Women's alcohol consumption: emerging patterns, problems and public health implications

Labor force status as a buffer against mortality risks associated with alcohol consumption: A study of adult U.S. women, 2001-2015

The association between women's labor force participation, their alcohol consumption patterns, and mortality risk is unclear. This study assessed all-cause mortality risk among women in the United States, considering their labor force status and alcohol drinking. This study used discrete-time hazard models to examine this association using 2001-2015 National Health Interview Survey-Linked Mortality Files (NHIS-LMF) data (n = 147,714) for women aged 25 to 65 with 5725 deaths in this sample. Complex survey-weighted adjustments and E-values calculations were used to limit quantitative and observational biases. Alcohol consumption and labor force status together lead to substantial mortality risks. There is a statistically significant mortality risk among unemployed women (HR 2.15, 95% CI 1.18-3.91) and women not in labor force (HR 2.38, 95% CI 1.87-3.01). In the stratified models, non-Hispanic blacks (HR 1.48, 95% CI 1.30-1.67) and Asians (HR 1.93, 95% CI 1.54-2.44) have heightened mortality risks borne out of employment. Women with higher psychological distress have a 26% higher risk of all-cause mortality when not in labor force. With the help of cross-sectional data, this study demonstrates that women not in labor force and unemployed women are more likely to be affected by their drinking habits, and their employment status is associated with lower mortality risk. Further research should be focused on cause-specific mortality, gender roles and norms, reasons for unemployment, and comorbidities using more recent data, causal modeling techniques, and an extended mortality follow-up period.

Age and Living Situation as Key Factors in Understanding Changes in Alcohol Use during COVID-19 Confinement

(1) The aim of the present study was to evaluate and characterize changes in alcohol use during the COVID-19 confinement in a sample of Spanish adults, analyzing their age and living situation as defining life cycle variables. (2) Method: Data from 3779 individuals were collected through a set of online surveys. AUDIT-C was used to measure the frequency of consumption, the average daily consumption, intensive consumption, risky consumption, and Standard Drink Units. (3) Results: Although alcohol consumption during confinement showed a significant general decline, age revealed important differences, with the decline being more pronounced in adults from 18 to 29 years old. The living situation also showed significant differences. The largest decreases in alcohol consumption were found in those who lived with their parents or other relatives, whereas those who lived alone or with a partner even increased their level of consumption. In addition, the data show a significant interaction between these two variables and gender. (4) Conclusions: Age and cohabitation processes are key factors in understanding the life situation of each individual during confinement and, consequently, in explaining consumption patterns. The results obtained provide interesting recommendations for designing prevention policies in both normal and crisis circumstances, emphasizing the need to understand alcohol use from a psychosocial perspective.

Sex bias in alcohol research: A 20-year comparative study

We aimed to assess the sex-inclusive and sex-based analysis bias in alcohol research for the past 20 years. Data were abstracted from 2988 original research articles published from 2000 through 2019 in 51 representative journals across 9 biomedical disciplines. An analysis in 5-year intervals revealed that the percentage of studies using participants of both sexes was significantly higher between 2015 and 2019 than between 2000 and 2014. When stratified, clinical studies showed a higher percentage of both-sex studies compared to basic studies using animals. The reasons for the use of single-sex cohorts mainly included insufficient participant numbers and misconceptions surrounding the hormonal variability of females. Implementation of the NIH SABV policy promoted the ratio of NIH-funded papers with sex-based analyses. In conclusion, sex bias in alcohol-related biomedical studies has improved over the past 20 years, particularly after the implementation of the SABV policy. Although clinical studies increasingly included sex-based analysis, basic studies were biased towards the use of males.

Gender differences in social harms from drinking among young Australians: findings from the Mater University Study of Pregnancy and its Outcomes

Background: Despite the growing interest in investigating social harms from drinking, little is known about drinkers' reports of these harms and their gender differences among Australian young adults at age 30. We aimed to examine gender differences of social harms from drinking as reported by drinkers.Methods: 2,200 young adults at age 30 with complete data on social harms from drinking were drawn from the 30-year follow-up of the Mater-University of Queensland Study of Pregnancy. Measures included percentages of 11 past-year drinkers' self-reported social harms stratified by gender. Logistic regression was used to examine associations between gender and each social harm, accounting for relevant confounding.Results: More than one in five young adults (22%) reported at least one social harm in the past year. Among binge drinkers, 44% reported at least one social harm. After adjustments for social roles and binge drinking, we found no gender differences on several self-reported social harms: friendship problems, people criticizing drinking, non-marital family problems, employment problems, and alcohol-fuelled fights. However, men were more likely to report spousal threats to leave, drink-driving legal problems and financial problems.Conclusions: Our findings demonstrate that young adults are still vulnerable to risky drinking at age 30 and the social harm resulting from drinking. Thus, alcohol prevention campaigns should target this age group and include women in their focus. Strategies aiming to reduce alcohol-related harms, such as screening in clinical settings for risky drinking and alcohol-related harms, followed by motivational behavior interventions, could be beneficial among these vulnerable groups.

Is there gender convergence in risky drinking when taking birth cohorts into account? Evidence from an Australian national survey 2001-13

BACKGROUND AND AIMS

Recent studies have argued that there has been substantial gender convergence in alcohol consumption. However, many of these rely on comparisons of different cohorts and do not adjust for age differences in male and female drinking patterns. We aimed to examine (1) whether the gender gap in risky drinking in Australia narrowed between 2001 and 2013, (2) if the evidence for gender convergence (or divergence) was consistent across age groups and (3) how a cohort-focused analysis of gender convergence compared with an age-focused approach.

DESIGN

Repeated cross-sectional data from five waves of the National Drug Strategy Household Survey (2001, 2004, 2007, 2010, 2013). Interaction terms in logistic and linear regression models were used to test for significantly different trends between men and women.

