Alcohol, Gender And Drinking Problems
Alcohol, Gender andDrinking ProblemsPerspectives from Low and Middle Income CountriesEdited byIsidore S. Obot & Robin RoomDepartment of Mental Health and Substance Abuse, Geneva
WHO Library Cataloguing-in-Publication DataAlcohol, gender and drinking problems: perspectives from low and middle incomecountries.1. Alcohol drinking - adverse effects 2. Alcoholic intoxication - epidemiology 3.Sex factors 4. Socioeconomic factors 5. Multicenter studies 6. Developingcountries I. World Health Organization II. GENACIS.ISBN 92 4 156302 8(NLM classification: WM 274) World Health Organization 2005All rights reserved. Publications of the World Health Organization can be obtainedfrom WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27,Switzerland (tel: 41 22 791 2476; fax: 41 22 791 4857; email:bookorders@who.int). Requests for permission to reproduce or translate WHOpublications - whether for sale or for noncommercial distribution - should beaddressed to WHO Press, at the above address (fax: 41 22 791 4806; email:permissions@who.int).The designations employed and the presentation of the material in this publicationdo not imply the expression of any opinion whatsoever on the part of the WorldHealth Organization concerning the legal status of any country, territory, city orarea or of its authorities, or concerning the delimitation of its frontiers orboundaries. Dotted lines on maps represent approximate border lines for whichthere may not yet be full agreement.The mention of specific companies or of certain manufacturers' products does notimply that they are endorsed or recommended by the World Health Organizationin preference to others of a similar nature that are not mentioned. Errors andomissions excepted, the names of proprietary products are distinguished by initialcapital letters.All reasonable precautions have been taken by the World Health Organization toverify the information contained in this publication. However, the publishedmaterial is being distributed without warranty of any kind, either express orimplied. The responsibility for the interpretation and use of the material lies withthe reader. In no event shall the World Health Organization be liable for damagesarising from its use.Typesetting: e-BookServices.com, IndiaCover design: Tushita Graphic Vision Sàrl, Geneva, SwitzerlandPrinted in China
CONTENTSForeword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vPreface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viiAcknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ixChapter 1: Why study gender, alcohol and culture? . . . . . . . . . . . .1Richard W. Wilsnack, Sharon C. Wilsnack & Isidore S. ObotChapter 2: Social consequences of alcohol consumptionin Argentina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Myriam I. MunnéChapter 3: Differences in drinking patterns betweenmen and women in Brazil . . . . . . . . . . . . . . . . . . . . . .49Florence Kerr-Corrêa, Andrea M. Hegedus,Alessandra F. Sanches, Luzia A.Trinca, Ligia R. S.Kerr-Pontes, Adriana M. Tucci & Tricia M. F. FloripesChapter 4: Alcohol, gender and partner aggression: a studyin the Greater Metropolitan Area of Costa Rica . . .69Julio Bejarano-OrozcoChapter 5: Women and alcohol in India . . . . . . . . . . . . . . . . . . . . . .89Vivek Benegal, Madhabika Nayak, Pratima Murthy,Prabha Chandra & G. GururajChapter 6: Alcohol consumption in Mexican women:implications in a syncretic culture . . . . . . . . . . . . . . .125Martha Romero Mendoza, Maria Elena Medina-Mora,Jorge Villatoro & Ana DurandChapter 7: The contexts of alcohol consumption by men andwomen in Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143Akanidomo J. Ibanga, Adebola V. Adetula,Zubairu Dagona, Haruna Karick & Ochiyna OjijiChapter 8: Gender and alcohol in Sri Lanka . . . . . . . . . . . . . . . . .167Siri Hettige & Dharmadasa ParanagamaChapter 9: Gender and the major consequences of alcoholconsumption in Uganda . . . . . . . . . . . . . . . . . . . . . . . . . .189Nazarius Mbona Tumwesigye & Rogers KasiryeChapter 10: Problems from women's and men's drinkingin eight developing countries . . . . . . . . . . . . . . . . . . . .209Robin Room & Klara Hradilova SelinAuthors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221
FOREWORDIn the year 2000 the Department of Health of the Government ofValencia, Spain, received a proposal from the Department of MentalHealth and Substance Dependence (now Substance Abuse) of the WorldHealth Organization for technical cooperation and financial support forseveral projects on alcohol programmes and policy. The projects suggestedin the proposal included data gathering, management of alcohol problemsthrough dissemination of brief intervention, the development of globalalcohol policy initiatives, and support for technology transfer in the field ofsubstance abuse in general.The reason behind this request for cooperation was a recognition of thegrowing role of alcohol in global public health, especially in developingcountries, and the need for more funding to continue some of the WorldHealth Organization's outstanding work on alcohol. For example, thoughWHO projects on screening and brief intervention (SBI) in primary heathcare settings had been recognized as an effective strategy in