COVID-19, the Global Alcohol Industry, and Women

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With the current state of the world during these unprecedented times of the Coronavirus pandemic, more women have turned towards alcohol to help them cope with this so called ‘new normal.’

What is the current state of the global alcohol industry?

In order to stabilize the U.S. alcohol market from the closure or to-go only orders of restaurants and bars caused by the shelter-in-place restrictions during the months of March and April, a 22% increase in sales across all alcoholic beverage categories is necessary. The United States’ alcohol market was not the only alcoholic market to face negative implications due to COVID-19, the world’s wine industry risks permanent changes with a 35% reduction of on-premise wine consumption in Europe, as well as a 50% decrease in wine sales across the entire European continent. While there have been decreases in on-premise alcohol sales due to Coronavirus, maybe out of fear of alcohol running out, much like Clorox wipes and toilet paper, there was a 50% increase in global alcohol sales during the close of March 21, 2020 compared the same week in 2019.

This is not the first-time women from around the world have turned to alcohol to cope with traumatic experiences. Economic events like the 2008 global financial crisis led to an increase in overall alcohol use. And other events such as terrorism, mass shootings, and natural disasters have also all led to an increase in alcohol use, on the global, national, and local levels. But the Coronavirus pandemic is creating new stressors where women are fearful that they or someone they love may be infected or maybe they are struggling to navigate this ‘new normal.’

Technavio has announced its latest market research report titled Global Alcoholic Beverages Market 2019-2023 (Graphic: Business Wire)

Source: Business Wire. Pre- and post-COVID-19 market estimates-alcoholic beverages market 2019-2023, demand for superior alcohol to boost growth, technavio. 2020. https://www.businesswire.com/news/home/20200417005297/en/Pre-Post-COVID-19-Market-Estimates-Alcoholic-Beverages-Market

How are women turning to alcohol during these unprecedented times?

Researchers have found that 1 in 5 British women are increasing their alcohol consumption during the pandemic, while 1 in 3 have decreased their consumption. With many women working from home, homeschooling their children, and practicing social distancing, home alcohol delivery sales have increased dramatically. There has been an estimated 300% increase in global alcohol sales in March compared to January.

The increased stress caused by the coronavirus pandemic has caused many women turn to alcohol to relieve their stress, reduce their sometimes racing heart rates due to anxiety, and potentially cause sedative effects in order to wind-down from the day and sleep well. While the sedating and stress relieving effects of alcohol may seem intriguing and helpful, they are actually harmful to women’s cognitive abilities, sleep cycles, and can aid in the increase of negative interactions and tensions in the home.Source: DailyMail.com. Pray for parents! Stressed-out mothers and fathers share hilarious memes as they struggle to keep children busy during coronavirus self-isolation. 2020. https://www.dailymail.co.uk/femail/article-8130525/Stressed-parents-share-hilarious-memes-struggle-children-busy.html

Are alcohol companies targeting women during the Coronavirus crisis?

Women who utilize Facebook, Google, and Instagram, have been seeing different ads than they normally would have if COVID-19 did not exist. For example, many women, myself included, have been seeing new ads for alcohol delivery and Instagram Live Happy Hours with influencers and alcohol brands. Targeted ads for alcohol have increased by 350% in Australia, “Quarantinis” have gained in popularity in the U.S., which are martini’s made from gin and Emergen-C, and virtual Happy Hours are happening all over the globe.

Source: eExtra News. Emergen-C, Aviation American Gin respond to ‘quarantine’ drink. 2020. https://eparisextra.com/living/emergen-c-aviation-american-gin-respond-to-quarantini-drink/

A virtual Happy Hour I have seen specifically target women is one where they can have a cocktail at home and virtually explore Highclere Castle, the famous and historic castle where the infamous “Downton Abbey” series and movie were filmed. One of the aims of this Happy Hour is the advertisement of Highclere Castle Gin, targeting fans of “Downton” and the Royal Family, to drink like a Royal, as the event is hosted by the Earl and Countess of Carnarvon, who reside in the castle.

Source: Highclere Castle Gin Spirits. 2019. https://www.instagram.com/p/B1UcjriHDI0/?utm_source=ig_web_copy_link

Globally, are women drinking more than before COVID-19?

In short, yes. As previously mentioned, 1 in 5 British women have increased their alcohol consumption since the beginning of the pandemic; 70% of Australian women reported drinking more than they normally would; and 26% of American women said they are drinking during work hours. But South African women are not drinking at all, as the government instituted a prohibition in order to decrease community spread of COVID-19 in order to keep about 5,000 trauma hospital beds free for Coronavirus-related care.

At the end of the day, while COVID-19 has decreased the on-premise sale of alcohol globally, sales for home delivery have increased drastically. Women from all over the world who are now working from home, homeschooling their children, and making all of their own meals in order to practice social distancing have been targeted by online ads and contributing to this increase are home alcohol delivery and increased drinking rates. Hopefully these increased rates in drinking due to COVID-19 will not create increased rates of alcohol use disorder in women, but only time will tell.

 

Alcohol as a Coping Mechanism: Anxiety in a Pandemic

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Authors: Ashley Watson, MPH and Alexandria Patterson, MPH

People all across the world are facing the hardship of COVID-19, a pandemic that many countries were unprepared for and completely shocked by its severity. Stay-at-home order mandates were put into place around mid-March, and our sense of reality was lost. All nonessential businesses and schools were forced to close for an uncertain amount of time, resulting in a spike in unemployment, with over 30 million Americans filing since the start of the outbreak [1]. The decline of the economy is well underway.

