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

Dissolving contradictory demands: A systematic review of alcohol use of working mothers

BACKGROUND

Working mothers perform 'double shifts' of paid and domestic labour. Increased rates of employment among mothers in high income countries, and the impact of the alcohol industry actively promoting alcohol to working mothers, makes it crucial for preventative efforts to understand the factors driving alcohol use among this population. This systematic review of qualitative and quantitative studies provides an overview of the drinking patterns of working mothers and their predictors.

METHODS

Four databases were systematically searched in August 2024. The population of interest were adult women in high income countries, who were both mothers of at least one dependent child and employed in any capacity. The methodological quality was assessed using the Mixed Methods Appraisal Tool. Following a convergent integrated approach, narrative synthesis was conducted for all studies.

RESULTS

Of the 4623 records maintained for screening, 22 articles (15 quantitative and 7 qualitative) were included. Working mothers were more often drinkers and consumed a higher quantity per occasion (including binge and risky drinking) in comparison to mid-life women and non-working mothers. Alcohol use was also linked to managing emotional states, as a commodity to 'cope' with gendered norms. Living in a society with increased gender equity and being partnered or married had a protective effect on heavy drinking and consumed quantity.

CONCLUSIONS

Working mother's drinking is governed by gender norms and expectations, and countries who advance policies to improve the acceptability and compatibility of motherhood and employment may reduce working mother's alcohol use.

A political economy of hope: Materialisations of social class and inequity in women's imaginings of alcohol (free) futures

This paper explores how social class shapes affective experiences, integrating the sociology of emotions with political economic theory to examine how systems of dis/advantage influence women's hopes and hopefulness about their futures and the potential for reductions in alcohol consumption. Using 149 open-ended qualitative interviews with 86 women across three studies, we analyse 'hope stories' to investigate how capacities for hopefulness are embedded in the social practices and temporal orientations of gender and class. Interviews focused on the role of alcohol in daily life and perceptions of opportunities for reducing consumption, particularly in the context of alcohol as a health risk. Throughout data analysis, we made sense of the data though literature on the sociology of hope and the political economy of hope, revealing how class and gender create differing conditions and expressions of hope. Women in affluent social class positions expressed confidence in reducing alcohol consumption (if desired), attributing this to agency and personal virtue, often dismissing the need for hope. Middle-class women reported relying on hope to navigate pressures to conform to gendered norms and respectability, where alcohol use is socially expected. In contrast, working-class women described feelings of hopelessness, as intersecting precarities in their lives reinforced reliance on alcohol to manage life stressors. This study highlights how social class and gender create varying distributions and conditions of hope, offering empirical evidence on the structuring structures of hopefulness. Our findings provide critical insights for policy makers to develop equitable and class-sensitive approaches to supporting women in reducing alcohol consumption.

Using a Sober Curious Framework to Explore Barriers and Facilitators to Helping Sexual Minority Women Reduce Alcohol-Related Harms: Protocol for a Descriptive Study

BACKGROUND

Globally, women consume less alcohol than men, but alcohol consumption among women has declined less in recent years than among men. Drinking rates and alcohol-related harms vary substantially across population groups of women, and sexual minority women (eg, lesbian, bisexual, and queer) are at notably high risk. An emerging body of literature suggests that in addition to minority stress (eg, stigma, discrimination), drinking norms and drinking cultures likely influence sexual minority women's drinking. Almost no research has explored these factors as possible targets of interventions. Sober curiosity is a rapidly growing wellness movement that may be particularly salient for sexual minority women. It encourages individuals to be "curious" about the reasons they choose to drink and alcohol's effects on their life and health.

OBJECTIVE

The aims of this research are to (1) explore the perspectives of the drinking social worlds of sexual minority women, their awareness of the sober curious movement, perceptions of their own and their peers' drinking and desire to drink less, and perceived barriers and facilitations to changing their drinking behaviors and (2) identify key elements of an alcohol reduction intervention tailored for sexual minority women.

METHODS

We conducted a comprehensive review of the literature on alcohol interventions with sexual minority women. The handful of studies we found paid scant attention to drinking cultures, normative beliefs, or other key elements of sober curiosity. To address the study aims, we are conducting 2 descriptive studies with adult (>18 years) sexual minority women using mixed methods. One includes focus group interviews (n=24-36) and a national survey (n=100-120) with sexual minority women in Scotland. The other includes in-depth interviews (n=18-20) with sexual minority women in the United States. Data from the 2 countries and 3 sources will be analyzed using qualitative and quantitative methods to identify patterns and relationships across data to validate or corroborate findings.

