"Women of my age tend to drink": the social construction of alcohol use by Australian and Danish women aged 50-70 years

The role of alcohol consumption in the lives of older Australian women: qualitative insights and an agenda for further research, policy and practice

BACKGROUND

Alcohol consumption presents a threat to the health and wellbeing of women. The alcohol industry often pushes back at global efforts to prioritise the prevention of alcohol harms to women. Qualitative researchers have investigated how younger and midlife women conceptualise their alcohol consumption, but there is very limited research relating to older women (those 60 years and over).

METHODS

Using data collected from an online qualitative survey, this paper explored the factors that influence how older Australian women drinkers (n = 144. 60-88 years) conceptualised the role of alcohol in their lives. The study used a 'Big Q' reflexive approach to thematic analysis, drawing upon sociological theories of risk and symbolic interactionism to construct four themes from the data.

RESULTS

First, alcohol consumption was viewed by participants as an accepted and normalised social activity, that was part of Australian culture. Second, alcohol played a role for some participants as a way to cope with life changes (such as retirement), as well as managing stressful or challenging life circumstances (such as loneliness). Third, alcohol was part of the routines and rituals of everyday life for some women. For example, women discussed the consumption of wine with their evening meal as an important part of the structure of their day. Fourth, participants had clear personal expectancies about what it meant to be a 'responsible drinker'. They had clear narratives about personal control and moral obligation, which in some cases created a reduced perception of their own risk of alcohol-caused harm.

CONCLUSIONS

This research provides a starting point for future public health research examining the factors that may shape older women's alcohol consumption beliefs and practices. Public health activities should consider the unique needs and potential vulnerabilities of older women drinkers, and how these may be potentially exploited by the alcohol industry.

Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design

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.

The symbolic consumption processes associated with 'low-calorie' and 'low-sugar' alcohol products and Australian women

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.

Through the wine glass: How biographical midlife transitions and women's affective interpretations interact with alcohol consumption

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.

Aging in nucleus accumbens and its impact on alcohol use disorders

Ethanol is one of the most widely consumed drugs in the world and prolonged excessive ethanol intake might lead to alcohol use disorders (AUDs), which are characterized by neuroadaptations in different brain regions, such as in the reward circuitry. In addition, the global population is aging, and it appears that they are increasing their ethanol consumption. Although research involving the effects of alcohol in aging subjects is limited, differential effects have been described. For example, studies in human subjects show that older adults perform worse in tests assessing working memory, attention, and cognition as compared to younger adults. Interestingly, in the field of the neurobiological basis of ethanol actions, there is a significant dichotomy between what we know about the effects of ethanol on neurochemical targets in young animals and how it might affect them in the aging brain. To be able to understand the distinct effects of ethanol in the aging brain, the following questions need to be answered: (1) How does physiological aging impact the function of an ethanol-relevant region (e.g., the nucleus accumbens)? and (2) How does ethanol affect these neurobiological systems in the aged brain? This review discusses the available data to try to understand how aging affects the nucleus accumbens (nAc) and its neurochemical response to alcohol. The data show that there is little information on the effects of ethanol in aged mice and rats, and that many studies had considered 2-3-month-old mice as adults, which needs to be reconsidered since more recent literature defines 6 months as young adults and >18 months as an older mouse. Considering the actual relevance of an aged worldwide population and that this segment is drinking more frequently, it appears at least reasonable to explore how ethanol affects the brain in adult and aged models.

Home drinking practices among middle-class adults in midlife during the COVID-19 pandemic: Material ubiquity, automatic routines and embodied states

INTRODUCTION

Harmful drinking is increasing among mid-life adults. Using social practice theory, this research investigated the knowledge, actions, materials, places and temporalities that comprise home drinking practices among middle-class adults (40-65 years) in Aotearoa New Zealand during 2021-2022 and post the COVID-19 pandemic lockdowns.

METHODS

Nine friendship groups (N = 45; 26 females, 19 males from various life stages and ethnicities) discussed their drinking practices. A subset of 10 participants (8 female, 2 male) shared digital content (photos, screenshots) about alcohol and drinking over 2 weeks, which they subsequently discussed in an individual interview. Group and interview transcripts were thematically analysed using the digital content to inform the analysis.

