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

Enhancing clinical decision-making: A novel nomogram for stratifying cancer-specific survival in middle-aged individuals with follicular thyroid carcinoma utilizing SEER data

Background

Thyroid cancer (TC) is the most common malignant tumor in the endocrine system, is also one of the head and neck tumor. Follicular Thyroid Carcinoma (FTC) plays an important role in the pathological classification of thyroid cancer. This study aimed to develop an innovative predictive tool, a nomogram, for predicting cancer specific survival (CSS) in middle-aged FTC patients.

Methods

We collected patient data from the Surveillance, Epidemiology, and End Results (SEER) database. The data from patients between 2004 and 2015 were used as the training set, and the data from patients between 2016 and 2018 were used as the validation set. To identify independent risk factors affecting patient survival, univariate and multivariate Cox regression analyses were performed. Based on this, we developed a nomogram model aimed at predicting CSS in middle-aged patients with FTC. The consistency index (C-index), the area under the receiver operating characteristic (ROC) curve (AUC), and the calibration curve were used to evaluate the accuracy and confidence of the model.

Results

A total of 2470 patients were enrolled in this study, in which patients from 2004 to 2015 were randomly assigned to the training cohort (N = 1437) and validation cohort (N = 598), and patients from 2016 to 2018 were assigned to the external validation cohort (N = 435) in terms of time. Univariate and multivariate Cox regression analysis showed that marriage, histological grade and TNM stage were independent risk factors for survival. The C-index for the training cohort was 0.866 (95 % CI: 0.805-0.927), for the validation cohort it was 0.944 (95 % CI: 0.903-0.985), and for the external validation cohort, it reached 0.999 (95 % CI: 0.997-1.001). Calibration curves and AUC suggest that the model has good accuracy.

Conclusions

We developed an innovative nomogram to predict CSS in middle-aged patients with FTC. Our model after a rigorous internal validation and external validation process, based on the time proved that the high level of accuracy and reliability. This tool helps healthcare professionals and patients make informed clinical decisions.

Increased anxiolytic effect in aged female rats and increased motoric behavior in aged male rats to acute alcohol administration: Comparison to younger animals

The population of most countries in the world is increasing and understanding risk factors that can influence the health of the older population is critical. Older adults consume alcohol often in a risky, binge manner. Previous work has demonstrated that aged rats are more sensitive to many of the effects of acute ethanol. In the current project aged, adult, and adolescent female and male rats were tested on the elevated plus maze and open field following either a 1.0 g/kg alcohol injection or a saline injection. We report sex- and age-dependent effects whereas aged female rats, but not aged male rats, showed an increased anxiolytic effect of alcohol in the elevated plus maze while aged male rats, but not aged female rats, showed increased stimulatory movement in the open field. In addition, significant age effects were found for both female and male rats. It is proposed that the sex- and age-dependent effects reported in the current studies may be due to differential levels of alcohol-induced allopregnanolone for the anxiolytic effects and differential levels of alcohol-induced dopamine for the stimulatory effects. The current work provides insights into factors influencing alcohol consumption in older adults.

Regrets, I've Had a Few: Exploring Factors Associated with Getting Drunk and Regret in an International Study of People Who Drink Alcohol

BACKGROUND

Excessive alcohol consumption is often followed by feelings of regret. This study aimed to explore country differences in experiences of drunkenness and regrets and predictors of experiencing a greater number of regrettable drinking occasions.

METHODS

This study draws on a sample of 82,821 respondents from 31 countries who completed the 2020 Global Drug Survey. Respondents were asked to report how many times in the last year they had been drunk, how many of those times they felt regret afterwards and to complete a range of sociodemographic measures.

RESULTS

In the last 12 months, the median times drunk was 6 and the median number of regretted occasions was 2. There was an inverse relationship between times drunk and regret. Respondents who got drunk more often regretted it a smaller percentage of the time than those who got drunk less often. Respondents from Argentina and Colombia regretted being drunk the most and Denmark the least. Being younger, in higher AUDIT categories were associated with more times drunk. Being a woman, having mental health conditions were associated with more regretted occasions.Discussion and conclusions: Country variations may reflect relative acceptability of being drunk. Those who drink more, per occasion, may become accustomed to the consequences and feel fewer regrets. Interventions promoting reduced alcohol consumption may benefit from encouraging people to consider their future regret following a drinking occasion but should account for lower levels of regret in those who get drunk more often.

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.

The role of alcohol in the lives of midlife women living on the Northern Beaches of Sydney, Australia

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.

Unpacking assertions made by the alcohol industry and how they make them: An analysis of submissions into Australia's National Alcohol Strategy

INTRODUCTION

Alcohol is a leading cause of morbidity and mortality globally. One significant barrier to the implementation of evidence-based alcohol policy is alcohol industry opposition. Making submissions to national policy processes is one way in which the industry exert influence. The aim of this study was to analyse alcohol industry submissions into Australia's National Alcohol Strategy to determine key assertions made by the alcohol industry and the ways in which they use evidence and refute the effectiveness of public health policies to make their claims.

METHODS

Submissions made by alcohol industry actors (n = 12) were analysed using content analysis to determine key industry assertions. A pre-existing framework on alcohol industry use of evidence was then applied to analyse the evidentiary practices used to make these assertions.

