The GENACIS project: a review of findings and some implications for global needs in women-focused substance abuse prevention and intervention

Understanding alcohol use and alcohol use disorders from a developmental psychopathology perspective: Research advances, challenges, and future directions

As part of the special issue of Development and Psychopathology honoring the remarkable contributions of Dr Dante Cicchetti, the current paper attempts to describe the recent contributions that a developmental psychopathology perspective has made in understanding the development of alcohol use and alcohol-related problems over the lifespan. The paper also identifies some of the future challenges and research directions. Because the scope of this task far exceeds the confines of a journal length article this paper does not attempt a comprehensive review. Rather, it builds on an earlier review and commentary that was published in Development and Psychopathology in 2013, with a similar goal.)Building on that work and updating its conclusions and suggestions for future directions, the current paper emphasizes findings from the research areas that were identified for further study in 2013 and the findings that have been published since that time.

High Intensity Drinking (HID) Assessed by Maximum Quantity Consumed Is an Important Pattern Measure Adding Predictive Value in Higher and Lower Income Societies for Modeling Alcohol-Related Problems

Adjusting for demographics and standard drinking measures, High Intensity Drinking (HID), indexed by the maximum quantity consumed in a single day in the past 12 months, may be valuable in predicting alcohol dependence other harms across high and low income societies. The data consisted of 17 surveys of adult (15,460 current drinkers; 71% of total surveyed) in Europe (3), the Americas (8), Africa (2), and Asia/Australia (4). Gender-disaggregated country analyses used Poison regression to investigate whether HID (8-11, 12-23, 24+ drinks) was incrementally influential, beyond log drinking volume and HED (Heavy Episodic Drinking, or 5+ days), in predicting drinking problems, adjusting for age and marital status. In adjusted models predicting AUDIT-5 for men, adding HID improved the overall model fit for 11 of 15 countries. For women, 12 of 14 countries with available data showed an improved fit with HID included. The results for the five Life-Area Harms were similar for men. Considering the results by gender, each country showing improvements in model fit by adding HID had larger values of the average difference between high intensity and usual consumption, implying variations in amounts consumed on any given day. The amount consumed/day often greatly exceeded HED levels. In many societies of varying income levels, as hypothesized, HID provided important added information on drinking patterns for predicting harms, beyond the standard volume and binging indicators.

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.

An Association Between Psychological Childbirth Trauma and Hazardous Alcohol Use

Hazardous alcohol use is increasing amongst some groups of women, yet little is known about the underlying reasons or gender-specific influences. The purpose of this study was to explore the association between psychological childbirth trauma and women’s hazardous alcohol use. We aimed to identify predictors of hazardous alcohol use given childbirth-related trauma, other life trauma (combat, natural disasters, physical or sexual assault, experiences threatening loss of life or loss of loved ones) and coping motives for drinking, whilst controlling for age, socio-economic status, negative affect and other drinking motives (enhancement and social motives). Australian data from the Why Women Drink survey (N = 301) was analysed. Women who experienced childbirth as traumatic scored higher overall for hazardous drinking and endorsed coping reasons more strongly than those who did not. Analyses of individual differences affecting hazardous drinking revealed coping reasons, rather than trauma itself, as the strongest predictor in a regression model. Other significant predictors included socio-economic status, enhancement of positive emotions and, marginally, negative affect. Findings identified a link between traumatic childbirth and hazardous drinking as a coping strategy. Prospective research is required to characterise predisposing and perpetuating vulnerabilities determining maladaptive coping after traumatic childbirth, and to inform effective interventions.