reducingharmful and hazardous alcohol consumption in several developedcountries, the strategy had not been tested in developing countries. Theproposal also recognized the need for dependable and comparable data ongender and alcohol issues, including differences between men and womenin patterns of drinking and related problems.Data from a variety of sources, especially WHO's Global AlcoholDatabase (GAD) and the annual world health reports, support thecontention that alcohol indeed has become a major risk factor for diseaseand disability in many countries across the world. That this risk isincreasing in, for example, the low-mortality developing countries of Asiaand South America where alcohol is often the highest contributor todisease burden.Considering its interest in global public health, the ValencianGovernment was pleased to approve the signing of a cooperativeagreement with WHO in 2001 and the agreement has been renewed everyyear since then. The agreement focused on work in the following areas:gender and alcohol, alcohol policy, and knowledge transfer throughtraining. One of the first activities in the agreement was a meeting ofexperts to discuss the implications of alcohol marketing to young people'sdrinking which took place in Valencia in March 2002. The product of thatmeeting is expected to serve as a major resource in our understanding ofthe role of alcohol marketing and promotion in youth drinking behaviours.Support provided through the agreement has also been used by WHOto fund projects on brief intervention for alcohol problems in Brazil andSouth Africa. It has also led to this book which is the product of the genderand alcohol project in seven countries on four continents (namely,
Argentina, Costa Rica, India, Kazakhstan, Nigeria, Sri Lanka and Uganda).I am indeed pleased to contribute the foreword to this book whichpublishes contributions on gender and alcohol from six of the countriesfunded through the Valencia-WHO cooperative agreement and two othercountries. The book will go a long way in enhancing our appreciation ofgender issues in alcohol research and in the management of alcoholrelated problems not only in primary care but in other settings, e.g.,prenatal clinics and the workplace. I am sure that the book will contributeto the development of alcohol policy and the provision of service to menand women with alcohol-related problems not only in the countries in thereports but all around the world. The Government of Valencia, through theDepartment of Health, is happy to be associated with WHO's commitmentto reducing alcohol problems globally and will continue to support itsefforts in achieving this goal.Dr Bartolomé Pérez GálvezDirector General, Drug DependenceDepartment of HealthAutonomous Government of ValenciaSpainvi
PREFACEThis book presents data and addresses significant issues on gender andalcohol in eight low and middle income countries where such data are oftennot available. The book is a product of the multinational collaborativeproject on "Gender, Alcohol and Culture: an International Study"(GENACIS). GENACIS was funded by the European Commission, the U.S.National Institute on Alcoholism and Alcohol Abuse (NIAAA), the SwissOffice of Education and Science, the German Federal Ministry of PublicHealth, the World Health Organization, government agencies and othersources in individual countries.The study was conceived by the International Research Group onGender and Alcohol (IRGGA), a group of researchers affiliated with theKettil Bruun Society for Social and Epidemiological Research on Alcohol(KBS). Beginning with a few countries in 1999, GENACIS grew to includeprojects in more than thirty countries and 50 researchers, all united by acommon interest in seeking greater understanding of gender and alcoholissues.GENACIS uses a centralized data analysis and standardized measuresto assess the differences between men and women within and acrosscultures in the following areas: patterns and contexts of drinking;prevalence of alcohol problems;the experience of drinking-related violence in close relationships;how social inequalities and social roles influence drinking andheavy alcohol consumption;the relationship of societal-level factors (e.g., gender equality,drinking culture norms) to drinking and alcohol-related problems.The study grew out of earlier projects in Europe and the U.S. and seeksto clarify further the factors associated with men's and women's drinkingand alcohol-related problems.GENACIS is truly an international project; participating countries aredrawn from all parts of the world, especially from countries where harmfuluse of alcohol poses a threat to public health and social welfare. Fundingprovided to WHO by the Government of Valencia, Spain, made it possiblefor countries in low and middle income countries to participate in theproject. These countries are Argentina, Costa Rica, India, Kazakhstan,Nigeria, Sri Lanka and Uganda. There are also ongoing WHO-fundedprojects in three countries in the region of the Americas.The papers published in this book report data from six of thesecountries and from two other countries (Brazil and Mexico) participatingin GENACIS. Each paper addresses a particular issue of relevance to thecountry and provides a general overview of drinking and alcohol problems.
