Gender and alcohol use: the roles of social support, chronic illness, and psychological well-being

Clarifying the neurobehavioral sequelae of moderate drinking lifestyles and acute alcohol effects with aging

Epidemiological estimates indicate not only an increase in the proportion of older adults, but also an increase in those who continue moderate alcohol consumption. Substantial literatures have attempted to characterize health benefits/risks of moderate drinking lifestyles. Not uncommonly, reports address outcomes in a single outcome, such as cardiovascular function or cognitive decline, rather than providing a broader overview of systems. In this narrative review, retaining focus on neurobiological considerations, we summarize key findings regarding moderate drinking and three health domains, cardiovascular health, Type 2 diabetes (T2D), and cognition. Interestingly, few investigators have studied bouts of low/moderate doses of alcohol consumption, a pattern consistent with moderate drinking lifestyles. Here, we address both moderate drinking as a lifestyle and as an acute event. Review of health-related correlates illustrates continuing inconsistencies. Although substantive reductions in risk for cardiovascular and T2D events are reported, robust conclusions remain elusive. Similarly, whereas moderate drinking is often associated with enhanced cognition and lower dementia risk, few benefits are noted in rates of decline or alterations in brain structure. The effect of sex/gender varies across health domains and by consumption levels. For example, women appear to differentially benefit from alcohol use in terms of T2D, but experience greater risk when considering aspects of cardiovascular function. Finally, we observe that socially relevant alcohol doses do not consistently impair performance in older adults. Rather, older drinkers demonstrate divergent, but not necessarily detrimental, patterns in neural activation and some behavioral measures relative to younger drinkers. Taken together, the epidemiological and laboratory studies reinforce the need for greater attention to key individual differences and for the conduct of systematic studies sensitive to age-related shifts in neurobiological systems.

The relationship between alcohol use and anxiety and retrospective attendance of primary care visits among women with human immunodeficiency virus

In this retrospective study, we sought to determine the associations between alcohol use and anxiety and RIC among WHIV. Alcohol use was assessed using the Timeline Follow-back to measure use over the 90 days preceding the interview. Anxiety symptoms scores, assessed with the Hospital Anxiety and Depression Scale- Anxiety Subscale (HADS-A). Primary care visits over twelve months prior to the interview were collected from clinic registration records. We used three logistic mixed models, adjusting for age, race, education, cocaine use, depression, viral load, and antiretroviral therapy (ART) status. Among 364 WHIV, mean attendance of primary care visits was 63.9%. Every one-day increase in drinking days (OR = 0.99, 95% CI 0.99, 1.00) or heavy drinking days (OR = 0.99, 95% CI 0.90, 1.00) was associated with decreased odds of attending primary care visits (P = 0.02). Moderate/severe anxiety scores, compared to minimal anxiety scores, were associated with decreased odds of attending primary care visits (OR = 0.69, 95% CI 0.50, 0.97). Cocaine use was associated with decreased odds of attending primary care visits (OR 0.56, 0.57). Our findings indicate that identifying and treating WHIV with alcohol use (especially heavy drinking), moderate/severe anxiety symptoms and/or cocaine use could potentially improve their RIC.

Exploring the characteristics of newly defined at-risk drinkers following the change to the UK low risk drinking guidelines: a retrospective analysis using Health Survey for England data

BACKGROUND

Alcohol guidelines enable individuals to make informed choices about drinking and assist healthcare practitioners to identify and treat at-risk drinkers. The UK Low Risk Drinking Guidelines were revised in 2016 and the weekly guideline for men was reduced from 21 to 14 units per week. This study sought to retrospectively establish 1) the number of additional at-risk male drinkers in England, 2) which demographic characteristics were associated with being an at-risk drinker under the previous versus new guidelines.

METHODS

Average weekly alcohol consumption for men aged 16+ from the cross-sectional nationally representative Health Survey for England were used to 1) calculate annual population prevalence estimates for newly defined at-risk (> 14 to ≤21 units/week) male drinkers from 2011 to 2015 (N = 3487-3790), and 2) conduct logistic regression analyses for at-risk vs low risk male drinkers under the previous (> 21 vs ≤21 units/week) and new (> 14 vs ≤14 units/week) guidelines to assess characteristics associated with being at-risk drinkers under each guideline using 2015 data (N = 2982).