Gender Differences among Sardinians with Alcohol Use Disorder

Sardinia is an Italian island in the Mediterranean characterized by secular isolation and the singular genetic characteristics of its inhabitants. Findings obtained in populations with diverse genetic make-up and cultural background indicate gender differences and/or similarities in drinking characteristics of patients with alcohol use disorder (AUD). Knowledge of these characteristics in AUD patients is useful to improve access to treatments. This paper investigated the drinking characteristics of 66 female and 282 male outpatients with AUD, born from 1937 to 1991, living in Sardinia, and compared their characteristics with those of AUD patients living in other countries. Most Sardinian patients were men, approximately 3 years younger than women; women consumed lower amounts of alcohol than men but did not differ from men in the severity of AUD. Men were more often single than women, while a higher proportion of women reported that their mother or spouse was affected by AUD. Anxiety and depression were more prevalent among women while a higher proportion of men were affected by substance use disorders. Women were older than men at the age of first drink, regular drinking, and onset of AUD, and progressed faster than men from regular use to AUD onset. Women did not differ from men in age at first request for care, and in the lapse from AUD onset to first request for care. Women and men waited for more than 8 and 9 years, respectively, before receiving medical treatment. Gender differences progressively decreased among younger patients. Although the scarce number of women in some cohorts limits the strength of these findings, drinking characteristics of Sardinian patients did not vary significantly from those of AUD patients living in other countries. These results suggest that the number of Sardinian women with AUD is increasing and services for treatment of AUD should (a) consider women’s specific needs, and (b) realize effective policies to reduce latency prior to accessing medical treatment for both men and women with AUD.

Daily Social Pressure and Alcohol Consumption Among Chinese Women: A Cross-Sectional Study

The purpose of this study was to examine the daily social pressure and socioeconomic factors related to women's alcohol consumption in China. Cross-sectional data were obtained from the 2012 China Family Panel Studies. A multivariate logistic regression analysis of a sample of 16 339 female adults with the mean age of 45.3 years was used to examine the relationships between dependent and independent variables. According to the results, first, the greater the daily social pressure, the more likely women were to engage in general alcohol consumption (odds ratio = 1.061) and risk drinking (odds ratio = 1.057). Second, while there is a positive relationship between the general level of social pressure and women's alcohol consumption, the relationship between the severe level of social pressure and women's alcohol consumption was not significant. Finally, women in the Central region were less likely to engage in risk drinking than women in the Western region; women with secondary school education were more likely to engage in risk drinking than women with primary school education or below; and age was significantly positively associated with both general and risk drinking. In conclusion, increasing alcohol consumption among women may be due to increased social pressure.

Past 6-Year Trends in Current Alcohol Use among Cyberbullied Adolescents

Most of the research on alcohol use and being cyberbullied has focused on the correlation between the two. Less is known about the recent epidemiology of adolescent current alcohol use. Objective: To describe the trends in current alcohol use among adolescence that self-report being cyberbullied across sex and racial/ethnic groups. Methods: The data from the present study came from the national Youth Risk Behavior Surveys (YRBS) from 2011 to 2017. We estimated the prevalence of current alcohol use across years by biological sex and race/ethnicity. Further we tested for linear and quadratic trends. Results: We observed statistically significant decreases in alcohol use cyberbullied (b= -0.12, p < 0.00), and non-cyberbullied individuals (b=-0.15, p < 0.00). Further, we found significant decreases for cyberbullied males (b= -0.10, p < 0.01), females (b= -0.17, p < 0.01) blacks (b= -0.39, p < 0.00), and Hispanics (b= -0.17, p < 0.01). Whites and other races were did not have a significant change. We also found significant decreases for cyberbullied white males and females, black males (b=-0.46, p < 0.03) and females (b= -0.37, p < 0.02), Hispanic males (b=-0.33, p < 0.00). White males and females and other males and females did not have significant changes in alcohol use prevalence. Conclusions: Consistent with national trends, alcohol use among adolescents is decreasing. The decrease is occurring within those that are being cyberbullied. Further research with different data are necessary to further validate these results.

Factors influencing alcohol use among female in-school adolescents in the Western Cape, South Africa

The increasing levels and more frequent use of alcohol among females, especially those in younger age groups, is a worldwide concern. An in-depth understanding of this phenomenon is, however, limited. This study aimed to explore the factors influencing alcohol use among female adolescent students as guided by the ecological systems theory of Bronfenbrenner. Data were collected from 25 female high school students in Grade 9 in the Western Cape, South Africa, using five individual semi-structured interviews and two focus group discussions with each group comprising 10 students. Thematic analysis was used to analyse the data. The findings of the study indicated that participants begin drinking at an early age and due to low self-esteem, which makes them prone to peer influence. Female adolescents are also influenced by various factors residing within the microsystem (family members and peers), mesosystem (lack of parental attention, weak mother-to-daughter relationship, influence of peers and dating partners), exosystem (media advertisement and lifestyle of celebrities), macrosystem (change in societal roles), and chronosystem (transition to higher education). Interventions are needed in schools to help female adolescents resist peer pressure and cope with the changing environment of high school. Also, parents should be educated on the influence of their drinking behaviour on their children in order for them to be more cautious when drinking at home. Adolescent students will benefit from educational materials on the harmfulness of alcohol use.

