Moderators and mediators of the relationship between receiving versus being denied a pregnancy termination and subsequent binge drinking.

BACKGROUND: Women who terminate pregnancies drink more subsequent to the pregnancy than women who give birth, including women who give birth after seeking to terminate a pregnancy. METHODS: Data are from the Turnaway Study, a prospective, longitudinal study of 956 women who sought to terminate pregnancies at 30 U.S. facilities. This paper focuses on the 452 women who received terminations just below facility gestational limits and 231 who were denied terminations because they presented just beyond facility gestational limits. This study examined whether baseline characteristics moderate the relationship between termination and subsequent binge drinking and whether stress, feelings about the pregnancy, and number of social roles mediate the relationship. RESULTS: Only having had a previous live birth modified the termination-binge drinking relationship. Among women with previous live births, binge drinking was reduced among women carrying to term compared to terminating the pregnancy. Among women who had not had a previous live birth, however, the reduction in binge drinking among those denied termination was not sustained over time, and binge drinking of those who had and had not had terminations converged by 2.5 years. Neither stress, negative emotions, nor social roles mediated effects on binge drinking. Positive emotions at one week mediated effects on binge drinking at six months, although positive emotions at two years did not mediate effects on binge drinking at 2.5 years. CONCLUSIONS: Higher levels of binge drinking among those who terminate pregnancies do not appear due to stress or to negative emotions. Only parous women - and not nulliparous women - denied terminations experienced sustained reductions in binge drinking over time.

Which women are missed by primary health-care based interventions for alcohol and drug use?

BACKGROUND: Women of reproductive age who binge drink or have alcohol-related problem symptoms (APS) and who do not use contraception are considered at risk of an alcohol-exposed pregnancy (AEP). In the U.S., efforts to prevent AEPs focus largely on delivering interventions in primary health care settings. While research suggests that these interventions are efficacious for women reached, it is unclear to what extent these interventions are likely to reach women at risk of AEPs. METHODS: Data are from the Turnaway Study, a study of 956 women seeking pregnancy termination at 30 U.S. facilities between 2008 and 2010, some of whom received and some of whom were denied terminations because they were past the gestational limit. We examined associations between binge drinking, APS, and drug use prior to pregnancy recognition and having a usual source of health care (USOC). RESULTS: Overall, 59% reported having a USOC. A smaller proportion with than without an APS reported a USOC (44 vs. 60%, p<.05) and a smaller proportion using than not using drugs reported a USOC (51 vs. 61%, p<.05). This pattern was not observed for binge drinking. In multivariate analyses, an APS continued to be associated with lack of a USOC, while drug use was no longer associated with lack of a USOC. CONCLUSIONS: As more than 40% did not have a USOC, with higher proportions among women with an APS, primary health-care based approaches to AEP prevention seem unlikely to reach the majority of women who have an APS and are at risk of an unintended pregnancy.

Sexual assault and alcohol abuse: a comparison of lesbians and heterosexual women.

PURPOSE: To compare and contrast lesbians' and heterosexual women's experiences of sexual assault and to investigate relationships between sexual assault and alcohol abuse. METHODS: In-depth interviews were conducted with 63 lesbians and a demographically matched comparison group of 57 heterosexual women. Lesbians' and heterosexual women's experiences of sexual assault, drinking levels, and alcohol-abuse indicators were compared using descriptive statistics. LISREL analysis was used to test the effects of sexual assault on a latent measure of alcohol abuse. RESULTS: Lesbians reported more childhood sexual experiences, were more likely to meet the study definition for childhood sexual abuse (CSA), and were more likely to perceive themselves as having been sexually abused as children. CSA was associated with lifetime alcohol abuse in both lesbian and heterosexual women. However, adult sexual assault (ASA) was associated with alcohol abuse only in heterosexual women. IMPLICATIONS: Sexual assault is a common experience among both lesbians and heterosexual women. Findings emphasize the importance of asking about sexual assault in health histories, and assessing clients for substance abuse and other sequelae of sexual assault.

