Structural models of gender,alcohol consumption,and health

BACKGROUND: Gender differences exist in patterns of alcohol consumption and in the health and social effects of alcohol use, but little is known about gender differences in how alcohol use is affected by mental and physical health conditions. METHODS: We used structural equation modeling techniques to examine gender differences in the relationships among alcohol consumption, physical and mental health, functional status, and social and demographic characteristics. Data were obtained from a random sample of the adult membership of a health maintenance organization in the U.S. Pacific Northwest. Simultaneous models evaluated gender differences in predictors of drinking vs. nondrinking status and, among drinkers, amount of alcohol consumed. RESULTS: Physical health was twice as strong a predictor of drinker/nondrinker status among women compared with men, but among drinkers, there were no gender differences in predictors of amount of alcohol consumed. Mental health predicted drinking status and alcohol consumption among drinkers, but these relationships did not differ by gender. Overall, sociodemographic characteristics and physical health were stronger predictors of alcohol use among women than among men. CONCLUSIONS: Women may be more amenable than men to alcohol-related preventive messages that target physical health concerns. Treating mental health conditions may be an important method for reducing alcohol consumption.     

Drinking patterns,gender and health I: Attitudes and health practices

Background: Despite considerable research, relationships among gender, alcohol consumption, and health remain controversial, due to potential confounding by health-related attitudes and practices associated with drinking, measurement challenges, and marked gender differences in drinking. We examined gender/alcohol consumption differences in health-related attitudes and practices, and evaluated how these factors affected relationships among gender, alcohol consumption, and health status.

Methods: A stratified random sample of adult health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). Using multivariate analyses of covariance and adjusting for health-related attitudes, values, and practices, we examined gender differences in relationships between alcohol consumption and health.

Results: More frequent heavy drinking was associated with worse health-related attitudes and values, worse feelings about visiting the doctor, and worse health-related practices. Relationships between health-related practices and alcohol use differed by gender, and daily or almost daily heavy drinking was associated with significantly lower physical and mental health for women compared to men. Drinking status (lifelong abstainers, former drinkers, and level of regular alcohol consumption) was related to health status and vitality, even after adjusting for health-related attitudes, values, and practices. Relationships did not differ by gender. Former drinkers reported lower physical and mental health status than either lifelong abstainers or current drinkers.

Conclusions: Drinking status is independently related to physical health, mental health, and vitality, even after controlling for the health-related attitudes, values, and practices expected to confound these relationships. Among current drinkers, women who engage in very frequent heavy drinking have worse physical and mental health than their male counterparts.     

Gender Differences in Stressful Life Events,Social Support,Perceived Stress,and Alcohol Use Among Older Adults: Results From a National Survey

Stressful life events, perceived stress, and social support relationships with consumption, at-risk drinking, and alcohol use disorder (AUD) were studied in a population-based sample of current drinkers age 60+ in the National Epidemiologic Survey of Alcohol and Related Conditions (Wave 2; 2004–2005; n = 4,360). Stressful life events were associated with AUD among men and women, and crime victimization among men only. However, greater perceived stress was associated with lower consumption among women and greater odds of AUD in men, highlighting differences in the relationship between stress and alcohol use by gender that may be the result of the stress alcohol link.     

Drinking patterns,gender and health II: Predictors of preventive service use

Background: Chronic diseases and injuries are elevated among people with substance use problems/dependence, yet heavier drinkers use fewer routine and preventive health services than non-drinkers and moderate drinkers, while former drinkers and abstainers use more than moderate drinkers. Researchers hypothesize that drinking clusters with attitudes and practices that produce better health among moderate drinkers and that heavy drinkers avoid doctors until they become ill, subsequently quitting and using more services. Gender differences in alcohol consumption, health-related attitudes, practices, and prevention-services use may affect these relationships.

Methods: A stratified random sample of health-plan members (7884; 2995 males, 4889 females) completed a mail survey that was linked to 24 months of health-plan records. Data were used to examine relationships between alcohol use, gender, health-related attitudes/practices, health, and prevention-service use.