Consequently, feelings of fear and anxiety may emerge in adults and children as COVID-19 continues to spread. Many adversities include new or more profound economic hardship, increased family disputes, feelings of isolation, and poor work-life balance. Individuals vary in their response to an outbreak based on their background, things that make one person different from another, and the community in which one resides [5]. The adverse reactions to stress can be more influential in individuals who are at higher risk of COVID-19 due to having a chronic illness, healthcare workers and first responders, and people with mental conditions such as substance abuse [5]. As we are living through unprecedented times, women, men, and children look for new ways to cope.

A commonly used coping strategy is alcohol. We know this because it is a not a new trend. According to the Anxiety and Depression Association of America, twenty percent of people diagnosed with social anxiety disorder experience some type of alcohol abuse or dependence. Generalized anxiety disorder and panic disorders are also often connected to alcohol use, with researchers suggesting that in some instances anxiety symptoms are the result of alcohol withdrawal [3]. According to a study conducted at the University of North Carolina School of Medicine, excessive drinking can make an individual more susceptible to anxiety and the experience of trauma, and subsequently, post-traumatic stress disorder [4].

Many women use alcohol to self-medicate when it comes to anxiety. Since alcohol is a depressant, many women consume it in order to reduce anxiety [2]. Initially, alcohol consumption can reduce anxiety. However, alcohol can also increase anxiety shortly after consumption. Furthermore, this increase in anxiety symptoms can persist for more than a day [6].

These problems can be exacerbated during the COVID-19 pandemic. Lack of social interaction and extreme boredom can cause anxiety. This is often referred to as going “stir crazy.” Current marketing strategies and social expectations already support and encourage concepts like women drinking wine after a hard day. This has been greatly magnified during the COVID-19 pandemic. An example is the meme below that suggests the consumer should stock up on a shopping cart full of wine as part of their emergency pandemic preparation. This type of marketing is especially harmful to women who are anxious about potentially contracting COVID-19 and/or a myriad of other concerns. The uptick in virtual “happy hours” as a replacement for in-person socialization has also become a form of self-medication. These types of gatherings further convince women that alcohol is quelling their anxiety, when in reality much-needed social interaction is the more probable cause for decreased anxiety symptoms.

Source: Alcohol Beverages Advertising Code (ABAC)

References

  1. 30 million have sought U.S. unemployment aid since COVID-19 hit. (2020, April 30). Retrieved from https://www.marketplace.org/2020/04/30/covid-19-us-unemployment-state-benefits/
  2. Ankrom, S. (2020, March 23). The Risks of Using Alcohol to Relieve Anxiety. Retrieved May 16, 2020, from https://www.verywellmind.com/using-alcohol-to-relieve-anxiety-2584210
  3. Anxiety and Depression Association of America. Social Anxiety Disorder and Alcohol Abuse. Anxiety and Depression Association of America, ADAA. https://adaa.org/understanding-anxiety/social-anxiety-disorder/social-anxiety-and-alcohol-abuse.
  4. Heavy drinking rewires brain, increasing anxiety problem. UNC Health Talk. (2012, September 4). https://healthtalk.unchealthcare.org/heavy-drinking-rewires-brain-increasing-susceptibility-to-anxiety-problems/.
  5. Mental Health and Coping During COVID-19. (2020, April 30). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
  6. Watkins, M. (2019, November 25). Anxiety and Alcohol: How They Are Linked. Retrieved from https://americanaddictioncenters.org/alcoholism-treatment/anxiety

Closing the Gap: Gender Disparities in Alcohol Use Disorder and Suicide Rates 

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While alcohol use disorders and suicide are topics often avoided due to their sensitivity and difficulty to encapsulate in words, they are everpresent in the lives of millions of Americans. Suicide alone accounted for over 47,000 deaths in 2017 alone, and is ranked overall as the 10th leading cause of death among Americans. But, adding context to this issue brings it more clearly into focus; suicide is the second leading cause of death among those aged 10-34. Some of the youngest of us are at the highest risk for ending their own lives. And, looking at those suffering from alcohol use disorders, the population of victims soars. The NIAAA estimates that 16 million americans have AUD. With such numbers being direct victims, it’s inarguable that we can ignore these challenges. 

While anyone from any background, gender, ethnicity, or culture can suffer from either or both suicidal tendencies and alcohol use disorder, we know that a higher rate of men suffer than women. In 2017 alone, men were 3.54 times – not percent, but multiplied – more likely to die by suicide than women. Men are also almost 2 times more likely to have AUD. Because of this reality, many treatment methods have been created by and, perhaps subconsciously, for men. Until recently, we have operated under the assumption that alcohol use, long term, impacts all genders in the same way. But now we know that we were wrong. By being less efficient at metabolizing alcohol, women suffer the negative consequences of alcohol abuse more quickly and with a lower volume of alcohol than men. When we take AUD into account in terms of death by suicide, then, what does the gender gap look like? In line with the new research showing that women are physiologically more susceptible to the effects of AUD, we may hypothesize that the same would occur psychologically. But, the question remains. By how much?   

Without taking into account the impact of AUD, men are 293.75% more likely to die by suicide. When we look at alcohol-attributable suicides, however, we see that enormous gap shrink to only 55.24%. This suggests that while the rate amongst men still remains higher, excessive alcohol use creates a greater impact on death via suicide amongst women. 

Our current culture is one that is both acknowledging women drinking – and drinking more- while simultaneously encouraging the behavior. While the awareness might create an openness for women to discuss AUD and recognize harmful patterns in their own drinking, the encouragement to drink more dwarfs this silver lining. 