SETTING

Australia.

PARTICIPANTS

Australians aged 14 years and older (n = 125 215) who provided data on alcohol consumption in the National Drug Strategy Household Survey.

MEASUREMENTS

Prevalence of long-term risky drinking (average of 20 g or more per day) and prevalence of risky single occasion drinking (12 or more sessions of 50 g or more).

FINDINGS

Gender differences were large for all age groups except adolescents (14-17-year-olds), with men typically reporting levels of drinking at least twice as high as women across the study period. Overall, there was statistically significant gender convergence in alcohol use measures showing a slight decrease in men's drinking and a slight increase in women's drinking. However, when age-specific analyses were conducted gender convergence was only observed for 50-69-year-olds.

CONCLUSIONS

In Australia, gender convergence in risky drinking since 2001 has been evident only in people aged 50-69 years.

Gender Difference in Offspring's Alcohol Use Disorder by 21 Years: A Longitudinal Study of Maternal Influences

AIMS

There is little known about the extent to which maternal alcohol consumption influences offspring's alcohol use disorder. This study aims to examine whether different maternal alcohol consumption trajectories predict gender difference in adolescent alcohol use disorder at child age 21 years.

METHODS

Data are from a prospective cohort, the Mater-University of Queensland Study of Pregnancy (MUSP) and its outcomes. The study involves 2531 mother-child pairs for whom data are available at the 21-year follow-up survey. Maternal alcohol consumption trajectories were determined by group-based trajectory modelling. Offspring's lifetime ever alcohol use disorder was assessed using DSM-IV diagnostic criteria.

RESULTS

Over 14 years of follow-up after the birth of a child, three distinct alcohol consumption trajectories were identified (abstainer, low-stable. and moderate-escalating drinker). A maternal trajectory of moderate-escalating alcohol consumption independently predicted offspring's lifetime ever alcohol use disorder at 21 years after adjustment for a range of potential confounders. "Cross-gender influence" is observed in the study.

CONCLUSIONS

A maternal life course pattern of alcohol consumption may have an independent effect on offspring alcohol consumption, with male offspring being more vulnerable to the effects of maternal alcohol use than are female offspring. Programs intended to address alcohol consumption by adolescents and young adults need to focus on the behaviors of both parents but acknowledging that maternal patterns of alcohol consumption may be particularly important for male offspring.

The natural history of risky drinking and associated harms from adolescence to young adulthood: findings from the Australian Temperament Project

BACKGROUND

We aimed to describe the natural history of heavy episodic drinking (HED) and associated harms from adolescence to young adulthood in a large Australian population cohort study.

METHOD

The Australian Temperament Project consists of mothers and babies (4-8 months) recruited from Infant Welfare Centres and followed every 2 to 4 years until age 28 years. Analyses were based on data from 1156 young people (497 male; 659 female) surveyed repeatedly at ages 16, 18, 20, 24 and 28 years. We used dual processes latent class growth analysis to estimate trajectories of HED and associated harms, employing a piecewise approach to model the hypothesized rise and subsequent fall across adolescence and the late twenties, respectively.

RESULTS

We identified four sex-specific trajectories and observed little evidence of maturing-out across the twenties. In males, a normative pattern of increasing HED across the twenties with little related harm was observed (40% of the male sample). Early and late starter groups that peaked in harms at age 20 years with only minor attenuation in binging thereafter were also observed (6.1% and 35%, respectively). In females, a normative pattern of increasing, but moderate, HED with little related harm was observed (44% of the female sample). Early and late starter groups were also identified (18% and 17%, respectively); however, unlike males, the female late starter group showed a pattern of increasing HED and related harms.

CONCLUSIONS

Continued patterns of risky alcohol use and related harms are apparent for both males and females across the twenties.

How community-level social and economic developments have changed the patterns of substance use in a transition economy?

Most social changes take place at the community level before indirectly affecting individuals. Although the contextual effect is far-reaching, few studies have investigated the important questions of: how do community-level developments affect drinking and smoking, and how do they change the existing gender and income patterns of drinking and smoking, particularly in transition economies? In this study, I used a Chinese panel dataset between 1991 and 2011 to reveal the moderating effects of community developments. Through multilevel growth curve modeling that controls for age, period, and cohort effects, as well as individual- and community-level covariates, I found that community-level economic development and social development are negatively associated with drinking and smoking. Moreover, economic and social developments also moderate the important influences of income and gender: women start to drink more in communities with higher economic development; the traditionally positive association between income and smoking/drinking is also reversed, i.e. the rich start to smoke and drink less in communities with higher social development. This study concludes that the rapid changes in communal social and economic structures have created new health disparities based on the gender and socioeconomic hierarchy.

Partying Last Weekend: Factors Related to Heavy Episodic Drinking Among People Who Use Recreational Drugs

BACKGROUND

Heavy episodic drinking (HED) has negative consequences for both the individual and society. Research on HED has focused mainly on the general population while research into HED and other drug use among recreational drug using populations is less developed.

OBJECTIVES

This study explores factors related to HED on a previous weekend among male and female recreational drug users.

METHODS

Cross-sectional interviews were undertaken with those age 19+ who regularly use recreational drugs in a nightlife setting in two cities in Canada (n = 931) between 2008 and 2014. Participants were asked about their alcohol and other drug use the previous Friday or Saturday. Chi-square bivariate tests were used to determine factors significantly associated with HED with significant variables then entered into multivariate logistic regression models to determine related factors for men and women.

RESULTS

Results showed that 53.4% of all participants met criteria for HED the previous weekend and the majority of those had used at least one other drug. Multivariate models showed being in postsecondary full-time, being between 19 and 25, using cocaine and using tobacco the previous weekend was associated with HED for men. For women, using cocaine the previous weekend was associated with HED, while being 26 and over, married or common law and using marijuana was associated with lower odds of HED.