RESULTS

Each of the studies received ethics approval in August 2023 and is currently open for recruitment. We anticipate completing data collection in spring 2025. The results of qualitative analyses will be summarized as themes, and results of survey data analyses will be summarized in tables. Findings will be presented to 2 panels of international experts who will assist in identifying critical elements of an alcohol reduction intervention tailored to the unique needs of sexual minority women.

CONCLUSIONS

With the assistance of the expert panels, we will use Acceptability, Practicability, Effectiveness, Affordability, Side-Effects, and Equity criteria to inform the development of a tailored intervention building on tenants of sober curiosity to assist sexual minority women in reducing harmful drinking.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63282.

A Hope for Hope: Refocusing Health Promotion on Hopefulness to Reduce Alcohol Consumption and Breast Cancer

Our perspective paper focuses on the sociology of hope and is a call to action for health promotion policy makers to create the conditions for hopefulness in alcohol reduction policy, advocacy and programs for/with midlife women. Alcohol is a major risk factor for breast cancer, and high proportions of midlife women in most high-income countries drink at "risky" levels, increasing the chances of breast cancer (due to both age and alcohol consumption). At present, alcohol reduction approaches convey mostly individualised risk messages and imply personal responsibility for behaviour change, stripped from contexts, and heavy drinking persists among groups. New approaches that address the social norms, identities and practices that operate to sustain heavy drinking are necessary considering alcohol harms. We argue that focusing on changing these factors to support hopeful futures may create hope for midlife women to reduce alcohol consumption. We synthesise contemporary theories on the sociology of hope and analyse how these might help to refocus health promotion policy on hopefulness in the context of alcohol reduction and breast cancer prevention. We will draw on Freire's notions of a Pedagogy of Oppression and a Pedagogy of Hope to show how enabling people to recognise and respond to the "oppressive forces" shaping their alcohol consumption might lead to more hopeful futures with reduced alcohol consumption for priority populations. Our focus on building hope into health-promoting alcohol reduction approaches intends to shift policy focus from the individual as the "problem" towards hope being a "solution".

Alcohol, affective atmospheres and structures of feeling in women at midlife

INTRODUCTION

Women at midlife have increased rates of harmful drinking in many high-income countries. This cohort grew up within permissive alcohol environments that encouraged women's consumption, linking it to success, femininity, and empowerment. This research drew on notions of 'structures of feeling' and 'affective atmospheres' to explore how women at midlife describe and make sense of alcohol and drinking within their lives.

METHODS

Eight friendship discussion groups and 17 individual interviews were conducted with 50 women (aged 35-59 years) in Aotearoa/New Zealand about alcohol and drinking. Transcripts were analysed using an affective-discursive approach.

FINDINGS

Shaped by idealised femininities and alcohol's chemical affordances, particular affective atmospheres and feelings arose in women before, during, and after drinking, providing insights into women's experiences and sense-making around alcohol. Three areas of life were highly affectively charged in discussions, namely drinking that: 1) enabled bonding with partner, 2) facilitated time out from busy lives, and 3) was part of coping with life's difficulties.

DISCUSSION AND CONCLUSIONS

Women at midlife experienced pressures to be economically and socially successful, to maintain slim bodies, and to have 'appropriate' feelings such as selflessness and gratitude. For women in this study, drinking alcohol was a way to achieve, and to cope with, expectations around idealised femininities and socially endorsed ways of living, being, and feeling. Repeated and routine affective experiences reinforced the role of alcohol in women's lives. Findings suggest the need for gender-transformative policies that address the structural environments of women's lives.

Uncorking the 'wine mum': Exploring the complexity of Australian women's everyday lives and drinking practices

BACKGROUND

With greater attention given to midlife women's drinking in research and in media representations of 'wine mums', we suggest that focusing on static gender roles (e.g., women as mothers) risks overlooking complex and dynamic features of women's lives. We draw on the concept of thick intersectionality to explore how everyday experiences of women's lives and multiple identities shape their drinking practices.

METHODS

This study draws on interviews with Australian women in their forties and fifties who were employed, had school-aged children and drank alcohol. We present four detailed accounts as interpreted narratives.

RESULTS

Close analysis of the stories of four women highlights important features of women's lives. Drinking practices were often intertwined with gendered labour, power inequalities and managing stresses borne from these. Gender, class, relationality, life course transitions, affect and various aspects of labour dynamics (temporality, autonomy and unseen labour) were prominent in the accounts. Alongside this health, geography, life histories and culture interacted in women's narratives and the various identities and roles they moved between, co-producing drinking practices in different ways.