The necessary response, I believe, is clear; gender and culture-sensitive AUD treatment methods and programs must be developed and made available to all those suffering. It would be an irresponsible and cruel act to divert all of our energy and resources to studying and treating AUD in women, leaving men behind. The next steps should be ones of equity as we continue to uncover the many variables that can affect one’s risk of suicide. 

 

Alcohol Use And Binge Drinking Among Georgia Women

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Consumption of past month Alcohol Use and Binge Drinking among women in Georgia

Excessive alcohol consumption among women are of special concern to public health. In Georgia, excessive drinking of alcohol results in 2,555 deaths and 79,183 years of potential life lost each year (1). Many adverse health outcomes associated with excessive alcohol consumption in women which include cancer, heart disease, stroke, liver cirrhosis, preterm birth (5,7), fetal alcohol syndrome (3), and unintentional and intentional injuries (2).  Although studies have been conducted on alcohol consumption of women in U.S., there is limited data on alcohol drinking patterns or changes in demographic shifts for alcohol drinking patterns among women in Georgia. Therefore, this study was conducted to compare alcohol consumption patterns of women in Georgia reported in 2011 with those reported in 2016.

The study used secondary data from telephone interviews of 14362 adults aged ≥18 years residing in Georgia; that participated in the Behavioral Risk Factor Surveillance System (BRFSS) survey in 2011 and 2016. Overall, 8977 women were analyzed. Measures focused on alcohol use and binge drinking and on the intensity of binge drinking in the past 30 days.  Prevalence and 95% confidence intervals (CIs) for past month alcohol use (in the past 30 days) and binge drinking (4+ drinks on more than one occasion) by the study population were estimated overall and then analyzed. Among the surveyed women (N=8977), overall past month alcohol use showed a significant decrease in relative risk (2.5%, p<0.0001, Table1) from 2011 to 2016.  However, significant increase in relative risk of past month alcohol use from 2011 to 2016 were found among women 65 years and older (41.8%, p <0.0001, Table 1) when compared to other age groups.  Similarly, significant decline in the relative risk (12.6 %, p<0.0001, Table 2) of binge drinking among surveyed women from 2016 to 2011.  However, significant increase in relative risk of binge drinking among women 65 years and older (145%, p<0.0001, Table 2) when compared to other groups from 2011 to 2016.

 

Alcohol is a risk factor for women for adverse health conditions.  Overall, the findings showed that past month prevalence of alcohol use among women significantly decreased from 43.6% in 2011 to 42.5% in 2016 for Georgia. This is lower than the national estimates of past month alcohol use (57%) and 2016 (54%) in 2013.  However, significant increase in the relative risk of past month alcohol use (41.8%) and binge drinking (percent change: 145 %) was seen among subgroup populations, particularly notable among women who are 65 years and older. Older adults are at particular risk for falls and injuries (6) and the unintentional injury death rate (8) ED-treated falls (9) hospitalized fall rates (2) and fall-related traumatic brain injury deaths (10). In 1990, those over the age of 65 comprised 13 percent of the U.S. population; by the year 2030, older adults are expected to account for 22 percent of the population. (U.S. Bureau of the Census 1996). As the population age 60 and older increases, there could be the potential for increase in the rate of alcohol consumption patterns leading to alcohol-related risks in this age group.

References

  1. Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI) [database]. Accessed Dec 13, 2013.
  2. DeGrauw X, Annest JL, Stevens JA, Xu L, Coronado V. Unintentional injuries treated in

hospital emergency departments among persons aged 65 years and older, United States, 2006-2011 J Safety Res. 2016;56:105-109.

  1. Ethen MK, Ramadhani TA, Scheuerle AE, et al. Alcohol consumption by women before and during pregnancy. Matern Child Health J 2009; 13:274–85.
  2. Grant, B. F., Chou, S. P., Saha, T. D., Pickering, R. P., Kerridge, B. T., June Ruan, W., Zhang. (2017). Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry, 74(9), 911.
  3. Hingson R, White A. New research findings since the 2007 Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking: A review. J Stud Alcohol Drugs. 2014;75(1):158-169. PMID: 24411808.
  4. Kramarow E, Chen LH, Hedegaard H, Warner M. Deaths from Unintentional Injury Among Adults Aged 65 and Over: United States, 2000-2013. NCHS Data Brief 199. Hyattsville, MD: National Center for Health Statistics, 2015.
  5. Rehm J, Baliunas D, Borges GLG, et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction. 2010;105(5):817-843.
  6. Stevens JA, Rudd RA. Circumstances and contributing causes of fall deaths among persons aged 65 and older: United States, 2010. J Am Geriatr Soc. 2014;62(3):470-475.
  7. Sung KC, Liang FW, Cheng TJ, Lu TH, Kawachi I. Trends in unintentional fall-related traumatic brain injury death rates in older adults in the United States, 1980-2010: a join point analysis Neurotrauma. 2015;32(14):1078-1082.
  8. White A, Castle IJ, Chen CM, et al. Converging patterns of alcohol use and related outcomes among females and males in the United States, 2002 to 2012. Alcohol Clin Exp Res. 2015;39(9):1712-1726. PMID: 2633187

 

Table 1: Prevalence of and Percent change in 1- month Alcohol Use for Women in Georgia, U.S. by Sociodemographic characteristics, 2011 and 2016

Characteristic                 BRFSS Survey

                    2011

                  N=5958

               BRFSS Survey

                      2016

                       N=3019

 