A Multilevel Analysis of Regional and Gender Differences in the Drinking Behavior of 23 Countries

Introduction: Drinking behavior differs not only among countries, but also among regions within a country. However, the extent of such variation and the interplay between gender and regional differences in drinking have not been explored and are addressed in this study. Methods: Data stem from 105,061 individuals from 23 countries of the GENACIS data set. The outcomes were heavy drinking (10/20 g or more of pure ethanol per day for women/men), and risky single occasion drinking (RSOD) (5+ drinks per occasion) at least monthly. Analyses used binary logistic mixed models. Variance at specific levels was measured by the intra-class correlation coefficient (ICC). Gender differences in outcomes were measured using gender ratios. Results: Country-level ICC was 0.13 (95% CI: 0.09-0.18) for heavy drinking and 0.16 (95% CI: 0.10-0.26) for RSOD. Within-country regional-level ICC for heavy drinking and RSOD was 0.02 (95% CI: 0.009-0.05; 0.01-0.04, respectively), implying that 2% of variation in heavy drinking and RSOD was explained by regional variation. Variance in drinking indicators was larger for women compared to men across countries. Gender ratios were higher in low- and middle-income countries. Conclusions: Regional variations in risky drinking were more often present in low- to middle-income countries as well as in a few higher-income countries, and could be due to cultural and demographic differences. Variations in gender differences were larger on the country level than on the regional level, with lower-income countries showing larger differences. These results can help to better identify specific high-risk groups for prevention strategies.

Alcohol consumption and consequences in adolescents in 68 low and middle-income countries - a multi-country comparison of risks by sex

AIMS

Alcohol use is a leading risk factor for disease burden among youth. This study estimated sex differences in the prevalence of alcohol use and consequences among adolescents living in low and middle-income countries (LMIC).

DESIGN

Multi-staged cross-sectional international standardized self-report questionnaires administered in the classroom.

SETTING

The Global school-based student health survey (GSHS) comprised adolescents from 68 LMIC between 2003-2014.

PARTICIPANTS

271,156 students aged 13-17 years old.

MEASUREMENTS

Alcohol measures included: past month alcohol consumption, history of intoxication and alcohol-related problems. Regions were based on the World Health Organization definitions: Africa, America, Eastern Mediterranean, Europe, South-east Asia, and Western Pacific.

FINDINGS

Overall, males had higher odds of alcohol use (OR = 2.38 [1.91-2.96]), a history of intoxication (OR = 2.64 [2.11-3.31]), and alcohol-related problems (OR = 1.72 [1.41-2.10]) than females. All regions recorded overall greater odds of alcohol use by males versus females; five regions (excluding Europe) recorded greater odds of intoxication in males; and three regions (America, South-east Asia, and Western Pacific) recorded greater odds of alcohol-related problems amongst males. However, there were country-level differences - in some countries, adolescent drinking rates and consequences were comparable by sex. Countries with the highest odds of alcohol use among males compared to females were Indonesia, Myanmar, Cambodia, Tuvalu, Morocco, Senegal, Kiribati, and Thailand.

CONCLUSIONS

Among adolescents living in LMIC, males had on average two-fold higher odds of drinking alcohol and experiencing adverse consequences. Growing affluence and improvements in sex equality in societies may increase the future prevalence of hazardous drinking in females in LMICs.

The collectivity of British alcohol consumption trends across different temporal processes: a quantile age-period-cohort analysis

BACKGROUND AND AIMS

UK alcohol consumption per capita has fallen by 18% since 2004, while the alcohol-specific death rate has risen by 6%. Inconsistent consumption trends across the population may explain this. Drawing on the theory of the collectivity of drinking cultures and age-period-cohort analyses, we tested whether consumption trends are consistent across lighter and heavier drinkers for three temporal processes: (i) the life-course, (ii) calendar time and (iii) successive birth cohorts.

DESIGN

Sex-specific quantile age-period-cohort regressions using repeat cross-sectional survey data.

