Background
While there has been a general decline in alcohol consumption in many countries in recent years, an increasing trend of hazardous drinking behaviors, such as high-risk drinking and binge drinking, has been noted among women and youth [
1,
2]. Traditionally, the absolute incidence of alcohol consumption or problem drinking has been markedly higher among men. However, recent studies indicate that the gender gap in various indices of alcohol use is narrowing by age group [
3,
4]. This evidence suggests that negative social and cultural views of female drinking are declining, and gender role norms are changing.
This rising rate of female drinking is evident in Korea as well. While the rate of male drinking dropped slightly from 21.4 to 20.8% in 2019, female drinking rates rose sharply from 5.4 to 8.4% during the same period [
5]. Consequently, there has been mounting interest in female drinking behaviors in Korean society.
The discussion over problem drinking has been primarily focused on men. Recently, however, there has been an increased interest in the gender differences in the prevalence, clinical characteristics, biological vulnerability, and course of treatment [
1,
6]. As women are more vulnerable to the physical effects of alcohol compared to men, they are at greater risk of health problems, sexual violence, binge drinking, and problem drinking [
7‐
9]. Female drinking is viewed in a more negative light than male drinking in Korean culture, and this hinders early or timely intervention for drinking problems [
10], resulting in a quicker progression to alcohol dependence [
11]. Further, excessive drinking is considered a serious public health problem due to the adverse effects of heavy drinking during pregnancy and childbirth in women of childbearing age [
1,
12‐
14]. From this perspective, some researchers have argued that female drinking must be treated as a different social phenomenon as opposed to male drinking [
15], and measures must be devised accordingly [
15‐
17]. However, research approaches to female drinking have remained fragmentary.
Studies thus far have noted differences between men and women in terms of the biological impact of alcohol consumption and drinking predictors [
13]. For example, men often engage in social drinking, but women tend to drink to relieve negative emotions. In this context, many studies have pointed to psychosocial factors—such as stress and coping mechanisms [
18,
19], low self-esteem, depression, social support, and social networks [
20‐
22]—as predictors of problem drinking in women. Furthermore, sociodemographic factors such as age, education level, marital status, income, economic activity status [
9,
16,
23‐
25], one-person households [
26], and relationship-related factors [
27,
28] have also been mooted as predictors of female drinking.
Meanwhile, some scholars have argued that the perspective of gender is necessary to pinpoint the underlying causes of increased drinking among women accurately. This necessity is accentuated considering compositional and social contextual characteristics such as gender roles and norms that have changed over time, [
3,
9,
16]. In other words, they assert that drinking behavior and its levels of harm would appear differently in women, depending on the interaction of various factors such as their social position and role, the gender norms that influence their values and beliefs associated with drinking, the industrial environment related to the availability of alcohol, and socio-cultural environmental characteristics as well as their physiological characteristics regarding alcohol [
17,
29‐
31].
However, previous studies have a limitation in that they are mainly described based on demographic variables [
17,
32,
33]. Moreover, they focus on women’s vulnerable psycho-emotional characteristics, thereby limiting one’s understanding of the fundamental reasons behind their increased alcohol consumption from a social contextual perspective. Therefore, identifying more fundamental causes behind female drinking is essential, specifically in terms of the effects of gender-related experiences—which are rooted in social structures and family systems—on women’s drinking.
Traditionally, it has been accepted that culturally defined gender roles shape male and female drinking patterns [
34,
35]. Some studies report that conservative and traditional patriarchal gender norms that stress women’s involvement in parenting and household chores are negatively associated with female drinking [
29,
36,
37]. Domestic violence has been identified as another gender-related factor, with female victims found to engage in hazardous drinking for various reasons, including escaping their trauma [
38‐
42]. Therefore, it has been speculated that gender factors, such as women’s perceived gender roles and experience of domestic violence, can help predict problem drinking in women.
Problem drinking involves cumulative and continuous drinking, which has harmful consequences. As drinking is a type of social behavior [
43], for an accurate understanding of the issue, problem drinking among women must be understood in the social context—as opposed to viewing it as a phenomenon specific to a single point in time. However, many studies have adopted a cross-sectional design, and some longitudinal studies that have applied the latent growth model have assumed that the entire population has experienced homogeneous changes. Hence, previously reported data have failed to shed light on the different patterns of changes in drinking within a given population.
