The extent and diversity of harm from the drinking of unknown others in Australia: An analysis of data from during the COVID-19 pandemic.

INTRODUCTION: This paper aims to produce a comprehensive estimate of alcohol's harm to others (AHTO) from strangers among Australia adults in 2021. This survey was undertaken during COVID-19 and aims to compare AHTO results with those from 12 years before and identify differences across socio-demographics. METHODS: Cross-sectional data of 2574 Australian adults were collected in November 2021 via two survey modes: random digit dialling and the Life in Australia™ panel. Questions pertained to harms from the drinking of known and unknown others ('strangers') in the previous 12 months. Multivariable logistic regression is used to analyse differences in the experience of AHTO from strangers across age, gender and other socio-demographics. RESULTS: Under half of Australian adults reported experiencing AHTO from a stranger (42.2%) during the period of COVID-19. Women were at significantly higher odds of reporting harm than men. Significantly higher percentages of participants aged 18-49 reported harm than those 65 and over. Rates of experience of harm from strangers' drinking varied between different Australian regions. Adults engaging in less frequent risky drinking (less than 4 days a month) reported significantly greater experiences of harm than those not engaging in risky drinking in the past year. DISCUSSION AND CONCLUSIONS: The current study provides a national estimate of AHTO from strangers in Australia during the COVID-19 pandemic. Finding greater risk of experiencing AHTO from strangers among women than men differs from previous AHTO literature, and further research is required to determine if this is an emerging trend.

Besides the drinking in alcohol's harm to others: potential economic and environmental factors.

INTRODUCTION: This paper considers how harm from others' drinking is distributed across several economic and environmental factors. METHOD: Economic, environmental, demographic and drinking measures include: household income, financial disadvantage indicators, home spaciousness; neighbourhood socioeconomic status (SES), connections and safety; and respondent's gender, age group and risky drinking status. The paper explores interactions of these factors with harms from the drinking of others in a 2021 survey of 2574 Australian adults. RESULTS: The home's degree of crowding (persons per bedroom) is related to harms from others in the household, while financial disadvantage is related to harm from drinkers outside the household, whether known or strangers. Perceived neighbourhood safety and knowing neighbours are negatively related to harms from the drinking of others outside the household. In multivariate analyses for harms from household members and from strangers, these findings are little affected by three individual factors related to harms from others' drinking: the respondent's gender, age group and risky drinking status. DISCUSSION: Some economic and ecological factors play an important role in the occurrence of harms from others' drinking, but the relationship varies both between factors and by the category of other person involved.

Substance misuse by birth parents: Outcomes for children and young people placed into out-of-home-care.

BACKGROUND: There is inconsistent evidence regarding the effect of birth parent substance use on developmental outcomes for children placed into out-of-home-care (OOHC). OBJECTIVE: This study aims to examine how parental substance use affects outcomes of Australian children in out-of-home care, adjusting for key demographic, social and system factors. PARTICIPANTS AND SETTING: Four waves of survey data were collected for children and young people who agreed to participate in the Pathways of Care Longitudinal Study (POCLS) between 2011 and 2018. The study sample included 1,506 children and young people (792 with a history of parental substance misuse) aged 9 months to 17 years who participated in at least one wave of the POCLS and had linked administrative data from the Department of Communities and Justice (DCJ), NSW, Australia. METHODS: Multilevel longitudinal models were used to analyse the relationship of child developmental outcomes (physical health, socio-emotional wellbeing, and verbal and non-verbal cognitive ability) with parental substance misuse in their child protection history. Each model included adjustments for child demographics, family socio-economic status, child protection system factors and the unbalanced panel. RESULTS: Children in OOHC with a history of parental substance misuse were more likely to be in the typical range for verbal cognitive development compared to those in OOHC without this history. In addition, younger (9 months to 5 years) children with a record of parental substance misuse exhibited significantly more typical fine and gross motor skill development than those without this history. CONCLUSIONS: Concerns that children in OOHC with a history of parental substance misuse may be more affected with regards to early-stage physical development, and later verbal cognitive development than those without this history in OOHC, may not be justified.

Harm to children from others' drinking: A survey of caregivers in Australia.