SETTING

Great Britain, 1984-2011.

PARTICIPANTS

Adult (18+) drinkers responding to 17 waves of the General Lifestyle Survey (total n = 175 986).

MEASUREMENTS

Dependent variables: the 10th, 25th, 50th, 75th, 90th, 95th and 99th quantiles of the logged weekly alcohol consumption distribution (excluding abstainers).

INDEPENDENT VARIABLES

seven age groups (18-24, 25-34… 65-74, 75+ years), five time-periods (1984-88… 2002-06, 2008-11) and 16 five-year birth cohorts (1915-19… 1990-94). Additional control variables: ethnicity and UK country.

FINDINGS

Within age, period and cohort trends, changes in consumption were not consistently in the same direction at different quantiles of the consumption distribution. When they were, the scale of change sometimes differed between quantiles. For example, between 1996-2000 and 2008-2011, consumption among women decreased by 18% [95% confidence interval (CI) = -32 to -2%] at the 10th quantile but increased by 11% (95% CI = 2-21%) at the median and by 28% (95% CI = 19-38%) at the 99th quantile, implying that consumption fell among lighter drinkers and rose among heavier drinkers. This type of polarized trend also occurred between 1984-88 and 1996-2000 for men and women. Age trends showed collectivity, but cohort trends showed a mixture of collectivity and polarization.

CONCLUSIONS

Countervailing alcohol consumption and alcohol-related harm trends in the United Kingdom may be explained by lighter and heavier drinkers having different period and cohort trends, as well as by the presence of cohort trends that mean consumption may rise in some age groups while falling in others.

Mini Review: Socio-Cultural Influences on the Link Between ADHD and SUD

Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development and persistence of substance use disorders (SUD). The prevalence of ADHD in patients with SUD varies across countries and cultures. So far, cross-cultural variance in ADHD prevalence rates among SUD patients was mainly ascribed to methodological differences between studies, leaving the role of societal and cultural practices in the ADHD-SUD link hardly acknowledged. The aim of the present mini review is to address this gap in the literature by providing evidence for the effect of socio-cultural practices on the ADHD-SUD link and suggesting directions for future research. To achieve this goal, we map the influence of socio-cultural factors on the ADHD-SUD link along three lines of research. The first line is concerned with the role of socio-cultural factors in the recognition, diagnosis and treatment of childhood ADHD. The second line of research is concerned with socio-cultural influences on substance use (e.g., religion, ethnic identity, acculturation, and socio-economic status). Finally, we describe potential socio-cultural factors which may operate as mechanisms for reducing or increasing access to substance abuse treatment (e.g., ethnic disparities in health care utilization). Identifying socio-cultural influences on the ADHD-SUD link may provide further insight into the bidirectional association between ADHD and SUD in different contexts and encourage future research in the field.

Studying Sex Differences in Animal Models of Addiction: An Emphasis on Alcohol-Related Behaviors

Animal models are essential for understanding the biological factors that contribute to drug and alcohol addiction and discovering new pharmacotherapies to treat these disorders. Alcohol (ethanol) is the most commonly abused drug in the world, and as the prevalence of alcohol use disorder (AUD) increases, so does the need for effective pharmacotherapies. In particular, treatments with high efficacy in the growing number of female AUD sufferers are needed. Female animals remain underrepresented in biomedical research and sex differences in the brain's response to alcohol are poorly understood. To help bridge the gender gap in addiction research, this Review discusses strategies that researchers can use to examine sex differences in the context of several common animal models of AUD. Self-administration, two-bottle choice, drinking in the dark, and conditioned place preference are discussed, with a focus on the role of estrogen as a mediator of sex differences in alcohol-related behaviors.

Gender Difference in Offspring's Alcohol Use Disorder by 21 Years: A Longitudinal Study of Maternal Influences

AIMS

There is little known about the extent to which maternal alcohol consumption influences offspring's alcohol use disorder. This study aims to examine whether different maternal alcohol consumption trajectories predict gender difference in adolescent alcohol use disorder at child age 21 years.