Family violence and victimization: treatment issues for women with alcohol problems.

A brief overview of the prevalence of violence in women's lives and psychological and physical consequences of these experiences is presented, with special attention to populations of women with alcohol and other drug problems. Barriers to identification of violent victimization within health care settings are discussed. Finally, potential areas for further consideration regarding policy, practice, and research are identified. The relationships between women's experiences of violent victimization and their use of alcohol and drugs are documented, although prior research has not fully explored or explained the etiologic nature of these relationships. Of additional importance is the recognition that various forms of violence occur throughout a single life span. Women's histories of violent victimization negatively affect their children, and thus, intergenerational issues are of concern. Understanding how the combined problems of alcohol and drugs interconnect with violence is relevant to the delivery of health services for women.

Gender differences in alcohol consumption and adverse drinking consequences: cross-cultural patterns.

AIMS: To examine the consistency and/or variability of gender differences in drinking behavior cross-culturally. DESIGN, SETTING, PARTICIPANTS: Women's and men's responses in 16 general population surveys from 10 countries, analyzed by members of the International Research Group on Gender and Alcohol. MEASUREMENTS: Comparable measures of drinking, versus abstention, typical drinking frequencies and quantities, heavy episodic drinking, intoxication, morning drinking, and alcohol-related family and occupational problems. FINDINGS: Women and men differed little in the probability of currently drinking versus abstaining, but men consistently exceeded women in typical drinking frequencies and quantities and in rates of heavy drinking episodes and adverse drinking consequences, while women were consistently more likely than men to be life-time abstainers. In older age groups, both men and women drank smaller quantities of alcohol and were more likely to stop drinking altogether, but drinking frequencies did not change consistently with age. CONCLUSIONS: A theoretical synthesis proposes that gender roles may amplify biological differences in reactions to alcohol, and that gender differences in drinking behavior may be modified by macrosocial factors that modify gender role contrasts.

The relationship between alcohol problems and use of tranquilizing drugs: longitudinal patterns among American women.

A previous community study of older adults (Graham et al., 1996) indicated a relationship between alcohol problems and use of tranquilizing drugs despite no relationship between alcohol consumption and tranquilizer use. The present paper explores this issue further using longitudinal data from a representative sample of American women. The results replicated previous findings of a significant relationship between alcohol problems and tranquilizer use that was unrelated to alcohol consumption. Analyses of longitudinal patterns indicated that alcohol problems in 1981 predicted subsequent use of tranquilizing drugs and that this relationship may be moderated by anxiety, with the relationship being strongest for respondents who reported few or no problems with anxiety. The results indicated no support for the relationship being due to: a pharmacological interaction of alcohol with tranquilizing drugs; use of tranquilizing drugs precipitating alcohol problems; or depression, anxiety, poor health or childhood sexual abuse being common causes of both alcohol problems and tranquilizer use. The link between alcohol problems and use of tranquilizing drugs needs to be investigated further to increase understanding of addictive behaviors.

Prevalence and risk factors for childhood sexual abuse in women: national survey findings.

OBJECTIVE: We interviewed a U.S. national sample of women, aged 18 years and older to determine the prevalence and characteristics of childhood sexual abuse. We also examined which family and background variables were predictive of CSA in this sample. METHOD: The study employed a series of detailed descriptive questions regarding childhood sexual experiences that were administered in a highly structured format by trained female interviewers. CSA prevalence rates were calculated using two definitions of CSA, one of which was slightly more inclusive. RESULTS: Prevalence rates for the more inclusive CSA definition ranged from 21% to 32%, depending on how respondents who provided incomplete information about their sexual experiences were classified. The less inclusive CSA definition resulted in prevalence rates ranging from 15% to 26%. Additional information about the types of abuse experienced, perpetrator characteristics, age at first abuse, and physical and affective consequences of the abusive experiences are reported. The risk of CSA was related to higher scores on a measure of father's rejection, and the interaction between parental drinking status and whether the respondent had lived with both parents during childhood. Further analysis of this interaction suggests that when respondents reported living with both biological parents, they were most at risk for CSA when their father was a nondrinker and their mother was a drinker.

