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Miller M, Kuntsche S, Kuntsche E, Cook M, Wright CJC. Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design. Health Promot Int 2023; 38:daad175. [PMID: 38128081 PMCID: PMC10735253 DOI: 10.1093/heapro/daad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Alcohol consumption is causally associated with long-term health-related consequences, such as cancer and cardiovascular disease, and short-term harms, such as accidents and injuries. Alcohol consumption has increased among midlife women (aged 40-65) over the last two decades in high-income countries. This study aimed to centre women's voices by using co-design methodologies to investigate what women identify as strategies that could assist them and other women their age to reduce their alcohol consumption. Human-centred design workshops were undertaken with 39 women, and conventional qualitative content analysis was used to analyse information from written workshop materials to develop categories in the data and count their occurrence. Six categories, or strategies, emerged, listed here from most to least represented: 'Participate in alternative activities to drinking alcohol', 'Track alcohol consumption and set goals', 'Seek support from family and friends', 'Drink alcohol-free beverages', 'Reduce supply of alcohol in the home' and 'Seek professional support'. Our findings identify strategies that are realistic and feasible to midlife women; our sample, however, likely reflects a more affluent subsection of this group, and as such, any focus on individual-level strategies must be complemented by policies that increase equitable access to healthcare and act on the social and commercial determinants of health. An intersectional approach to alcohol and other drug research is required to examine how the interplay of gender and other markers of social identities shape alcohol consumption.
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Affiliation(s)
- Mia Miller
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Sandra Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Megan Cook
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
- Institute for Social Marketing, University of Stirling, Stirling, Scotland
| | - Cassandra J C Wright
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Institute for Social Marketing, University of Stirling, Stirling, Scotland
- Burnet Institute, Melbourne, Australia
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Pitt H, McCarthy S, Keric D, Arnot G, Marko S, Martino F, Stafford J, Thomas S. The symbolic consumption processes associated with 'low-calorie' and 'low-sugar' alcohol products and Australian women. Health Promot Int 2023; 38:daad184. [PMID: 38158741 PMCID: PMC10757065 DOI: 10.1093/heapro/daad184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
The influence of commercial actors, practices and processes on the health and wellbeing of women is still not well understood. The alcohol industry has developed a range of products to appeal to new 'health conscious' markets, such as 'low-calorie' and 'low-sugar' products. While these products may have specific appeal for women, there has been little in-depth research that has sought to understand how women conceptualize these products and the range of symbolic meanings that women associate with these products. An online qualitatively led survey was conducted with n = 497 Australian women who had consumed alcohol in the last year. Questions related to the reasons for and influences on alcohol use, the purchasing of 'low-calorie' or 'low-sugar' products and the influence that these products might have on women's alcohol use. Data were interpreted using reflexive thematic analysis. Women consumed alcohol to relax, cope with everyday stressors and because of the alignment with social practices and social connection. Women perceived that these products provided a healthier alternative to traditional alcohol products and that they aligned with women's values relating to weight and the thin ideal. Some women were concerned that these products could increase alcohol consumption by reducing the perceptions of risk associated with alcohol. Policy consideration is needed to address how product claims and attributes may influence population groups' interpretations of the risks and benefits of these alcohol products, including the illusion that these products have protective potential and are better for overall health and wellbeing.
