Young women & alcohol abuse

A look at trends, consequences, influences, and prevention approaches

Adapted from Girl-Centred Approaches to Prevention, Harm Reduction, and Treatment and Heavy Alcohol Use Among Girls and Young Women: Highlights of Findings from Literature Review and Web Search

Increasing attention is being brought to the issue of substance use by girls and young women, and the associated health and social consequences of heavy drinking, smoking cigarettes, as well as the use of both licit and illicit substances. Historically young men have been more likely than young women to drink alcohol, smoke cigarettes, and use illicit substances, but local, national, and international data now show that this gender gap in substance use is closing.

In 2009, a national virtual Community of Practice (vCoP) provided the opportunity for a “virtual discussion” of issues, research, and programming related to girls’ and women’s substance use in Canada. The goal of the vCoP was to serve as a mechanism for “gendering” the National Framework for Action to Reduce the Harms Associated with Alcohol and other Drugs and Substances in Canada. Participants included planners, decision-makers, direct service providers, educators, NGO leaders, policy analysts, researchers, and interested women. The project was sponsored by the British Columbia Centre of Excellence for Women’s Health (BCCEWH) in partnership with the Canadian Centre on Substance Abuse (CCSA) and the Universities of Saskatchewan and South Australia.

To inform this discussion, the BCCEWH took a closer look at the heavy use of alcohol specifically, examining trends, risks, influences, and preventative programming available, in a literature review.

Trends

In the 2004 Canadian Addiction Survey, over 85 percent of the alcohol consumption reported by females aged 15-24 years was consumed in excess of Canadian guidelines. The report also found 15 percent of young women (18-19) and 11 percent of women (20-24) reported heavy, frequent drinking. British Columbia has one of the highest rates in Canada. The 2008 British Columbia Adolescent Health Survey found male and female students were equally likely to binge drink with males only slightly more likely (less than 1 percent) to binge drink on 20 or more days in the previous month.

A recent international study examining gender specific trends in alcohol using cross-cultural comparisons from 1998 to 2006 in 24 countries and regions, found drinking and drunkenness remained higher among boys than girls, but the gap between boys and girls declined and girls appear to be catching up with boys in some countries. A 2004 survey of England revealed British young women (16 to 24) tend to engage in heavy drinking sessions with 49 percent consuming alcohol over one to three days. They are also likely to exceed the daily benchmark, with 28 percent drinking over 6 units at least once in a week. According to the U.S. Centres for Disease Control and Prevention (CDC), among young people ages 12 to 22 years old, the percentage of girls who drink alcohol is increasing at a much faster rate than that for boys.

Health Consequences

Girls and young women are at risk for accelerated development of long-term health problems associated with heavy drinking, these include: liver disease; cardiac problems; damage to stomach; brain damage; hypertension; and addiction. Moderate to heavy alcohol consumption also increases girls’ and young women’s risk for breast cancer later in life, as well as other forms of cancer shown to be linked to alcohol including: cancer of the mouth; pharynx; esophagus; colon; rectum; and, liver. Chronic heavy drinking, particularly in adolescence and the young adult years can compromise bone quality, increasing risk of osteoporosis later in life.

Alcohol use also negatively affects puberty and disrupts normal sexual reproductive functioning, which may result in a number of menstrual and reproductive problems, including irregular menstrual cycles, absence of ovulation, endometriosis and infertility. Another key sex difference for young women who consume alcohol is the risk of unwanted, unplanned, or unintended pregnancy due to unprotected and unplanned sex. Findings show young women tend to realize they are pregnant later in term. This raises the concern that young women may consume alcohol before they aware they are pregnant, thereby creating risk of fetal damage such as fetal alcohol spectrum disorder (FASD) and other birth defects. Even if they do know, studies show teenage girls are likelier than women of any age to binge drink during pregnancy.

Drinking to intoxication also makes girls and young women more vulnerable to date rape, sexual assault and unprotected sex, also increasing their vulnerability to HIV and sexually transmitted infections.

Key Protective Factors

To better understand gender-specific risk and protective factors for substance use, authors of the report Substance use among early adolescent girls: risk and protective factors surveyed adolescent girls and their mothers about substance use and related concerns. From their study, they identified the following key gender-specific protective factors:

• Going home after school

• Positive body image

• Mother’s knowledge of daughter’s whereabouts

• Mother’s knowledge of daughter’s companions

• Girl’s ability to always contact her parent(s)

• Family rules against substance use

• Parents encouragement to abstain

Influences on Girls’ Drinking

As yet, there is not a large literature on influences and pathways to substance use by girls. One study that has contributed to our understanding of sex- and gender-based influences on use and pathways to use is The Formative Years report, published in 2003 by the National Centre on Addiction and Substance Abuse at Columbia University in the US. This study identified key influences on girls’ and young women’s substance use in four domains: 1) personal attributes, attitudes, and childhood experiences; 2) peer and school influences; 3) family, culture, and community; and 4) societal influences, such as media advertising. They found for example that young women tend to use substances to improve mood, increase confidence, reduce tension, cope with problems, lose inhibitions, enhance sex or lose weight, whereas young males tend to use alcohol or drugs for sensation seeking or to enhance their social status. They identified a strong media influence on girls and young women’s substance use — that tobacco and alcohol advertisers tend to target females’ concerns about their appearance, reinforcing unhealthy standards of thinness and sex appeal. They also made note of gendered influences related to the transitions into adolescence and early adulthood — occurring when entering middle or junior high school, entering and graduating from high school or college or entering the workforce — frequently involve many changes in social and physical environment that influence the risk of substance use.