METHODS

Data are from a prospective cohort, the Mater-University of Queensland Study of Pregnancy (MUSP) and its outcomes. The study involves 2531 mother-child pairs for whom data are available at the 21-year follow-up survey. Maternal alcohol consumption trajectories were determined by group-based trajectory modelling. Offspring's lifetime ever alcohol use disorder was assessed using DSM-IV diagnostic criteria.

RESULTS

Over 14 years of follow-up after the birth of a child, three distinct alcohol consumption trajectories were identified (abstainer, low-stable. and moderate-escalating drinker). A maternal trajectory of moderate-escalating alcohol consumption independently predicted offspring's lifetime ever alcohol use disorder at 21 years after adjustment for a range of potential confounders. "Cross-gender influence" is observed in the study.

CONCLUSIONS

A maternal life course pattern of alcohol consumption may have an independent effect on offspring alcohol consumption, with male offspring being more vulnerable to the effects of maternal alcohol use than are female offspring. Programs intended to address alcohol consumption by adolescents and young adults need to focus on the behaviors of both parents but acknowledging that maternal patterns of alcohol consumption may be particularly important for male offspring.

The Gender Difference in the Association between Early Onset of Drinking and Problem Drinking between the U.S. and Japan

Using comparable survey data from the GENACIS Project, collected from representative samples of people aged 20 to 70 years old in the U.S. (n=2,598) and Japan (n=1,734), this study examined, across these two diverse societies, the gender difference in the association between the early onset of drinking and the development of drinking problems. The results of this study suggest that there does not appear to be a cross-national causal relationship between the early onset of drinking and problem drinking because of significant country and gender variations in this association and because there is no association found among Japanese females. As hypothesized, the early onset of drinking predicted problem drinking among males more strongly than among females in both countries.

The GENAHTO Project (Gender and Alcohol's Harm to Others): Design and methods for a multinational study of alcohol's harm to persons other than the drinker

AIMS

Most alcohol research has focused on how drinking harms the drinker. Research on alcohol's harms to others (AHTO) has studied primarily single or small groups of countries. This article describes the methodology of a new multinational study - GENAHTO - of how social and cultural contexts are related to AHTO, from the perspectives of both perpetrators and victims.

DESIGN

The GENAHTO Project uses surveys in 21 countries that provide data from drinkers who report causing harms to others, and surveys in 16 countries that provide data from victims of AHTO. The countries surveyed vary widely in alcohol policies, drinking cultures, gender-role definitions, and socioeconomic conditions.

PARTICIPANTS

More than 140,000 men and women, aged 15-84, participated in the surveys.

MEASURES

Individual-level measures include demographics, alcohol use patterns, and alcohol-related harms. Regional- and societal-level measures include socioeconomic conditions, drinking patterns, alcohol policies, gender inequality, and income inequality.

FINDINGS

The project seeks to identify characteristics of AHTO victims and perpetrators; within-country regional differences in AHTO; and associations between national alcohol polices and individual and regional levels of AHTO.

CONCLUSIONS

GENAHTO is the first project to assess AHTO in diverse societies. Its findings can inform policies to abate AHTO in varying cultural contexts.

Gender Differences in Binge Drinking

Just as binge drinking rates differ for men and women, the predictors and consequences of binge drinking vary by gender as well. This article examines these differences and how binge drinking definitions and research samples and methods may influence findings. It also describes the relationship between age and binge drinking among men and women, and how drinking culture and environment affect this relationship. It examines gender-specific trends in binge drinking, predictors of binge drinking for men and women, and binge drinking in the context of smoking. The article reviews current findings on gender differences in the health consequences of binge drinking, including morbidity and mortality, suicidality, cancer, cardiovascular disorders, liver disorders, and brain and neurocognitive implications. It also discusses gender differences in the behavioral and social consequences of binge drinking, including alcohol-impaired driving, sexual assault, and intimate partner violence, and includes implications for treatment and prevention.

Evidence for Sex Convergence in Prevalence of Cannabis Use: A Systematic Review and Meta-Regression

OBJECTIVE

Generally, cannabis use has been more prevalent in men than in women. However, emerging evidence suggests that the prevalence of cannabis use is converging among males and females from recent cohorts. This study aimed to systematically summarize published literature on birth cohort changes in male-to-female ratios in prevalence of cannabis use.