RESULTS

Population prevalence estimates of newly defined at-risk drinkers ranged from 10.2% (2014 = 2,182,401 men)-11.2% (2011 = 2,322,896 men). Under the new guidelines, men aged 55-74 (OR = 1.63,95% CI = 1.25-2.12); men in managerial/professional occupations (OR = 1.64,95% CI = 1.34-2.00); current smokers (OR = 2.26,95% CI = 1.73-2.94), ex-regular smokers (OR = 2.01,95% CI = 1.63-2.47) and ex-occasional smokers (OR = 1.85,95% CI = 1.25-2.74); men from the North East (OR = 2.08,95% CI = 1.38-3.13) and North West (OR = 1.91,95% CI = 1.41-2.60) of England all had greater odds, and non-white men had reduced odds (OR = 0.53,95% CI = 0.34-0.80) of being at-risk drinkers, as they had under the previous guidelines. Under the new guidelines only: a higher percentage of at-risk drinkers aged 16-34 (32% vs 19%) attenuated the odds of men aged 35-54 being at-risk (OR = 1.18,95% CI = 0.92-1.51); a higher percentage of married at-risk drinkers (37% vs 24%) attenuated the odds of single men being at-risk (OR = 1.28,95% CI = 0.99-1.67); men from the West Midlands (OR = 1.68,95% CI = 1.17-2.42) and London (OR = 1.53,95% CI = 1.03-2.28) had greater odds of being at-risk drinkers.

CONCLUSIONS

The change to the Low Risk Drinking Guidelines would have resulted in more than 2 million additional male at-risk drinkers in England. Most groups with greater odds of being at-risk drinkers under the new guidelines were those already known to be drinking the most, strengthening the case for targeted screening and education. Additionally, under the new guidelines, a marked proportion of 16-35 year olds and married men were at-risk and men in the West Midlands and London had greater odds of being at-risk drinkers. These groups may benefit from specific education around the new Low Risk Drinking Guidelines.

'Make it another for me and my mates': Does social capital encourage risky drinking among the Danish general population?

AIMS

The aim of this study was to examine the relationship between several indicators of social capital and risky single occasion drinking (RSOD) in a representative survey sample of the Danish general population.

METHODS

Data from the 2011 Danish national survey (n=2569) with respondents aged 15-79 years were used. Ordered logit modelling was applied to investigate the influence of social networks, social support, social participation and trust on RSOD.

RESULTS

A strong positive relationship was found between frequency of contact with male friends and RSOD between both sexes. Furthermore, social trust among men and membership in voluntary organisations among women was significantly associated with RSOD. Additionally, contact with male family members for women and active participation in religious services for both sexes were strongly and negatively correlated with RSOD.

CONCLUSIONS

Some aspects of social capital can be positively related to at-risk health behaviours, as was found for RSOD in the Danish general population.

Perceived social support and preventive health behavioral outcomes among older women

Although research has documented that social support is a positive pathway to healthpromoting behavioral practices, very few longitudinal studies have assessed the relationship between social support and health-promoting behaviors among older, diverse women. Three waves of data from the Americans' Changing Lives (ACL) survey assessed whether or not changes in perceived social support influenced behavioral outcomes among 671 African American women and non-Hispanic white women aged 60 years and older. Positive social support from friends was the most successful in predicting physical activity across the life span while positive spousal support, positive support from children, and health behavior-specific support were insignificant determinants of physical activity. The results suggest that social support from friends may be an important predictive factor in engaging older women in physical activity during the aging process.