CONCLUSION

HED is common among recreational drug users but different factors were associated HED for men and women. Interventions for recreational drug users should include both alcohol and other drug messaging and be gender specific.

Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression

OBJECTIVE

Historically, alcohol use and related harms are more prevalent in men than in women. However, emerging evidence suggests the epidemiology of alcohol use is changing in younger cohorts. The current study aimed to systematically summarise published literature on birth cohort changes in male-to-female ratios in indicators of alcohol use and related harms.

METHODS

We identified 68 studies that met inclusion criteria. We calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcohol-related harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1568 sex ratios. Random-effects meta-analyses produced pooled sex ratios within these 3 categories separately for each birth cohort.

FINDINGS

There was a linear decrease over time in the sex ratio for all 3 categories of alcohol use and related harms. Among those born in the early 1900s, males were 2.2 (95% CI 1.9 to 2.5) times more likely than females to consume alcohol, 3.0 (95% CI 1.5 to 6.0) times more likely to drink alcohol in ways suggestive of problematic use and 3.6 (95% CI 0.4 to 30.3) times more likely to experience alcohol-related harms. Among cohorts born in the late 1900s, males were 1.1 (95% CI 1.1 to 1.2) times more likely than females to consume alcohol, 1.2 (95% CI 1.1 to 1.4) times more likely to drink alcohol in ways suggestive of problematic use and 1.3 (95% CI 1.2 to 1.3) times more likely to experience alcohol-related harms.

CONCLUSIONS

Findings confirm the closing male-female gap in indicators of alcohol use and related harms. The closing male-female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.

Investigating Sociodemographic Factors and HIV Risk Behaviors Associated With Social Networking Among Adolescents in Soweto, South Africa: A Cross-Sectional Survey

Background

Internet access via mobile phones and computers facilitates interaction and potential health communication among individuals through social networking. Many South African adolescents own mobile phones and can access social networks via apps.

Objective

We investigated sociodemographic factors and HIV risk behaviors of adolescent social networking users in Soweto, South Africa.

Methods

We conducted an interviewer-administered, cross-sectional survey of adolescents aged 14-19 years. Independent covariates of social networking were assessed by multivariate logistic regression analysis.

Results

Of 830 adolescents, 57% (475/830) were females and the median age was found to be 18 years (interquartile range 17-18). Social networking was used by 60% of adolescents (494/830); more than half, that is, 87% (396/494) accessed social networks through mobile phones and 56% (275/494) spent more than 4 hours per day using their mobile phones. Social networking was independently associated with mobile usage 2-4 hours (adjusted odds ratio [AOR]: 3.06, CI: 1.69-5.51) and more than 4 hours per day (AOR: 6.16, CI: 3.46-10.9) and one (AOR: 3.35, CI: 1.79-6.27) or more sexual partner(s) (AOR: 2.58, CI: 1.05-6.36).

Conclusions

Mobile phone–based social networking is prevalent among sexually active adolescents living in Soweto and may be used as an entry point for health promotion and initiation of low-cost adolescent health interventions.

Gender differences in the prospective association between maternal alcohol consumption trajectories and young adult offspring's problem gambling at 30 years

Although a large number of studies have examined the association between young adult’s alcohol consumption and their problem gambling behaviours, none of these studies address the prospective association between mother’s alcohol consumption and their young adult offspring’s problem gambling behaviours. Using data from a 30 year prospective pre-birth cohort study in Brisbane, Australia (n = 1691), our study examines whether different maternal alcohol consumption trajectories predict offspring’s risk of problem gambling behaviours and whether these associations differ by the young adults’ gender. Offspring’s level of problem gambling behaviours was assessed by the short version of the Canadian Problem Gambling Index, with about 10.6 % of young adults having some risk of problem gambling behaviours. Trajectories of maternal alcohol consumption were determined by group-based trajectory modelling over five time points. Our study found that mother’s alcohol consumption pattern fits into three drinking trajectory groups, namely abstainers (17.2 %), a low-stable drinkers group (64.6 %) and a moderate-escalating drinkers group (18.2 %). Multivariate logistic regression analyses showed that the moderate-escalating alcohol trajectory group is independently associated with a risk of their male young adult offspring having problem gambling behaviours at 30 years—even after adjustment for a range of potential confounding variables. Mothers who exhibit a persistent life course pattern of moderate-escalating drinking have male children who have a high risk of engaging in problem gambling behaviours. Offspring’s alcohol consumption partially mediated the association between maternal drinking trajectories and young adult’s risk of problem behaviours. High levels of maternal alcohol consumption may lead to male offspring antisocial behaviours. Programs intended to address problem gambling behaviours by young adults may need to focus on male group with a focus which specifically addresses family influences as these contribute to gambling behaviour.

Trajectories and predictors of alcohol consumption over 21 years of mothers׳ reproductive life course

INTRODUCTION

Little is known about the patterns of women׳s alcohol consumption over their reproductive life course. This study identifies trajectories of alcohol consumption by mothers over 21 years of their reproductive life course and examines baseline predictors of these trajectories.

METHODS

Data were obtained from a prospective cohort study of 3715 women in Brisbane, Queensland, Australia over 21 years of follow-up. Women׳s alcohol consumption was measured by frequency and quantity of use across the surveys. Potential predictors and confounding variables were assessed at baseline. Group based-trajectory modelling was used to identify typical drinking trajectories over the maternal reproductive life course. Multinomial logistic regression was employed to examine predictors associated with these trajectories.

RESULTS

Four trajectories of alcohol consumption were indentified for mothers over the 21-year period. These trajectories included abstainers (11.9%), low-stable drinkers (58.0%), moderate-escalating drinkers (25.3%), and heavy-escalating drinkers (4.8%). After adjustment for significant covariates, membership of the abstaining trajectory was predicted by lower family income, being married, and high frequency of church attendance while membership of the heavier-escalating trajectory was associated with women who were not currently married, never went church and had unhealthy lifestyle behaviours.

