00)0.85(0.30–2.40)0.18(.03–1.25)0.34(.04–2.76)
 Married/cohabitatinge1.19(.63 - 2.24)2.29*(1.14–4.62)2.59*(1.05–6.36)0.68*(.49–.94)0.79(.49–1.25)0.85(.52–1.40)
Drinking to cope1.11(.81–1.51)1.18(.84–1.67)1.63*(1.04–2.57)1.44***(1.19–1.73)1.61***(1.27–2.04)2.17***(1.63–2.88)
Sensation seeking1.13(.99–1.29)1.24**(1.07–1.44)1.19*(1.01–1.42)0.99(.93–1.06)0.99(.90–1.09)1.08(.98–1.19)
Marijuana use days0.99(.99–1.00)0.99(.98–1.00)0.99(.98–1.00)0.99**(.99–1.00)1.00(.99–1.00)1.00(.99–1.00)
SACf
 Monthly or less2.16(.81–5.80)3.64*(1.22–1.85)13.37***(4.31–41.47)3.56***(1.93–6.57)3.17**(1.51–6.66)7.70***(3.55–16.71)
 Weekly to every 2–3 weeks3.69(.79–17.12)4.85(.59–4.01)11.97*(1.26–113.32)9.76***(2.74–34.69)4.62*(1.04–2.49)7.99**(1.76–36.18)
 (Nearly) everyday8.84e+06***(1.29e+06–6.06e+07)2.56e+07***(2.21e+06)6.18e+08***(6.85e+07)7.43*(1.16–47.51)8.56*(1.26–58.30)7.14(.59–86.58)
Bar use frequencyf
 At least yearly1.46(.70–3.07)0.75(.30–1.87)1.15(.31–4.20)1.60*(1.09–2.36)1.33(.79–2.27)1.17(.60–2.29)
 At least monthly3.18**(1.34–7.57)2.25(.79–6.37)9.86***(2.78–34.94)2.40***(1.54–3.75)2.68**(1.48–4.88)1.63(.76–3.46)
 At least weekly0.47(.15–1.53)0.84(.23–3.02)2.16(.48–9.80)2.32*(1.22–4.40)3.13**(1.44–6.83)4.48***(2.02–9.92)
Party frequencyf
 At least yearly1.95(.93–4.09)3.35*(1.25–8.96)10.30**(2.01–52.78)1.44(.95–2.18)2.28**(1.29–4.02)1.56(.80–3.06)
 At least monthly2.62*(1.03–6.65)4.52*(1.32–15.47)23.68***(4.34–129.34)1.81*(1.06–3.09)3.34**(1.60–7.00)2.51*(1.17–5.38)
 At least weekly4.24*(1.17–15.43)5.88*(1.09–31.65)12.01*(1.27–113.68)5.71***(2.05–15.89)16.18***(5.45–48.03)13.89***(4.78–40.33)
 Survey year (2020)g1.26(.66–2.38)0.33**(.17–.67)0.41*(0.18–.94)1.00(.74–1.35)0.78(.53–1.15)0.68(.42–1.09)
Men ages 18–29 (n = 598)Men ages 30 or older (n = 2761)
HEDa8-11 drinksa12+ drinksaHEDa8–11 drinksa12+ drinksa
RRR95% CIRRR95% CIRRR95% CIRRR95% CIRRR95% CIRRR95% CI
Age (continuous)0.90*(.82–1.00)0.91(.81–1.03)0.80**(0.69–.93)0.96***(.95–.97)0.95***(.93–.96)0.95***(.93–.96)
Educationb
 High school graduation0.27(.07–1.03)2.09(.21–2.87)0.55(.09–3.39)0.77(0.35–1.70)2.00(.67–5.92)0.47(.17–1.32)
 Some college0.33(.09–1.27)3.27(.35–3.74)0.74(.12–4.62)0.88(.40–1.90)1.58(.54–4.61)0.72(.26–1.94)
 4-year college degree+0.65(.16–2.60)5.25(.54–51.04)0.82(.12–5.73)0.58(.26–1.26)1.20(.41–3.48)0.22**(.08–.64)
 >Median incomec0.83(.42–1.61)0.72(0.35–1.49)1.18(.49–2.84)1.40(.99–1.96)1.38(.88–2.15)1.29(.77–2.16)
Race/ethnicityd
 Black1.06(.47–2.41)0.35*(0.13–.92)0.26*(.08–.80)0.58*(0.35–.96)0.43*(.20–.93)0.20***(.09–.46)
 Hispanic0.94(.44–1.99)0.27**(0.10–.71)0.15***(.05–.44)0.97(.64–1.47)0.58(0.34–1.01)0.43*(.22–.82)
 Asian/Pacific Islander0.93(0.35–2.47)0.41(0.14–1.21)0.12**(.02–.59)0.55(0.18–1.64)0.29*(0.10–.79)0.36(.09–1.47)
 AmInd/NatAm0.96(.08–11.83)0.22(.02–2.04)0.97(.08–12.34)0.10*(.01–.82)0.74(0.19–2.93)0.26(.01–6.93)
 Others2.91(.44–19.20)0.01***(.00–.14)0.00***(.00–.00)0.85(0.30–2.40)0.18(.03–1.25)0.34(.04–2.76)
 Married/cohabitatinge1.19(.63 - 2.24)2.29*(1.14–4.62)2.59*(1.05–6.36)0.68*(.49–.94)0.79(.49–1.25)0.85(.52–1.40)
Drinking to cope1.11(.81–1.51)1.18(.84–1.67)1.63*(1.04–2.57)1.44***(1.19–1.73)1.61***(1.27–2.04)2.17***(1.63–2.88)
Sensation seeking1.13(.99–1.29)1.24**(1.07–1.44)1.19*(1.01–1.42)0.99(.93–1.06)0.99(.90–1.09)1.08(.98–1.19)
Marijuana use days0.99(.99–1.00)0.99(.98–1.00)0.99(.98–1.00)0.99**(.99–1.00)1.00(.99–1.00)1.00(.99–1.00)
SACf
 Monthly or less2.16(.81–5.80)3.64*(1.22–1.85)13.37***(4.31–41.47)3.56***(1.93–6.57)3.17**(1.51–6.66)7.70***(3.55–16.71)
 Weekly to every 2–3 weeks3.69(.79–17.12)4.85(.59–4.01)11.97*(1.26–113.32)9.76***(2.74–34.69)4.62*(1.04–2.49)7.99**(1.76–36.18)
 (Nearly) everyday8.84e+06***(1.29e+06–6.06e+07)2.56e+07***(2.21e+06)6.18e+08***(6.85e+07)7.43*(1.16–47.51)8.56*(1.26–58.30)7.14(.59–86.58)
Bar use frequencyf
 At least yearly1.46(.70–3.07)0.75(.30–1.87)1.15(.31–4.20)1.60*(1.09–2.36)1.33(.79–2.27)1.17(.60–2.29)
 At least monthly3.18**(1.34–7.57)2.25(.79–6.37)9.86***(2.78–34.94)2.40***(1.54–3.75)2.68**(1.48–4.88)1.63(.76–3.46)
 At least weekly0.47(.15–1.53)0.84(.23–3.02)2.16(.48–9.80)2.32*(1.22–4.40)3.13**(1.44–6.83)4.48***(2.02–9.92)
Party frequencyf
 At least yearly1.95(.93–4.09)3.35*(1.25–8.96)10.30**(2.01–52.78)1.44(.95–2.18)2.28**(1.29–4.02)1.56(.80–3.06)
 At least monthly2.62*(1.03–6.65)4.52*(1.32–15.47)23.68***(4.34–129.34)1.81*(1.06–3.09)3.34**(1.60–7.00)2.51*(1.17–5.38)
 At least weekly4.24*(1.17–15.43)5.88*(1.09–31.65)12.01*(1.27–113.68)5.71***(2.05–15.89)16.18***(5.45–48.03)13.89***(4.78–40.33)
 Survey year (2020)g1.26(.66–2.38)0.33**(.17–.67)0.41*(0.18–.94)1.00(.74–1.35)0.78(.53–1.15)0.68(.42–1.09)