All papers evolved through a series of revisions after consultations withand reviews by a team of experts associated with the project. These expertsand lead authors participated in group discussions held in Berlin, Krakow,and Helsinki during GENACIS steering committee meetings or the annualconference of the Kettil Bruun Society.GENACIS is one of several projects on alcohol by the Department ofMental Health and Substance Abuse that are designed to enhance ourunderstanding of alcohol problems and provide the basis for effectiveinterventions. This product from the GENACIS project will serve as avaluable resource to researchers, service providers, policy-makers,students and all those engaged in work on alcohol and public health, andcontribute to shaping a global response to the harmful consequences ofalcohol.Dr Benedetto SaracenoDirectorDepartment of Mental Health and Substance Abuseviii
ACKNOWLEDGEMENTSThe preparation and publication of this book would not have beenpossible without the generous financial contribution of the AutonomousGovernment of Valencia, Spain, to the World Health Organization forprojects on Alcohol and Public Health. This support started in 2001 with agrant for work in three related areas — gender and alcohol, screening andbrief intervention for alcohol problems, and alcohol policy. The grant madeit possible for WHO to sponsor the participation of researchers from lowand middle income countries in the multinational project on Gender,Alcohol and Culture: an International Study (GENACIS).Special thanks are due to Dr Bartolomé Pérez Gálvez, Director Generalfor Drug Dependence, Department of Health, Autonomous Government ofValencia, for his exceptional commitment to the GENACIS project and hisoverall interest in working with WHO to reduce alcohol related problemsin developing countries. Several staff of the Department of Health inValencia, especially Dr José Martinez-Raga, also contributed in variousways to the success of the projects funded by their office.The participation of contributors in project meetings (in Berlin,Krakow and Helsinki) was made possible by grants from the U.S. NationalInstitute on Alcohol Abuse and Alcoholism/National Institutes of Health(R01AA04610 and R21AA12941), and the European Union's FifthFramework Research Programme (contract QLG4-CT-2001-01496).Grateful thanks are due to the principal investigators in these grants(Sharon Wilsnack and Kim Bloomfield, respectively), and to ArlindaKristjanson, Stephanie Kramer, and Friedericke Froehner for facilitatingthe participation of contributors in these meetings in various ways.Richard Wilsnack and Sharon Wilsnack reviewed the papers in thisvolume and provided guidance to contributors during the preparation ofthe manuscripts, and Gerhard Gmel provided advice on data managementand statistical analysis. Their contributions greatly enhanced the quality ofthe papers published in this volume.The WHO-GENACIS project was initiated by Maristela Monteiro andcontinued under the coordination of Vladimir Poznyak. Both of themprovided the support and encouragement needed at different stages of theproject, including the publication of this book.Tess Narciso and Mylene Schreiber provided invaluable secretarialsupport for all activities related to the WHO/GENACIS project. IsidoreObot had overall responsibility for the implementation of the project in theseven WHO funded countries and represented WHO in the steeringcommittee of the multinational research initiative.