Results: Controlling for attitudes, practices, and health, female lifelong abstainers and former drinkers were less likely to have mammograms; individuals with alcohol-use disorders and positive AUDIT scores were less likely to obtain influenza vaccinations. AUDIT-positive women were less likely to undergo colorectal screening than AUDIT-positive men. Consistent predictors of prevention-services use were: self-report of having a primary care provider (positive); disliking visiting the doctor (negative); smoking cigarettes (negative), and higher body mass index (BMI) (negative).

Conclusions: When factors associated with drinking are controlled, patterns of alcohol consumption have limited effects on preventive service use. Individuals with stigmatized behaviors (e.g., hazardous/harmful drinking, smoking, or high BMIs) are less likely to receive care. Making care experiences positive and carefully addressing stigmatized health practices could increase preventive service use.     

Alcohol policy support among mandated college students

Background

Alcohol consumption on college campuses is high, and often dangerous. College administrators have created policies to control alcohol consumption, but student body support or opposition of specific policies has been relatively unexplored.

Method

The current study examined the relations of alcohol policy support with gender and alcohol consumption. Mandated students (N = 229; 44% women) completed self-report assessments of alcohol policy support and alcohol consumption.

Results

Women supported policies to a greater extent than did men, as did lighter drinkers relative to heavier drinkers. Drinks per drinking day fully mediated the relation between gender and alcohol policy support.

Conclusion

While alcohol policy support differs by gender, this covariation is explained by differences in alcohol consumption. Findings have implications for addressing alcohol policy support among mandated college students.     

Characteristics associated with alcohol consumption in Germany

OBJECTIVE: Knowledge about predictors of alcohol intake in Germany is scarce. The purpose of this study was to analyze the association of sociodemographic and lifestyle characteristics and quality of life with alcohol consumption among German adults. METHOD: Analyses are based on cross-sectional data of the German adult population derived from the representative German National Health Interview and Examination Survey 1998 and the integrated German Nutrition Survey. In total, 1,925 women and 1,615 men, 18 to 79 years old, were included. Multiple linear regression analyses of alcohol intake were used to identify predictors of alcohol consumption. The analyses of drinkers were performed separately for women and men. RESULTS: Among women, alcohol consumption was associated with age, socioeconomic status, household size, smoking status, physical activity, use of soft drugs, body mass index, pregnancy and general health perception. The highest alcohol consumption was observed for women of middle age with high socioeconomic status. Among men, age, socioeconomic status, smoking status, physical activity, use of soft drugs, vegetarian diet, contentment with family or neighbors/friends, social functioning and physical functioning were associated with alcohol consumption, with age and smoking being the most important predictors. CONCLUSIONS: A variety of factors, including newly analyzed factors describing lifestyle and quality of life, are jointly associated with the higher alcohol consumption of German women and men. These findings may be valuable to focus health promotion projects on population groups with higher alcohol intake and, therefore, higher risk for harmful alcohol effects.     

Harms from alcohol consumption by strangers in five Indian states and policy implications

Introduction and Aims . India has a checkered history of alcohol prohibition; however, alcohol use is becoming more prevalent. We assessed the reporting of tangible and intangible harms from strangers' alcohol consumption by respondents' sex and how respondents' drinking and sociodemographic characteristics were associated with the reporting of these alcohol‐related harms by strangers. Design and Methods . We analysed cross‐sectional data from household interviews administered in five Indian states from October 2011 to May 2012. We analysed data among 7332 adults who responded to all 12 questions on alcohol‐related harms from strangers' drinking and for whom data were available on drinking status and sex. Result . In this sample, 63.2% reported experiences of one or more harms from strangers' drinking in the past year, with 47.4% reporting at least one tangible harm. Nearly one‐fifth reported being physically harmed from strangers' alcohol consumption. Drinking by women did not predict reports of alcohol‐related harms from strangers, while drinking by men was associated with at least 1.9 greater odds of reporting these harms compared with non‐drinkers. Living in rural areas was associated with reduced odds of reporting psychological harms from strangers' drinking among women but greater odds of reporting physical and sexual harms among men. Discussion and Conclusions . In five Indian states, both drinkers and non‐drinkers report being harmed by strangers' alcohol consumption. Greater implementation and enhanced enforcement of multilevel interventions may effectively reduce these alcohol‐related harms, such as regulating the density of alcohol outlets, screening and brief interventions in health settings and community empowerment initiatives. [Esser MB, Gururaj G, Rao GN, Jayarajan D, Sethu L, Murthy P, Jernigan DH, Benegal V. Harms from alcohol consumption by strangers in five Indian states and policy implications. Drug Alcohol Rev 2016;00:000‐000]     