***P < .001, **P < .01, *P < .05

RRR: relative risk ratio, CI: confidence interval, SAC: Simultaneous use of alcohol and cannabis

aNo heavy episodic drinking (HED, 5–7 drinks for men) as reference category

bNo high school diploma as reference category

cMedian income or less as reference category

dWhite as reference category

eNever married/divorced/widowed as reference category

fNever as reference category

g2015 survey as reference category

Table 3 shows corresponding models for women. Drinking to cope and sensation-seeking were significantly associated with HID 8+ drinks for women in both age groups. All categories of SAC were significant for HID for women, with this relationship being dose–response for younger women. With some exceptions, bar drinking frequency had a dose–response relationship with HID for women, but only monthly partying was significant for HID for younger women, and ‘(nearly) everyday’ was for older women.

Table 3

Contextual factors associated with any heavy episodic and high-intensity drinking for adult female drinkers: multinomial logistic regression models

Women ages 18–29 (n = 863)Women ages 30+ (n = 3735)
HEDa8+ drinksaHEDa8+ drinksa
RRR95% CIRRR95% CIRRR95% CIRRR95% CI
Age (continuous)0.93(.85–1.01)0.99(.88–1.10)0.96***(.95–.97)0.95***(.93–.96)
Educationb
 High school graduation1.70(0.38–7.54)0.43(.12–1.46)0.63(.29–1.38)0.34*(.13–.92)
 Some college1.94(.45–8.25)0.48(.15–1.56)0.73(.34–1.55)0.38(.15–1.00)
 4-year college degree+2.11(.49–9.13)0.43(0.13–1.43)0.51(.24–1.09)0.16***(.06–.45)
 >Median incomec1.27(.73–2.22)1.44(.72–2.86)0.99(.75–1.31)0.71(.44–1.16)
Race/ethnicityd
 Black0.30**(.14–0.64)0.33**(.14–.76)0.54**(0.37–.79)0.28***(0.14–.53)
 Hispanic0.54*(0.31–.94)0.77(0.36–1.64)0.66*(.47–.92)0.74(.45–1.22)
 Asian/Pacific Islander1.02(0.38–2.74)0.32(.05–1.97)0.43*(.20–.93)0.82(0.32–2.09)
 AmInd/NatAm0.88(.10–8.04)0.50(.06–3.96)2.61*(1.25–5.44)1.34(0.36–5.06)
 Others0.89(0.16–4.81)1.51(.29–7.96)1.06(.28–4.06)1.32(.24–7.21)
Married/cohabitatinge1.14(.70 - 1.87)1.09(0.60–2.01)1.08(.83–1.41)1.62*(1.04–2.53)
Drinking to cope1.66***(1.26–2.20)1.91***(1.36–2.66)1.57***(1.35–1.83)1.54**(1.15–2.06)
Sensation seeking1.05(.94–1.18)1.18*(1.02–1.35)1.03(.98–1.09)1.16**(1.06–1.27)
Marijuana use days1.00(.99–1.00)1.00(.99–1.01)0.99**(.99–1.00)0.99(.99–1.00)
SACf1.84(.84 - 4.06)4.37***(1.88–10.16)4.61***(2.57–8.26)16.78***(6.86–41.02)
 Monthly or less2.91(.54–15.68)7.38*(1.59–34.29)3.10*(1.08–8.92)16.39***(3.30–81.38)
 Weekly to every 2–3 weeks6.02(.93–38.86)25.67***(4.31–152.69)8.62***(2.42–3.72)2.83**(2.92–148.36)
(Nearly) everyday
Bar use frequencyf
 At least yearly2.60**(1.40–4.80)1.83(.88–3.84)1.85***(1.37–2.49)2.35**(1.24–4.43)
 At least monthly4.29***(2.04–9.00)3.70**(1.62–8.41)3.39***(2.35–4.89)5.30***(2.64–10.67)
 At least weekly3.66*(1.27–1.53)6.93***(2.38–20.19)4.51***(2.32–8.79)32.06***(13.92–73.84)
Party frequencyf
 At least yearly1.79(.88–3.65)1.82(.82–4.08)2.07***(1.46–2.94)1.22(0.67–2.24)