CHAPTER 1WHY STUDY GENDER, ALCOHOL AND CULTURE?RICHARD W. WILSNACK, SHARON C. WILSNACK & ISIDORE S. OBOTINTRODUCTIONlcoholic beverages have been a part of social life for millennia, yetsocieties have always found it difficult to understand or restrain theiruse. A central theme of this book is that to better understand alcoholconsumption and its consequences, we need to better understand socialand cultural influences on the differences between men and women. Thattheme deserves careful and detailed attention for several reasons.AFirst, compared with women throughout the world, men are morelikely to drink, consume more alcohol, and cause more problems by doingso. This gender gap is one of the few universal gender differences in humansocial behavior. It is evident in all areas of the world (Almeida-Filho et al.,2004; Degenhardt et al., 1997; McKee et al., 2000; Perdrix et al., 1999;Rijken, Velema, & Dijkstra, 1998; Sieri et al., 2002), in drinking versusabstinence (Mohan, Chopra, & Sethi, 2002; Peltzer, 2002), in heavydrinking and intoxication (Gmel, Rehm, & Kuntsche, 2003; Higuchi et al.,1994; Siegfried et al., 2001), and in alcohol use disorders (Jhingan et al.,2003; Kebede & Alem, 1999; Yamamoto et al., 1993). The gender gap hasvaried but persisted for a long time, at least in European history (Martin,2001; Plant, 1997; Sandmaier, 1980; Warner, 1997) and in the traditions ofmany pre-industrial societies elsewhere (Child, Barry, & Bacon, 1965; Sealeet al., 2002; Suggs, 2001; Willis, 2001).Research has suggested several possible reasons why universal genderdifferences in drinking behavior might arise. For example, if women havelower rates of gastric metabolism of alcohol than men (Baraona et al.,2001; Frezza et al., 1990; Thomasson, 1995) or smaller volumes of bodywater in which alcohol is distributed (Mirand & Welte, 1994; York & Welte,1994), women may need to consume less alcohol than men to derive thesame effects. Or, women may be more likely than men to experienceunpleasant acute effects from alcohol (such as hangover symptoms)(Slutske et al., 1995, 2003), or may not enjoy risky and poorly controlledbehavioral effects of alcohol as much as men (Hill & Chow, 2002;Rosenblitt et al., 2001; Spigner, Hawkins, & Lorens, 1993), characteristicswhich might inhibit women’s drinking. However, despite the universalityof gender differences in drinking behavior, the size of gender differences
ALCOHOL, GENDER AND DRINKING PROBLEMShas varied greatly in different societies, historical eras, and drinkingpatterns; and neither the universality nor the variability of those genderdifferences has yet been adequately explained (Graham et al., 1998;Watten, 1997; R. Wilsnack et al., 2000).A second important reason to study how gender and alcohol interact isthat some of the gender differences in drinking, and much of the variationin such gender differences, are cultural. Societies have long used alcoholconsumption and its effects as important ways to differentiate, symbolize,and regulate gender roles (Joffe, 1998; Warner, 1997). Differences innormative drinking patterns help reveal to what extent societiesdifferentiate gender roles, for example, by making drinking behavior ademonstration of masculinity (Campbell, 2000; Driessen, 1992;MacDonald, 1994; Roberts, 2004; Suggs, 1996) or by forbidding women todrink as a symbol of subservience or to prevent sexual autonomy (Martin,2001; Nicolaides, 1996; Willis, 1999). Better understanding of how men’sand women’s drinking patterns differ is thus an important key toanswering broader questions of how and why societies try to get womenand men to behave differently (Gefou-Madianou, 1992; MacDonald, 1994;Murdock, 2001; Wilsnack & Wilsnack, 1997).In recent decades there has been increased concern about drinkingbehavior as an aspect of gender roles, because in some societies genderdifferences in drinking behavior have grown smaller. A commonhypothesis about such convergence in drinking patterns is that increasedopportunities for women to perform traditionally male roles (particularlyin the workforce) have also enabled and encouraged women to increasetheir drinking, with more adverse consequences (Bergmark, 2004;Bloomfield et al., 2001). Consistent with this hypothesis, whereconvergence has occurred, it has usually