METHOD

Twenty-two studies with a median sample size of 85,052 were identified for inclusion. Data were collected between 1979 and 2010, representing birth cohorts from 1936 to 1999. For quantitative synthesis, male-to-female ratios in prevalence of any cannabis use were calculated for all 5-year birth cohorts available, generating 348 separate ratios among birth cohorts from 1941 to 1995 in 30 countries. Random-effects meta-analyses generated pooled sex ratios, stratified by 5-year birth cohorts.

RESULTS

Of the 22 included studies, 10 reported some evidence of sex convergence in cannabis use among more recent cohorts. Quantitative synthesis found that the ratio of cannabis use prevalence in males and females decreased significantly from 2.0 among cohorts born in 1941 to 1.3 among those born in 1995.

CONCLUSIONS

Findings support the narrowing sex gap in the prevalence of cannabis use. Results are concordant with a broader literature demonstrating sex convergence in prevalence of other substance use, particularly alcohol use and related harms. Both young women and men should be the target of prevention and early intervention efforts. Future research in more diverse global settings, especially in low- and middle-income countries, would enhance the international scope of the findings.

Gender and Country Differences in Alcohol-Aggression Expectancy and Alcohol-Related Intimate Partner Violence

Alcohol use is associated with a higher rate of violent offending among males and a higher rate of violent victimization among females, especially for Intimate Partner Violence (IPV). Using comparable self-reported data from the GENACIS Project, the present study examines between the United States (n=2,363) and Japan (n=1,660) whether the expected gender difference in alcohol-related IPV is explained by alcohol-aggression expectancy. The results indicate that though males are more likely than females to expect that alcohol would make them more aggressive, alcohol-aggression expectancy has a very little to do with the gender difference in alcohol-related IPV. In both countries, overall, alcohol use of males, irrespective of their alcohol-aggression expectancy, most strongly and directly accounted for the gender difference in alcohol-related IPV.

Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression

OBJECTIVE

Historically, alcohol use and related harms are more prevalent in men than in women. However, emerging evidence suggests the epidemiology of alcohol use is changing in younger cohorts. The current study aimed to systematically summarise published literature on birth cohort changes in male-to-female ratios in indicators of alcohol use and related harms.

METHODS

We identified 68 studies that met inclusion criteria. We calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcohol-related harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1568 sex ratios. Random-effects meta-analyses produced pooled sex ratios within these 3 categories separately for each birth cohort.

FINDINGS

There was a linear decrease over time in the sex ratio for all 3 categories of alcohol use and related harms. Among those born in the early 1900s, males were 2.2 (95% CI 1.9 to 2.5) times more likely than females to consume alcohol, 3.0 (95% CI 1.5 to 6.0) times more likely to drink alcohol in ways suggestive of problematic use and 3.6 (95% CI 0.4 to 30.3) times more likely to experience alcohol-related harms. Among cohorts born in the late 1900s, males were 1.1 (95% CI 1.1 to 1.2) times more likely than females to consume alcohol, 1.2 (95% CI 1.1 to 1.4) times more likely to drink alcohol in ways suggestive of problematic use and 1.3 (95% CI 1.2 to 1.3) times more likely to experience alcohol-related harms.

CONCLUSIONS

Findings confirm the closing male-female gap in indicators of alcohol use and related harms. The closing male-female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.

Gender differences in the impact of population-level alcohol policy interventions: evidence synthesis of systematic reviews

BACKGROUND AND AIMS

Consistent review-level evidence supports the effectiveness of population-level alcohol policies in reducing alcohol-related harms. Such policies interact with well-established social, cultural and biological differences in how men and women perceive, relate to and use alcohol, and with wider inequalities, in ways which may give rise to gender differences in policy effectiveness. This paper aimed to examine the extent to which gender-specific data and analyses were considered in, and are available from, systematic reviews of population-level alcohol policy interventions, and where possible, to conduct a narrative synthesis of relevant data.

METHODS

A prior systematic 'review of reviews' of population level alcohol interventions 2002-2012 was updated to May 2014, all gender-relevant data extracted, and the level and quality of gender reporting assessed. A narrative synthesis of extracted findings was conducted.

RESULTS

Sixty-three systematic reviews, covering ten policy areas, were included. Five reviews (8%) consistently provided information on baseline participation by gender for each individual study in the review and twenty-nine (46%) reported some gender-specific information on the impact of the policies under consideration. Specific findings include evidence of possible gender differences in the impact of and exposure to alcohol marketing, and a failure to consider potential unintended consequences and harm to others in most reviews.