 At least monthly2.53*(1.08–5.91)3.01*(1.19–7.60)3.20***(2.03–5.04)1.10(.50–2.42)
 At least weekly1.28(.21–8.00)4.16(0.60–28.67)1.33(0.38–4.62)1.87(.41–8.63)
Survey year (2020)g0.79(.46–1.36)0.92(.49–1.72)1.16(.90–1.51)0.79(.51–1.23)
Women ages 18–29 (n = 863)Women ages 30+ (n = 3735)
HEDa8+ drinksaHEDa8+ drinksa
RRR95% CIRRR95% CIRRR95% CIRRR95% CI
Age (continuous)0.93(.85–1.01)0.99(.88–1.10)0.96***(.95–.97)0.95***(.93–.96)
Educationb
 High school graduation1.70(0.38–7.54)0.43(.12–1.46)0.63(.29–1.38)0.34*(.13–.92)
 Some college1.94(.45–8.25)0.48(.15–1.56)0.73(.34–1.55)0.38(.15–1.00)
 4-year college degree+2.11(.49–9.13)0.43(0.13–1.43)0.51(.24–1.09)0.16***(.06–.45)
 >Median incomec1.27(.73–2.22)1.44(.72–2.86)0.99(.75–1.31)0.71(.44–1.16)
Race/ethnicityd
 Black0.30**(.14–0.64)0.33**(.14–.76)0.54**(0.37–.79)0.28***(0.14–.53)
 Hispanic0.54*(0.31–.94)0.77(0.36–1.64)0.66*(.47–.92)0.74(.45–1.22)
 Asian/Pacific Islander1.02(0.38–2.74)0.32(.05–1.97)0.43*(.20–.93)0.82(0.32–2.09)
 AmInd/NatAm0.88(.10–8.04)0.50(.06–3.96)2.61*(1.25–5.44)1.34(0.36–5.06)
 Others0.89(0.16–4.81)1.51(.29–7.96)1.06(.28–4.06)1.32(.24–7.21)
Married/cohabitatinge1.14(.70 - 1.87)1.09(0.60–2.01)1.08(.83–1.41)1.62*(1.04–2.53)
Drinking to cope1.66***(1.26–2.20)1.91***(1.36–2.66)1.57***(1.35–1.83)1.54**(1.15–2.06)
Sensation seeking1.05(.94–1.18)1.18*(1.02–1.35)1.03(.98–1.09)1.16**(1.06–1.27)
Marijuana use days1.00(.99–1.00)1.00(.99–1.01)0.99**(.99–1.00)0.99(.99–1.00)
SACf1.84(.84 - 4.06)4.37***(1.88–10.16)4.61***(2.57–8.26)16.78***(6.86–41.02)
 Monthly or less2.91(.54–15.68)7.38*(1.59–34.29)3.10*(1.08–8.92)16.39***(3.30–81.38)
 Weekly to every 2–3 weeks6.02(.93–38.86)25.67***(4.31–152.69)8.62***(2.42–3.72)2.83**(2.92–148.36)
(Nearly) everyday
Bar use frequencyf
 At least yearly2.60**(1.40–4.80)1.83(.88–3.84)1.85***(1.37–2.49)2.35**(1.24–4.43)
 At least monthly4.29***(2.04–9.00)3.70**(1.62–8.41)3.39***(2.35–4.89)5.30***(2.64–10.67)
 At least weekly3.66*(1.27–1.53)6.93***(2.38–20.19)4.51***(2.32–8.79)32.06***(13.92–73.84)
Party frequencyf
 At least yearly1.79(.88–3.65)1.82(.82–4.08)2.07***(1.46–2.94)1.22(0.67–2.24)
 At least monthly2.53*(1.08–5.91)3.01*(1.19–7.60)3.20***(2.03–5.04)1.10(.50–2.42)
 At least weekly1.28(.21–8.00)4.16(0.60–28.67)1.33(0.38–4.62)1.87(.41–8.63)
Survey year (2020)g0.79(.46–1.36)0.92(.49–1.72)1.16(.90–1.51)0.79(.51–1.23)

***P < .001, **P < .01, *P < .05

RRR = relative risk ratio, CI = confidence interval, SAC = Simultaneous use of alcohol and cannabis

aNo heavy episodic drinking (HED, 4–7 for women) as reference category;

bNo high school diploma as reference category

cMedian income or less as reference category

dWhite as reference category

eNever married/divorced/widowed as reference category

fNever as reference category

g2015 survey as reference category

Table 3

Contextual factors associated with any heavy episodic and high-intensity drinking for adult female drinkers: multinomial logistic regression models