RESULTS

Three themes were identified around home drinking practices, namely: (i) alcohol objects as everywhere, embedded throughout spaces and places in the home; (ii) drinking practices as habitual, automatic and conditioned to mundane everyday domestic chores, routines and times; and (iii) drinking practices intentionally used by participants to achieve desired embodied states to manage feelings linked to domestic and everyday routines.

DISCUSSION AND CONCLUSIONS

Alcohol was normalised and everywhere within the homes of these midlife adults. Alcohol-related objects and products had their own agency, being entangled with domestic routines and activities, affecting drinking in both automatic and intentional ways. Developing alcohol policy that would change its ubiquitous and ordinary status, and the 'automatic' nature of many drinking practices, is needed. This includes restricting marketing and availability to disrupt the acceptability and normalisation of alcohol in the everyday domestic lives of adults at midlife.

Women, alcohol consumption and health promotion: the value of a critical realist approach

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.

'I have a healthy relationship with alcohol': Australian midlife women, alcohol consumption and social class

Alcohol consumption by Australian women during midlife has been increasing. Health promotion efforts to reduce alcohol consumption in order to reduce alcohol-related disease risk compete with the social contexts and value of alcohol in women's lives. This paper draws on 50 qualitative interviews with midlife women (45-64 years of age) from different social classes living in South Australia in order to gain an understanding of how and why women might justify their relationships with alcohol. Social class shaped and characterized the different types of relationships with alcohol available to women, structuring their logic for consuming alcohol and their ability to consider reducing (or 'breaking up with') alcohol. We identified more agentic relationships with alcohol in the narratives of affluent women. We identified a tendency for less control over alcohol-related decisions in the narratives of women with less privileged life chances, suggesting greater challenges in changing drinking patterns. If classed differences are not attended to in health promotion efforts, this might mitigate the effectiveness of alcohol risk messaging to women.

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.

Clusters of older adults with and without experience of alcohol-related harms based on affective motivations for drinking

Aim: This cross-sectional study explores profiles of community-residing Norwegian older adults (aged 62-95 years) in relation to their personally expressed motives for alcohol use. It specifically investigates drinking motives as they uniquely characterise alcohol consumers reporting problem and non-problem drinking assessed using the Drinking Problem Index (DPI). Methods: Two-step cluster analysis was used to delineate subgroups of alcohol consumers on seven drinking motivation variables, together with DPI score. The clusters were evaluated by gender, physical health and psychological health status. Results: Four clusters of alcohol consumers were identified in relation to drinking motives: Low motivated drinkers, Ambivalent drinkers, Enhancement drinkers, and Coping drinkers. For one subgroup, a strong reliance on alcohol to cope with negative feelings was most relevant to both non-problem and problem drinkers. For another subgroup, enjoying the effects of alcohol, but non-reliance on alcohol to cope with negative mood were associated with reporting drinking problems. Ambivalent drinkers reported overall low satisfaction with mental health. Very poor physical and mental health were more prevalent in men than in women characterised as Coping drinkers. Predominantly mental health status supported distinctiveness of delineated clusters. Conclusion: This study demonstrates that the classification approach to profiling of characteristics of alcohol consumers based on their motivations to drink may have a potential utility in human care settings to identify individuals who incur or may be at risk of developing alcohol-related problems in later life, and those who are not.

Exploring the significance of relationality, care and governmentality in families, for understanding women's classed alcohol drinking practices

In this paper we explore the importance of relationality and care for understanding women's alcohol use, using a theoretical framework comprising concepts from feminist ethics of care, the sociology of personal life, and feminist approaches to governmentality. A key focus is how care giving responsibilities and expectations in families appear to be particularly significant for creating or constraining possibilities for drinking practices. We draw on findings from a qualitative study about alcohol use and stress with 26 women, aged 24-67 years, in the North East of England, UK. We consider how care practices in families feature in the accounts of alcohol use by women with and without children, and how the symbolic and material aspects of social class interact with care to alter the drinking practices women engage in. The interpretation extends scholarship on women's drinking, by adopting a relational approach to identity and linking private care practices and alcohol use to social and political structures. Public health approaches for preventing or reducing heavy drinking practices are predominantly situated within biomedical or psychological paradigms. Intervention approaches to reduce women's drinking that draw on our theoretical framework could offer potential for reducing harmful alcohol use in a more meaningful way.