Drinking to cope among college students: prevalence,problems and coping processes

OBJECTIVE: To examine four issues regarding college-student drinking to cope: (1) The prevalence of drinking to cope among students in a medium-sized Midwestern state university; (2) the relationships among drinking to cope and alcohol-related outcomes; (3) the use of drinking to cope within the larger context of students' coping processes; and (4) gender differences in drinking to cope. METHOD: Data were drawn from a sample of 275 undergraduates (164 women, 104 men, 7 subjects of unreported gender) in a cross-sectional sample. Of the 275 students assessed, data were analyzed from the 260 who reported ever having consumed alcohol. Drinking to cope was examined both as a style and in response to a specific situation identified by the participant. RESULTS: Drinking to cope is very common among college students and is related to much higher levels of alcohol consumption, episodes of heavy drinking, and levels of both negative and positive alcohol-related consequences. In examining the relative influence of drinking to cope and other variables on alcohol use, regression analyses indicated that positive alcohol expectancies were strongly related to alcohol use and that, even when considering other variables, situational drinking to cope remained a fairly strong predictor of most of the alcohol-use indicators. Analysis of gender differences suggested that men rely on alcohol to cope more than women do. CONCLUSIONS: Drinking to cope is a significant and highly problematic factor in college student alcohol use. Implications for interventions are discussed.     

Gender,history of alcohol use and number of drinks consumed predict craving among drinkers in a field setting

To the extent that craving serves to compel excessive drinking, it would be important to predict the intensity of an individual's craving over the course of a drinking episode. Previous research indicates that regular alcohol use (measured by the AUDIT) and the number of drinks individuals have already consumed that evening independently predict craving to drink (Schoenmakers & Wiers, 2010). The current study aims to replicate those findings by testing whether these same variables predict craving to drink in a sample of 1320 bar patrons in a naturalistic setting. In addition, we extend those findings by testing whether regular alcohol use and self-reported number of drinks consumed interact to predict craving, and whether gender independently predicts craving or interacts with other variables to predict craving. Results indicate that for men, AUDIT score alone predicted craving, whereas for women, AUDIT score and number of drinks consumed interacted to predict craving, with craving highest among women with either high AUDIT scores or relatively high consumption levels. Our findings have implications for targeted intervention and prevention efforts, as women who have a history of harmful alcohol use and consume several drinks in an evening might be at the greatest risk for continued alcohol consumption.     

Patterns of alcohol dependence in Thai drinkers: a differential item functioning analysis of gender and age bias

In Caucasians, the patterns of alcohol use disorders in women and adolescents are likely to be different from those in men and adults, respectively. The authors examined these differences in a Southeast Asian sample of Thai people living in communities. A two-parameter logistic model of the IRT log-likelihood-ratio (IRTLR) test for differential item functioning (DIF) procedure was used. Participants were a subsample of 3718 current drinkers participating in the 2008 Thai National Mental Health Survey (n = 17,140). The 1-year prevalence rates of alcohol dependence were 1.4% in women and 13.7% in men. Based on the Mini International Neuropsychiatric Interview (MINI), alcohol dependence and abuse module, all current drinkers were interviewed for a yes/no response to each of seven alcohol dependence criteria. Confirmatory factor analysis suggested a single-factor model of alcohol dependence criteria (χ2 = 211.51, RMSEA = 0.06, SRMR = 0.03 and CFI = 0.96). Compared with 3174 men, 544 women had a significantly higher threshold estimate for quit/control problems and a lower threshold value for drinking despite physical/mental problems (b parameter difference of 0.25 and − 0.30, respectively). Thai adolescents (n = 272) and Thai adults (n = 3446) had no statistically significant DIF on any criterion. The criterion of time spent drinking had significantly high discrimination estimates in women, men, adolescent and adults (a parameters of 2.50, 2.08, 2.33 and 2.16, respectively). Gender bias on alcohol dependence criteria can be found in Thai drinkers. Time spent drinking may be the most useful criterion for discriminating the severity of alcohol dependence across age and gender groups of Thai drinkers.     