CONCLUSIONS

Patterns of women׳s alcohol consumption exhibit a high level of stability for abstainers and women who drink at low levels. After the birth of their child, there are some changes in alcohol consumption for the moderate and heavy-escalating alcohol consumption groups. Low risk patterns of consumption are associated with variables which generally reflected a low risk behaviour lifestyle. Intervention programmes should particularly target women engaging in the heavy-escalating alcohol consumption group as this group increase their consumption shortly after the birth of their child. There is a need to understand more about the social and health consequences to mothers and their children of being in the moderate and heavy-escalating drinking trajectory groups.

Intellectual disability in Indigenous Australians: issues and challenges

OBJECTIVES

Literature on Indigenous Australians (Aboriginal and Torres Strait Islander people) and intellectual disability (ID) is summarized in order to identify current state of knowledge, gaps, and areas for further research.

METHODS

A selective review of psychiatric literature using relevant medical databases was undertaken. Key articles were identified and their findings described.

RESULTS

ID is reported to be more prevalent in Indigenous Australians. Sociocultural constructs and a lack of validated psychometric measures affect what is considered to be ID in Indigenous communities. Prenatal, perinatal, and postnatal factors impair brain development and contribute to ID in Indigenous communities. Comorbid physical and psychiatric disorders need to be assessed and managed.

CONCLUSIONS

ID is an emerging area of health concern for general and mental health professionals working with Indigenous Australians. This important area requires further research, appropriate training, and resourcing.

Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations

AIMS

To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences.

METHODS

MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence.

RESULTS

Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women.

CONCLUSIONS

Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.

The relationship between exposure to alcohol-related content on Facebook and predictors of alcohol consumption among female emerging adults

Consuming an unhealthy level of alcohol is a significant problem for some young women. Potential determinants of excess consumption include perceptions of usual consumption among peers-perceptions of what is "normal." The present study examined whether perceptions of social normative endorsement of drinking, operationalized by measures of perceived alcohol consumption of close friends (proximal norms), the consumption of the "average student" (distal norms), and the extent of alcohol-related content posted by peers on Facebook were related to alcohol-related attitudes and self-reported consumption. Female university students (n=129; Mage=21.48 years, SD=3.00) completed an online questionnaire assessing Facebook use, perceived alcohol-related norms, and self-reported alcohol attitudes and consumption. Perceptions of the consumption of the average female student were a negative predictor of attitudes. Positive alcohol attitudes, extent of own alcohol-related photographic posts on Facebook, average female student alcohol consumption, and report of male close friend consumption predicted self-report of own alcohol consumption. Interestingly, female close friend norms failed to predict consumption, whereas male close friend norms predicted consumption but not attitudes, suggesting the possibility of separate cognitive pathways for alcohol-related attitudes and behavior. This study builds on existing research by casting new light on predictors of alcohol-related attitudes, as well as describing the potential role of social networking sites such as Facebook in the formation of social norms and the modulation of drinking behavior.

'What a man can do, a woman can do better': gendered alcohol consumption and (de)construction of social identity among young Nigerians

BACKGROUND

The misuse of alcohol and other drugs among young people, especially students, is a growing global phenomenon. In traditional Nigerian society, different locally-produced alcoholic beverages served complex roles but were mainly consumed among adult males for pleasure. Though adult females in some communities consumed alcohol, the practice of drinking was culturally controlled. In contemporary Nigeria, available quantitative studies reveal changing patterns of alcohol use amongst youth but fail to unravel the social variables that motivate alcohol use among this group.

METHODS

Qualitative data were collected through in-depth interviews with 31 (22 males and 9 females, aged 19-23 years) undergraduate students attending a university located in a metropolitan city in Anambra State, south-eastern Nigeria. Data were collected and analysed to generate themes with the aid of Nvivo 10 software.

RESULTS

There appears to be a resilient socio-cultural belief in which men see alcohol as 'good for males' while the females in contrast believe that alcohol does not discriminate according to gender and should be drunk by both males and females. Findings also point to the ways in which male-gendered drinking behaviours, such as heavy or fast drinking are employed by women to develop social capital.

CONCLUSIONS

These results do suggest how gendered constructions of alcohol consumption create risks for both men and women, how they negotiate and ameliorate those risks, and how women challenge gender roles through their use of alcohol. Some focus on formulating evidence-based policies and comprehensively evaluated campaigns are needed to disseminate information about the risks and potential consequences of heavy alcohol consumption in order to promote safer alcohol use by young people.

Intellectual disability and indigenous Australians: an overview

The review summarizes important literature in the emerging field of intellectual disability (ID) in indigenous Australians. Search of various electronic databases revealed 19 papers that provide information regarding prevalence, sociodemographic factors, and issues in assessment and management. Overall, there is limited information regarding ID in indigenous Australians, which is reported to be more prevalent compared with nonindigenous Australians. Sociocultural constructs affect what is considered to be ID in indigenous communities and this may be at odds with western notions. Other difficulties include lack of validated psychometric instruments to effectively measure cognitive functioning in indigenous Australians. Prenatal, perinatal, and postnatal factors are significant factors that impair brain development and contribute to ID in indigenous communities. Comorbid physical and psychiatric disorders need to be assessed and managed. This paper provides an overview of current knowledge regarding this important area that requires further research, appropriate training, and resourcing.

