| Considerable attention has been
paid to heavy episodic or "binge" drinking
among college youth in the United States. Despite
widespread use, the binge measure is perceived
by some as a low intervention threshold. We use
data from the Harvard School of Public Health
College Alcohol Study (n = 49,163) to describe
patterns of consumption and harms along a continuum
including the binge measure to demonstrate the
validity of the binge threshold and prevention
paradox in college. While the heaviest drinkers
are at greatest risk for harm, they are relatively
few and generate proportionately small amounts
of all drinking-harms. The risk of harms is not
zero among lower level drinkers in college. Because
they are numerous, they account for the majority
of harms. This paradoxical pattern suggests we
moderate consumption among the majority using
environmental approaches, the efficacy of which
are described using case study data from a national
prevention demonstration. Implications for prevention
policy, programming, and media advocacy are discussed.
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