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.

3. Ethen MK, Ramadhani TA, Scheuerle AE, et al. Alcohol consumption by women before and during pregnancy. Matern Child Health J 2009; 13:274–85.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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

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

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

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

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

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). 

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.

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. 

Excessive alcohol use is responsible for approximately 88,000 deaths in the united states each year and $249 billion in economic costs in 2010. Excessive alcohol use includes

• Heavy drinking (defined as consuming 8 or more alcoholic beverages per week for women or 15 or more alcoholic beverages per week for men)
• Binge drinking (defined as consuming 4 or more alcoholic beverages per week for women or 5 or more drinks per occasion for men)
• Any drinking by pregnant women or those younger than age 21.

The strategies listed below can help communities create social and physical environment that discourage excessive consumption thereby, reducing alcohol-related fatalities, costs and other harms. (https://www.cdc.gov/alcohol/fact-sheets/prevention.htm)

Some of the recommendations are-

• Regulations of alcohol outlet density– alcohol outlet density refers to the number and concentration of alcohol retailers (such as bars, restaurants, liquor stores) in an area. Reducing the alcohol outlet density is one of the strategies to reduce alcohol sales and consumption by people.

• Increasing alcohol taxes – alcohol excise taxes may include wholesale, excise, or sales taxes, all of which affect the price of alcohol. Taxes can be levied at the federal, state, or local level on beer, wine or distilled spirits. (https://pubs.niaaa.nih.gov/publications/aa83/aa83.htm)
• Dram shop liability – Dram shop liability, also known as commercial host liability, refers to laws that hold alcohol retail establishments liable for injuries or harms caused by illegal service to intoxicated or underage customers.
• Maintaining limits on days of sale – states or communities may limit the days that alcohol can legally be sold or served.
• Maintaining limits on hours of sale – states or communities may limit the hours that alcohol can legally be sold.
• Electronic screening and brief intervention (e-SBI) – e-SBI uses electronic devices (e.g., computers, telephones, or mobile devices) to facilitate delivery of key elements of traditional screening and brief interventions. At a minimum, e-SBI involves screening individuals for excessive drinking, and delivering a brief intervention, which provides personalized feedback about the risks and consequences of excessive drinking. (https://www.integration.samhsa.gov/clinical-practice/alcohol_screening_and_brief_interventions_a_guide_for_public_health_practitioners.pdf)
• Enhanced enforcement of laws prohibiting sales to minors – Enhanced enforcement programs initiate or increase compliance checks at alcohol retailers (such as bars, restaurants, and liquor stores) for laws prohibiting the sale of alcohol to minors
• Screening and brief intervention for excessive drinking in clinical settings – Screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings can identify people whose levels or patterns of alcohol consumption do not meet the criteria for alcohol dependence, but place them at increased risk of alcohol-related harms.¹¹
• Additional alcohol policies – other policy areas such as laws and regulations related to the minimum legal drinking age and sales to underage youth, privatization or monopolization of alcohol control systems, monitoring of alcohol outlet densities. Restriction in these areas make alcohol less available. (https://pubs.niaaa.nih.gov/publications/aa83/aa83.htm)

According to me, the prevention strategies should not be different for men and women.

Also by the UK’s new alcohol guidelines advise that men and women shouldn’t drink more than 14 units of alcohol a week.

Earlier the British drinkers presented a higher threshold for men but now the alcohol guidelines are same for men and women. So, what was the evidence that the limits shouldn’t take gender into account. The different risk factors faced by men and women are apparent at higher levels of consumption-what we now call “drinking with increasing risk”.

That is, men who regularly drink more than three or four units a day and women who regularly drink more than this or three units a day. But at levels of consumption lower than this, these differences are not as clear cut. (http://theconversation.com/should-alcohol-limits-for-men-and-women-really-be-the-same-55914) 

The new guidelines present the message that there is no “safe” level of alcohol consumption but stop short of recommending abstention as the best policy. In fact, the Sheffield data shows that for both men and women drinking up to seven units a week, spread across three or more days, actually has a protective effect on death from an alcohol-related health condition. For men the benefit is very small (a 0.1% improvement), compared with over 2% for women.

References-

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756494/
2. https://www.integration.samhsa.gov/clinical-practice/alcohol_screening_and_brief_interventions_a_guide_for_public_health_practitioners.pdf

3. https://www.webmd.com/mental-health/addiction/alcohol-use-disorder-treatments#1
4. https://www.helpguide.org/articles/addictions/overcoming-alcohol-addiction.htm
5. https://www.cdc.gov/alcohol/fact-sheets/prevention.htm
6. http://theconversation.com/should-alcohol-limits-for-men-and-women-really-be-the-same-55914