been most evident amongadolescents or young adults (Grant et al., 2004; McPherson, Casswell, &Pledger, 2004; Mercer & Khavari, 1990; Plant et al., 1999). However,convergence has not always occurred where it might be expected(Bloomfield et al., 2001; Neve et al., 1996; Serdula et al., 2004; Williams,1998); it may occur for some aspects of drinking behavior but not others(Grant et al., 2004; Malyutina et al., 2004); it may sometimes occurbecause men are drinking less instead of women drinking more (Bergmark,2004; O’Brien et al., 2001; Osler et al., 2001); and it is not always relatedto women’s nontraditional roles (Malyutina et al., 2004; Neve et al, 1996).If social influences on women’s and men’s drinking are likely to behistorically and culturally complex, better cross-cultural research ongender and drinking over longer periods of time may be essential to avoidoversimplified conclusions about effects of changes in women’s and men’sroles.A third important reason to study how gender affects alcohol use isthat false assumptions about male or female drinking may adversely affecthow societies identify and try to control alcohol-related problems. If heavy2
WHY STUDY GENDER, ALCOHOL AND CULTURE?drinking is associated with displays of masculinity or male camaraderie,
This book presents data and addresses significant issues on gender and alcohol in eight low and middle income countries where such data are often not available. The book is a product of the multinational collaborative project on "Gender, Alcohol and Culture: an International Study" (GENACIS). GENACIS was funded by the European Commission, the U.S.
accessible and diverse gender information. It is one of a family of knowledge services based at IDS . Other recent publications in the Cutting Edge Pack series: Gender and Care, 2009 Gender and Indicators, 2007 Gender and Sexuality, 2007 Gender and Trade, 2006 Gender and Migration, 2005 Gender and ICTs, 2004 . 6.3.1 Gender mainstreaming .
7 A number of studies on alcohol-related morbidity have found a J-shaped curve, i.e. those who drink no alcohol appear to have a greater risk of death from conditions linked to alcohol than those who drink a small amount of alcohol per week, but as drinking gets heavier, the risk of alcohol-related death increases steadily.
1. Past-Year and Past-Month Drinking and Driving Behavior 7 2. National Estimates of Total Drinking and Driving Trips 9 3. Frequency and Amount of Drinking for Drinker-Drivers vs. Others Who Drink 11 4. Most Recent Driving After Drinking Occasion 13 5. Calculated or Estimate BAG for Most Recent Drinking-Driving Occasion 15 6.
Binge (Episodic) Drinking: Having 5 or more drinks on a single occasion at least once in the past 30 days. Moderate Drinking: 1 drink per typical drinking occasion at least once a week, or 2-4 drinks per typical drinking occasion 2-3 times per month, or 5 or more drinks per typical drinking occasion once a month or less, or
The metabolism of alcohol is primarily dependent on the activity of ADH, and the average adult blood alcohol concentration decreases 15 - 20 mg/dL/hour. A drink of alcohol is defined as 14 grams of alcohol. Fourteen grams of alcohol are contained in 12 ounces of beer (5% alcohol content), 5 ounce
Illegal drugs, underage drinking, drunk driving, public consumption--even giving guests alcohol--can get you into legal trouble. Risks to Health: Alcohol Alcohol goes directly into the bloodstream, physically affecting the whole body. Some illnesses and health problems caused by alcohol include: Hangovers. Headaches, nausea, vomiting, aches and .
cause-and-effect relationships from the study findings. Another consideration when analyz ing price effects on alcohol consump tion is the potentially addictive nature of alcohol. Next to cigarette smoking, excessive drinking is the most common example of legally consuming an addic tive substance. However, alcohol and
Anatomy and Physiology for Sports Massage 11. LEVEL: 3: Term: Definition: Visuals: Cytoplasm Within cells, the cytoplasm is made up of a jelly-like fluid (called the cytosol) and other : structures that surround the nucleus. Cytoskeleton The cytoskeleton is a network of long fibres that make up the cell’s structural framework. The cytoskeleton has several critical functions, including .