Sociodemographic characteristics and drinking status as predictors of older women's health.

As part of a U.S. national survey of women's drinking and life experiences, the authors used responses from a subsample (n = 245) of women aged 55-90 years (M = 65.8 years) to examine the relationship of sociodemographic characteristics (income, marital status, and occupational status) and drinking status to several health outcomes (self-perceived general health, depression, sexual satisfaction, and sexual dysfunction). In all analyses, the authors controlled for respondent age. Results indicated that higher household income predicted greater lifetime and current sexual satisfaction with a partner as well as higher general health ratings. Women drinkers also reported better general health than did abstainers. An interaction between marital status (married or cohabitating vs. nonmarried) and employment status (employed vs. nonemployed) was a predictor of general health ratings. The authors found significant contrasts among the 4 groups when they controlled for age, income, and drinking status: (a) Among the employed respondents, the nonmarried women reported better general health than did the married women; and (b) among nonmarried respondents, the employed women reported better general health than did the nonemployed women.

Prevalence of sexual assault history among women with common gynecologic symptoms.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of a sexual assault history among women with and without 3 common gynecologic complaints: dysmenorrhea, menorrhagia, and sexual dysfunction. STUDY DESIGN: Data came from 3 surveys of women randomly selected from general populations: 2 United States regional samples (n = 1428 and n = 1703) and 1 national sample (n = 963). Prevalence rates and adjusted odds ratios were calculated and combined across the 3 samples with a meta-analysis. RESULTS: The prevalence of an assault history ranged from 6% to 26% among women with 1 symptom to 13% to 40% among women with 3 symptoms. Symptoms were associated with increased odds of an assault history for women 18 to 34 years old (odds ratio 1.90, 95% confidence interval 1.56 to 2.32), 35 to 44 years old (odds ratio 1.99, 95% confidence interval 1.57 to 2.53), and >54 years old (odds ratio 1.37, 95% confidence interval 1.04 to 1.80). Symptoms were unrelated to sexual assault history for women in the perimenopausal (45 to 54 years) age group (odds ratio 0.94, 95% confidence interval 0.71 to 1.24). Symptom level was unrelated to having disclosed assaults to a physician (odds ratio 1.17, 95% confidence interval 0.85 to 1.62). CONCLUSIONS: Women in the general population with common gynecologic complaints are at a substantially increased risk of having a history of sexual assault.

Ten-year prediction of women's drinking behavior in a nationally representative sample.

This study evaluates how well women's personal and social characteristics predict their drinking behavior over a 10-year period, using data from a national representative sample of 696 U.S. women interviewed in 1981 and 1991. Interviews obtained data on drinking behavior, personality characteristics, childhood and recent experiences, and perceptions of the social environment. Analyses using paired comparisons, correlations, and linear and logistic regression found that women's alcohol use and its adverse consequences in 1991 were predicted by age, 1981 drinking behavior, and many other aspects of their lives measured 10 years before. Heavier and riskier drinking patterns were associated in particular with adverse childhood experiences, missing interpersonal ties, and expected self-expressive benefits of drinking. However, no variables predicted all patterns of drinking behavior, and specific predictors of different drinking patterns showed little overlap. We conclude that many aspects of women's lives, and particularly their interpersonal relationships, have long-term influences on their drinking behavior, but different patterns of drinking behavior have different antecedents.

Childhood sexual abuse and women's substance abuse: national survey findings.