Women ages 18–29 (n = 863)Women ages 30+ (n = 3735)
HEDa8+ drinksaHEDa8+ drinksa
RRR95% CIRRR95% CIRRR95% CIRRR95% CI
Age (continuous)0.93(.85–1.01)0.99(.88–1.10)0.96***(.95–.97)0.95***(.93–.96)
Educationb
 High school graduation1.70(0.38–7.54)0.43(.12–1.46)0.63(.29–1.38)0.34*(.13–.92)
 Some college1.94(.45–8.25)0.48(.15–1.56)0.73(.34–1.55)0.38(.15–1.00)
 4-year college degree+2.11(.49–9.13)0.43(0.13–1.43)0.51(.24–1.09)0.16***(.06–.45)
 >Median incomec1.27(.73–2.22)1.44(.72–2.86)0.99(.75–1.31)0.71(.44–1.16)
Race/ethnicityd
 Black0.30**(.14–0.64)0.33**(.14–.76)0.54**(0.37–.79)0.28***(0.14–.53)
 Hispanic0.54*(0.31–.94)0.77(0.36–1.64)0.66*(.47–.92)0.74(.45–1.22)
 Asian/Pacific Islander1.02(0.38–2.74)0.32(.05–1.97)0.43*(.20–.93)0.82(0.32–2.09)
 AmInd/NatAm0.88(.10–8.04)0.50(.06–3.96)2.61*(1.25–5.44)1.34(0.36–5.06)
 Others0.89(0.16–4.81)1.51(.29–7.96)1.06(.28–4.06)1.32(.24–7.21)
Married/cohabitatinge1.14(.70 - 1.87)1.09(0.60–2.01)1.08(.83–1.41)1.62*(1.04–2.53)
Drinking to cope1.66***(1.26–2.20)1.91***(1.36–2.66)1.57***(1.35–1.83)1.54**(1.15–2.06)
Sensation seeking1.05(.94–1.18)1.18*(1.02–1.35)1.03(.98–1.09)1.16**(1.06–1.27)
Marijuana use days1.00(.99–1.00)1.00(.99–1.01)0.99**(.99–1.00)0.99(.99–1.00)
SACf1.84(.84 - 4.06)4.37***(1.88–10.16)4.61***(2.57–8.26)16.78***(6.86–41.02)
 Monthly or less2.91(.54–15.68)7.38*(1.59–34.29)3.10*(1.08–8.92)16.39***(3.30–81.38)
 Weekly to every 2–3 weeks6.02(.93–38.86)25.67***(4.31–152.69)8.62***(2.42–3.72)2.83**(2.92–148.36)
(Nearly) everyday
Bar use frequencyf
 At least yearly2.60**(1.40–4.80)1.83(.88–3.84)1.85***(1.37–2.49)2.35**(1.24–4.43)
 At least monthly4.29***(2.04–9.00)3.70**(1.62–8.41)3.39***(2.35–4.89)5.30***(2.64–10.67)
 At least weekly3.66*(1.27–1.53)6.93***(2.38–20.19)4.51***(2.32–8.79)32.06***(13.92–73.84)
Party frequencyf
 At least yearly1.79(.88–3.65)1.82(.82–4.08)2.07***(1.46–2.94)1.22(0.67–2.24)
 At least monthly2.53*(1.08–5.91)3.01*(1.19–7.60)3.20***(2.03–5.04)1.10(.50–2.42)
 At least weekly1.28(.21–8.00)4.16(0.60–28.67)1.33(0.38–4.62)1.87(.41–8.63)
Survey year (2020)g0.79(.46–1.36)0.92(.49–1.72)1.16(.90–1.51)0.79(.51–1.23)
Women ages 18–29 (n = 863)Women ages 30+ (n = 3735)
HEDa8+ drinksaHEDa8+ drinksa
RRR95% CIRRR95% CIRRR95% CIRRR95% CI
Age (continuous)0.93(.85–1.01)0.99(.88–1.10)0.96***(.95–.97)0.95***(.93–.96)
Educationb
 High school graduation1.70(0.38–7.54)0.43(.12–1.46)0.63(.29–1.38)0.34*(.13–.92)
 Some college1.94(.45–8.25)0.48(.15–1.56)0.73(.34–1.55)0.38(.15–1.00)
 4-year college degree+2.11(.49–9.13)0.43(0.13–1.43)0.51(.24–1.09)0.16***(.06–.45)
 >Median incomec1.27(.73–2.22)1.44(.72–2.86)0.99(.75–1.31)0.71(.44–1.16)
Race/ethnicityd
 Black0.30**(.14–0.64)0.33**(.14–.76)0.54**(0.37–.79)0.28***(0.14–.53)
 Hispanic0.54*(0.31–.94)0.77(0.36–1.64)0.66*(.47–.92)0.74(.45–1.22)
 Asian/Pacific Islander1.02(0.38–2.74)0.32(.05–1.97)0.43*(.20–.93)0.82(0.32–2.09)
 AmInd/NatAm0.88(.10–8.04)0.50(.06–3.96)2.61*(1.25–5.44)1.34(0.36–5.06)
 Others0.89(0.16–4.81)1.51(.29–7.96)1.06(.28–4.06)1.32(.24–7.21)
Married/cohabitatinge1.14(.70 - 1.87)1.09(0.60–2.01)1.08(.83–1.41)1.62*(1.04–2.53)
Drinking to cope1.66***(1.26–2.20)1.91***(1.36–2.66)1.57***(1.35–1.83)1.54**(1.15–2.06)
Sensation seeking1.05(.94–1.18)1.18*(1.02–1.35)1.03(.98–1.09)1.16**(1.06–1.27)
Marijuana use days1.00(.99–1.00)1.00(.99–1.01)0.99**(.99–1.00)0.99(.99–1.00)
SACf1.84(.84 - 4.06)4.37***(1.88–10.16)4.61***(2.57–8.26)16.78***(6.86–41.02)
 Monthly or less2.91(.54–15.68)7.38*(1.59–34.29)3.10*(1.08–8.92)16.39***(3.30–81.38)
 Weekly to every 2–3 weeks6.02(.93–38.86)25.67***(4.31–152.69)8.62***(2.42–3.72)2.83**(2.92–148.36)
(Nearly) everyday
Bar use frequencyf
 At least yearly2.60**(1.40–4.80)1.83(.88–3.84)1.85***(1.37–2.49)2.35**(1.24–4.43)
 At least monthly4.29***(2.04–9.00)3.70**(1.62–8.41)3.39***(2.35–4.89)5.30***(2.64–10.67)
 At least weekly3.66*(1.27–1.53)6.93***(2.38–20.19)4.51***(2.32–8.79)32.06***(13.92–73.84)
Party frequencyf
 At least yearly1.79(.88–3.65)1.82(.82–4.08)2.07***(1.46–2.94)1.22(0.67–2.24)
 At least monthly2.53*(1.08–5.91)3.01*(1.19–7.60)3.20***(2.03–5.04)1.10(.50–2.42)
 At least weekly1.28(.21–8.00)4.16(0.60–28.67)1.33(0.38–4.62)1.87(.41–8.63)
Survey year (2020)g0.79(.46–1.36)0.92(.49–1.72)1.16(.90–1.51)0.79(.51–1.23)