Lack of an association between SNPs within the cholinergic receptor genes and smoking behavior in a Czech post-MONICA study

Smoking has a significant heritable component of approximately 30–60%. Recent genome wide association studies have identified single nucleotide polymorphisms (SNPs) within the nicotinic cholinergic receptor subunits 3 (rs578776), 5 (rs16969968) and β3 (rs6474412), which are associated with nicotine dependence in Western European populations. To analyze the association in a Czech population, we genotyped 1,191 males and 1,368 females (post-MONICA study). The WHO protocol was used to examine smoking status and the number of cigarettes smoked per day. There were 32.1% current and 27.6% past smokers among the males and 22.5% current and 13.8% past smokers among the females. We have not confirmed the original results: the SNPs rs16969968 (p = 0.07), rs578776 (p = 0.16) and rs6474412 (p = 0.76) were not associated with smoking status (never-smokers vs. ever-smokers) in the entire population, if a codominant model of analysis was used. This result was valid for both the male and female subpopulations if analyzed separately and adjusted for age. Finally, in ever-smokers, the number of cigarettes smoked per day was also independent of different genotypes, regardless of which polymorphism (and gender) was analyzed (the lowest p value was 0.49). The association between the cholinergic receptors–nicotinic subunits (-3, -5 and -ß3), and smoking behavior may be population-dependent.

Midwives' knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder

Background

Midwives are an influential profession and a key group in informing women about alcohol consumption in pregnancy and its consequences. There are no current quantitative Australian data on midwives’ knowledge, attitudes and practice in relation to alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorder. We aimed to reduce this knowledge gap by understanding midwives’ perceptions of their practice in addressing alcohol consumption during pregnancy.

Methods

This cross-sectional study was conducted at 19 maternity sites across the seven health regions of country Western Australia. A questionnaire was designed following review of the literature and other relevant surveys. Midwifery managers of the maternity sites distributed questionnaires to all midwives working in their line of management. A total of 334 midwives were invited to participate in the research and (n = 245, 73.4%) of these were eligible.

Results

The response fraction was (n = 166, 67.8%). Nearly all (n = 151, 93.2%) midwives asked pregnant women about their alcohol consumption during pregnancy and (n = 164, 99.4%) offered advice about alcohol consumption in accordance with the Australian Alcohol Guideline, which states “For women who are pregnant or planning a pregnancy, not drinking is the safest option”. Nearly two thirds (n = 104, 64.2%) of the midwives informed pregnant women about the effects of alcohol consumption in pregnancy, they did not always use the recommended AUDIT screening tool (n = 66, 47.5%) to assess alcohol consumption during pregnancy, nor conduct brief intervention when indicated (n = 107, 70.4%). Most midwives endorsed professional development about screening tools (n = 145, 93.5%), brief intervention (n = 144, 92.9%), and alcohol consumption during pregnancy and FASD (n = 144, 92.9%).

Conclusion

Nearly all midwives in this study asked and advised about alcohol consumption in pregnancy and around two thirds provided information about the effects of alcohol in pregnancy. Our findings support the need for further professional development for midwives on screening and brief intervention. Policy should support midwives’ practice to screen for alcohol consumption in pregnancy and offer brief intervention when indicated.

Drinking games participation among female students at a regional Australian university

Participation in drinking games (DGs) by university students is often associated with heavy drinking and negative social and health impacts. Although research in Australia indicates that university students tend to drink at risky levels, there is paucity of literature on DGs among students, especially those residing at regional universities. This research examined drinking among female college students of white background. Eighteen female students participated in face-to-face in-depth interviews to describe their DG experiences. Most women played DGs for social and monetary reasons, with many drinking high volumes of alcohol during the game. Excessive drinking was linked with the type of beverage consumed. Despite knowing the health risks associated with DGs, there was a strong social imperative for these young women to play these games. Research and public health initiatives to better understand and address problematic drinking activities in rural and regional Australia have tended to ignore women and the dominant white populations whose heavy drinking has been largely restricted to private spheres.

The nature and correlates of young women's peer-directed protective behavioral strategies

OBJECTIVE

Recently, a number of studies have identified self-employed Protective Behavioral Strategies (PBS) as effective in decreasing the level of alcohol-related harm among young people. However, much of the published research has ignored important gender differences, such as women's increased tendency to rely on PBS that are social in nature. To further the understanding of women's PBS, the current study sought to investigate the nature and correlates of the strategies young women employ to keep their friends safe when drinking (i.e., peer-directed PBS).

METHOD

A scale measuring peer-directed PBS was developed and administered in conjunction with existing measures of alcohol consumption, personal PBS, and peer attachment. Participants consisted of 422 women aged 18-30 years, recruited among psychology students and the general public.

RESULTS

Exploratory factor analysis revealed two clusters of peer-directed PBS; those that were aimed at reducing intoxication among one's friends and those that were designed to minimize alcohol-related harms. Further analysis found a positive relationship between women's tendency to implement personal and peer-directed PBS and that risky drinkers were less likely to engage in personal or peer-directed PBS (either type).

CONCLUSION

Findings indicate that personal and peer-directed PBS are related behaviors that are less frequently adopted by risky drinkers.

Academic and personal problems among Australian university students who drink at hazardous levels: web-based survey

ISSUE ADDRESSED

Australian university students consume large amounts of alcohol. There is little published information about personal and academic problems associated with this behaviour. We sought to estimate the prevalence, and identify variables associated with, alcohol-related problems among undergraduate hazardous drinkers.

METHODS

The control group members (942 undergraduates, 53.3% male, mean age 19.4 years) of an internet-based intervention trial, who scored ≥8 on the Alcohol Use Disorders Identification Test, completed two validated questionnaires about their experience of alcohol-related problems in the preceding 4 weeks. Regression models were used to identify associations between individual characteristics and alcohol-related problems.

RESULTS

One-quarter of participants had missed a class (25.6%) and/or had been unable to concentrate in class (25.7%), and 45% reported that their drinking had impacted negatively on their learning or grades. The most frequent non-academic problems were hangovers (74.8%), blackouts (44.8%), emotional outbursts (30.5%), vomiting (28.1%), arguments (20.2%) and drink-driving (23.2%). Male gender, lower age, being a smoker, being in the Faculty of Health (versus Humanities) and living in shared housing (versus with parents/guardians) were each associated with alcohol-related problems, whereas year of study had no association.