These critical transitions can be particularly stressful for girls/young women and are at risk of turning to use of tobacco, alcohol and drugs.

Gender-Informed Prevention Approaches

Despite the serious health consequences and alarming trends in levels and patterns of alcohol use by girls and young women, relatively few prevention programs have been designed and evaluated which address these risk and protective factors for girls and young women. The search found over 35 examples of gender-informed preventative programming/interventions in BC, Canada and abroad. Below are a few examples of gender specific programming organized into universal, selected and targeted levels.

Universal prevention focuses on broad population of girls or young women with prevention and health promotion efforts i.e. ‘girl-centred’ positive youth development programs, awareness campaigns, and virtual communities for girls.

Peer support - Go Girl! YWCA Greater Vancouver (Vancouver, BC), provides workshops for girls 10-13 years which covers topics such as body image, self-esteem, bullying, assertiveness skills, relationships, peer pressure, goal setting, decision-making combined with fitness activities. www.saleemanoon.com/gogirl/ [1]

Leadership based - ELLE Project: Leadership Building for Young Women (Canada), mentorship and community leadership development training program for young women 16-25 years. For seven days, twenty young women from across Canada get together to explore and address issues in their communities, in their lives and how to make change. Includes 4-day training/ workshops, national network retreat and mentoring.

www.powercampnational.ca/en/elle-project-fall-2009 [2]

Selective prevention focuses on particular sub-population of girls and young women with a particular risk potential. Programs aim to reduce risk by building strengths and protective factors.

Community based - Anti-Dote: Multiracial and Indigenous Girls and Women’s Network (Victoria, BC), grassroots network and community-based organization for girls and young women of racialized minority and Indigenous backgrounds. Provides outreach services, weekly programs, workshops and social events that address the needs of marginalized girls and young women. Offers supportive environment that reduces social isolation and connects girls and young women to other health, education and social services they may not otherwise access. www.antidotenetwork.org [3]

Art based - Art Attack (Verdun, Quebec), after-school art program engages girls 14-17 in arts-based activities designed to build self awareness and self-esteem; increase critical thinking skills and ability to act on issues of violence and discrimination; and connect girls to people and resources in their community, as well as engage girls in community action project that they develop themselves. Includes photography, spoken word, dance, zines, etc. www.fillesdaction.ca/en/art-attack [4]

Rites of Passage Girls Group - Interior Indian Friendship Centre (Kamloops, BC), group for marginalized and at-risk Aboriginal/ First Nations girls. Empowers girls to resist societal stereotypes and develop healthy definitions of themselves as Aboriginal/ First Nations girls. www.cdnwomen.org/PDFs/EN/CWF-Grants-GF-2009.pdf [5]

Indicated prevention and harm reduction focuses on girls and young women who are drinking and who may be engaging in harmful patterns of drinking, with an emphasis on minimizing harm, promoting health and preventing dependence.

College-age intervention - My Student Body (USA), high-risk drinking prevention website for college students. Provides internet-based brief, tailored interventions to help heavy drinking college students reduce their alcohol use. Consists of 4 weekly 20-minute sessions to provide students with tailored motivational feedback about high-risk drinking. Because of the growing concerns about the drinking among college women, they evaluated the effect of the intervention according to gender. Outcomes were found to be especially effective for women and persistent binge drinkers. www.mystudentbody.com [6]

Teen Parent intervention - ROCA Healthy Families Program (Boston, USA), an outreach and home-visiting intervention with teen parents. Home Visitors reach young parents through outreach, home visits, and referrals from community partners, health centres and Roca’s other programs. Home visitors run gender-specific school-based parenting groups at local high schools, an off-site Family Centre, and life skills/ parenting groups in collaboration with school-based health centres. One vision is to see “Young immigrant mothers raise their children in safety and be recognized for their contributions to society.” www.rocainc.org/strategy_relationships.php [7]

Parent-involved intervention – Mother Daughter Computer Delivered Program (USA), a computer-delivered program for preventing substance use among adolescent girls. Aimed to enhance mother-daughter relationships and to teach girls skills for managing conflict, resisting media influences, refusing alcohol and drugs, and correcting peer norms about underage drinking, smoking and drug use.

BCCEWH is grateful to Health Canada and the Provincial Health Services Authority in BC for financial support for the projects underlying this work on girls and alcohol. As a second step, BCCEWH researchers will be examining in depth this girl-centred programming in an effort to understand the risk and protective factors being addressed, and outcomes achieved and working with agencies in Canada interested in developing/ adapting such programming.