OBJECTIVE: Clinical studies have found elevated rates of childhood sexual abuse (CSA) in women seeking treatment for alcohol or drug abuse, and elevated rates of alcohol and drug disorders among female psychiatric patients with histories of CSA. The present study examines the relationship of CSA to women's use of alcohol and other drugs in a large, nationally representative sample of U.S. women. METHOD: As part of a national survey of women's drinking, 1,099 women were asked about sexual experiences occurring before age 18. Women who reported sexual experiences classified as abusive were compared to women without histories of CSA on nine measures of substance use, self-perception of anxiousness, the occurrence of one or more lifetime depressive episodes, five measures of sexual dysfunction, and early onset of masturbation and consensual sexual intercourse. RESULTS: Results of logit analyses, controlling for age, ethnicity and parental education, indicated that women with histories of CSA were significantly more likely than women without CSA histories to report recent alcohol use, intoxication, drinking-related problems and alcohol dependence symptoms; lifetime use of prescribed psychoactive drugs and illicit drugs; depression and anxiety; pain that prevented intercourse; and consensual sexual intercourse before age 15. CONCLUSIONS: Findings from this U.S. national sample support those of previous clinical studies and suggest that women's experience of sexual abuse in childhood may be an important risk factor for later substance abuse, psychopathology and sexual dysfunction. Implications of these findings for future research, treatment and prevention are discussed.

Use of alcohol among lesbians: research and clinical implications.

A review of the literature on the prevalence of alcohol use and problems among lesbians reveals that the few studies yielding information on this population are beset by design and methodological problems. Those factors possibly associated with higher risk status of lesbians are identified, as are gaps in the literature, and implications for clinical practice and research are discussed.

Childhood sexual abuse and bulimic behavior in a nationally representative sample.

OBJECTIVES: This study examines whether childhood sexual abuse is a significant risk factor for the development of bulimic behavior in women. METHODS: Interviews were conducted among a representative national sample of 1099 US women regarding their sexual experiences during childhood as well as their lifetime prevalence of bulimic behavior. Logistic regression was used to calculate adjusted odds ratios to measure the contribution of childhood sexual abuse to the odds of several measures of bulimic behavior in the population, controlling for the respondent's age, ethnic group, and parents' educational level. Attributable risk analyses were conducted to estimate how much risk for bulimic behavior was due to childhood sexual abuse. RESULTS: Victims of childhood sexual abuse were significantly more likely to display bulimic behavior, and a substantial fraction of cases of bulimic behavior could be attributed to such abuse. CONCLUSIONS: Childhood sexual abuse is a risk factor for bulimic behavior. Between one sixth and one third of the cases of significant bulimic disturbance could be attributed to childhood sexual abuse.

Drinking and problem drinking in US women. Patterns and recent trends.

General population surveys suggest that the percentage of US women who drink declined slightly during the 1980s. Comparisons of 1981 and 1991 national surveys using the same drinking measures show that fewer women drank heavily in 1991, and women drinkers drank less frequently and had fewer episodes of heavy drinking, although younger drinkers reported more frequent intoxication. Longitudinal analyses of 5-year changes in drinking behavior indicate that movement both into and out of problem drinking is greatest among women aged 21 to 34. Subgroups of women with elevated rates of heavy drinking and/or adverse drinking consequences include younger women; women lacking social roles or occupying unwanted social statuses; women in nontraditional jobs; cohabiting women; and ethnic minority women experiencing rapid acculturation. Risks of heavy and/or problem drinking are also greater among women with a heavy-drinking husband or partner; depression; sexual dysfunction; or violent victimization in childhood or adulthood. Future research should focus on (1) the causes and consequences of recent declines in women's drinking; (2) antecedents and consequences of specific patterns of multiple substance use in women; (3) social and relational contexts of women's drinking, including occupational influences, drinking behavior of significant others, sexual dysfunction, and relationship violence; (4) longitudinal predictors of both problem drinking onset and "spontaneous" remission of women's alcohol problems; and (5) childhood sexual abuse as a potentially powerful risk factor for later alcohol abuse in women.

Women, work, and alcohol: failures of simple theories.