CONCLUSIONS

There is a high prevalence of preventable alcohol-related problems among undergraduates drinking at hazardous levels and a need for restriction of the availability and promotion of alcohol as well as intervention for individuals at high risk. SO WHAT?: Universities have a duty of care to large populations of young people drinking at hazardous levels and should make greater efforts to address hazardous alcohol consumption.

Hospital admissions for alcohol use disorders before, during, and after pregnancy: a study based on linked population data in new South Wales, Australia

BACKGROUND

Alcohol use disorders (AUD) during pregnancy can have profound lifelong effects on the baby, including fetal alcohol spectrum disorders (FASD). Hospital admission for AUD during pregnancy provides an opportunity for intervention. Characterization of women along the AUD spectrum during pregnancy aids the development of prevention strategies, policy, and clinical management guidelines aimed at this population. This study describes the hospital admission levels for AUD between the sixth month before pregnancy and the first year after birth and explores risk factors associated with the hospital admissions.

METHODS

This study was based on linked population data between 2002 and 2005 using the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC), Australia. The study subjects included primiparous mothers who were admitted to hospital in the period from the sixth month before pregnancy to 1 year after birth with at least 1 of the following diagnoses (ICD-10-AM): mental and behavioral disorders due to the use of alcohol (MBDA) (F10.0-10.9); toxic effects of alcohol (T51.0-51.9); maternal care for suspected damage to fetus from alcohol (O35.4); or alcohol rehabilitation (Z50.2).

RESULTS

A total of 175 new mothers had 287 hospital admissions with the principal or stay AUD diagnoses during the study period in NSW. Of the 287 admissions, 181 admissions (63.07%) were reported for an alcohol-related disorder as the principal diagnosis. The hospital admission rate for AUD was 1.76/1,000 person-years (PY) (95% CI: 1.45 to 2.07) during the 6 months prepregnancy. The rate decreased to 0.49/1,000 PY (95% CI: 0.36 to 0.63) during pregnancy and to 0.82/1,000 PY (95% CI: 0.67 to 0.97) in the first year after birth. Women who smoked during pregnancy, lived in a remote area and were younger than 25 years, were more likely to be admitted to hospital with AUD diagnoses. Women in the middle disadvantaged quintile and born in other countries were less likely to be admitted to hospital with AUD diagnoses.

CONCLUSIONS

Hospital admission for AUD decreased significantly in pregnancy and the first year postpartum compared to the prepregnancy period.

Trends and social differences in alcohol consumption during the postcommunist transition in Lithuania

The aim of the study was to evaluate the trends and social differences in consumption of various types of alcoholic beverages in Lithuania over the postcommunist transition period (1994–2010). The data were obtained from nine nationally representative postal surveys of Lithuanian population aged 20–64 conducted every second year (n = 17154). Prevalence of regular (at least once a week) consumption of beer, wine, or strong alcoholic beverages and the amount of alcohol consumed per week were examined. Regular beer drinking as well as the amounts consumed increased considerably in both genders. The increase in regular consumption of strong alcohol was found among women. Sociodemographic patterning of regular alcohol drinking was more evident in women than in men. In women, young age and high education were associated with frequent regular drinking of wine and beer. Social differences in regular alcohol drinking should be considered in further development of national alcohol control policy in Lithuania.

Drug, sex and age differentials in the use of Australian publicly funded treatment services

Context:

Little is known about the proportion of the Australian population using alcohol or other drugs who may seek treatment. There is a need to have some additional estimates of population morbidity which reflect harms associated with use.

Objective:

To determine Australian population rates of publicly funded community based specialised alcohol and other drug treatment and in-patient hospital care by those ‘at risk’, by drug type, sex and age.

Design and setting:

The design is secondary data analysis of publicly available datasets. We use the latest available complete data on Australian general population incidence of alcohol, cannabis amphetamines and ecstasy use (2007 National Drug Strategy Household Survey) and nationally collected administrative data on publicly funded specialised alcohol and other drug treatment services (2006–2007 Alcohol and Other Drug Treatment Services National Minimum Dataset) and public hospitals (2006–2007 National Hospital Morbidity Minimum Dataset) to calculate rates of drug treatment and in-patient hospital care per 1000 Australians. ‘At risk’ for alcohol is defined as being at risk of short term harm, as defined by the National Health and Medical Research Council (2001). ‘At risk’ for illicit drugs is defined as those exposed to potential harm through at least weekly use of cannabis, amphetamines and ecstasy use.

Results:

Risky alcohol consumption followed by recent cannabis use appears to lead to most harm. Greater harm seems to be experienced by males rather than females. Younger adults (15–19 years) and older adults (40+ years) seem also to experience the highest rates of harm.

Conclusions:

It is possible to derive population estimates of harms associated with licit and illicit drugs use. Treatment rates vary across drug type, gender and age. Alcohol and cannabis are the substances whose use leads to the greatest demand for services. Ecstasy appears to generate few presentations for treatment. Publicly available data can be used to estimate harms associated with the use of particular substances. Such estimates are best interpreted in the light of other ways of estimating harms.

Undergraduate student drinking and related harms at an Australian university: web-based survey of a large random sample

Background

There is considerable interest in university student hazardous drinking among the media and policy makers. However there have been no population-based studies in Australia to date. We sought to estimate the prevalence and correlates of hazardous drinking and secondhand effects among undergraduates at a Western Australian university.

Method

We invited 13,000 randomly selected undergraduate students from a commuter university in Australia to participate in an online survey of university drinking. Responses were received from 7,237 students (56%), who served as participants in this study.