Does Religious Participation Predict Future Expectations About Health? Using a Life Course Framework to Test Multiple Mechanisms

Though an impressive array of health outcomes has been studied, research within the field of religion and health has not yet considered how religious involvement may affect future expectations about health. This is a significant shortcoming because the teachings of many religions direct adherent's focus to the distant future, and future self-ratings of health are a known predictor of subjective life expectancy and eventual mortality risk. Recognizing the need for a life course approach to conceptualizing patterns of religious involvement, we assess how stability or change in religious attendance from childhood to adulthood structures individual expectations of future health. Drawing on data from the 2017 Values and Beliefs of the American Public Study (Baylor Religion Survey Wave 5), we find that stable high (weekly) attendance between childhood and adulthood is associated with higher future health expectations. Parametric mediation analyses conducted in the counterfactual framework suggest that this association is explained by the tendency of frequent stable attenders to have (a) higher levels of beliefs in the sense of divine control and (b) a lower likelihood of engaging in harmful health behaviors (smoking).

The who and what of women's drinking: Examining risky drinking and associated socio-demographic factors among women aged 40-65 years in Australia

INTRODUCTION

Recent trends in Australian national survey data show an increase in alcohol use among middle-aged people, amidst declines in alcohol use among other population groups. There is limited research, however, on middle-aged women's alcohol use. This study aimed to examine patterns in alcohol use among Australian women aged 40-65 and the associated sociodemographic and contextual factors.

METHODS

Cross-sectional data from six waves of the National Drug Strategy Household Survey (2001-2019). We estimated the prevalence of long-term risky drinking (>2 Australian standard drinks per day) and risky-single occasion drinking (>5 Australian standard drinks on one occasion) among middle-aged women. Logistic regression models were estimated using 2019 data to examine demographic characteristics and contextual factors associated with alcohol use.

RESULTS

Since 2001, there has been a statistically significant increase in long-term risky drinking and risky-single occasion drinking amongst middle-aged women in Australia. Educational attainment, marital status and employment status were negatively associated with risky drinking, whereas rurality, age and location of use were positively associated with risky drinking. Beverage type was both positively and negatively associated with risky drinking.

DISCUSSION AND CONCLUSIONS

Given the significant increase in alcohol use amongst middle-aged women in Australia, prevention efforts are needed for this group, which may focus in particular on home drinking and the impact of rurality on alcohol use.

Place of alcohol in the 'wellness toolkits' of midlife women in different social classes: A qualitative study in South Australia

In this article, we explore how women in different social classes had differential access to resources and services to enhance their 'wellness'-resulting in classed roles in alcohol consumption. We analyse data from a qualitative study on alcohol by midlife women in South Australia and employ the analogy of a 'toolkit' in order to understand the structural patterning of 'wellness tools'. Bourdieu's relational model of class guides our exploration of women's inequitable opportunities for wellness. Higher social class women had 'choices' facilitated by bulging wellness toolkits, such as yoga, exercise and healthy eating regimens-alcohol consumption was not essential to promoting 'wellness' and did not have an important place in their toolkits. Middle-class women had less well-stocked toolkits and consumed alcohol in a 'compensation approach' with other wellness tools. Alcohol consumption received positive recognition and was a legitimised form of enjoyment, fun and socialising, which needed counterbalancing with healthy activities. Working-class women had sparse toolkits-other than alcohol-which was a tool for dealing with life's difficulties. Their focus was less on 'promoting wellness' and more on 'managing challenging circumstances'. Our social class-based analysis is nestled within the sociology of consumption and sociological critiques of the wellness industry.

Alcohol and drinking within the lives of midlife women: A meta-study systematic review

BACKGROUND

A range of societal changes have created positive and encouraging environments for women's alcohol use. Within this context, in Western countries there is evidence of rising rates of alcohol consumption and related harms among midlife and older women. It is timely and important to explore the role of alcohol in the lives of midlife women to better understand observed data trends and to develop cohort specific policy responses. Focussing on Western countries and those with similar mixed market systems for alcohol regulation, this review aimed to identify 1) how women at midlife make sense of and account for their consumption of alcohol; 2) factors that play a role; and 3) the trends in theoretical underpinnings of qualitative research that explores women's drinking at midlife.