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Affiliation(s)
- Hannah Pitt
- Faculty of Health, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Simone McCarthy
- Faculty of Health, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Danica Keric
- Cancer Council Western Australia, Level 1/420 Bagot Road, Subiaco, Western Australia, 6008, Australia
| | - Grace Arnot
- Faculty of Health, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Sarah Marko
- Faculty of Health, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Florentine Martino
- Faculty of Health, GLOBE, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Julia Stafford
- Cancer Council Western Australia, Level 1/420 Bagot Road, Subiaco, Western Australia, 6008, Australia
| | - Samantha Thomas
- Faculty of Health, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
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Willman A, Harkness J, McDonnell K, Palermo M, Macnaughton R. The role of alcohol in the lives of midlife women living on the Northern Beaches of Sydney, Australia. Heliyon 2023; 9:e21440. [PMID: 38027780 PMCID: PMC10651435 DOI: 10.1016/j.heliyon.2023.e21440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background In Australia, midlife women are experiencing increasing levels of risky drinking behaviours and alcohol-related harms. This is despite the general population trend of decreasing alcohol consumption overall. In light of these diverging trends, this research explores the role of alcohol in the lives of midlife women from their own perspective. Methods Six semi-structured focus groups were conducted with 47 women aged 35-59 years of age. Residents from the Northern Beaches of Sydney, Australia were recruited, as this group of women appear to be experiencing heightened alcohol-related harms, with an alcohol-related hospitalisation rate 40 % higher than the NSW state average in 2017-18. Results Midlife women described the practical utility of drinking as a habit to relieve stress and escape trauma, as well as an effective method for creating and strengthening social connections within the parenthood life stage. Participants also described the act of moderation as a potent trigger for peer pressure and discussed the individual's tendency to prioritise the short term relieving effects of drinking, despite awareness of the long term health risks. Conclusion Findings around the pro-social role of alcohol as a woman and a parent should be explicitly considered when designing 'swap it' population health messages. Furthermore, the marked social penalty of moderation and tendency to discount long term health risks should also be factored into health promotion messages which seek to utilise moderation as a strategy to reduce alcohol-related harm for midlife women.
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Foley K, Lunnay B, Kevin C, Ward PR. Developing a Women's Thought Collective methodology for health research: The roles and responsibilities of researchers in the reflexive co-production of knowledge. Health Expect 2023; 26:1954-1964. [PMID: 37522791 PMCID: PMC10485336 DOI: 10.1111/hex.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Co-produced research holds enormous value within the health sciences. Yet, there can be a heavy focus on what research participants think, do and know; while the researcher's responsibility to explore and re/work their own knowledge or praxis tends to escape from view. This is reflected in the limited use of co-production to explore broad structural distributions of health and risk(s). We argue this missed opportunity has the potential to unfold as what Berlant calls a 'cruel optimism', where something desirable becomes an obstacle to flourishing and/or produces harm. We explore challenges to involving lay populations meaningfully in health research amidst a neoliberal cultural landscape that tends to responsibilise people with problems they cannot solve. METHODS AND FINDINGS Drawing together principles from hermeneutic and feminist philosophy, we develop a novel methodology for co-producing research about determinants of health and health risk (using a case study of alcohol consumption as an example) that centres on what researchers do, know and think during research: Women's Thought Collectives. DISCUSSION Keeping the constructed nature of social systems-because they shape ideas of value, expertise and knowledge-in view during co-produced research illuminates the potential for cruel optimisms within it. Such reflexive awareness carves out starting points for researchers to engage with how social hierarchies might (tacitly) operate during the co-production of knowledge. Our work has broad utility for diverse population groups and provides important considerations around the roles and responsibilities for reflexive co-production of knowledge at all levels of health systems. PATIENT OR PUBLIC CONTRIBUTION The development of these ideas was sparked by working with lay participants during the Women's Thought Collectives for Kristen Foley's doctoral research 2021-2023, but undertaken without their direct involvement-in accordance with the responsibilities of researchers in the reflexive co-production of knowledge. Forthcoming publications will address the outcomes and processes of this work.