***P < .001, **P < .01, *P < .05

RRR = relative risk ratio, CI = confidence interval, SAC = Simultaneous use of alcohol and cannabis

aNo heavy episodic drinking (HED, 4–7 for women) as reference category;

bNo high school diploma as reference category

cMedian income or less as reference category

dWhite as reference category

eNever married/divorced/widowed as reference category

fNever as reference category

g2015 survey as reference category

We performed another set of regressions using HED as the reference group to understand whether there are risk factors unique to HID (Appendix 1A-1C). These models yielded fewer significant associations than did those using no HED as reference. For example, for men in both age groups, there were no significant associations between contextual factors and HID 8–11 drinks. Still, patterns of significant associations were similar between the two sets of models. SAC frequencies—'at least monthly’ (RRR = 6.18, P < .001) and ‘(nearly) everyday’ (RRR = 69.87, P < .01) for younger men and “at least monthly” (RRR = 5.29, P < .05) for older men—were significantly associated with HID 12+ drinks. Additionally, party drinking frequencies—'at least yearly’ (RRR = 5.29, P < .05) and ‘at least monthly’ (RRR = 9.03, P < .05)—were also significant for younger men, and drinking to cope (RRR = 1.51, P < .001) was for older men. For women, only ‘at least monthly’ SAC was associated with HID 8+ drinks for younger women. Sensation-seeking (RRR = 1.13, P < .05), at least monthly (RRR = 3.64, P < .001) and weekly to every 2–3 week SAC (RRR = 5.29, P < .05), and at least weekly drinking at a bar (RRR = 7.10, P < .001) were positively, and at least monthly drinking at a bar (RRR = .34, P < .001) was negatively, associated with HID for older women.

Table 4 presents linear regression models with HID frequencies as the outcomes. For younger men, drinking to cope and sensation-seeking were positively associated with frequent HID 8–11 drinks; for older men, only drinking to cope was significant for frequencies of the two HID levels. With some exceptions, SAC frequency mostly had a dose-relationship with HID for both men and women. Older men and women showed positive associations between bar drinking frequency and HID frequency more consistently than their younger counterparts, with the risk of frequent HID being the highest for ‘(nearly) everyday’ bar drinking. Party drinking, on the other hand, had a more consistent dose–response relationship with frequent HID for younger men than for older men. Only one category of partying (‘at least monthly’) was significant for young adult women.

Table 4

Contextual factors associated with frequencies of high-intensity drinking for adult drinkers: linear regression models

Men ages 18–29 (n = 615)Men ages 30 or older (n = 2832)Women ages 18–29 (n = 894)Women ages 30+ (n = 3861)
8–11 drinks12+ drinks8–11 drinks12+ drinks8+ drinks8+ drinks
bSEbSEbSEbSEbSEbSE
Age−.02(.02)−.04*(.02)−.01***(.00)−.00***(.00)0.01(.02)−.00**(.00)
Educationa
 High school graduation0.20(.42)−.17(0.39)−.01(.18)−.27(.16)−1.27*(.49)0.01(0.14)
 4-year college degree+0.24(.41)−0.32(0.38)−.15(0.17)−.29(.16)−1.37**(.49)−.13(.14)
 > Median incomeb−.03(0.16)0.06(0.13)0.02(.07)−.07(.05)0.08(0.13)−.01(.04)
Race/ethnicityc
 Black−.49**(.16)−0.12(0.15)−.21*(.10)−.16**(.06)−.03(.13)−.03(.06)
 Hispanic−0.65***(.16)−.29*(.13)−.21**(.08)−0.14*(.06)0.05(0.15)0.00(.04)
