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This study aims to assess the association of cigarette smoking, including e-cigarette use, with level of binge drinking, especially high-intensity and extreme high-intensity binge drinking, among a nationally representative sample of middle-aged US adults.    METHODS  Data were derived from the 2017 Behavioral Risk Factor Surveillance System (BRFSS). The final sample consisted of 162748 respondents aged 40–64 years (48.7% male). Weighted distributions of sample characteristics were estimated by intensity of binge drinking. Pearson chi-squared tests were used to compare groups. Bivariate and multivariate logistic regressions were used to estimate crude and adjusted odds ratios to indicate the strength of the association between independent variables and each level of binge drinking.    RESULTS  In all, 2.3% and 0.7% of the sample reported high-intensity and extreme high-intensity binge drinking, respectively. Past-month high-intensity and extreme high-intensity binge drinking were reported in 36.3% and 45.0% of smokers, respectively. Mental distress was positively associated with both levels of high-intensity binge drinking; having multiple chronic health conditions was negatively associated with past-month high-intensity binge drinking. Smokers had 3.27 (95% CI: 2.69–3.98) and 4.14 (95% CI: 3.12–5.49) times greater odds of reporting past-month high-intensity and extreme high-intensity binge drinking, respectively. E-cigarette users had 1.56 (95% CI: 1.01–2.42) times increased odds of reporting past-month high-intensity binge drinking, but not extreme high-intensity binge drinking. The largest odds were seen among dual users reporting extreme high-intensity binge drinking (AOR=6.05; 95% CI: 3.78–9.68) in the past month.    CONCLUSIONS  Cigarette smoking and e-cigarette use were potentially strong risk factors for high-intensity binge drinking, with cigarette smoking associated with extreme high-intensity binge drinking.

tobacco induced diseases

High-intensity binge drinking is associated with cigarette smoking and e-cigarette use among US adults aged 40–64 years: Findings from the 2017 BRFSS survey