Therefore, this study aims to identify the types of longitudinal changes in female drinking behaviors and explores their characteristics. It also seeks to investigate the effects of gender-related experiences of women arising from the social structure—domestic violence, work–family balance stress, and perceived gender roles—on the types of longitudinal changes in their drinking. Based on our findings, we present clinical and policy directions to reduce the negative effects of problem drinking behaviors in women.
Discussion
We examined the types of longitudinal changes in female drinking by analyzing 3 years of KOWEPS (2018–2020) data using LCGA and explored their features. We also identified the gender-related determinants of the different classes of changes in female drinking.
First, three classes emerged in relation to changes in drinking patterns among women: “low level/decreased,” “moderate level/maintained,” and “high level/increased.” This confirms that there were heterogeneous changes in drinking patterns among women. With reference to the cut-off criteria for AUDIT scores, the “moderate level/maintained” group could be considered to engage in social drinking. Further, the “high level/increased” group demonstrated hazardous drinking behaviors at the baseline, but progressed to suspected alcohol use disorder over time, suggesting that they are a more risky drinking group compared to the other groups. These are different from previous longitudinal studies, which used the traditional potential growth model, in which only the pattern of decrease or increase over time was considered depending on the predictor [
10,
54,
55]. Potential classes that exhibited heterogeneous trends in the pattern of change regarding problem drinking among women were identified, which enabled the discovery of predictors that increased the likelihood of belonging to a class with undesirable problem drinking changes, providing evidence for early intervention strategies in problem drinking. Therefore, there is a need to tailor drinking prevention and intervention programs according to the type of change observed in female drinking behavior. For example, prevention programs for the “moderate level/maintained” group should be designed to help maintain their healthy use of alcohol, while programs for the “high level/increased group” should involve early screening and therapeutic interventions that seek to lower problem drinking.
Second, after adjusting for sociodemographic factors (e.g., age, religion) and psychosocial factors (e.g., depression, satisfaction with social relationships), which differ according to the types of changes in female drinking, we found: I) Gender-related factors were not significant for the “moderate level/maintained” class compared to other reference classes. However, depression and satisfaction with social relationships were significant predictors of drinking behavior. II) Unlike for the “moderate level/maintained” class, experience of domestic violence, work–family conflict, and perceived gender roles were identified as significant predictors in the “high level/increased” class. In other words, women with low levels of depression and high levels of satisfaction with social relationships were likely to be in the “moderate level/maintained” class, which engaged in a healthy and enjoyable level of drinking. Meanwhile, the odds of being in the “high level/increased class”—women engaging in hazardous drinking behaviors at the baseline and quickly progressing to suspected alcohol use disorder (addiction) over time—were higher among women with more experience of domestic violence, higher work–family conflict, and more open gender role perceptions. This supports previous findings that women victims of domestic violence frequently experience substance use disorder [
56,
57], women often utilize drinking as a stress-coping strategy [
58‐
60], and more conservative gender role perceptions are negatively correlated with drinking because women holding such views value family life more than their non-conservative counterparts do [
9,
23,
36,
61].
In particular, it is noteworthy that, as per the traditional gender roles in Korean society, women are perceived to place more value on family and are required to fulfill their duties as a spouse, parent, daughter-in-law, and daughter, all of which contribute to controlling their alcohol consumption. This can also be understood in terms of the association between gender role perceptions and work–family conflict. Considering reports that women with more traditional gender role perceptions face greater difficulties in becoming economically active [
47,
62], it can be speculated that women with more open gender role perceptions are relatively more economically active. Since socioeconomic activities increase the opportunities for alcohol consumption [
17], gender role perceptions are likely to be closely associated with hazardous drinking [
43]. Moreover, while women’s economic involvement is commonplace in modern society, failure to achieve an appropriate division of roles and household chores with their husbands can result in greater stress in women due to work–family conflict. Consequently, to relieve this stress, women may end up increasing their alcohol intake [
17,
63].