Gender differences in using alcohol to cope with depression.

To examine gender differences in alcohol consumption as a function of mood and expectancies, 32 nondepressed and 32 moderately depressed male and female social drinkers were compared during a 15-minute taste-rating session. Results indicated that depressed subjects tended to consume more alcohol than nondepressed subjects and men consumed more alcohol than women. Depressed men drank more and drank more per sip than all other subjects. Three depressed men consumed more than all other subjects. Depression and anxiety decreased over time for all subjects. However, a Sex x Depression x Time interaction showed that only depressed men and nondepressed women were substantially less depressed after drinking. The nondepressed women, compared to the depressed men, consumed less alcohol and reported a greater increase in positive mood. Men expected more global positive effects from drinking than women, suggesting the tension reduction hypothesis (TRH) is mediated by gender-specific expectancies.     

Alcohol consequences,not quantity,predict major depression onset among first-year female college students

Alcohol use and its consequences have often been associated with depression, particularly among female college students. Interpretation of this association has been challenging due to potential reverse causation. The current study sought to clarify the temporality of these relationships. We examined: (1) the association between alcohol consumption and onset depression among female college students, and (2) the association between drinking consequences and onset depression among drinkers only. We used a prospective longitudinal design. Participants were first-year female college students who completed a baseline survey at study entry, and monthly assessments of alcohol consumption, drinking consequences, and depression symptoms. Cox proportional hazards regression with time-varying covariates were constructed among the full sample (N = 412) and the drinkers only sample (N = 335). Adjusted hazard ratios accounted for known risk factors for depression such as race/ethnicity, academic challenge, not getting along with one's roommate, sexual victimization prior to college, marijuana use, and socioeconomic status. For each additional average drink per week, adjusting for all covariates, there was no (95% CI: -4%, +4%) increased risk of onset depression. For each additional alcohol consequence, adjusting for all covariates, there was a 19% (95% CI: 5%, 34%) increased risk of onset depression. This significant relationship remained after adjusting for quantity of alcohol consumption. Quantity of alcohol consumed did not predict incident depression. However, experiencing alcohol consequences, regardless of consumption, did increase the risk of incident depression. College substance use and mental health interventions should aim to reduce not only alcohol consumption, but also alcohol-related consequences.     

Relating alcohol use and mood: results from the Tromsø study

OBJECTIVE: The interrelationships between alcohol consumption and depressed mood were studied in a population to determine if the relationships differed by sex and consumption. METHOD: Alcohol consumption and mood were surveyed at a 7-year interval by self-report (N = 8,260; 4,407 women). Frequency of intoxication was used to divide the sample into moderate and immoderate drinkers. Structural equations modeling was then applied to describe the interrelationships of drinking and mood both cross-sectionally and over time. RESULTS: Overall, self-reported drinking was stable over a 7-year period, although drinking patterns were less stable for immoderate drinkers. Drinking predicted higher levels of depressed mood among the immoderate drinkers of both sexes at follow-up. Drinking also weakly predicted depressed mood among moderately consuming men. However, among moderately consuming women dysphoric mood predicted less drinking. Depressed mood was related to higher levels of concurrent drinking among the immoderately drinking men. Among immoderately drinking women, however, concurrent depressed mood predicted more drinking. CONCLUSIONS: Generally, drinking predicted subsequent depressed mood although this pattern was reversed among moderately drinking women. Furthermore, a synchronous effects model indicated that some immoderately drinking women used alcohol as a response to emotional distress. It appears that gender and the level of consumption need to be taken into account in studies relating mood and drinking.     