 % Change
  % (95% CLa) p-value % (95% CLa) p-value  
Total 43.6 (41.7-45.5) <0.0001 42.5% (40.1-45.0) <0.0001 -2.5
Age          
18-24 49.8(41.0-58.6)   46.0(39.6-52.4)   -7.6
25-44 52.0(48.6-55.3)   56.3(52.8-59.7)   8.2
44-65 42.1(39.7-44.5)   48.6(45.8-51.5)   15.4
65+ 23.4(21.0-25.7) <0.0001 33.2(30.6-35.9) <0.0001 41.8
Race /Ethnicity          
White/Non-Hispanic 46.2(44.0-48.5)   45.8(42.6-48.9)   -0.9
Black/Non-Hispanic 41.2(37.2-45.1)   39.8(35.2-44.4)   -3.3
Hispanic 33.1(24.4-41.7)   33.9(24.9-42.9)   2.4
Other 41.0(30.8-51.1) 0.0102 34.1(21.9-46.3) 0.0140 -16.8
Education          
No High School 22.6(17.4-27.9)   29.7(24.5-35.0)   31.4
High School 38.0(34.2-41.7)   39.3(35.9-42.7)   3.4
Attended College 44.7(41.1-48.3)   52.5(49.1-56.0)   17.4
College or technical school graduate 62.6(59.7-65.4) <0.0001 64.5(61.8-67.3) <0.0001 3.0
Income          
<$15,000 39.9(34.8-45.1)   23.7(17.3-30.2)   -4.0
$15,000-$25,000 44.6(40.7-48.6)   28.0(22.7-33.4)   -3.7
$25,000-$35,000 44.4(39.5-49.2)   41.5(33.1-49.9)   -6.5
$35,000-$50,000 51.1(46.7-55.5)   46.5(39.6-53.4)   -9
>=$50,000 63.7(61.4-66.0) <0.0001 63.4(59.4-67.4) <0.0001 -0.4

 

 

Table 2: Prevalence of and Percent change in binge drinking** for Women in Georgia, U.S. by Sociodemographic characteristics, 2011 and 2016

 

Characteristic                 BRFSS Survey

                    2011

                  N=5922

               BRFSS Survey

                      2016

                       N=2986

 

 % Change
  % (95% CLa) p-value % (95% CLa) p-value  
Total 11.1 (9.6-12.5) <0.0001 9.7(8.2-11.2) <0.0001 -12.6
Age          
18-24 22.8(15.6-30.1)   13.8(7.6-20.0)   -39.4
25-44 14.9(12.4-17.5)   13.4(10.4-16.4)   -10.0
45-64 7.4(6.0-8.7)   8.3(6.2-10.5)   12.1
65+ 1.1(0.6-1.6) <0.0001 2.7(1.6-3.9) <0.0001 145
Race /Ethnicity          
White/Non-Hispanic 12.2(10.4-14.0)   9.6(7.7-11.5)   -21.3
Black/Non-Hispanic 8.2(5.9-10.6)   9.8(6.8-12.8)   16.3
Hispanic 10.8(4.5-7.1)   9.4(4.0-14.9)   -12.9
Other 17.0(7.1-27.0) 0.0419 9.0(2.3-15.8) 0.9968 -47.0
Education          
No High School 9.5(5.3-13.8)   7.0(2.4-11.7)   -26.3
High School 10.2(7.5-13.0)   5.8(3.5-8.0)   -43.1
Attended College 10.6(8.1-13.2)   11.4(8.5-14.3)   7.5
College or technical school graduate 13.6(11.3-15.9) 0.1584 13.2(10.4-16.0) 0.0002 -2.94
Income          
<$15,000 9.3(5.4-13.3)   9.2(5.5-13.0)   -1.07
$15,000-$25,000 11.2(7.7-14.8)   13.8(10.5-17.1)   23.2
$25,000-$35,000 7.4(3.6-11.2)   9.2(5.5-13.0)   24.3
$35,000-$50,000 9.7(6.6-12.9)   17.3(12.9-21.7)   78.3
>=$50,000 13.2(11.0-15.5) 0.0773 17.0(14.7-19.3) 0.0003 28.7

 

a- CL means Confidence Limits

** Binge Drinking in women defined as women having 4+ drinks on one occasion

 

Table 3: Intensity of Binge Drinking Prevalence and Percent change by Age category for Women in Georgia, 2011

  Past 30 days, average # of drinks had on days you drank
Age categories 1 drink 2 drinks 3-4 drinks 5 drinks or more
  % (95% CLa) % (95% CLa) % (95% CLa) % (95% CLa)
18-24 40.1(27.7-52.6) 21.3(11.2-31.4) 20.1(10.7-29.6) 18.5(9.1-27.9)
25-44 45.8(41.1-50.4) 30.4(26.2-34.6) 16.6(12.8-20.4) 7.2(4.5-9.9)
45-64 54.6(50.8-58.4) 30.4(27.8-33.8) 11.1(8.4-13.7) 3.9(1.9-5.9)
65+ 70.2(64.7-75.6) 23.2(18.1-28.3) 4.6(2.2-7.0) 2.0(0.4-3.6)

p-value: <0.0001; a- CL means Confidence Limits

 

 

 

 

Table 4: Intensity of Binge Drinking Prevalence and Percent change by Age category for Women in Georgia, 2016

  Past 30 days, average # of drinks had on days you drank
Age categories 1 drink 2 drinks 3-4 drinks 5 drinks or more
  % (95% CLa) % (95% CLa) % (95% CLa) % (95% CLa)
18-24 42.7(28.9-56.5) 23.1(12.3-33.9) 23.7(11.8-15.6) 10.5(2.4-18.6)
25-44 47.7(41.1-54.2) 36.5(30.1-42.9) 12.4(8.2-16.7) 3.4(1.2-5.6)
45-64 49.9(44.1-55.6) 33.2(27.7-38.6) 11.1(7.5-14.7) 5.9(2.4-9.3)
65+ 71.8(65.7-77.8) 20.1(14.9-25.3) 6.4(3.3-9.6) 1.7(0.0-4.4)

p-value:0.0017; a- CL means Confidence Limits

 

Differences in heavy alcohol consumption and depression among Non-Hispanic Black women compared to Non-Hispanic White women in the United States

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Have you ever wondered what the differences in alcohol dependence and depression were among Non-Hispanic black women compared to Non-Hispanic white women? 