 Asian/Pacific Islander−.48*(.23)−.26(.16)−.30**(.09)−0.13*(.06)−.32(.20)−.01(.05)
 AmInd/NatAm−0.39(.40)0.01(.26)0.15(0.35)−.16(.17)−.14(.25)−.24(.14)
 Others−1.08**(.36)−0.36(.19)−.37***(0.10)−.12(.09)0.36(0.39)0.05(0.17)
Married/cohabitatingd0.37*(.17)0.14(0.13)−.05(.07)0.00(.06)0.04(0.12)0.03(.04)
Drinking to cope0.19*(.08)0.09(.07)0.23***(.05)0.15***(.04)0.18*(.08)0.05(.03)
Sensation seeking0.08**(.03)0.03(.02)0.00(.01)0.01(.01)0.04(.03)0.01(.01)
Marijuana use days−.00**(.00)−.00(.00)−.00(.00)−.00(.00)0.00(.00)−.00(.00)
SACe
 Monthly or less0.74***(0.19)0.72**(.22)0.57**(.18)0.30*(0.14)0.35(0.19)0.59***(0.17)
 Weekly to every 2–3 weeks0.90*(.40)0.58(0.31)0.76*(0.31)0.34(.24)1.19**(0.37)0.52(0.31)
 (Nearly) everyday1.77***(0.39)2.08***(.40)1.29**(.48)0.73(.49)2.39***(0.67)0.89*(.40)
Bar use frequencye
 At least yearly−0.12(0.18)−.04(.11)−.01(.07)−.01(.04)−.07(0.10)0.03(.03)
 At least monthly0.22(.22)0.33*(0.16)0.10(0.11)−.02(.08)0.15(0.16)0.14*(.05)
 At least weekly0.40(.28)0.41(.27)0.65***(0.18)0.38**(0.14)0.42(.28)0.97***(.25)
Party frequencye
 At least yearly0.52***(0.15)0.28*(0.12)0.08(.07)−.02(.05)0.10(.09)−.04(.04)
 At least monthly0.76***(.21)0.39**(0.14)0.34*(0.14)0.14(0.11)0.35*(0.15)−.00(.07)
 At least weekly0.82*(0.33)0.28(.29)1.60***(0.30)0.80*(0.32)1.17(0.62)0.53(0.38)
Survey year (2020)f−.48**(.15)−0.13(.11)−.03(.06)0.02(.05)−.10(.11)0.01(.03)
R-squared0.280.220.230.150.340.17
Men ages 18–29 (n = 615)Men ages 30 or older (n = 2832)Women ages 18–29 (n = 894)Women ages 30+ (n = 3861)
8–11 drinks12+ drinks8–11 drinks12+ drinks8+ drinks8+ drinks
bSEbSEbSEbSEbSEbSE
Age−.02(.02)−.04*(.02)−.01***(.00)−.00***(.00)0.01(.02)−.00**(.00)
Educationa
 High school graduation0.20(.42)−.17(0.39)−.01(.18)−.27(.16)−1.27*(.49)0.01(0.14)
 4-year college degree+0.24(.41)−0.32(0.38)−.15(0.17)−.29(.16)−1.37**(.49)−.13(.14)
 > Median incomeb−.03(0.16)0.06(0.13)0.02(.07)−.07(.05)0.08(0.13)−.01(.04)
Race/ethnicityc
 Black−.49**(.16)−0.12(0.15)−.21*(.10)−.16**(.06)−.03(.13)−.03(.06)
 Hispanic−0.65***(.16)−.29*(.13)−.21**(.08)−0.14*(.06)0.05(0.15)0.00(.04)
 Asian/Pacific Islander−.48*(.23)−.26(.16)−.30**(.09)−0.13*(.06)−.32(.20)−.01(.05)
 AmInd/NatAm−0.39(.40)0.01(.26)0.15(0.35)−.16(.17)−.14(.25)−.24(.14)
 Others−1.08**(.36)−0.36(.19)−.37***(0.10)−.12(.09)0.36(0.39)0.05(0.17)
Married/cohabitatingd0.37*(.17)0.14(0.13)−.05(.07)0.00(.06)0.04(0.12)0.03(.04)
Drinking to cope0.19*(.08)0.09(.07)0.23***(.05)0.15***(.04)0.18*(.08)0.05(.03)
Sensation seeking0.08**(.03)0.03(.02)0.00(.01)0.01(.01)0.04(.03)0.01(.01)
Marijuana use days−.00**(.00)−.00(.00)−.00(.00)−.00(.00)0.00(.00)−.00(.00)
SACe
 Monthly or less0.74***(0.19)0.72**(.22)0.57**(.18)0.30*(0.14)0.35(0.19)0.59***(0.17)
 Weekly to every 2–3 weeks0.90*(.40)0.58(0.31)0.76*(0.31)0.34(.24)1.19**(0.37)0.52(0.31)
 (Nearly) everyday1.77***(0.39)2.08***(.40)1.29**(.48)0.73(.49)2.39***(0.67)0.89*(.40)
Bar use frequencye
 At least yearly−0.12(0.18)−.04(.11)−.01(.07)−.01(.04)−.07(0.10)0.03(.03)
 At least monthly0.22(.22)0.33*(0.16)0.10(0.11)−.02(.08)0.15(0.16)0.14*(.05)
 At least weekly0.40(.28)0.41(.27)0.65***(0.18)0.38**(0.14)0.42(.28)0.97***(.25)
Party frequencye
 At least yearly0.52***(0.15)0.28*(0.12)0.08(.07)−.02(.05)0.10(.09)−.04(.04)
 At least monthly0.76***(.21)0.39**(0.14)0.34*(0.14)0.14(0.11)0.35*(0.15)−.00(.07)
 At least weekly0.82*(0.33)0.28(.29)1.60***(0.30)0.80*(0.32)1.17(0.62)0.53(0.38)
Survey year (2020)f−.48**(.15)−0.13(.11)−.03(.06)0.02(.05)−.10(.11)0.01(.03)
R-squared0.280.220.230.150.340.17