Gender differences in the use of alcohol and prescription drugs in relation to job insecurity. Testing a model of mediating factors

BackgroundThe results of several studies suggest that economy-related stressors are less distressing for women compared with men. This study proposed to examine the relationship of perceived job insecurity with the use of licit drugs using a theoretical model that considered antecedents and mediators of this association, in order to identify differences between working men and women.MethodsUsing information from the Catalan Health Survey (2010–2014), we selected working individuals aged 16–64 who were primary providers of household income (N = 5315). The outcomes were two measures of alcohol consumption (heavy drinking and binge drinking) and the use of hypnotics/sedatives. As antecedents of the exposure to job insecurity we considered the type of contractual relationship and occupational class. The mediating factors were poor mental health, household structure and the hours of housework per week. The theoretical model was assessed using path analysis where the moderating effect of gender was considered in all the associations.ResultsNo differences in the prevalence of job insecurity were found between men and women (17%). Job insecurity (Odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.23–1.48) and house workload (OR = 1.01, 95% CI = 1.00–1.02) were positively associated with poor mental health, with no significant interactions with gender. Poor mental health was significantly associated with binge drinking (OR = 1.23, 95% CI = 1.13–1.33) and with the use of hypnotics/sedatives (OR = 1.71, 95% CI = 1.53–1.91). House workload showed a direct negative association with binge drinking (OR = 0.99, 95% CI = 0.98–1.00), while those in households with no children were more likely to be binge drinkers, with no significant interactions with gender. An alternative model had better fitting results for heavy drinking.ConclusionNo gender differences were found in the association of job insecurity with mental health nor with the use of substances among primary providers of household income, emphasising the importance of social roles when assessing differences in mental health among men and women.     

Gender differences in predictors of initiation,retention, and completion in an HMO-based substance abuse treatment program

We studied gender differences in treatment process indicators among 293 HMO members recommended for substance abuse treatment. Treatment initiation, completion, and time spent in treatment did not differ by gender, but factors predicting these outcomes differed markedly. Initiation was predicted in women by alcohol diagnoses; in men, by being employed or married. Failure to initiate treatment was predicted in women by mental health diagnoses; in men, by less education. Treatment completion was predicted in women by higher income and legal/agency referral; in men, by older age. Failure to complete was predicted in women by more dependence diagnoses and higher Addiction Severity Index Employment scores; in men, by worse psychiatric status, receiving Medicaid, and motivation for entering treatment. More time spent in treatment was predicted, in women, by alcohol or opiate diagnoses and legal/agency referral; in men, by fewer mental health diagnoses, higher education, domestic violence victim status, and prior 12-step attendance. Clinical implications of results are discussed.     

Alcohol expectancies,protective behavioral strategies,and alcohol-related outcomes: A moderated mediation study

Aims: The influence of alcohol expectancies on alcohol consumption and the negative consequences of alcohol consumption among college students has been well documented. Protective behavioral strategies are associated with decreases in alcohol use and related consequences. This study examined the extent to which the use of protective behavioral strategies mediated the influence that alcohol expectancies had for alcohol consumption and negative alcohol-related consequences.

Methods: Measures of expectancies about alcohol consumption, protective behavioral strategies used when consuming alcohol, amount of alcohol consumed and negative consequences associated with alcohol use were completed by 679 traditional age undergraduate students via a secure website. A moderated mediation data analytic strategy was employed because of the gender differences that have been observed for alcohol expectancies, consumption, and consequences.

Findings: The use of protective behavioral strategies was found to mediate the associations that positive expectancies had with both the amount of alcohol consumed and the negative consequences of alcohol consumption only for women.

Conclusions: Education and harm reduction efforts for college student drinkers, including expectancy challenge initiatives, would benefit from including information about use of protective behavioral strategies.     