Results

Ninety percent had consumed alcohol in the last 12 months and 34% met criteria for hazardous drinking (AUDIT score ≥ 8 and greater than 6 standard drinks in one sitting in the previous month). Men and Australian/New Zealand residents had significantly increased odds (OR: 2.1; 95% CI: 1.9-2.3; OR: 5.2; 95% CI: 4.4-6.2) of being categorised as dependent (AUDIT score 20 or over) than women and non-residents. In the previous 4 weeks, 13% of students had been insulted or humiliated and 6% had been pushed, hit or otherwise assaulted by others who were drinking. One percent of respondents had experienced sexual assault in this time period.

Conclusions

Half of men and over a third of women were drinking at hazardous levels and a relatively large proportion of students were negatively affected by their own and other students' drinking. There is a need for intervention to reduce hazardous drinking early in university participation.

Trial registration

ACTRN12608000104358

Gender differences in alcohol treatment: an analysis of outcome from the COMBINE study

BACKGROUND

Relatively few studies have examined gender differences in the effectiveness of specific behavioral or pharmacologic treatment of alcohol dependence. The aim of this study is to assess whether there were gender differences in treatment outcomes for specific behavioral and medication treatments singly or in combination by conducting a secondary analysis of public access data from the national, multisite NIAAA-sponsored COMBINE study.

METHODS

The COMBINE study investigated alcohol treatment among 8 groups of patients (378 women, 848 men) who received medical management (MM) with 16 weeks of placebo, naltrexone (100 mg/day), acamprosate (3 g/day), or their combination with or without a specialist-delivered combined behavioral intervention. We examined efficacy measures separately for men and women, followed by an overall analysis that included gender and its interaction with treatment condition in the analyses. These analyses were performed to confirm whether the findings reported in the parent trial were also relevant to women, and to more closely examine secondary outcome variables that were not analyzed previously for gender effects.

RESULTS

Compared to men, women reported a later age of onset of alcohol dependence by approximately 3 years, were significantly less likely to have had previous alcohol treatment, and drank fewer drinks per drinking day. Otherwise, there were no baseline gender differences in drinking measures. Outcome analyses of 2 primary (percent days abstinent and time to first heavy drinking day) and 2 secondary (good clinical response and percent heavy drinking days) drinking measures yielded the same overall pattern in each gender as that observed in the parent COMBINE study report. That is, only the naltrexone by behavioral intervention interaction reached or approached significance in women as well as in men. There was a naltrexone main effect that was significant in both men and women in reduction in alcohol craving scores with naltrexone-treated subjects reporting lower craving than placebo-treated subjects.

CONCLUSIONS

This gender-focused analysis found that alcohol-dependent women responded to naltrexone with COMBINE's Medical Management, similar to the alcohol-dependent men, on a wide range of outcome measures. These results suggest that clinicians can feel comfortable prescribing naltrexone for alcohol dependence in both men and women. In this study, it is also notable that fewer women than men reported receiving any alcohol treatment prior to entry into the COMBINE study. Of note, women tend to go to primary health care more frequently than to specialty substance abuse programs for treatment, and so the benefit we confirm for women of the naltrexone and MM combination has practical implications for treating alcohol-dependent women.

Alcohol consumption and gender in rural Samoa

INTRODUCTION AND AIMS

There are significant gender differences in alcohol consumption throughout the world. Here we report the results of an alcohol consumption survey on the rural island of Savaii, in the Pacific nation of Samoa.

DESIGN AND METHODS

Eleven villages were selected for sampling using a randomized stratified cluster sampling methodology. A total of 1049 inhabitants over the age of 40 years (485 males and 564 females) were surveyed about alcohol consumption over the past year, and a 72.2% participation rate was achieved.

RESULTS

A SIGNIFICANT GENDER DIFFERENCE IN ALCOHOL CONSUMPTION WAS FOUND: 97.3% of women and 59.4% of men reported no alcohol consumption over the past year. This is one of the most significant gender differences in alcohol consumption in the world. No significant difference between genders was seen in those who consume only 1-5 alcoholic drinks per week (P = 0.8454). However, significantly more males than females consumed 6-25 drinks per week (P < 0.0001), 26-75 drinks per week (P < 0.0001), and 75+ drinks per week (P < 0.0001).

DISCUSSION AND CONCLUSION

This extreme gender difference in alcohol consumption is attributed to several factors, both general (alcoholic metabolism rates, risk-taking behaviors, general cultural taboos, etc) and specific to Samoa (church influence, financial disempowerment, and Samoan gender roles).

Intoxication and violent women

Alcohol and drugs have been linked to severe violent offending among women as well as men. The purpose of this study was to make a contribution to the limited knowledge of characteristics related to the state of intoxication in violent female offenders. The putative differences in the characteristics of female offenders and their violent offenses in relation to the state of intoxication at the time of the violent offending were examined. Of a nation-wide sample of 109 female offenders found guilty of homicide and other violent crimes and incarcerated in 1999-2000 in Finland, 60 offenders participated in the study. Of these offenders 49 (81.7%) had been intoxicated at the time the of index offenses. These were compared with 11 (18.3%) non-intoxicated offenders using a structured interview, the Structured Clinical Interview II for DSM-IV (SCID-II) and the Hare Psychopathy Checklist-Revised (PCL-R). The prevalence of substance abuse or dependence (73.3% and 0%), personality disorder (89.6% and 36.4%), particularly antisocial personality disorder (66.7% and 0%), as well as a history of criminality (69.4% and 0%) were significantly higher among the intoxicated women than among the non-intoxicated. The PCL-R scores were also significantly higher among the intoxicated offenders than among non-intoxicated offenders. The victims of the intoxicated women (23.9%) were less often emotionally close to the perpetrator than were the victims of the non-intoxicated women (66.6%). No differences emerged between the groups in experiences of childhood and adulthood abuse or stressful life events prior to the index crime. The findings indicate that intoxicated violent female offenders exhibit more of the characteristics previously found in violent men, than do the non-intoxicated female offenders. Moreover, the non-intoxicated group comprises both psychotic non-responsible and non-psychotic, fairly well-adjusted women, who are educated, working or studying at the time of the offense and has no history of criminality. Substance misuse constitutes an obvious risk factor for violent behavior in women, and therefore the prevention should include substance abuse treatment.