RESULTS

Five common industry assertions were identified: 'Drinking alcohol in moderation has health benefits'; 'Alcohol isn't the cause of violence'; 'Targeted initiatives, not population level alcohol policies, are needed'; 'Strong alcohol advertising regulations are not necessary'; and 'Minimum unit price and pricing and taxation policies more broadly are not needed'. The industry systematically manipulated, misused and ignored evidence throughout their submissions.

DISCUSSION AND CONCLUSIONS

The alcohol industry is misusing evidence in their submissions to government consultations to make their assertions about alcohol policy. It is therefore essential that industry submissions are scrutinised and not accepted on face value. Additionally, it is suggested that the alcohol industry requires a distinct model of governance similarly to that which regulates the tobacco industry to prevent their attempts to undermine evidence-based public health policy.

A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial

OBJECTIVES

To assess the effectiveness of a brief alcohol intervention for improving awareness of alcohol as a breast cancer risk factor, improving alcohol literacy, and reducing alcohol consumption by women attending routine breast screening.

DESIGN

Single-site, double-blinded randomised controlled trial.

SETTING

Maroondah BreastScreen (Eastern Health, Melbourne), part of the national breast cancer screening program.

PARTICIPANTS

Women aged 40 years or more, with or without a history of breast cancer and reporting any alcohol consumption, who attended the clinic for routine mammography during 5 February - 27 August 2021.

INTERVENTION

Active arm: animation including brief alcohol intervention (four minutes) and lifestyle health promotion (three minutes).

CONTROL ARM

lifestyle health promotion only.

MAJOR OUTCOME MEASURE

Change in proportion of women who identified alcohol use as a clear risk factor for breast cancer (scaled response measure).

RESULTS

The mean age of the 557 participants was 60.3 years (standard deviation, 7.7 years; range, 40-87 years); 455 had recently consumed alcohol (82%). The proportions of participants aware that alcohol use increased the risk of breast cancer were larger at four weeks than at baseline for both the active intervention (65% v 20%; odds ratio [OR], 41; 95% confidence interval [CI], 18-97) and control arms of the study (38% v 20%; OR, 4.9; 95% CI, 2.8-8.8), but the change over time was greater for the active intervention arm (arm × time: P < 0.001). Alcohol literacy also increased to a greater extent in the active than the control arm, but alcohol consumption did not significantly change in either arm.

CONCLUSION

A tailored brief alcohol intervention for women attending breast screening was effective for improving awareness of the increased breast cancer risk associated with alcohol use and alcohol literacy more broadly. Such interventions are particularly important given the rising prevalence of risky drinking among middle-aged and older women and evidence that even very light alcohol consumption increases breast cancer risk.

REGISTRATION

ClinicalTrials.gov, NCT04715516 (prospective; 20 January 2021).

The Effects of a Web-Based Intervention to Reduce Alcohol Consumption Among Middle-Aged Women: Protocol for a Randomized Controlled Trial

BACKGROUND

In the last decade, alcohol consumption among middle-aged women (40-65 years old) in Australia increased, despite declines in overall population consumption. Web-based, brief interventions are promising for reducing alcohol consumption, with efficacy shown in a wide range of populations. However, no published interventions have been designed specifically for and tested with middle-aged women.

OBJECTIVE

This study aims to design and implement a web-based intervention intended to reduce alcohol consumption among middle-aged women.

METHODS

The study is a 3-arm randomized controlled trial with a web-based intervention plus ecological momentary assessment (EMA) group compared to an EMA-only and a pre-post only control group. The study is aimed at middle-aged women, defined as women aged between 40 and 65 years, who consume alcohol at least weekly or who have consumed 4 or more drinks on 1 occasion in the last month. The intervention aims to reduce alcohol consumption through 4 modules that provide information on the health impacts of alcohol, mindfulness, social influences, and alcohol marketing. Intervention participants will also fill out biweekly EMA assessments. The comparators are EMA-only and pre-post control only. The primary outcome is alcohol consumption at 8 weeks compared between groups. Secondary outcomes are awareness of alcohol-related harms, readiness to change alcohol consumption, health status, mental health, and social support.

RESULTS

Ethics approval for this project was received on September 11, 2019. The trial was registered on August 14, 2020. Recruitment has commenced, and the expected results will be available in 2022.

CONCLUSIONS

This web-based intervention aims to reduce alcohol consumption among middle-aged women, a currently understudied cohort in alcohol research.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000814976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000814976.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34842.

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.

Double shifts, double trouble: Alcohol as a problematic panacea for working mothers

Alcohol consumption among midlife women has become an area of research focus. We suggest it is important to examine the social roles that many midlife women take on - specifically working mothers. Working mothers balance both employment and the unequal burden of caring/domestic duties, leading to 'double shifts' of paid and unpaid labor. This creates unique stresses that may impact their drinking. This is particularly important as a growing number of mothers re-enter the workforce after childbirth. In this commentary, we suggest that working mothers' drinking tends to be overlooked or even endorsed as a means of managing the gendered stresses they face - stresses which have been exacerbated during the pandemic. We highlight the dearth of literature focusing on the drinking patterns, practices, and motives of working mothers and argue that gendered expectations placed on working mothers may be an increasingly important social determinant of health among this group.