Drinking Patterns of Doctors: a comparison between Aarhus in Denmark and Mainz in Germany

The aims of this study was to compare the drinking patterns of General Practitioners (GPs) and Hospital Practitioners (HPs) between Aarhus in Denmark and Mainz in Germany, to determine useful precursors of risk drinking among doctors and to serve as a useful data source for policy makers who have an interest in planning preventive strategies for doctors. In the winter of 2000, the data were collected in an anonymous mailed survey. The identified sample was n = 572 , and the response rate 66% (n = 374). Regression models on drinking patterns controlled for gender, age, profession and nationality. It was found that the majority of doctors in Aarhus (87.3%) and Mainz (97.5%) consumed alcohol at a sensible level (less than 14 units for women and less than 21 units for men; 1 unit = 12 g of pure alcohol). They drank twice to three times a week, and they preferred wine to beer and spirits. Doctors in Aarhus consumed a significantly larger amount of alcohol, and the rate of risk and binge drinkers was also higher among them. Within nationality, doctors had, to a great extent, similarities in their drinking patterns. The professional status correlated with the volume of alcohol consumption: GPs in Aarhus and in Mainz consumed significantly more alcohol than HPs did. Among doctors in Aarhus, the rate of risk drinkers was also higher among GPs. It was concluded that, even though the minority of doctors were risk drinkers, the attention must still be focussd on this group on account of its function for preventive work in the health sector.     

Drinking Patterns of Doctors: a comparison between Aarhus in Denmark and Mainz in Germany

The aims of this study was to compare the drinking patterns of General Practitioners (GPs) and Hospital Practitioners (HPs) between Aarhus in Denmark and Mainz in Germany, to determine useful precursors of risk drinking among doctors and to serve as a useful data source for policy makers who have an interest in planning preventive strategies for doctors. In the winter of 2000, the data were collected in an anonymous mailed survey. The identified sample was n = 572 , and the response rate 66% (n = 374). Regression models on drinking patterns controlled for gender, age, profession and nationality. It was found that the majority of doctors in Aarhus (87.3%) and Mainz (97.5%) consumed alcohol at a sensible level (less than 14 units for women and less than 21 units for men; 1 unit = 12 g of pure alcohol). They drank twice to three times a week, and they preferred wine to beer and spirits. Doctors in Aarhus consumed a significantly larger amount of alcohol, and the rate of risk and binge drinkers was also higher among them. Within nationality, doctors had, to a great extent, similarities in their drinking patterns. The professional status correlated with the volume of alcohol consumption: GPs in Aarhus and in Mainz consumed significantly more alcohol than HPs did. Among doctors in Aarhus, the rate of risk drinkers was also higher among GPs. It was concluded that, even though the minority of doctors were risk drinkers, the attention must still be focussd on this group on account of its function for preventive work in the health sector.     

Routine screening for risky alcohol consumption at an emergency department using the AUDIT-C questionnaire

A questionnaire including the three AUDIT-C items was used to screen for alcohol use among trauma patients. The aim was to display, in a pragmatic way, how the AUDIT-C scores can be converted into different levels and kind of risky drinking. Using AUDIT-C scores with a cut-off score of 4 points for women and 5 for men indicated that 28% of the women and 40% of the men were risky drinkers. When calculating weekly alcohol consumption from the answers in AUDIT-C, 3% of the women and 7% of the men were hazardous and/or harmful drinkers. Regarding heavy episodic drinking 7% of the women and 30% of the men was drinking 72g alcohol or more at on at least one occasion a month. These results indicate that the AUDIT-C score as such give little information about the pattern of alcohol consumption and that evaluation of risky drinking must be calculated from the three items in order to differentiate between risky drinking in terms of alcohol consumed per week and heavy episodic drinking.     

The Great Recession, somatic symptomatology and alcohol use and abuse

While most research has examined the long-term effects of alcohol consumption on health, the current study examines how health status impacts on drinking behavior. Using data from a national study conducted between 2010 and 2011 to assess the impact of the recession on drinking behavior, this study examines how economic hardships linked to the recent economic recession affect physical health, and how physical health may in turn affect alcohol use. Structural equation models were used to test the predicted associations. The data demonstrate that many of the economic stressors linked to the recession are associated with increased somatic symptoms. Somatic symptoms are also associated with increased drinking for men, but not for women. These findings suggest that men may use alcohol to self medicate somatic symptomatology. The current findings are consistent with gender role-based explanations that account for gender disparities in the utilization of medical care.