Risky Bingeing: Women in Appalachian Ohio Report Higher Rates of Alcohol Misuse

How much alcohol women drink may depend on where they live. A new study finds one-fifth of women in Appalachian Ohio imbibe at alarming levels

Newswise, June 27, 2017 — Appalachia — stretching from the southern tier of New York state to northern Alabama, Mississippi and Georgia — has long experienced deep economic distress and deprivation, and the gamut of accompanying social problems.

Compared with women living in urban areas, women who reside in these rural areas face multiple health concerns, including substance abuse issues, and often at greater rates. While the opioid epidemic in rural areas has gained attention, the rampant alcohol use has not.

“Alcohol continues to be the most prevalent and widely used and abused substance among Appalachian adults and is reported to be the primary reason for seeking substance use treatment in the region, surpassing drug abuse,” says Golfo K. Tzilos, Ph.D.

Tzilos is an assistant professor in the University of Michigan’s Departments of Family Medicine and Psychiatry and the U-M Addiction Center. She and Mack T. Ruffin IV, M.D., MPH, professor emeritus and chair of the Department of Family and Community Medicine at Penn State Hershey Medical Center, studied excessive drinking behavior in women from rural Appalachian Ohio because of a surprising lack of empirical data.

Tzilos and Ruffin analyzed data from the Community Awareness, Resources, and Education (CARE) Project, which investigated determinants of abnormal cervical cytology.

More than 6,000 women older than 18 and representing 14 counties in Appalachian Ohio, 95 percent of whom were non-Hispanic whites, participated in the original study.

Approximately 2,300 of those women supplied relevant information about their alcohol use and other possible predictive alcohol abuse variables. Of these, one-fifth (19.9 percent) reported recent, heavy episodic drinking.

Heavy episodic drinking, or binge drinking, is defined as consuming four or more alcoholic beverages — beer, wine, wine coolers, mixed drinks and liquor — in one sitting for women.

Younger women (under age 26) were five times more likely to binge drink than women older than 50, researchers found. Those who identified themselves as current smokers, single and with four or more lifetime sexual partners also had an increased adjusted risk of binge drinking.

“One interpretation of the findings is that these women are a vulnerable population,” says Tzilos.

“Typically, these women face a number of disadvantages in their environment, including chronic stressors such as limited resources and living in poverty, as well as acute stressors such as exposure to violence and abuse, which can all play a role in the likelihood of higher rates of alcohol use.”

Their results are published in the Journal of Rural Mental Health.

Clinical takeaways and broader implications

Binge drinking is associated with a broad range of hazardous behaviors, including tobacco use, risky sexual activity, higher risks of unintended pregnancy and sexually transmitted infections. These behaviors can lead to harmful consequences that can negatively affect society as a whole.

Tzilos says primary care physicians have an opportunity to act as a conduit between their patients and critical health resources.

“Clinicians have the opportunity to inquire about risky alcohol use among their patients,” says Tzilos. “In rural settings, there are often barriers to health services that women face, including stigma, cultural concerns of confidentiality and trust, lack of anonymity, and lack of access and providers.”

This gap is particularly important to address given that rural women, including those from Appalachian regions, report a higher rate of health concerns that may be associated with, or a consequence of, unaddressed or undertreated alcohol misuse.

Tzilos and Ruffin’s findings also reflect what is happening at the national level. Women are increasingly participating in risky alcohol use at younger ages.

They suggest increasing sensitivity to this fact and work to address the obstacles to improving health outcomes for women from Appalachian communities. This could include leveraging technology to increase reach and access to screening, treatment and referrals.

“My future work will explore the relationship between stress and alcohol use among women in this region,” says Tzilos. “It may shed light on opportunities for prevention.”

Tzilos also plans to help adapt integrative strategies to identify and reduce health risk behaviors and to enhance protective factors among these women.