***P < .001, **P < .01, *P < .05

RRR = relative risk ratio, CI = confidence interval, SAC = Simultaneous use of alcohol and cannabis

aNo high school diploma as reference category

bMedian income or less as reference category

cWhite as reference category

dNever married/divorced/widowed as reference

eNever as reference category

f2015 survey as reference category

Table 4

Contextual factors associated with frequencies of high-intensity drinking for adult drinkers: linear regression models

Men ages 18–29 (n = 615)Men ages 30 or older (n = 2832)Women ages 18–29 (n = 894)Women ages 30+ (n = 3861)
8–11 drinks12+ drinks8–11 drinks12+ drinks8+ drinks8+ drinks
bSEbSEbSEbSEbSEbSE
Age−.02(.02)−.04*(.02)−.01***(.00)−.00***(.00)0.01(.02)−.00**(.00)
Educationa
 High school graduation0.20(.42)−.17(0.39)−.01(.18)−.27(.16)−1.27*(.49)0.01(0.14)
 4-year college degree+0.24(.41)−0.32(0.38)−.15(0.17)−.29(.16)−1.37**(.49)−.13(.14)
 > Median incomeb−.03(0.16)0.06(0.13)0.02(.07)−.07(.05)0.08(0.13)−.01(.04)
Race/ethnicityc
 Black−.49**(.16)−0.12(0.15)−.21*(.10)−.16**(.06)−.03(.13)−.03(.06)
 Hispanic−0.65***(.16)−.29*(.13)−.21**(.08)−0.14*(.06)0.05(0.15)0.00(.04)
 Asian/Pacific Islander−.48*(.23)−.26(.16)−.30**(.09)−0.13*(.06)−.32(.20)−.01(.05)
 AmInd/NatAm−0.39(.40)0.01(.26)0.15(0.35)−.16(.17)−.14(.25)−.24(.14)
 Others−1.08**(.36)−0.36(.19)−.37***(0.10)−.12(.09)0.36(0.39)0.05(0.17)
Married/cohabitatingd0.37*(.17)0.14(0.13)−.05(.07)0.00(.06)0.04(0.12)0.03(.04)
Drinking to cope0.19*(.08)0.09(.07)0.23***(.05)0.15***(.04)0.18*(.08)0.05(.03)
Sensation seeking0.08**(.03)0.03(.02)0.00(.01)0.01(.01)0.04(.03)0.01(.01)
Marijuana use days−.00**(.00)−.00(.00)−.00(.00)−.00(.00)0.00(.00)−.00(.00)
SACe
 Monthly or less0.74***(0.19)0.72**(.22)0.57**(.18)0.30*(0.14)0.35(0.19)0.59***(0.17)
 Weekly to every 2–3 weeks0.90*(.40)0.58(0.31)0.76*(0.31)0.34(.24)1.19**(0.37)0.52(0.31)
 (Nearly) everyday1.77***(0.39)2.08***(.40)1.29**(.48)0.73(.49)2.39***(0.67)0.89*(.40)
Bar use frequencye
 At least yearly−0.12(0.18)−.04(.11)−.01(.07)−.01(.04)−.07(0.10)0.03(.03)
 At least monthly0.22(.22)0.33*(0.16)0.10(0.11)−.02(.08)0.15(0.16)0.14*(.05)
 At least weekly0.40(.28)0.41(.27)0.65***(0.18)0.38**(0.14)0.42(.28)0.97***(.25)
Party frequencye
 At least yearly0.52***(0.15)0.28*(0.12)0.08(.07)−.02(.05)0.10(.09)−.04(.04)
 At least monthly0.76***(.21)0.39**(0.14)0.34*(0.14)0.14(0.11)0.35*(0.15)−.00(.07)
 At least weekly0.82*(0.33)0.28(.29)1.60***(0.30)0.80*(0.32)1.17(0.62)0.53(0.38)
Survey year (2020)f−.48**(.15)−0.13(.11)−.03(.06)0.02(.05)−.10(.11)0.01(.03)
R-squared0.280.220.230.150.340.17
Men ages 18–29 (n = 615)Men ages 30 or older (n = 2832)Women ages 18–29 (n = 894)Women ages 30+ (n = 3861)
8–11 drinks12+ drinks8–11 drinks12+ drinks8+ drinks8+ drinks
bSEbSEbSEbSEbSEbSE
Age−.02(.02)−.04*(.02)−.01***(.00)−.00***(.00)0.01(.02)−.00**(.00)
Educationa
 High school graduation0.20(.42)−.17(0.39)−.01(.18)−.27(.16)−1.27*(.49)0.01(0.14)
 4-year college degree+0.24(.41)−0.32(0.38)−.15(0.17)−.29(.16)−1.37**(.49)−.13(.14)
 > Median incomeb−.03(0.16)0.06(0.13)0.02(.07)−.07(.05)0.08(0.13)−.01(.04)
Race/ethnicityc
 Black−.49**(.16)−0.12(0.15)−.21*(.10)−.16**(.06)−.03(.13)−.03(.06)
 Hispanic−0.65***(.16)−.29*(.13)−.21**(.08)−0.14*(.06)0.05(0.15)0.00(.04)
 Asian/Pacific Islander−.48*(.23)−.26(.16)−.30**(.09)−0.13*(.06)−.32(.20)−.01(.05)
 AmInd/NatAm−0.39(.40)0.01(.26)0.15(0.35)−.16(.17)−.14(.25)−.24(.14)
 Others−1.08**(.36)−0.36(.19)−.37***(0.10)−.12(.09)0.36(0.39)0.05(0.17)
Married/cohabitatingd0.37*(.17)0.14(0.13)−.05(.07)0.00(.06)0.04(0.12)0.03(.04)
Drinking to cope0.19*(.08)0.09(.07)0.23***(.05)0.15***(.04)0.18*(.08)0.05(.03)
Sensation seeking0.08**(.03)0.03(.02)0.00(.01)0.01(.01)0.04(.03)0.01(.01)
Marijuana use days−.00**(.00)−.00(.00)−.00(.00)−.00(.00)0.00(.00)−.00(.00)
SACe
 Monthly or less0.74***(0.19)0.72**(.22)0.57**(.18)0.30*(0.14)0.35(0.19)0.59***(0.17)
 Weekly to every 2–3 weeks0.90*(.40)0.58(0.31)0.76*(0.31)0.34(.24)1.19**(0.37)0.52(0.31)
 (Nearly) everyday1.77***(0.39)2.08***(.40)1.29**(.48)0.73(.49)2.39***(0.67)0.89*(.40)
Bar use frequencye
 At least yearly−0.12(0.18)−.04(.11)−.01(.07)−.01(.04)−.07(0.10)0.03(.03)
 At least monthly0.22(.22)0.33*(0.16)0.10(0.11)−.02(.08)0.15(0.16)0.14*(.05)
 At least weekly0.40(.28)0.41(.27)0.65***(0.18)0.38**(0.14)0.42(.28)0.97***(.25)
Party frequencye
 At least yearly0.52***(0.15)0.28*(0.12)0.08(.07)−.02(.05)0.10(.09)−.04(.04)
 At least monthly0.76***(.21)0.39**(0.14)0.34*(0.14)0.14(0.11)0.35*(0.15)−.00(.07)
 At least weekly0.82*(0.33)0.28(.29)1.60***(0.30)0.80*(0.32)1.17(0.62)0.53(0.38)
Survey year (2020)f−.48**(.15)−0.13(.11)−.03(.06)0.02(.05)−.10(.11)0.01(.03)
R-squared0.280.220.230.150.340.17

***P < .001, **P < .01, *P < .05

RRR = relative risk ratio, CI = confidence interval, SAC = Simultaneous use of alcohol and cannabis

aNo high school diploma as reference category

bMedian income or less as reference category

cWhite as reference category

dNever married/divorced/widowed as reference

eNever as reference category

f2015 survey as reference category

Discussion

This study is the first one, to our knowledge, to examine the associations of potential risk factors with HID among US adult population sample, comparing them across sex and age groups. Overall, patterns of association between concurrent risk factors and HID were similar across subgroups, with no HED as referent. Among men, the most notable differences between younger (under 30) and older (30+) groups involved sensation-seeking and drinking to cope. For younger men, sensation-seeking was significantly associated with HID at both levels and frequency of HID 8–11 drinks, while drinking to cope was significant only for HID 12+ drinks. For older men, in contrast, drinking to cope was a consistent predictor for both HID level and its frequency, while sensation-seeking was not significant. Among women, both drinking to cope and sensation-seeking were significantly associated with any HID, while drinking to cope was significant for HID frequency for younger women.