Racial differences in co-occurring substance use and serious psychological distress: the roles of marriage and religiosity

The study examined how marriage and religiosity can protect members of certain racial/ethnic groups against co-occurring substance use and serious psychological distress. Using the national dataset 2007 National Survey on Drug Use and Health, we analyzed data via multinomial logistic regression, observing several important results. Our findings generally support the deprivation-compensation thesis, in that religiosity elevates the mental health of racial/ethnic minority individuals more than that of Whites. We also found, however, that race/ethnicity moderates effects of education and poverty on the co-occurring behaviors, with Whites' mental health benefiting more from wealth and education than Blacks' or Hispanics' mental health did.

The Association of Well-Being with Health Risk Behaviors in College-Attending Young Adults

The present study investigated the associations of well-being with engagement in illicit drug use, sexual risk taking, and impaired driving in a sample of 9,515 students from 30 U.S. colleges and universities. Participants completed measures of subjective well-being, psychological well-being, and eudaimonic well-being, and indicated how many times in the past 30 days that they had engaged in several illicit drug use, sexual risk, and impaired driving behaviors. Findings indicated that well-being was negatively associated with incidence of illicit drug use and some sexual risk behaviors, but not with incidence of drunk/drugged driving or riding with an impaired driver. Well-being was negatively related to frequency of casual sex, sex while drunk/high, drunk/drugged driving, and riding with an impaired driver. Associations of well-being were strongest for more dangerous types of drug use and sexual behavior and for riding with an impaired driver. Results are discussed in terms of implications for research and intervention development.

Alcohol consumption among men and women with tuberculosis in Tomsk, Russia

Drinking behavior among Russian women remains poorly described. We analyzed gender differences in alcohol use among 374 tuberculosis patients in Tomsk, Siberia. Twenty-six (28.3%) women had lifetime alcohol abuse or dependence, compared with 70.6% of men. Women with alcohol use disorders drank 12.7 +/- 14.0 standard drinks per day and > or = 34.6% drank 2 three days per week. Among individuals with a lifetime alcohol use disorder, age of onset and typical consumption did not differ significantly by gender. We conclude that Russian women with alcohol use disorders consume almost as much alcohol as men and may be at greater risk for negative social and medical consequences.

Changes in coping moderate substance abuse outcomes differentially across behavioral treatment modality

In this secondary data analytic study, we examined whether the relationship between changes in coping and treatment outcome differed between women enrolled in either the Women's Recovery Group (WRG) (n = 29), a new manualized group treatment for women with substance use disorders, or Group Drug Counseling (GDC) (n = 7), an empirically supported mixed-gender group treatment. We examined subscales of the Ways of Coping Questionnaire and found that while changes in coping did not differ significantly across treatment groups, the association between changes in coping and substance abuse outcome was related to treatment condition. Increases in problem-focused coping were associated with decreased drinking days in WRG, but paradoxically with increased drinking days in GDC. For both groups, increases in wishful thinking were associated with increases in substance use, and increases in social support coping associated with decreases in use, but these associations were greater in GDC. Our results highlight the importance of examining the impact of treatment modality on coping, as well as contextual factors that may help to explain the specific pattern of results. 

Barriers and facilitators for alcohol treatment for women: are there more or less for rural women?

Among women at-risk for problems drinking, treatment seeking can be hindered by a complex array of issues such as a lack of transportation, social stigma, denial, fear of losing children, and reluctance of primary care physicians to refer women. This study describes the barriers/facilitators and need for treatment among a community sample of rural and urban women at-risk drinkers. Data for this study were assembled from the baseline sample of individuals who participated in a large probability sample of rural and urban at-risk drinkers (N = 733) from six Southern states: Alabama, Arkansas, Georgia, Louisiana, Mississippi, and Tennessee. Men and women differed on perceived barriers/facilitators and need for alcohol treatment. Women differed from men on measures of treatment affordability, accessibility, acceptability and report of social support, illness severity, comorbidities, and demographic characteristics. Rural women differed from urban women on measures of treatment affordability and accessibility and report of illness severity and comorbidities.

