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Do we need to consider gender differences when developing prevention strategies for excessive alcohol consumption?

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The negative consequences of alcohol consumption are harmful to both men and women. This could not be overstated, as there are numerous studies in the literature documenting the risks associated with alcohol consumption.   Excessive alcohol consumption leads to alcohol dependence and abuse, but overtime it can lead to the development of chronic diseases. 

Given the high costs of excessive alcohol consumption and the concern of alcohol abuse and dependence to both people and society, evidence-based approaches for preventing harmful alcohol use are key. Are these prevention strategies different for men and women? What do you all think?

Some strategies could be targeted towards both sexes however, definitely without a doubt there needs to be strategies focused only for women. Why is this so?

Most importantly, women are more vulnerable to negative effects of alcohol than men. As noted in the literature alcohol is metabolized differently in women than men and women continue to be at a higher risk for serious health consequences when compared to men. There is evidence from studies that for equivalent doses of alcohol, women are more vulnerable than men to tissue damage and the onset of certain diseases such as cirrhosis of the liver and physical alcohol dependence (1). In addition, it is found from studies that women often start drinking at an older age, yet the progression from first drink to alcohol dependency progresses much more quickly in women than in men (2). This phenomenon is known as telescoping (3).Further, we all know that excessive alcohol consumption by pregnant women is a risk behavior for Fetal Alcohol Spectrum Disorders and other adverse pregnancy and birth outcomes, including miscarriage and stillbirth.

What are some of these prevention strategies targeted for women?

Well, before we think about these, we should first try to determine the reasons why women drink in the first place? According to studies reviewed in the literature, the experience of a negative effect such as anxiety, depression and violence against women serves as cue for alcohol consumption in women. Prevention strategies must focus on targeting the underlying risk factors related to excessive alcohol use such as mental health component of anxiety and depression and offer support to women who are victims of violence. This may in-turn cause the reduction of alcohol use among women.

Another prevention strategy is to make women aware of risks of alcohol use. However, education and awareness strategies on Alcohol and its related risks use must be given at a time for women in their adolescence period as this can contribute to behavior change thereby enabling opportunities to encourage delaying the use of alcohol. This prevents excessive alcohol consumption among women which can also delay all potential risks associated for young women when using alcohol.

An American College of Obstetricians and Gynecologists Committee Opinion recommends alcohol use screening for all women seeking obstetric-gynecologic care, including counseling patients that there is no known safe level of alcohol use during pregnancy, and recommends that women who are pregnant or who might be pregnant be advised to avoid alcohol use.

REFERENCES
1. Kalant H. Absorption, diffusion, distribution and elimination of ethanol: effects on biological membranes. In: Kissin B, Begleiter H, eds. The biology of Alcohol ism, vol 1. Biochemistry. New York: Plenum Press, 1971.
2. Cyr MG, McGarry KA. Alcohol use disorders in women. Screening methods and approaches to treatment. Postgrad Med.2002; 112:31-32,39-40,43-47.
3. Greenfield SF, Manwani SG, Nargiso JE. Epidemiology of substance use disorders in women. Obstet Gynecol Clin North Am.2003; 30:413-446.

How Does Consumption of Alcoholic Beverages Impact Women?

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Gone are those days when you would think excessive alcohol drinking was a man’s problem. The shift in excessive alcohol drinking patterns among women is on the rise particularly in younger age groups. Findings from the 2015 National Survey on Drug Use and Health estimated that about 5.3 million women suffer from Alcohol Use Disorder (AUD).
Women tolerate alcohol differently than men. Do you know why? Perhaps this may be since women have a lower body weight than men, less body water and higher percentage of body fat. In addition, women metabolize alcohol at a slower rate than men, so alcohol may remain in their tissues longer (1). There is evidence from studies that for equivalent doses of alcohol, women are more vulnerable than men to tissue damage and the onset of certain diseases such as cirrhosis of the liver and physical alcohol dependence (2). Heavier alcohol use by women is also thought to increase risk of bone fracture and osteoporosis (3). Furthermore, women can be more vulnerable to physical risks through violence or abuse when intoxicated (4).

But the harms done to women by alcohol are many, and most do not seem to know. You will be surprised to learn this. Consumption of alcoholic beverages is now recognized as a known human carcinogen. This is stated in the Report on Carcinogens by the National Toxicology Program of the US Department of Health and Human Services.

What is more alarming is the fact that alcohol is a risk factor for breast cancer in women. It is estimated that about 2.1 to 4.0% of breast cancers are primarily due to alcohol consumption accounting for 9000–23,000 new invasive breast cancer cases each year. Studies suggest a 7–10% increase in risk for each 10 g (~1 drink) alcohol consumed daily by adult women. And the risk increases for every additional drink they have per day. This raises a clinical and public health concern because nearly half of women of child-bearing age drink alcohol and 15% of drinkers at this age have four or more drinks at a time.

Do Women need to be informed about the association of Alcohol and breast cancer? Definitely? What can be done? Some strategies to consider: – Use mass media advertising campaigns involving television, billboard displays and Transit advertising on modes of public transportation or in public transportation areas), social media platforms to disseminate this information.


Image source: CDC

These can aim at reduction of alcohol consumption in women, influence risk perceptions of women on alcohol consumption and increase their level of awareness on Alcohol as a risk factor for breast cancer.

Another strategy- Make the women aware through their Family Physicians. Family Physicians could screen female patients and provide behavioral counseling and make them aware of association of alcohol with breast cancer. How about using cancer centers to do some outreach to the community? Appropriate staff in these centers could post position papers in peer reviewed journals on how alcohol affects risk of cancer in women.

Yet another strategy would be to have warning labels on alcohol bottles, however this is not easy as it seems, and this is some food for thought I suppose.

 

References
1. Plant M. Women and Alcohol: contemporary and historical perspectives. London: Free Association Books, 1997.
2. Kalant H. Absorption, diffusion, distribution and elimination of ethanol: effects on biological membranes. In: Kissin B, Begleiter H, eds. The biology of Alcohol ism, vol 1. Biochemistry. New York: Plenum Press, 1971.
3. Baron JA, Bahman YF, Weiderpass E, et al. Cigarette smoking, Alcohol consumption and risk of hip fracture in women. Arch Int Med 2001; 161:983 ± 90.
4. Jacobs J. The links between substance misuse and domestic violence: current knowledge and debates. London: Alcohol Concern and ISDD, 1998.