CONCLUSIONS

Gender is poorly reported in systematic reviews of population-level interventions to reduce alcohol-related harm, hindering assessment of the intended and unintended effects of such policies on women and men.

Converging Patterns of Alcohol Use and Related Outcomes Among Females and Males in the United States, 2002 to 2012

BACKGROUND

Females in the United States consume less alcohol and cause and experience fewer alcohol-related harms than males. However, recent research suggests such gaps might be narrowing. The purpose of this study was to explore changes in alcohol use and associated outcomes among females and males in the United States between 2002 and 2012.

METHODS

Data from the National Survey on Drug Use and Health were used to assess the prevalence and trends for females and males aged 12+ in lifetime abstinence, age of onset, current drinking, binge drinking, drinking and driving, reaching DSM-IV criteria for an alcohol use disorder, combining alcohol with other drugs such as marijuana, and other variables. Of particular interest was whether differences between females and males narrowed during the decade under study.

RESULTS

Differences in the drinking patterns of females and males aged 12+ narrowed between 2002 and 2012 for current drinking, number of drinking days per month, past year DSM-IV alcohol abuse, and past-year driving under the influence of alcohol. In addition, convergence was noted in 1 or more age subgroups for the prevalence of binge drinking and DSM-IV alcohol dependence and mean age at drinking onset. Divergence in drinking habits did not occur for any measure in any age subgroups with the exception of a greater increase in the prevalence of combining alcohol with marijuana among young adult male drinkers than female drinkers aged 18 to 25.

CONCLUSIONS

Between 2002 and 2012, differences in alcohol consumption and related outcomes narrowed for females and males. Reasons for converging patterns of alcohol use are unclear and do not appear to be easily explainable by recent trends in employment status, pregnancy status, or marital status. More research is needed to identify the psychosocial and environmental contributors to these changes and to assess implications for prevention and treatment efforts.

Gender differences in the prospective association between maternal alcohol consumption trajectories and young adult offspring's problem gambling at 30 years

Although a large number of studies have examined the association between young adult’s alcohol consumption and their problem gambling behaviours, none of these studies address the prospective association between mother’s alcohol consumption and their young adult offspring’s problem gambling behaviours. Using data from a 30 year prospective pre-birth cohort study in Brisbane, Australia (n = 1691), our study examines whether different maternal alcohol consumption trajectories predict offspring’s risk of problem gambling behaviours and whether these associations differ by the young adults’ gender. Offspring’s level of problem gambling behaviours was assessed by the short version of the Canadian Problem Gambling Index, with about 10.6 % of young adults having some risk of problem gambling behaviours. Trajectories of maternal alcohol consumption were determined by group-based trajectory modelling over five time points. Our study found that mother’s alcohol consumption pattern fits into three drinking trajectory groups, namely abstainers (17.2 %), a low-stable drinkers group (64.6 %) and a moderate-escalating drinkers group (18.2 %). Multivariate logistic regression analyses showed that the moderate-escalating alcohol trajectory group is independently associated with a risk of their male young adult offspring having problem gambling behaviours at 30 years—even after adjustment for a range of potential confounding variables. Mothers who exhibit a persistent life course pattern of moderate-escalating drinking have male children who have a high risk of engaging in problem gambling behaviours. Offspring’s alcohol consumption partially mediated the association between maternal drinking trajectories and young adult’s risk of problem behaviours. High levels of maternal alcohol consumption may lead to male offspring antisocial behaviours. Programs intended to address problem gambling behaviours by young adults may need to focus on male group with a focus which specifically addresses family influences as these contribute to gambling behaviour.

Trajectories and predictors of alcohol consumption over 21 years of mothers׳ reproductive life course

INTRODUCTION

Little is known about the patterns of women׳s alcohol consumption over their reproductive life course. This study identifies trajectories of alcohol consumption by mothers over 21 years of their reproductive life course and examines baseline predictors of these trajectories.