From a gender perspective, the highest odds ratios, or the highest likelihood, of a woman being in the ‘high-problem drinking/increased class’, were associated with experiences of domestic violence, followed by work-family balance stress and perceived gender roles, in that order. Its implications are as follows: First, the experience of domestic violence is a strong predictor of being in the “high level/increased” group, and individuals experiencing post-traumatic stress disorder seek to lower alertness [
64] or relieve negative emotions [
65,
66] through continuous hazardous drinking. Therefore, it is important to assess drinking problems in female victims of domestic violence and provide services accordingly, to prevent their negative spiral into alcohol addiction.
Second, there is a need for programs in the community and workplaces to promote mental health or coping skills that can help women cope with the stress caused by their heavy role in socio-economic activities and housework. In modern society, the increase in participation from women in socio-economic activities is a natural phenomenon. However, women still shoulder the burden of housework and childcare, the stress of which can be the most prevalent cause of drinking behavior in them. Additionally, women with a high level of work-family stress are likely to experience increasing levels of problem drinking, not only due to existing social perceptions of women’s problem drinking, but also the fact that their commitment to treatment is limited by their primary role of family care. Therefore, when designing a problem drinking prevention policy or a drinking problem intervention program for women, it is necessary to consider measures such as the inclusion of a work-family stress reduction program.
Third, from the perspective of promoting women’s health, educational programs that improve social perceptions by separating women’s identity from gender role perceptions and programs that prevent problem drinking in women need to be developed. In terms of gender role attitudes (perceptions), society has traditionally been lenient toward male drinking, but relatively stricter toward female drinking [
43]. However, increased economic participation of women [
67] and improved awareness regarding gender equality and women’s rights [
68] have diminished the social stigma and negative perceptions of female drinking. In line with these social changes, the mainstream industry and mass media in Korean society have been actively marketing to women [
29,
69,
70]. Particularly, they strive to provide women who used to be constrained by gender norms and traditional roles with the image of women in modern society by linking drinking behavior with women, their right to self-determination, and freedom [
70,
71]. In this regard, it is necessary to actively monitor alcohol marketing targeted at women and promote anti-alcohol campaigns and education in response to messages promoting drinking, thereby inducing healthy drinking habits and reducing harm.
Taken together, the alcohol consumption of women has increased dramatically in recent years. The combination of the perception that drinking liberates women who have been socially oppressed for a long time, and the implicit social coercion of drinking being essential for smooth work and social life contributes to patterns of problem drinking in women in South Korea. On the other hand, the problem of female drinking due to domestic violence is not a phenomenon that can only be explained by demographic, socioeconomic, and psychological factors. Therefore, this study emphasizes that problem drinking in women should be addressed from a gender perspective, in terms of their vulnerability within existing social and cultural hierarchies, based on their experiences. Gender-conscious policies should be proposed to reduce the harm of problem drinking in women, such as prevention education, improvement of the drinking environment, policy development, preparation of research and monitoring systems, and the establishment of leadership to implement them.
This study has several strengths. First, we shed light on the heterogeneous changes in drinking within the female population by not assuming that all women undergo the same changes in their drinking patterns over time. Second, we address the shortcomings of previous studies that have primarily examined sociodemographic, psychosocial, and relational factors as predictors of problem drinking in women. we analyze the effects of women’s gender-related experiences in the actual social structure on the longitudinal changes in their drinking patterns. This examination has enriched our discussion on female drinking from a gender perspective. However, the study is not without limitations. We could not examine gender gaps in the effects studied—we could not study how the gender perspective influences men. In addition, it was not possible to capture specific and minute changes of patterns by time point because we investigated patterns of change with data over 3 years, which is the minimum number of time points required for conducting a longitudinal study. Also, this study did not reflect the pattern of changes in independent variables, though they did exist. Finally, despite the change in social perceptions of women’s drinking, we are unable to rule out the possibility that respondents underreported their drinking due to pre-existing negative perceptions. Moreover, we believe that accounting for the limitations of our study and mapping gender differences and differences across generations (cohorts) within the female population would lead to more interesting findings.
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