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Affiliation(s)
- Kristen Foley
- Research Centre for Public Health, Equity and Human FlourishingTorrens University AustraliaAdelaideAustralia
| | - Belinda Lunnay
- Research Centre for Public Health, Equity and Human FlourishingTorrens University AustraliaAdelaideAustralia
| | - Catherine Kevin
- College of Humanities and Social ScienceFlinders UniversityAdelaideAustralia
| | - Paul R. Ward
- Research Centre for Public Health, Equity and Human FlourishingTorrens University AustraliaAdelaideAustralia
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Batchelor S, Lunnay B, Macdonald S, Ward PR. Extending the sociology of candidacy: Bourdieu's relational social class and mid-life women's perceptions of alcohol-related breast cancer risk. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:1502-1522. [PMID: 37056162 DOI: 10.1111/1467-9566.13644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 03/30/2023] [Indexed: 06/19/2023]
Abstract
Alcohol is a modifiable breast cancer risk, increasing risk in a dose-dependent manner. Mid-life women (aged 45-64 years) consume alcohol at higher rates than younger women and this, combined with age, make them a high-risk group for breast cancer. This critical public health problem has a seemingly obvious solution (reduce drinking); however, women do not necessarily know alcohol causes breast cancer, and if they do, reducing consumption is not always possible, or desirable. To innovate public health responses, we employ an interpretative sociological framework 'candidacy' to understand women's perspectives on breast cancer risk relative to alcohol consumption and their social class. Drawing on 50 interviews with Australian mid-life women, our findings reveal the socio-structural determinants of 'candidacy', that mean modifying alcohol consumption for breast cancer prevention is impacted by social class. Utilising Bourdieu's relational capitals, our interpretations show how social class shapes women's ascriptions and enactments of breast cancer candidacy. We offer an important theoretical extension to 'candidacy' by demonstrating more or less fluidity in women's assessment of breast cancer risk according to their agency to adopt breast cancer prevention messages. Understanding the social class possibilities and limitations in women's perceptions of breast cancer risk provides a new opportunity to reduce inequities in breast cancer incidence.
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Affiliation(s)
- Samantha Batchelor
- Research Centre for Public Health, Equity and Human Flourishing, Adelaide Campus, Torrens University, Adelaide, Australia
| | - Belinda Lunnay
- Research Centre for Public Health, Equity and Human Flourishing, Adelaide Campus, Torrens University, Adelaide, Australia
| | - Sara Macdonald
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul R Ward
- Research Centre for Public Health, Equity and Human Flourishing, Adelaide Campus, Torrens University, Adelaide, Australia
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Lunnay B, Seymour J, Foley K, Musolino C, Ward PR. Through the wine glass: How biographical midlife transitions and women's affective interpretations interact with alcohol consumption. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104046. [PMID: 37207408 DOI: 10.1016/j.drugpo.2023.104046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/30/2023] [Accepted: 05/01/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Women during midlife are consuming larger quantities of alcohol than any other age group of women and any other generation of midlife women previously. This is concerning given alcohol related-health risks coalesce with age-related health risks for women, in particular, breast cancer. METHODS In-depth interviews with 50 Australian midlife women (aged 45-64) from different social classes explored women's personal accounts of midlife transitions and their descriptions of the role of alcohol in navigating these life experiences; both daily occurrences as well as significant moments in the life course. RESULTS Our findings point to the complex, confusing and co-existing biographical transitions women experience during midlife (generational, embodied/physiological and material changes) that sharpen a role for alcohol in women's lives and are nuanced by social class (volumes of social, economic and cultural capital). We pay close attention to women's affective interpretations of these transitions and ways alcohol is used to feel robust in navigating daily life or easing their prospective futures. Critically, for women living with limited access to capital, and who could not 'measure up' to social ideals by comparison with the achievements and trajectories of other midlife women, alcohol reconciled their disappointment. Our exploration shows how the social class conditions that shape how women make sense of their transitions through midlife might be differently shaped to enable different options forreducing drinking. CONCLUSIONS Policy must address the social and emotional concerns women experience through midlife transitions that give alcohol a worthwhile place in their lives. A first step might be responding to the absence of community and leisure spaces for midlife women especially those that do not integrate alcohol, with benefits including addressing loneliness, isolation and feeling invisible, and enabling positive constructions of midlife identities. Structural barriers to participation and feelings of worth must be removed for women who lack social, cultural and economic resources.
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Affiliation(s)
- Belinda Lunnay
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University of Australia, Adelaide Campus, 88 Wakefield St, Adelaide SA 5000, Australia.