With HED as referent, fewer significant associations were found, although patterns of significant associations, where observed, were similar to those from models with no HED as referent. Notably, no significant associations were found for HID 8–11 drinks for younger men with HED as referent. These results suggest that the risk factors for HED may operate similarly for HID among adults, particularly for younger men.

Past research using college or young adult samples is mixed on the relationship between coping motives and HID. While some studies reported positive associations between coping motives and HID (White et al. 2016; Patrick et al. 2017a), another found the former not associated with HID but only with negative alcohol consequences (e.g. having a hangover, becoming aggressive)(Patrick and Terry-McElrath 2021). Additionally, the association between coping motives and HID was found to decrease with age among young adults ages 18–26 in a prior study (Patrick et al. 2017a); our results, on the contrary, suggest that coping motives continues to play a significant role in HID beyond young adulthood, among both men and women. These results point to the need to prioritize coping motives in HID interventions for all adults, especially given research suggesting long-term health harms (e.g. persistent AUD) associated with drinking to cope (Crum et al. 2013).

Sensation-seeking was significant for HID for all subgroups except older men and for the frequency of HID 8–11 drinks for younger men. The lack of a significant association for older men is somewhat consistent with a prior study reporting such null results for adults older than 21, as opposed to a significant association for underage persons (Bonar et al. 2022). Sensation-seeking may not provide a strong motivation to drink at an extremely high level for older men, for whom HID may not be an externalizing behavior but an internalizing one to cope with stress.

The positive associations of SAC frequency with HID and its frequency that were found across age and sex are consistent with past findings that simultaneous use of cannabis was associated with increased frequency and quantity of drinking in adults (Subbaraman and Kerr 2015; Yurasek et al. 2017). An important focus of recent research on SAC has been on whether alcohol and cannabis substitute or complement each other, with stronger support for substitution than complementarity. A review found different effects in different populations and across different study designs, although most studies reported substitution (Risso et al. 2020). A more recent review on complementarity/substitution, on the other hand, found younger adults more likely to complement in medical cannabis use (Gunn et al. 2022), but further information is scarce. The consistent, and mostly dose–response relationships between SAC frequency and HID for both men and women we found also appear to support the complementarity thesis. Future research might clarify the role cannabis plays in HID (or vice versa) and how the relationship varies across demographic subgroups.

Consistent with past research (Cox et al. 2022), our study found that frequent drinking at bars and parties where others are also intoxicated tended to be associated with HID in adults. Bar drinking frequency appears to be more consistently associated with HID for older men and women than their younger counterparts, given the larger number of significant associations for the former than for the latter. Some null results here for younger men and women here may be partly attributed to underage drinkers’ being less likely to drink at bars due to minimum legal drinking age of 21. Party drinking was more consistently associated with HID and its frequency for men than for women. Understanding the social contexts and drinking locations by sex among adults ages 30+ and the mechanisms at play to facilitate HID for them could be informative for tailoring interventions.

We acknowledge the following study limitations. First, the cross-sectional design of the current study precludes from determining the directionality of the relationships between the contextual factors and HID. Second, due to the limited information in our data, we were able to consider only one type of drinking motives, coping. That it is based upon a single item is a limitation, as is our inability to examine four factor model of drinking motives (also including enhancement, social, and conformity) in relation to HID. Still, the consistent associations between drinking to cope and HID and its frequencies for most subgroups demonstrate the significant role drinking to cope may play in adult HID. Third, due to the lack of information in our data, we were unable to consider other potential risk factors for HID identified in the literature (e.g. size and gender composition of drinking group, having close relationships with other drinkers, presence of heavy drinkers, experiencing intense affective states) (Merrill et al. 2021; Cox et al. 2022). Fourth, low statistical power prevents formal tests of age interactions with contextual factors. Lastly, the lack of information about whether HID took place in the particular contexts we considered is a limitation. Still, contextual patterns associated with HID might be more stable for adults, and this study is intended to identify such patterns.

Despite these limitations, this study is one of the few to examine HID risk factors for mid-to-older adults and can guide future HID research. Using a nationally-representative sample of US adults, this study identified contextual factors (including drinking locations, drinking to cope, and simultaneous use of cannabis) and a personality trait (sensation-seeking) associated with HID for each age and sex subgroup. Our nuanced findings, which includes commonalities across age and sex, as well as the key difference between older men and other subgroups (most notably, the lack of a significant association between HID and sensation-seeking for the former), uniquely contribute to the literature. In calling attention to HID among adults and identifying its risk factors, this study has the potential to promote efforts to better understand HID and address this important public health problem.

Acknowledgements

Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number P50AA005595. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author contributions

Won Cook (Conceptualization [equal], Formal Analysis [lead], Funding acquisition [supporting], Investigation [lead], Methodology [lead], Writing—original draft [lead], Writing—review & editing [lead]), Camillia Lui (Conceptualization [equal], Data curation [supporting], Formal Analysis [supporting], Funding acquisition [supporting], Investigation [supporting], Methodology [supporting], Writing—review & editing [supporting]), Thomas Greenfield (Conceptualization [equal], Data curation [supporting], Funding acquisition [supporting], Investigation [supporting], Methodology [supporting], Writing—review & editing [supporting]), Meenakshi Subbaraman (Conceptualization [supporting], Funding acquisition [supporting], Methodology [supporting], Writing—review & editing [supporting]), Libo Li (Formal Analysis [supporting], Methodology [supporting], Writing—review & editing [supporting]), WILLIAM KERR (Conceptualization [supporting], Data curation [lead], Funding acquisition [lead], Investigation [supporting], Methodology [supporting], Writing—review & editing [supporting].

Data availability

The data underlying this article are from the 2015 and 2020 National Alcohol Surveys (NASs). Deidentified 2015 NAS data are available at https://arg.org/resources-tools/databases/#NAS. The 2020 NAS data will be made available at the same location in October 2026. Consistent with Alcohol Research Group’s resource sharing plan per NIH funding, de-identified NAS datasets are made publicly available after the completion of the project and fulfillment of study aims.

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