  Well have no fear, Quonesha is here (to inform you)! 

Depression and alcohol use disorder affects many Americans nationwide. Evidence suggests that depression and alcoholism are closely associated as there are at least 30-40% of those with alcohol dependence that experience some type of depressive disorder (Hobden, Bryant, Sanson-Fisher, Oldmeadow, Carey 2018); however, there is conflicting evidence that suggests whether depression causes alcohol dependence or if alcohol dependence is the cause of depression (Boden & Fergusson 2011).

Although the prevalence of alcohol dependence affects many racial groups, Non-Hispanic black women are known to be less likely than persons of other racial groups, such as Non-Hispanic whites, to use and abuse alcohol. In contrast, the prevalence of depression is higher among Non-Hispanic black women (9.2%) compared to Non-Hispanic white women (7.9%) (Klein, Sterk, Elfison, 2016 & Caetano, Baruah, Chartier, 2011).

For a further look into previous research studies, I decided to take it upon myself to conduct my own study that examined the differences in heavy alcohol consumption and depression among Non-Hispanic black women compared to Non-Hispanic white women.

To conduct this study, I used data from 2015-2016 National Health and Nutrition Examination Survey (NHANES)  to examine the differences in heavy alcohol consumption and depression among Non-Hispanic black women compared to Non-Hispanic white women residing in the United States. There were 971 (32.6%) Hispanic women, 651 (21.8%) Non-Hispanic black women, 910 (30.6%) Non-Hispanic white women, and 444 (15%) women of other racial groups present in this research study; however, Non-Hispanic black women and Non-Hispanic white women where used for this study.

Heavy alcohol consumption was measured by women that consumed more than eight drinks per week or more than three drinks per occasion, and mental health status was measured using a depression screening that asked participants a series of questions regarding depression. To analyze the data, i decided to perform Chi-square tests of independence and logistic regressions to predict the relationship between the independent variable, race, and the dependent variables, heavy alcohol consumption and depression. 

There were significant differences among Non-Hispanic black women compared to Non-Hispanic white women, regarding heavy alcohol consumption (p-value: 0.002). However, there were no significant differences among Non-Hispanic black women compared to Non-Hispanic white women, regarding depression (p-value: 0.288) and depression and heavy alcohol consumption (p-value: 0.242).

Additionally, the logistic regression analysis found that there were significant differences between the two groups regarding heavy alcohol consumption (p-value: 0.007, O.R: 1.51, 95% C.I: 1.13, 1.99). However, there were no significant differences among the two groups regarding depression (p-value: 0.259, O.R: 1.16, 95% C.I: 0.88, 1.55) and depression and heavy alcohol consumption (p-value: 0.271, O.R: 1.34, 95% C.I: 0.77, 2.32). 

  Depressed* Heavy alcohol consumption* *Depressed and heavy alcohol consumption
  **N (%) P-value Odds Ratio

(95% CI)

 **N (%) P-value Odds Ratio (95% CI) **N (%) P-value Odds Ratio

(95% CI)
Total 370 (25.9) N/A N/A

 

 381 (35.4) N/A N/A

 

 134 (34.8) N/A N/A

 
†Race/ Ethnicity

    Non-Hispanic Black women

    Non-Hispanic White women

  

 

132 (3.6)

 

238 (22.2)

  

 

 

0.288

  

 

1.00 (ref)

 

1.16 (0.88,1.55)

  

 

120 (3.9)

 

261 (31.5)

  

 

 

0.002¢

  

 

1.00 (ref)

 

1.51 (1.13,1.99)

  

 

43 (4.0)

 

91 (30.8)

  

 

 

0.242

  

 

1.00 (ref)

 

1.34

(0.77, 2.32)
       

 

The results from this study both contradict and support previous studies. The analyzed data indicates that there were significant differences among Non-Hispanic black women compared to Non-Hispanic white women regarding heavy alcohol consumption, which supports previous studies. However, there were no significant differences among Non-Hispanic black women compared to Non-Hispanic white women regarding depression and depression and heavy alcohol consumption, which contradicts previous studies. Additional research is clearly needed to better understand the etiology and patterns of alcohol use and depression among women across and within racial and ethnic groups. 

I also think that a better understanding of the underlying causes of alcoholism and depression among the two groups will inform public health officials to develop effective prevention programs and interventions that are specifically targeted towards each group (Withbrodt, Mulia, Zemore, Kerr 2014 & Assari 2014).  Affordable alcohol rehabilitation centers that provide mental health services with certified clinicians should be placed in areas with increased rates of alcohol abuse and depressive disorders to make certain that every individual, regardless of race, can receive the same treatment.

.

 

https://www.alcohol.org/women/

https://www.alcoholrehabguide.org/resources/dual-diagnosis/alcohol-and-depression/

 

Assari S. (2014). Separate and Combined Effects of Anxiety, Depression and Problem Drinking on Subjective Health among Black, Hispanic and Non-Hispanic White Men. International journal of preventive medicine, 5(3), 269–279.

Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906-     914.

Caetano, R., Baruah, J., & Chartier, K. G. (2011). Ten-Year Trends (1992 to 2002) in Sociodemographic Predictors and Indicators of Alcohol Abuse and Dependence Among Whites, Blacks, and Hispanics in the United States. Alcoholism: Clinical and Experimental Research.