CONCLUSION

By juxtaposing women's stories with 'wine mum' stereotypes, and the broader feminisation of drinking, we highlight how women's drinking practices are influenced not only by static identities, but the complex interplay between gender, a myriad of fluid social categories, and day-to-day life. We suggest that attending to context and women's everyday experiences is crucial for generating a nuanced understanding of drinking beyond women's traditional gender roles.

The role of alcohol consumption in the lives of older Australian women: qualitative insights and an agenda for further research, policy and practice

BACKGROUND

Alcohol consumption presents a threat to the health and wellbeing of women. The alcohol industry often pushes back at global efforts to prioritise the prevention of alcohol harms to women. Qualitative researchers have investigated how younger and midlife women conceptualise their alcohol consumption, but there is very limited research relating to older women (those 60 years and over).

METHODS

Using data collected from an online qualitative survey, this paper explored the factors that influence how older Australian women drinkers (n = 144. 60-88 years) conceptualised the role of alcohol in their lives. The study used a 'Big Q' reflexive approach to thematic analysis, drawing upon sociological theories of risk and symbolic interactionism to construct four themes from the data.

RESULTS

First, alcohol consumption was viewed by participants as an accepted and normalised social activity, that was part of Australian culture. Second, alcohol played a role for some participants as a way to cope with life changes (such as retirement), as well as managing stressful or challenging life circumstances (such as loneliness). Third, alcohol was part of the routines and rituals of everyday life for some women. For example, women discussed the consumption of wine with their evening meal as an important part of the structure of their day. Fourth, participants had clear personal expectancies about what it meant to be a 'responsible drinker'. They had clear narratives about personal control and moral obligation, which in some cases created a reduced perception of their own risk of alcohol-caused harm.

CONCLUSIONS

This research provides a starting point for future public health research examining the factors that may shape older women's alcohol consumption beliefs and practices. Public health activities should consider the unique needs and potential vulnerabilities of older women drinkers, and how these may be potentially exploited by the alcohol industry.

Gendered pleasures, risks and policies: Using a logic of candidacy to explore paradoxical roles of alcohol as a good/poor health behaviour for Australian women early during the pandemic

Drinking alcohol facilitates pleasure for women while also elevating disease risk. Symbolic expectations of what alcohol 'does in' life per lay insight (relax, identity-work, connect) sit in tension with scientific realities about what alcohol 'does to' women's bodies (elevate chronic disease risks such as breast cancer). Policy must work amidst - and despite - these paradoxes to reduce harm(s) to women by attending to the gendered and emergent configurations of both realities. This paper applies a logic of candidacy to explore women's alcohol consumption and pleasure through candidacies of wellness in addition to risk through candidacies of disease (e.g. breast cancer). Using qualitative data collected via 56 interviews with Australian women (n = 48) during early pandemic countermeasures, we explore how risk perceptions attached to alcohol (like breast cancer) co-exist with use-values of alcohol in daily life and elucidate alcohol's paradoxical role in women's heuristics of good/poor health behaviours. Women were aged 25-64 years, experienced varying life circumstances (per a multidimensional measure of social class including economic, social and cultural capital) and living conditions (i.e. partnered/single, un/employed, children/no children). We collated coding structures from data within both projects; used deductive inferences to understand alcohol's paradoxical role in candidacies of wellness and disease; abductively explored women's prioritisation of co-existing candidacies during the pandemic; and retroductively theorised prioritisations per evolving pandemic-inflected constructions of alcohol-related gendered risk/s and pleasure/s. Our analysis illuminates the ways alcohol was configured as a pleasure and form of wellness in relation to stress, productivity and respectability. It also demonstrates how gender was relationally enacted amidst the priorities, discourses and materialities enfolding women's lives during the pandemic. We consider the impact of policy regulation of aggressive alcohol marketing and banal availability of alcohol in pandemic environments and outline gender-responsive, multi-level policy options to reduce alcohol harms to women.

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design

Alcohol consumption is causally associated with long-term health-related consequences, such as cancer and cardiovascular disease, and short-term harms, such as accidents and injuries. Alcohol consumption has increased among midlife women (aged 40-65) over the last two decades in high-income countries. This study aimed to centre women's voices by using co-design methodologies to investigate what women identify as strategies that could assist them and other women their age to reduce their alcohol consumption. Human-centred design workshops were undertaken with 39 women, and conventional qualitative content analysis was used to analyse information from written workshop materials to develop categories in the data and count their occurrence. Six categories, or strategies, emerged, listed here from most to least represented: 'Participate in alternative activities to drinking alcohol', 'Track alcohol consumption and set goals', 'Seek support from family and friends', 'Drink alcohol-free beverages', 'Reduce supply of alcohol in the home' and 'Seek professional support'. Our findings identify strategies that are realistic and feasible to midlife women; our sample, however, likely reflects a more affluent subsection of this group, and as such, any focus on individual-level strategies must be complemented by policies that increase equitable access to healthcare and act on the social and commercial determinants of health. An intersectional approach to alcohol and other drug research is required to examine how the interplay of gender and other markers of social identities shape alcohol consumption.