METHODS

A meta-study approach was undertaken. The review process involved extracting and analysing the data findings of eligible research, as well as reviewing the contextual factors and theoretical framing that actively shape research and findings.

RESULTS

Social meanings of alcohol were interwoven with alcohol's psycho-active qualities to create strong localised embodied experiences of pleasure, sociability, and respite from complicated lives and stressful circumstances in midlife women. Drinking was shaped by multiple and diverse aspects of social identity, such as sexuality, family status, membership of social and cultural groups, and associated responsibilities, underpinned by the social and material realities of their lives, societal and policy discourses around drinking, and how they physically experienced alcohol in the short and longer term.

CONCLUSION

For harm reduction strategies to be successful, further research effort should be undertaken to understand alcohol's diverse meanings and functions in women's lives and the individual, material, and socio-cultural factors that feed into these understandings. As well as broad policies that reduce overall consumption and "de-normalise" drinking in society, policy-makers could usefully work with cohorts of women to develop interventions that address the functional role of alcohol in their lives, as well as policies that address permissive regulatory environments and the overall social and economic position of women.

'What makes up wine o'clock? Understanding social practices involved in alcohol use among women aged 40-65 years in Australia

BACKGROUND

In the context of global declines in alcohol consumption, studies have recently shown that middle-aged women's alcohol use has increased in the past decade. Limited research has focused on this demographic group. We aimed to understand the perspectives of women aged 40-65 years on the role of alcohol in their lives and their motivations for consuming alcohol. We used social practice theory to identify distinctive assemblages of meanings, materials, competences and temporalities relating to alcohol use.

METHODS

We used qualitative methods incorporating Human Centred-Design principles into activity-based workshops. We conducted ten 3-hour workshops with a total of 39 women aged 40-65 years. We coded the transcribed data using the three original components of social practice theory - meanings, materials, competences as well as the fourth component of temporality.

RESULTS

Women described their alcohol use as nuanced, with different meanings across contexts and settings. 'Wine o'clock' was the term used by many women to describe the practice of consuming wine as soon as they finished their day's duties. Women appeared conscious of representing their drinking as rational, measured and safe, particularly when discussing weekday use, and drinking alone. Women described it as an act of relaxation, and rationalised it as earned. Alcohol consumption on weekends was strongly tied to social connection. Alcohol was explicitly described as the means to see people socially and was also implicitly present in social gatherings such as lunches, barbecues and dinners on weekends. Although women rejected the notion of experiencing social pressures to consume alcohol, they also described needing excuses for not consuming alcohol, such as partaking in temporary abstinence periods such as Dry July.

CONCLUSIONS

Our study describes how midlife women use alcohol to demarcate between duty and pleasure and for social connection. Prevention efforts which focus on social connection, relaxation and changing the discourse on alcohol's role in women's social lives may be beneficial for reducing women's alcohol consumption.

Managing older people's perceptions of alcohol-related risk: a qualitative exploration in Northern English primary care

BACKGROUND

Risk of harm from drinking increases with age as alcohol affects health conditions and medications that are common in later life. Different types of information and experiences affect older people's perceptions of alcohol's effects, which must be navigated when supporting healthier decisions on alcohol consumption.

AIM

To explore how older people understand the effects of alcohol on their health; and how these perspectives are navigated in supportive discussions in primary care to promote healthier alcohol use.

DESIGN AND SETTING

A qualitative study consisting of semi-structured interviews and focus groups with older, non-dependent drinkers and primary care practitioners in Northern England.

METHOD

A total of 24 older adults aged ≥65 years and 35 primary care practitioners participated in interviews and focus groups. Data were analysed thematically, applying principles of constant comparison.

RESULTS

Older adults were motivated to make changes to their alcohol use when they experienced symptoms, and if they felt that limiting consumption would enable them to maintain their quality of life. The results of alcohol-related screening were useful in providing insights into potential effects for individuals. Primary care practitioners motivated older people to make healthier decisions by highlighting individual risks of drinking, and potential gains of limiting intake.

CONCLUSION

Later life is a time when older people may be open to making changes to their alcohol use, particularly when suggested by practitioners. Older people can struggle to recognise potential risks or perceive little gain in acting on perceived risks. Such perceptions may be challenging to navigate in supportive discussions.