Hobden, B., Bryant, J., Sanson-Fisher, R., Oldmeadow, C., & Carey, M. (2018). Co-occurring depression and alcohol misuse is under-identified in general practice: A cross-sectional study. Journal of Health Psychology, 23(8), 1085–1095.

Klein, H., Sterk, C. E., & Elifson, K. W. (2016). The Prevalence of and Factors Associated with Alcohol-Related Problems in a Community Sample of African American Women. Journal of Addiction, 2016, 1-11.

Witbrodt, J., Mulia, N., Zemore, S. E., & Kerr, W. C. (2014). Racial/Ethnic Disparities in Alcohol-Related Problems: Differences by Gender and Level of Heavy Drinking. Alcoholism: Clinical and Experimental Research,38 (6), 1662-1670.

Alcohol prevention strategies: Prevention efforts should be different for men and women

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Over the past few weeks in class, we’ve had conversations about alcohol use and risks associated with it. The NIAAA described the health risks associated with excessive drinkings such as heart disease, cancer, problems of the liver, pancreas and others such as sexually transmitted infections, violence, suicide. Most researchers believe that risks associated with alcohol drinking outweigh any potential health benefits from moderate drinking. As an example, Professor Walter Willett of epidemiology and nutrition at Harvard T.H. Chan School of Public Health thinks that heavy drinking is harmful.

What’s moderate drinking?

 

  The CDC  and NIAA defines the term “moderate drinking” as  

       1. Beer 12 ounces (5% alcohol content).

       2. For malt liquor 8 ounces  (7% alcohol content).

       3. For wine 5 ounces  (12% alcohol content).

       4. 1.5 ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whisk

 

A new study on  Alcohol: Balancing Risks and Benefits concluded that there’s no amount of alcohol consumption that’s safe for overall health — a finding that’s likely to surprise moderate drinkers, and that has left some experts unconvinced.

The federal, state and local authorities in the US work together to minimize health risks associated with alcohol drinking.  

In this blog, I’m sharing some of the alcohol prevention strategies I’ve learned for the past few weeks while taking a class in Special topics in Epidemiology on alcohol and women.

  • Prohibitions of alcohol sponsorship of public events – Alcohol sponsorship by alcohol companies has been a  debated issue in recent months. According to a Sponsorship Today report, more than $1 billion was spent on sports sponsorships by beer companies alone in 2012. prohibition by integrating sports sponsorship with responsible consumption messages. 
  • Increases in price through excise taxes –Increase taxes have consistently been found to reduce alcohol consumption and problems, especially among youth. Alcohol excise taxes affect the price of alcohol and are intended to reduce alcohol-related harms, raise revenue, or both. Alcohol taxes are implemented at the state and federal level, and are beverage-specific (i.e., they differ for beer, wine, and spirits). In the US, Alabama and Washington’s state have some of the highest taxes on alcohol
  • Controls on alcohol advertising (especially on billboards, sides of buses, and in other public areas)-The alcohol industry are among the leading advertisers on billboards. Billboards advertising beer and hard liquor are readily visible to children. These advertisements expose and encourage excessive drinking among youth. Laws of Billboard advertisement in Georgia prohibits advertising alcoholic drinks and tobacco products at children, educational and medical institutions, culture and sports organizations within 100 meters radius of them is prohibited.

  • Limiting hours of sale:    –Another strategy to prevent excessive alcohol consumption and related harms is to limit access by limiting the hours during which alcohol can legally be sold.  In the US they differ from one state to another. In Atlanta, Georgia, packaged liquor may be sold between 12:30 p.m. and 11:30 p.m. on Sunday, and between 8:00 a.m. and 11:45 p.m., Monday through Saturday. Packaged beer and wine may be sold at any time except between midnight Saturday night and 12:30 p.m. Sunday afternoon, or between 11:30 p.m. Sunday night and 12:01 a.m. on Monday.  Alcoholic beverages may be served in bars and restaurants between 12:30 p.m. and midnight on Sunday, and between 9:00 a.m. and 2:30 a.m., Monday through Saturday.

 

Should we make these strategies different for women and men?

The answer to this question is YES. Alcohol offers each group a different spectrum of risks. It is necessary for everyone, especially policymakers to understand that alcohol affects women’s bodies differently. Unlike males, women are more likely to suffer the health and social effects of alcohol consumption. Also, women are vulnerable to the secondhand effects or alcohol harms of excessive alcohol consumption among others.

With a recent report on an increase in the number of women who drink, there should be an awareness of these health risks and make informed decisions about alcohol use. As such, it should be given special attention.

We also need to be aware that women are the target for more recent alcohol ads and campaigns. Advertisers market liquor as “diet” or “natural” in an effort to appeal to health-conscious women. 

To drink or not to drink? That is the question…

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    If you had asked me as a child, or even as a young teenager if I ever thought I would drink, my answer would have been “No.” I came from a family of people who out right opposed alcohol due to direct family members on both my mother and father’s sides who had died due to alcohol/drug use, including my father’s biological father. Growing up, I saw alcohol as something I never even wanted to do, I had no desire to even try it. It was not that I despised alcohol or thought less of people who drank it, at that time, for myself at least, I simply thought I would never want it in my life.