When trying to explain how women's employment affects their drinking behavior, oversimplified theories produce weak and inconsistent results. Recent research casts doubt on any simple ideas that paid employment is hazardous for women's mental health and drinking, or that paid employment is beneficial for women's mental health and drinking, or that stressful jobs increase women's risks of problem drinking. Improved, more complex theories could specify which women will modify their drinking behavior as a result of particular employment experiences, predict interaction effects of employment conditions with other aspects of women's lives, and explain how employment may create a context where other variables may increase or reduce risks of problem drinking.

Predicting onset and chronicity of women's problem drinking: a five-year longitudinal analysis.

BACKGROUND: Longitudinal studies of adult drinking have typically excluded or sampled only small numbers of problem drinking women, and have measured a limited range of influences on women's drinking behavior. METHODS: To study the development of women's problem drinking over time, five-year follow-up interviews were conducted with two groups of respondents from a 1981 national survey of women's drinking: 143 problem drinkers and 157 nonproblem drinkers. Regression analyses examined effects of 1981 predictors on six measures of 1986 problem drinking, for problem drinkers and nonproblem drinkers separately. RESULTS: Among 1981 nonproblem drinkers, predictors of onset of problem drinking indicators by 1986 included younger age, cohabiting, and lifetime use of drugs other than alcohol. The most consistent predictor of persistent (chronic) problem drinking was sexual dysfunction; other predictor included being employed part-time or never married, and experiencing recent depression. Divorce or separation predicted lower levels of subsequent alcohol dependance among problem drinkers. CONCLUSIONS: Findings suggest that different personal and social factors predict the onset of problem drinking as compared with its continuation, and point to nontraditional life-style, sexual dysfunction, and role deprivation as potentially important variables.

Epidemiology of women's drinking.

Although U.S. and Canadian surveys conducted over the past two decades have found little evidence of major changes in drinking levels or drinking problems among women in general, change may be occurring within certain subgroups of women, for example, based on age, ethnicity, employment, or marital status. Women's drinking behavior shows significant linkages to aspects of women's social environments, including gender of co-workers and drinking behavior of significant others. The greater complexity of recent findings reflects the increasing maturation of epidemiological research on women's drinking.

Sexual experience and drinking among women in a U.S. national survey.

A 1981 national survey of 917 women provided rates of major sexual experiences and dysfunctions for the entire sample and across alcohol abstention/consumption categories. Most women drinkers (heavier drinkers most often) reported that drinking lessens sexual inhibition and helps them feel close to others; only 8% reported becoming less particular in sexual partner choice, 22% more sexually assertive, but over half (60%) had been targets of other drinkers' sexual aggression. On a sexual dysfunction index combining lifetime lack of sexual interest, lifetime lack or low frequency of orgasm with a partner, and vaginismus, moderate drinkers scored significantly lower than lighter and heavier drinkers. The heaviest drinking women had the highest rates of lifetime sexual disinterest and lack of orgasm with a partner. "Temporary abstainers" (who drank in the past 12 months but not the last 30 days) also had elevated sexual dysfunction rates, particularly those with substantial drinking histories. Several nontraditional sexual behaviors were correlated with heavier drinking, which was also related to morally liberal sexual attitudes. The study's findings may show the effects of a generalized moral value framework in which one large portion of the nation's population, especially females, is subject to pervasive proscriptions of behavioral, including their drinking and sexuality, while others vary in the freedom they find to drink and be sexual. More suppressed traditional sexuality occurs more frequently with lighter drinking and abstention, as is also true of sexual dysfunction. At heavier drinking levels suppressed and dysfunctional sexuality and heavy drinking may be both cause and consequence in a vicious circle, sometimes escaped by temporary or lasting abstention.

Retrospective analysis of lifetime changes in women's drinking behavior.

Retrospective data on drinking behavior and related life experiences have been a neglected resource in research on alcohol use in the general population. Data from a 1981 national survey of women's drinking indicate the potential value of retrospective data analysis. The 1981 data provide comparative ages of onset for drinking behavior, drinking consequences, and health problems, and allow comparisons among different cohorts of women. The data also show the variability in women's lifetime drinking patterns and the time-ordering of heavy drinking in relation to onset of depression and reproductive dysfunction.