METHODS

Data were obtained from a prospective cohort study of 3715 women in Brisbane, Queensland, Australia over 21 years of follow-up. Women׳s alcohol consumption was measured by frequency and quantity of use across the surveys. Potential predictors and confounding variables were assessed at baseline. Group based-trajectory modelling was used to identify typical drinking trajectories over the maternal reproductive life course. Multinomial logistic regression was employed to examine predictors associated with these trajectories.

RESULTS

Four trajectories of alcohol consumption were indentified for mothers over the 21-year period. These trajectories included abstainers (11.9%), low-stable drinkers (58.0%), moderate-escalating drinkers (25.3%), and heavy-escalating drinkers (4.8%). After adjustment for significant covariates, membership of the abstaining trajectory was predicted by lower family income, being married, and high frequency of church attendance while membership of the heavier-escalating trajectory was associated with women who were not currently married, never went church and had unhealthy lifestyle behaviours.

CONCLUSIONS

Patterns of women׳s alcohol consumption exhibit a high level of stability for abstainers and women who drink at low levels. After the birth of their child, there are some changes in alcohol consumption for the moderate and heavy-escalating alcohol consumption groups. Low risk patterns of consumption are associated with variables which generally reflected a low risk behaviour lifestyle. Intervention programmes should particularly target women engaging in the heavy-escalating alcohol consumption group as this group increase their consumption shortly after the birth of their child. There is a need to understand more about the social and health consequences to mothers and their children of being in the moderate and heavy-escalating drinking trajectory groups.

Are alcohol policies associated with alcohol consumption in low- and middle-income countries?

AIMS

To examine the associations between alcohol control policies in four regulatory domains with alcohol consumption in low- and middle-income countries (LAMICs), controlling for country-level living standards and drinking patterns.

DESIGN

Cross-sectional analyses of individual-level alcohol consumption survey data and country-level alcohol policies using multi-level modeling.

SETTING

Data from 15 LAMICs collected in the Gender, Alcohol, and Culture: an International Study (GENACIS) data set.

PARTICIPANTS

Individuals aged 18-65 years.

MEASUREMENTS

Alcohol policy data compiled by the World Health Organization; individual-level current drinking status, usual quantity and frequency of drinking, binge drinking frequency and total drinking volume; gross domestic product based on purchasing power parity (GDP-PPP) per capita; detrimental drinking pattern scale; and age and gender as individual-level covariates.

FINDINGS

Alcohol policies regulating the physical availability of alcohol, particularly those concerning business hours or involving a licensing system for off-premises alcohol retail sales, as well as minimum legal drinking age, were the most consistent predictors of alcohol consumption. Aggregate relative alcohol price levels were associated inversely with all drinking variables (P < 0.05) except drinking volume. Greater restrictions on alcohol advertising, particularly beer advertising, were associated inversely with alcohol consumption (P < 0.05). Policies that set legal blood alcohol concentration (BAC) limits for drivers and random breath testing to enforce BAC limits were not associated significantly with alcohol consumption.

CONCLUSIONS

Alcohol policies that regulate the physical availability of alcohol are associated with lower alcohol consumption in low- and middle-income countries.

Influence from friends to drink more or drink less: a cross-national comparison

Drinking habits are socially patterned and social networks influence individuals' drinking behaviors. Previous studies have focused primarily upon the influence from family members to drink less. Those studies that have focused upon peer influence have been largely confined to social norms among adolescent and college-age drinkers. By contrast, based in adult populations, this article examines exhortations from friends not only to reduce alcohol consumption but also to increase it. Survey data in 15 countries that participate in the Gender, Alcohol and Culture: An International Study project (GENACIS) were used to test whether there were country and gender differences concerning the influence to drink less or to drink more by friends and examine if this was affected by the drinking behavior. The findings revealed that those influenced to drink less had more heavy episodic drinking (HED) occasions than those who did not report such influence. By contrast, influence to drink more, originating mainly from same-sex friends, may be more the result of social situations that encourage all drinkers, regardless of their frequency of HED occasions. At the country level, influence to drink less for both sexes decreased with the proportion of drinkers in a country. Similarly, influence to drink less for both sexes also decreased in countries where gender roles were more egalitarian. Thus, in countries where alcohol use is more widespread and fewer differences are observed between male and female gender role expectations, fewer people were influenced to drink less. These findings have implications for social and behavioral strategies designed to reduce alcohol-related harm across a wide range of cultures.