RESEARCH ARTICLE Intensity of Binge Drinking a Decade After the September 11th Terror Attacks Among Exposed Individuals Alice E. Welch, DrPH, MPH, RPh, Kimberly Caramanica Zweig, MPH, Jonathan M. McAteer, MPH, Robert M. Brackbill, PhD, MPH Introduction: The 9/11 terrorist attacks on the World Trade Center resulted in elevated post- traumatic stress disorder (PTSD) and alcohol use among exposed individuals. The relationship among traumatic exposure, PTSD, and excessive drinking is well documented; however, little is known about these relationships in the long term. This study examines factors increasing binge drinking risk among exposed individuals a decade post-9/11. Methods: In 2015–2016, data were analyzed from 28,592 World Trade Center Health Registry enrollees aged Z18 years who completed the Wave 3 (2011–2012) survey. Women comprised 38.9% of participants. Binge drinking in the last 30 days was categorized as low (men, five to seven drinks; women, four to six drinks) or high intensity (men, eight or more drinks; women, seven or more drinks). Probable 9/11-related PTSD was defined as scoring Z44 on the PTSD Checklist. Exposures to 9/11 (e.g., witnessing horror, sustaining an injury) were categorized as none/low (zero to two) or high (three or more). Results: Binge drinking was reported by 24.7% of participants, of whom 36.9% reported high- intensity binge drinking. Compared with non-binge drinkers, the odds of low- and high-intensity binge drinking were greater among enrollees who were male, aged 18–34 years, non-Hispanic white, had income 4$75,000, were rescue/recovery workers, had high 9/11 exposure, or 9/11-related PTSD. Conclusions: The observed associations among traumatic exposure, PTSD, and excessive drinking underscore the need for improved therapies addressing excessive drinking and PTSD concurrently, inclusion of repeated post-event screening for excessive drinking, and evidence-based population- level interventions to reduce alcohol consumption. Am J Prev Med 2017;52(2):192–198. & 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved. INTRODUCTION E xcessive alcohol use, including binge drinking, is associated with multiple adverse health outcomes as well as social problems. 1–3 In 2010, the prev- alence of binge drinking (five or more [for men] or four or more [for women] drinks on a single occasion) among adults aged Z18 years in the U.S. was 17.1%, with an average frequency of four episodes per month and average intensity of 7.9 drinks per occasion. 3 In New York City (NYC), the prevalence of binge drinking (17.9%) is similar to the U.S. population 4 with an average intensity of 5.2 drinks among low-intensity binge drinkers and 11.1 drinks among high-intensity binge drinkers (unpublished data). Binge drinking is strongly associated with alcohol poisoning and alcohol-related mortality 5 and is typically observed among men, adults aged 18–24 years, non-Hispanic whites, 3,6 and individu- als reporting binge drinking five or more times in the last From the Division of Epidemiology, New York City Department of Health and Mental Hygiene, Queens, New York Address correspondence to: Alice E. Welch, DrPH, MPH, RPh, NYC Department of Health and Mental Hygiene, 42-09 28 Street, 17-63, Queens NY 11101. E-mail: awelch1@health.nyc.gov. 0749-3797/$36.00 http://dx.doi.org/10.1016/j.amepre.2016.10.034 192 Am J Prev Med 2017;52(2):192–198 & 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.