The symbolic consumption processes associated with 'low-calorie' and 'low-sugar' alcohol products and Australian women

The influence of commercial actors, practices and processes on the health and wellbeing of women is still not well understood. The alcohol industry has developed a range of products to appeal to new 'health conscious' markets, such as 'low-calorie' and 'low-sugar' products. While these products may have specific appeal for women, there has been little in-depth research that has sought to understand how women conceptualize these products and the range of symbolic meanings that women associate with these products. An online qualitatively led survey was conducted with n = 497 Australian women who had consumed alcohol in the last year. Questions related to the reasons for and influences on alcohol use, the purchasing of 'low-calorie' or 'low-sugar' products and the influence that these products might have on women's alcohol use. Data were interpreted using reflexive thematic analysis. Women consumed alcohol to relax, cope with everyday stressors and because of the alignment with social practices and social connection. Women perceived that these products provided a healthier alternative to traditional alcohol products and that they aligned with women's values relating to weight and the thin ideal. Some women were concerned that these products could increase alcohol consumption by reducing the perceptions of risk associated with alcohol. Policy consideration is needed to address how product claims and attributes may influence population groups' interpretations of the risks and benefits of these alcohol products, including the illusion that these products have protective potential and are better for overall health and wellbeing.

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

Background

In Australia, midlife women are experiencing increasing levels of risky drinking behaviours and alcohol-related harms. This is despite the general population trend of decreasing alcohol consumption overall. In light of these diverging trends, this research explores the role of alcohol in the lives of midlife women from their own perspective.

Methods

Six semi-structured focus groups were conducted with 47 women aged 35-59 years of age. Residents from the Northern Beaches of Sydney, Australia were recruited, as this group of women appear to be experiencing heightened alcohol-related harms, with an alcohol-related hospitalisation rate 40 % higher than the NSW state average in 2017-18.

Results

Midlife women described the practical utility of drinking as a habit to relieve stress and escape trauma, as well as an effective method for creating and strengthening social connections within the parenthood life stage. Participants also described the act of moderation as a potent trigger for peer pressure and discussed the individual's tendency to prioritise the short term relieving effects of drinking, despite awareness of the long term health risks.

Conclusion

Findings around the pro-social role of alcohol as a woman and a parent should be explicitly considered when designing 'swap it' population health messages. Furthermore, the marked social penalty of moderation and tendency to discount long term health risks should also be factored into health promotion messages which seek to utilise moderation as a strategy to reduce alcohol-related harm for midlife women.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION AND CONCLUSIONS

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

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

OBJECTIVES

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

DESIGN

Single-site, double-blinded randomised controlled trial.

SETTING

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

PARTICIPANTS

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

INTERVENTION

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

CONTROL ARM

lifestyle health promotion only.

MAJOR OUTCOME MEASURE

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

RESULTS

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

CONCLUSION

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

REGISTRATION

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34842.

Women, alcohol consumption and health promotion: the value of a critical realist approach

Research on women's drinking occurs in largely disparate disciplines-including public health, health promotion, psychology, sociology, and cultural studies-and draws on differing philosophical understandings and theoretical frameworks. Tensions between the aims and paradigmatic underpinnings of this research (across and within disciplines) have meant that knowledge and insight can be frequently disciplinary-specific and somewhat siloed. However, in line with the social and economic determinants of the health model, alcohol research needs approaches that can explore how multiple gender-related factors-biological, psycho-social, material, and socio-cultural-combine to produce certain drinking behaviours, pleasures and potential harms. We argue that critical realism as a philosophical underpinning to research can accommodate this broader conceptualization, enabling researchers to draw on multiple perspectives to better understand women's drinking. We illustrate the benefit of this approach by presenting a critical realist theoretical framework for understanding women's drinking that outlines interrelationships between the psychoactive properties of alcohol, the role of embodied individual characteristics and the material, institutional and socio-cultural contexts in which women live. This approach can underpin and foster inter-disciplinary research collaboration to inform more nuanced health promotion practices and policies to reduce alcohol-related harm in a wide range of women across societies.

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

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