     I still remember my first drink, and I regret how I handled myself when I started to drink. I was only a few weeks into my freshman year of college and through some ongoing circumstances that I had been dealing with over the last several years, along with new pressures of college I found myself sitting in the middle of my college campus, on a bench, at close to midnight. I was in a bad place personally and I felt so lost and had no idea what I wanted to do or even what I should do. My friends found me and dragged me to their house right on the edge of campus where I just sat on their front porch and cried. Then they handed me a drink which I at first said I didn’t want. But after a while with their constant prodding, I felt that I couldn’t say no. They convinced me that it would help and so I had my first drink at a point in time where I hated everything about myself. And that situation influenced my drinking habits for the next few years. I drank because I didn’t like myself. I drank to avoid my life and avoid facing the world. Through that freshman year I drank several times a week and by my sophomore year I can really only remember a few days that I was not drinking. And, I would honestly say that I am lucky I was able to stop and find myself in a place where I did not ever feel like I had to drink, or that I craved to drink, because if I had, I am not sure where I would be now. I do not regret drinking on occasion now, what I regret is how I started drinking and how long I drank for the wrong reasons.

     But why did I take up so much time to share this, because I always thought I would be sober, I never thought I would drink. And, I believe that abstaining is an important avenue for some people. It just becomes complicated when peer pressure and society come into play. Abstaining from drinking is something we accept on a surface level, but when it comes down to it, people are judged when they don’t participate in what everyone else is doing. When I had that first drink, I felt like I could not say no, and that is dangerous. We have to come up with ways for not drinking to be accepted.

     I first thought of seeing what was out there in supporting people who are in recovering and trying to remain sober. The Recovery foundations network actually had 6 ways to help a loved one stay sober: https://www.foundationsrecoverynetwork.com/6-ways-help-someone-love-stay-sober/ Now I believe that while these are aimed at individuals who are recovering, they still frame the conversation in a light we should take to heart. They say to accept the person without judgement, this is important because why in the first place are we judging a person for not drinking? It should be a personal decision that peers do not force upon a person. There is also the focus on creating a substance-free environment. This can be so hard as even now alcohol is used at parties, business, tv shows, movies, music videos. Even at my college new alumni event right before I graduated (my college was a dry campus) all they served us to drink was sweet tea, beer, or wine. They didn’t even have water. What we need is a move towards not showcasing alcohol as the go to beverage of these industries, but instead chose a path that shows that there is a choice not to drink.  

     I remember an add I saw when I was in Uganda last month that said 0% alcohol, 100% fun. I tied to find a photo of it but sadly I could not. When I first saw it, I was thinking, “Oh this is cool, it’s showing an add that is promoting that you do not need to drink to have a good time. That is great!” I think that there could be a wonderful campaign using something like this to promote the idea of being sober and that you do not need to drink to have a good time. There could be the use, not only of social media, but of ambassadors and celebrities who already choose to have a sober life. It would provide a positive roll model people could turn to.  

However, I recently discovered the new thing in the market. The 0% alcohol beers.

These are beers and other drinks, but, they have no alcohol in them. Personally, I am not sure if this is a step in the right direction and a way for people who do not drink to have less pressure on them within social environments where there is alcohol, or if it is increasing the pressure even more. I have included a few links about them though below: https://www.heineken.com/us/heineken00?gclid=

 

EAIaIQobChMIqp2TlMeF4wIVSEsNCh26Yga5EAAYASAAEgLzsPD_BwE

https://www.delish.com/food-news/a25836691/heineken-zero-alcohol-beer/

https://www.thespiritsbusiness.com/2018/08/top-seven-non-alcoholic-spirits-brands/

https://www.youtube.com/watch?v=qNU3-1_n8qI

     At the end of the day, I believe that choosing to drink should be a personal choice. You should never feel pressured to drink, but I think you should also be in an environment where you feel comfortable saying no. Nothing will change overnight, but we all need to stand and support people who chose to abstain so that the environment can be shifted.  

I Didn’t Black Out, I Just Got A Little Absinthe-Minded

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To have an effective prevention strategy, you must first understand what causes people to engage in such behaviors you’d like to prevent. Knowing why people do what they do is a critical first step in creating meaningful change. As most people can personally attest to, making or breaking habits is hard work. If successful, it is often only after many false starts. To make a long-lasting change at the population level you need buy in from many; however, you must also recognize that with many people, comes many different ‘why’s’.

Consider alcohol consumption; people overindulge for many reasons. Simplistically, we can divide those reasons into two overarching concepts, positive reinforcement and negative reinforcement. It has been established men typically drink for the former, and women for the latter. Because the motivating factors for drinking differ among gender, so too should an effective prevention strategy.  Targeting a campaign about alternative ways to party and celebrate without alcohol, especially regarding sporting events may be effective for men, but significantly less so for women, because that’s not why the majority of women drink or abuse alcohol.

 

 

Women drink to excess to alleviate societal pressures and undiagnosed or unregulated mental health disorders like anxiety and depression. One effective alcohol prevention strategy targeting women could start with mental health awareness. Teaching women how to recognize the signs of anxiety and depression, and then help them to identify how and where to get help would hugely reduce the onset of female alcohol misuse. If women understood the emotions they are experiencing are actually symptoms of a condition that can be treated, they may be more likely to address them with a healthcare professional, instead of thinking that’s just the hand they were dealt and cope independently and unregulated with alcohol. Education is power, and teaching women what to look out for, both for themselves and for the women in their lives around them, could stop a lot of damage before it starts.  

Rob Turrisi, professor of biobehavioral health and prevention research at Pennsylvania State University, featured in Drink, has developed a handbook for effective parental interventions concerning drinking.  This handbook is meant to capitalize on the concept that knowledge is power and communication is key. Young people are particularly vulnerable to alcohol misuse, because the regulatory part of their brain is has not yet reached full maturity. This means an effective prevention strategy is parents sitting down with their college bound students and preparing them for the dangers ahead. Turrisi states that this prevention strategy is more effective with young girls than young boys. Because it’s less effective for boys does not mean that the prevention strategy is not working for girls, it means that another strategy should be identified to help males.