Exploring the relationships of women's sexual assault disclosure, social reactions, and problem drinking

The goal of this exploratory study was to examine correlates of sexual assault disclosure and social reactions in female victims with and without drinking problems. An ethnically diverse sample of sexual assault survivors was recruited from college, community, and mental health agencies. Ethnic minority women were less likely to disclose assault, and women with a greater number of traumatic life events disclosed assault more often. Although there were no differences in disclosure likelihood by drinking status; of those disclosing, problem drinkers told more support sources and received more negative and positive social reactions than nonproblem drinkers. Correlates of receiving negative social reactions were similar for normal and problem drinkers; however, negative social reactions to assault disclosure were related to more problem drinking for women with less frequent social interaction. Implications for future research and possible support interventions with problem-drinking victims are provided.

Social support and social undermining as correlates for alcohol, drug, and mental disorders in American Indian women presenting for primary care at an Indian Health Service hospital

The purpose of this study was to determine the relationship of two types of social support (emotional and instrumental) and two types of social undermining (critical appraisal and isolation) with five categories of alcohol, drug, or mental disorders (ADM; any mood, any anxiety, any substance abuse, any disorder, and two or more disorders) in 169 American Indian women presenting for primary care at an Indian Health Service facility. Social support and social undermining are often treated as opposite poles, but in fact they are distinct factors with independent effects. The findings illustrate that social support and undermining variables have a significant relationship with ADM outcomes even when controlling for confounding demographic variables. Any substance abuse was associated with all four social variables, while two or more disorders were associated with instrumental support and isolation. Any anxiety (isolation), any mood (critical appraisal), and any disorder (isolation) were each associated with one social variable. Overall, social undermining appears to have a stronger relationship with mental health than with social support.

The development and initial validation of the identification of alcohol dependence in women scale

The purpose of this research was to develop the Identification of Alcohol Dependence in Women (IADW) Scale, which is a 51-question instrument, designed to discriminate between alcohol and non-alcohol dependent women. Questions focus on physical, psychological, family and home life, and use of alcohol. Initial testing of the IADW Scale provides preliminary evidence that it is reliable, has content validity, and is capable of correctly classifying group membership with accuracy. Eighty-six percent of the cases in the alcohol dependent group and 98% of the non-alcohol dependent group were correctly classified using direct and stepwise methods of discriminant analysis.

[Factors influencing juvenile alcohol consumption: the role of gene-environment interactions]

INTRODUCTION

Excessive alcohol consumption in youth increases the risk of subsequent alcohol use disorders. Despite the recognition of genetic and environmental factors, an appropriate aetiological model is needed to take adequate preventative steps. This is in part due to the complex interactions between genotype and environment. In this article we review research on factors determining alcohol use by adolescents and on the development of an unifying model.

METHOD

The data bank Medline Advanced was searched for topical articles that were then checked for relevance and sorted according to genetic factors, environmental factors, and their interactions.

RESULTS

Many factors, alone and in combination with others, influence juvenile alcohol consumption. Each single variable, however, can explain only a small part of the variation in consumption behaviour.

CONCLUSION

The manifold possibilities of interactions between these factors become clear. There is a strong need for comprehensive models of juvenile alcohol use and the integration of current results into these models.

Engendering health disparities

How is gender implicated in our exploration of health disparities in Canada? Set against the backdrop of federal government policy, this review paper examines the ways in which gender intersects with other health determinants to produce disparate health outcomes. An overview of salient issues including the impact of gender roles, environmental exposures, gender violence, workplace hazards, economic disparities, the costs of poverty, social marginalization and racism, aging, health conditions, interactions with health services, and health behaviours are considered. This review suggests health is detrimentally affected by gender roles and statuses as they intersect with economic disparities, cultural, sexual, physical and historical marginalization as well as the strains of domestic and paid labour. These conditions result in an unfair health burden borne in particular by women whose access to health determinants is--in various degrees--limited. While progress has certainly been made on some fronts, the persistence of health disparities among diverse populations of women and men suggests a postponement of the vision of a just society with health for all that was articulated in the Federal Plan on Gender Equality. Commitment, creativity and collaboration from stakeholders ranging from various levels of government, communities, academics, non-governmental agencies and health professionals will be required to reduce and eliminate health disparities between and among all members of our society.