| | - Jessica Seymour
- Flinders University College of Medicine and Public Health, Bedford Park, SA, Australia
| | - Kristen Foley
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University of Australia, Adelaide Campus, 88 Wakefield St, Adelaide SA 5000, Australia
| | - Connie Musolino
- Stretton Health Equity, Stretton Institute, School of Social Sciences, The University of Adelaide, Australia
| | - Paul R Ward
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University of Australia, Adelaide Campus, 88 Wakefield St, Adelaide SA 5000, Australia
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Kersey K, Hutton F, Lyons AC. Women, alcohol consumption and health promotion: the value of a critical realist approach. Health Promot Int 2023; 38:6974794. [PMID: 36617295 DOI: 10.1093/heapro/daac177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Research on women's drinking occurs in largely disparate disciplines-including public health, health promotion, psychology, sociology, and cultural studies-and draws on differing philosophical understandings and theoretical frameworks. Tensions between the aims and paradigmatic underpinnings of this research (across and within disciplines) have meant that knowledge and insight can be frequently disciplinary-specific and somewhat siloed. However, in line with the social and economic determinants of the health model, alcohol research needs approaches that can explore how multiple gender-related factors-biological, psycho-social, material, and socio-cultural-combine to produce certain drinking behaviours, pleasures and potential harms. We argue that critical realism as a philosophical underpinning to research can accommodate this broader conceptualization, enabling researchers to draw on multiple perspectives to better understand women's drinking. We illustrate the benefit of this approach by presenting a critical realist theoretical framework for understanding women's drinking that outlines interrelationships between the psychoactive properties of alcohol, the role of embodied individual characteristics and the material, institutional and socio-cultural contexts in which women live. This approach can underpin and foster inter-disciplinary research collaboration to inform more nuanced health promotion practices and policies to reduce alcohol-related harm in a wide range of women across societies.
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Affiliation(s)
- Kate Kersey
- School of Health, Victoria University of Wellington, Kelburn Campus, Wellington, New Zealand
| | - Fiona Hutton
- Institute of Criminology, Victoria University of Wellington, Kelburn Campus, Wellington, New Zealand
| | - Antonia C Lyons
- Department of Social and Community Health; Centre for Addiction Research, University of Auckland, Auckland, New Zealand
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Lunnay B, Nicholls E, Pennay A, MacLean S, Wilson C, Meyer SB, Foley K, Warin M, Olver I, Ward PR. Sober Curiosity: A Qualitative Study Exploring Women's Preparedness to Reduce Alcohol by Social Class. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214788. [PMID: 36429505 PMCID: PMC9690974 DOI: 10.3390/ijerph192214788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Urgent action is required to identify socially acceptable alcohol reduction options for heavy-drinking midlife Australian women. This study represents innovation in public health research to explore how current trends in popular wellness culture toward 'sober curiosity' (i.e., an interest in what reducing alcohol consumption would or could be like) and normalising non-drinking could increase women's preparedness to reduce alcohol consumption. METHODS Qualitative interviews were undertaken with 27 midlife Australian women (aged 45-64) living in Adelaide, Melbourne and Sydney in different social class groups (working, middle and affluent-class) to explore their perceptions of sober curiosity. RESULTS Women were unequally distributed across social-classes and accordingly the social-class analysis considered proportionally the volume of data at particular codes. Regardless, social-class patterns in women's preparedness to reduce alcohol consumption were generated through data analysis. Affluent women's preparedness to reduce alcohol consumption stemmed from a desire for self-regulation and to retain control; middle-class women's preparedness to reduce alcohol was part of performing civility and respectability and working-class women's preparedness to reduce alcohol was highly challenging. Options are provided for alcohol reduction targeting the social contexts of consumption (the things that lead midlife women to feel prepared to reduce drinking) according to levels of disadvantage. CONCLUSION Our findings reinstate the importance of recognising social class in public health disease prevention; validating that socially determined factors which shape daily living also shape health outcomes and this results in inequities for women in the lowest class positions to reduce alcohol and related risks.
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Affiliation(s)
- Belinda Lunnay
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide 5000, Australia
| | - Emily Nicholls
- Department of Sociology, University of York, York YO10 5DD, UK
| | - Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Melbourne 3000, Australia
| | - Sarah MacLean
- Centre for Alcohol Policy Research, La Trobe University, Melbourne 3000, Australia
| | - Carlene Wilson
- College of Medicine and Public Health, Flinders University, Bedford Park 5042, Australia
| | - Samantha B. Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Kristen Foley
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide 5000, Australia
| | - Megan Warin
- Fay Gale Centre for Research
on Gender, School of Social Sciences, University of Adelaide, Adelaide 5000, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide 5000, Australia
| | - Paul R. Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide 5000, Australia
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