Alcohol’s Effect Can Be More Damaging to Women

Newswise, March 9, 2017— Listen up ladies.Women simply don’t metabolize alcohol in the same way as men. It’s called the telescoping effect.

Several research studies have shown that some women who drink heavily can do as much damage to their bodies in four to five years as a man who has been drinking for 20 to 25 years, according to Laura Veach, Ph.D., director of screening and counseling intervention services at Wake Forest Baptist Medical Center.

“It has something to do with the concentration of water and fat, but we’re really not sure that we understand the whole picture because there is much less research on how women process alcohol,” Veach said.

“We do know that alcohol stays in the liver longer in women than in men, which may explain why women can experience more impairment and liver damage.”

Knowing what constitutes a standard drink size and learning to count and visually measure drinks can help women stay healthy, just as getting an annual physical or skin cancer check does, Veach said.

Here are some things to remember:
• According to the National Institute on Alcohol Abuse and Alcoholism’s website Rethinking Drinking, a standard drink is five ounces of wine, 12 ounces of beer or one-and-a-half ounces of liquor.
• A regular bottle of wine contains five standard drinks.
• For women, no more than seven standard drinks a week are recommended.
• Risky drinking is considered to be four standard drinks in any one day or drinking episode.
• It takes about an hour per drink for the liver to metabolize alcohol.

“Get a measuring cup and pour out five ounces of wine to see what that really looks like,” Veach said. “It might surprise you to see how it looks in a wine glass, especially because the size and shape of glasses can vary so much. 

“That one simple thing can really help you keep track of how much you are drinking the next time you’re out with friends and help you avoid risky drinking.”

Problem Drinking in Older Adults

Newswise, January 14, 2017 – Older adults suffering from multiple chronic health conditions and depression are nearly five times as likely to be problem drinkers as older adults with the same conditions and no depression, according to researchers at the University of Georgia. Their study is the first to document the connection between multiple chronic illnesses, depression and alcohol use in seniors.

This information could help health care providers identify which older adults are most likely to experience problem drinking and lead to better preventive care for this segment of society.

The study, conducted by researchers from the UGA School of Social Work, utilized data from the National Social Life, Health and Aging Project, a nationwide survey of older adults that is funded by the National Institutes of Health. Researchers looked at more than 1,600 individuals aged 57 to 85 who identified as active alcohol consumers.

Among problem drinkers, or individuals who reported a high amount of negative consequences associated with alcohol use, the researchers found that more than half—66 percent—reported having multiple chronic health conditions, or MCC, and 28 percent reported having symptoms of depression.

The researchers also found that older adults who experienced MCC combined with depression were those who experienced the highest likelihood of problem drinking.

“These findings suggest that effective training in screening and referral for mental health and alcohol use issues for health care providers of older adults may better serve the approximate 4 million older adults who currently experience problem drinking in the U.S.,” said Orion Mowbray, assistant professor at the UGA School of Social Work and lead author of the study.

Previous efforts to prevent and manage disease in older adults have focused on a single disease at a time, said Mowbray. Few physicians consider the combination of multiple chronic conditions in connection with depression as a potential sign for increased alcohol misuse, although screening and follow-up counseling for behavioral problems is known to help.

“There is sufficient evidence that even brief interventions delivered in medical-related settings can have a positive influence on reducing problem drinking among most older adults,” said Mowbray.

“These interventions can include screening for signs of depression in individuals with long-term health problems, engaging the individual in a conversation about the risks of problem drinking, and providing a referral for brief alcohol-related treatment.”

Other contributors to the paper include Tiffany Washington, assistant professor of social work, social work doctoral student Greg Purser and Jay O’Shields.

The study, “Problem drinking and depression in older adults with multiple chronic health conditions,” was published in the October issue of the Journal of the American Geriatrics Society, and will be presented this month at the Society for Social Work and Research’s annual conference in New Orleans. It is available online at http://onlinelibrary.wiley.com/doi/10.1111/jgs.14479/full