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.

An Increasing Proportion of Women Who Are 60 Years of Age and Older Are Drinking

Newswise, June 6, 2017 — Most older Americans drink alcohol. Given that this segment of the population is projected to almost double by 2050, reaching 112 million, in the future, there will likely be many more older drinkers in the United States than currently.

Importantly, older individuals are more sensitive to alcohol’s effects than their younger counterparts, and are also more likely to take prescription medications that can interact negatively with alcohol, potentially leading to falls and other injuries. This study examined trends in drinking status among U.S. adults 60 years of age and older.

Researchers analyzed data from the 1997-2014 National Health Interview Surveys: 65,303 respondents 60 years of age and older (31,803 men, 33,500 women) were current drinkers; 6,570 men and 1,737 women were binge drinkers. Analysis of respondents by sex, age group, and birth cohort showed differing trends over time.

The observed upward trends in drinking among adults 60 years of age and older, particularly women, are of public health concern. Among older men, the prevalence of current drinking trended upward an average of 0.7% per year, while average volume and the prevalence of binge drinking remained stable.

Among older women, the prevalence of current drinking trended upward an average of 1.6% per year, while average volume remained stable; moreover, the prevalence of binge drinking increased an average of 3.7% per year. These findings indicate a need for alcohol-related public-health education, screening, and treatment for the growing older population.

Study Confirms Link Between Alcohol Consumption, Breast Cancer Risk in Black Women

Newswise, May 2, 2017– Alcohol consumption is known to be a risk factor for breast cancer based on studies predominantly done in white women. Now a University of North Carolina Lineberger Comprehensive Cancer Center study has found the same risk exists for black women, an understudied group.

Researchers found in the new study that black women who drank more than 14 alcoholic drinks per week had a significantly higher risk of invasive breast cancer than those who drank less.

The findings, published in the journal Cancer, Epidemiology, Biomarkers & Prevention, confirmed the link between alcohol consumption and breast cancer risk, which has been seen in other studies drawn from majority white populations.

And while some breast cancer risk factors - like age or genetics -- aren’t easily modified, alcohol consumption is one risk factor that women, regardless of race, can change to potentially lower their cancer risk.

“Minority groups are often understudied because they represent a smaller proportion of study populations. This work avoided that limitation by working with a consortium of many different studies, including more than 20,000 black women,” said Melissa Troester, PhD, a member of UNC Lineberger and professor of epidemiology in the UNC Gillings School of Global Public Health.

“We found that the patterns observed in other studies examining alcohol and breast cancer risk hold in black women, too.”

The researchers analyzed data for 22,338 women from the African American Breast Cancer Epidemiology and Risk (AMBER) consortium, which combines data from four large breast cancer studies.

Researchers evaluated alcohol as a risk factor for invasive breast cancer as well as for specific breast cancer subtypes, such as estrogen receptor positive or negative cancer.

“Our study demonstrated there is benefit in creating consortia to focus on understudied groups,” said the study’s first author Lindsay Williams, a graduate research assistant at UNC Gillings.

When they studied the data across all breast cancer subtypes, they found consuming seven or more alcoholic drinks per week was linked to increased risk of breast cancer across all subtypes.

Women who previously drank alcohol, and later stopped, had lower risk than women who reported recent use – indicating that women may be able to reduce their risk by drinking less.

However, they did find significantly higher risk for some women who have never drank alcohol.

The researchers said that the group of women that avoids alcohol also sometimes includes women who have other health conditions, and some of these health conditions can increase risk for breast cancer. The finding may direct additional research.

“In the future, it may be worth-while to better characterize women who identify as never drinkers to understand reasons for abstaining from alcohol,” Williams said.

The researchers underscored that the study is important as alcohol consumption can be changed or addressed.

“Overall, our findings among African American women mirror those reported in the literature for white women, namely that high levels of alcohol intake – more than one drink per day – are associated with increased breast cancer risk,” Troester said.

“Alcohol is an important modifiable exposure, and women who are concerned about their risk of breast cancer could consider reducing levels of exposure.”

In addition to Troester and Williams, other authors include: Andrew F. Olshan, Chi-Chen Hong, Elisa V. Bandera, Lynn Rosenberg, Ting-Yuan David Cheng, Kathryn L. Lunetta, Susan E. McCann, Charles Poole, Laurence N. Kolonel, Julie R. Palmer, and Christine B. Ambrosone.