Another important part of successful alcohol prevention is to help make people aware of what other things they may be at higher risk for when under the influence. This differs for men and women. Women are at higher risk of sexual assault, STDs, and having a child born with fetal alcohol syndrome. Men, who typically occupy higher level professional positions are more at risk for getting fired or losing status and position. They’re also more likely to be arrested for assault than women while under the influence of alcohol. Effective prevention strategies will help people make internal pro/con lists and help them evaluate if abusing alcohol is worth the potential outcomes, but first you must make it personal for them, make them feel invested, give them a reason to listen. After you’ve gotten their attention, it is important to educate them, and empower them to successfully commit to the prevention strategy. 


The Consequence of Turning a Blind Eye 

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While there are some general, yet quantifiable, differences between males and females in terms of biology and physiology, there are seemingly endless dichotomies between these two genders in terms of social norms and expected behaviors. From preferences to habits, from tendencies to relationship expectations – we’ve created cultural binaries and placed men and women on opposing sides. This results in measurable differences that have real impacts on physical, mental, and emotional health. 

We know about how alcohol has varying physiological afflictions on these two sexes, but we haven’t yet adequately considered the different approaches required to address how men and women must approach recovery. Because women are “less likely to seek treatment” for an alcohol use disorder and instead “tend to seek care in mental health or primary care settings,” women are immediately at a disadvantage when it comes to addressing dependence and addiction (Gender and Use of Substance Treatment Services). Part of this is due to a heavier stigma placed upon women when it comes to substance abuse – leading women to not only avoid such a diagnosis but also be less able to recognize one – and it seriously damages a woman’s ability and likelihood to recover. 

In order to address this disparity, we must recognize the ramifications not only presented by physiological divergence, but also those created by an arbitrary, two-sided culture. By seeking equality, we fail to achieve equity. Our response must be to acknowledge these distinctions while they continue in light of gender-specific norms. We must accept the unique needs of different cohorts – be they by gender identity, ethnicity, or the unpredictable nature of individuality. 

As it relates to women in need of treatment for alcohol use disorders, a crucial next step in improving care and outcomes would be to collaborate with mental and primary healthcare providers. If women are failing to see the addiction within their anxiety or depressive symptoms, they must be defined. Mental and primary healthcare providers should receive additional training on recognizing alcohol use disorder in women of all ages, and they should have appropriate and specialized referrals they can make. In this way, we address one of the first and most crucial obstacles – helping people to recognize that they have an unhealthy and toxic relationship with alcohol.  

Sober Curious: Are you curious?

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Chris Marshall had a rocky past with alcohol. As is written in a recent feature posted on NPR, he drank throughout much of his teen years, receiving a DUI at the age of 16. After he got sober and become a substance abuse counselor, he realized that it was hard for freshly sober people to rejoin the ‘real world’ after completing treatment or rehabilitation.

It’s one thing to stay sober in an environment with no alcohol, but how do you resist a night out with friends at a trendy restaurant? Alcohol is everywhere, ingrained in much of our social, evening, and weekend activities, and it can be difficult to still feel social without its consumption—whether you are recovering from alcohol addiction or not.

Enter: sober curious. A new trend making its way through cities and countries, being sober curious can vary in meaning depending on who you ask. For some, it is a way to explore a permanently sober lifestyle. For others, it simply means incorporating more alcohol-free days and activities into their routine.

Marshall explored this idea and created a new nightlife option for sober curious folks, named the Sans Bar in Austin, TX. Since its inception, the bar has become a traveling pop-up bar making its way throughout the US, visiting various cities and encouraging more alcohol-free activities. In the video below, you can see Marshall demonstrating a few sans-alcohol drinks that his customers enjoy.

Personally, the Topo Chico with raspberry sounds right up my alley.

But the question is, is it sustainable? Can sober curious go from a grassroots effort to a cultural phenomenon, without the stigma of “not drinking” tied to it? Although I do think certain trends pass through for a season, I believe sober curious can withstand the test of our generation. Why, you ask? Because our society is trending towards health, prevention, and wellness in all areas of our life. A report published in 2018 by Nielsen reported that 67% of Americans say they will be prioritizing healthy or socially conscious food purchases in 2018. Although this data does not focus on alcohol drinking specifically, it does highlight the growth in general health and wellness consumption trends in the US market.

Credit: The Nielsen Company. February 7, 2018.

And it is no secret that alcohol is bad for us. As stated by the Centers for Disease Control and Prevention (CDC), excessive alcohol use over time can cause high blood pressure, heart disease, stroke, liver disease, certain types of cancer, learning and memory problems, mental health problems, social problems, and more. Americans are concerned with what they are putting in their body, and I think this timing of the sober curious trend is conducive to continued growth. And as you can see above, healthy, non-alcoholic beverages are on the rise.

As if that wasn’t convincing enough, Instagram reveals even more. Accounts focused on living sober or being alcohol-free have gained popularity recently, some—like Sober Girl Society and Sober Nation—amassing over thirty thousand followers each. There is even a post on Sober Girl Society’s page specifically referencing the sober curious trend, and asking her followers to define what it means to them.

I feel strongly that being sober curious can become a regular, run of the mill way of life for many. I feel the timing is right, and the opportunity to melt the hardened stigma around not drinking is here. But the trend won’t grow on its own! We need to do our part to show support for these spaces. Request them in your area, patronize events/activities that purposefully are alcohol-free, or simply do your part in making those without alcohol comfortable in drinking situations.

With our help, sober curious can become the new sober normal.