Alcohol and other drug specialist treatment services and their managers: findings from a national survey

OBJECTIVE

To examine the characteristics of alcohol and other drug (AOD) specialist treatment agencies, their workforce and workforce development issues.

METHODS

A national survey of AOD specialist treatment agency managers was conducted using the Clients of Treatment Service Agencies (COTSA) database as the sampling framework. Agency managers across Australia were surveyed by phone or electronically between April and October 2002. Qualitative and quantitative data were collected. Two hundred and thirty-four managers participated, representing 318 agencies, and a response rate of 65%. More than 50% of managers from each State and Territory participated in the study.

RESULTS

The study found a high prevalence of alcohol-related problems. Managers estimated 45% of clients nominated alcohol as their primary problematic drug and that 53% of poly-drug clients identified alcohol-related problems. Managers reported increasingly complex client needs such as co-occurring substance and mental health issues. A harm minimisation treatment approach was supported by more than three-quarters of AOD agencies. The majority of the AOD workforce were trained professionals and consisted of nurses (26%), general AOD workers (19%) and psychologists (9%). Approximately half the sample had been in their current managerial role for less than five years. Key workforce development issues identified were education and training, funding, and staff recruitment and retention.

CONCLUSION

More information is required on the key characteristics of the AOD workforce and their workforce development needs. Such information can contribute to policies and strategies that develop the capacity of the AOD sector to manage and treat the increasingly complex needs of clients.

From data to evidence, to action: findings from a systematic review of hospital screening studies for high risk alcohol consumption

OBJECTIVE

To conduct a systematic review of hospital alcohol screening studies to identify effective and efficient evidence-based strategies.

METHOD

Sixty-five studies (N=100,980) of alcohol problem prevalence amongst hospital patients were reviewed.

RESULTS

Prevalence of positive alcohol screens varied according to hospital location, screening tool and patient characteristics. BAC measures (26%) were nearly twice as likely (OR=1.92, p<.001) to reveal positive screens in the ED than self-reports (16%). No difference was found in prevalence of self-report positive screens between ED (16%) and ward settings (17%). Males were two to four times more likely than females to screen positive (BAC: OR=2.37, p<.001, ED self-report: OR=3.07, p<.001, ward self-report: OR=4.30, p<.001). ED patients aged 20-40 years and ward patients aged 30-50 years had the highest prevalence of positive screens.

CONCLUSIONS

Prevalence of risky or problematic drinking among hospital patients is high and warrants systematic screening and intervention. Many hospitals lack sufficient resources to undertake widespread screening programs. For optimum return on resources, it is recommended to screen males in the ED using BAC measures. Established protocols applying priority criteria and staff training can increase screening accuracy and effectiveness.

Gender differences in drinking: why do they still exist?

AIMS

The paper discusses the kinds of reasoning that have been presented as possible mechanisms and reasons for gender differences in alcohol consumption.

DESIGN AND METHODS

An overview of the existing literature from different countries is presented.

FINDINGS

The existing studies provide a picture of great cultural variance in patterns of alcohol use among men and women. The gender differences in drinking behaviour have been shown to be linked with many aspects of biological differences between men and women leading to women's greater vulnerability to alcohol, of women's and men's differing needs, reasons and motivations in relation to drinking, of gender-specific roles in other areas of life and of ways in which societies regulate peoples' behaviour, often giving women the role of warden or moderator of others' drinking.

CONCLUSIONS

The gender differences in drinking behaviour continue to be considerable and are found in all cultures studied so far. Several studies have argued for reasons underlying these differences, but they still remain largely unexplained.

Early predictors of adult drinking: a birth cohort study

Few studies have explored early predictors of problem drinking in youth, and fewer still have simultaneously considered the role of biologic, familial, and intrapersonal factors. The present study explored early life course and later life course predictors of alcohol abuse and dependence in young adulthood. Data were taken from a cohort of 2,551 mothers and their children recruited as part of the longitudinal Mater University Study of Pregnancy and its outcomes (MUSP) carried out in Brisbane, Australia, from 1981 to 1984. Data were collected prenatally and then postnatally at 6 months and at 5, 14, and 21 years. A range of biologic, familial, and intrapersonal factors was considered. A series of logistic regression models with inverse probability weighting was used to explore pathways to problem drinking from adolescence to early adulthood. For males and females, no association was found between either birth factors or childhood factors and a lifetime diagnosis of alcohol disorders at age 21 years. Externalizing symptoms and maternal factors at age 14 years were significantly associated with alcohol problems. For youth aged 14 years, maternal moderate alcohol consumption accounted for the highest percentage of attributable risk among those exposed. Results show that exposure to maternal drinking in adolescence is a strong risk factor for the development of alcohol problems in early adulthood.

The general practitioner's role in AOD issues: overcoming individual, professional and systemic barriers

General practitioners (GPs) and increasingly other medical practitioners are well placed to address alcohol and other drug (AOD) problems. Their involvement in this area of care, however, is assessed to be less than optimal. There is, however, a growing body of evidence for the potential efficacy of medical practitioner intervention at the primary care, emergency department and in-patient level. There is also considerably expanded scope to operate from an evidence-based perspective. However, key questions arise regarding what constitutes best practice in the translation of the growing AOD knowledge base into clinical practice behaviours. This paper explores possible contributory factors to the low level of engagement with AOD issues by GPs and examines a wide range of individual, structural and systemic issues that may be amenable to change. Strategies for the dissemination of research findings, changing professional practice behaviour and introducing sustainable structural reforms are also addressed.