AIMS: This study aimed to identify the prevalence and types of harm to children from others' drinking in Australia, as indicated by caregivers, and examine socio-demographic characteristics of caregivers who indicated a child was affected by others' drinking. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: A subsample of 854 adult respondents, who were caregivers of children under 18 years from the 2021 Australian Alcohol's Harm to Others study, were asked questions about whether children in their care had been negatively affected by others' drinking in the past year. Weighted prevalence estimates of overall and specific harms to children are presented. Logistic regressions were conducted to determine characteristics associated with indicating harms to children from others' drinking. FINDINGS: Over 17% of caregivers (95% confidence interval [CI] = 13.0-19.0) indicated that one or more children in their care had been affected by others' drinking in the past 12 months. Verbal abuse (6.2%; 95% CI = 4.3-8.3) was the most common harm indicated, followed by financial harm (4.3%; 95% CI = 2.7-6.2). One percent of caregivers (95% CI = 0.4-2.3) indicated a child was physically hurt and less than 1% (95% CI = 0.2-1.4) indicated a child was the subject of a child protection call due to someone's drinking. Women and caregivers over 65 years were more likely to indicate a child had been affected compared with men and caregivers under 65 years. Caregivers who drank five or more drinks at least three times per week were four times more likely to indicate a child was affected compared with abstainers. Living in a household with someone who drinks heavily and who had negatively affected the child's caregiver was associated with an increased likelihood of child harm. CONCLUSIONS: In 2021, a weighted survey estimate for caregivers in Australia indicated that almost one in six children had been affected by others' drinking. Heavier drinking of caregivers and other household members was the most substantial predictor for indicating a child had been negatively affected by others' drinking.

Are Heavier drinkers' Views on Situational Drinking Norms Affected by Recent Experience of Harm from others' Drinking?

OBJECTIVE: The relation is investigated between situational drinking norms which accept heavier drinking and the experience of harm from others' drinking. How does the experience of such harm relate to the acceptance of heavier drinking in drinking situations? METHODS: Respondents in a 2021 combined sample from random digitally dialed mobile phones and a panel survey of Australian adults (n = 2,574) were asked what level of drinking is acceptable in 11 social situations, including 3 "wet" situations where drinking is generally acceptable. Besides their own drinking patterns, respondents were also asked about their experience of harm from others' drinking in the last 12 months. Focussing on respondents' answers concerning the wetter situations, regression analyses were used to examine the relation between experiencing such harm and views on how much drinking was acceptable in the situations. RESULTS: Heavier drinkers were more likely to have experienced harm from others' drinking. Among heavier drinkers, those who experienced such harm generally did not differ significantly in their normative acceptance of any drinking in "wet" situations but were more accepting of drinking enough to feel the effects. DISCUSSION: From these cross-sectional results, experiencing harm from others' drinking does not seem to result in less acceptance of drinking to intoxication; rather, experiencing such harm was associated with more acceptance of heavy drinking. However, these findings may be the net result of influences in both directions, with the acceptance of intoxication in wet situations being more common among heavier drinkers, whose drinking exposes them to harm from others' drinking.

Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design.

Alcohol consumption is causally associated with long-term health-related consequences, such as cancer and cardiovascular disease, and short-term harms, such as accidents and injuries. Alcohol consumption has increased among midlife women (aged 40-65) over the last two decades in high-income countries. This study aimed to centre women's voices by using co-design methodologies to investigate what women identify as strategies that could assist them and other women their age to reduce their alcohol consumption. Human-centred design workshops were undertaken with 39 women, and conventional qualitative content analysis was used to analyse information from written workshop materials to develop categories in the data and count their occurrence. Six categories, or strategies, emerged, listed here from most to least represented: 'Participate in alternative activities to drinking alcohol', 'Track alcohol consumption and set goals', 'Seek support from family and friends', 'Drink alcohol-free beverages', 'Reduce supply of alcohol in the home' and 'Seek professional support'. Our findings identify strategies that are realistic and feasible to midlife women; our sample, however, likely reflects a more affluent subsection of this group, and as such, any focus on individual-level strategies must be complemented by policies that increase equitable access to healthcare and act on the social and commercial determinants of health. An intersectional approach to alcohol and other drug research is required to examine how the interplay of gender and other markers of social identities shape alcohol consumption.

Alcohol's harm to others in 2021: Who bears the burden?

BACKGROUND AND AIMS: Alcohol's harm to others (AHTO) has become a key driver of national and international alcohol policy. This study aimed to produce a contemporary, comprehensive estimate of the correlates and harms from others' drinking in 2021 in Australia. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Across Australia, 2574 adults (1380 women; 1172 men) were sampled via two cross-sectional survey modes: a random-digit dial mobile phone sample of 1000 people and 1574 people from the Life in Australia™ panel survey. In 2021 participants were asked about harms they had experienced from the drinking of family, friends, co-workers and the public in the past year. Applying combined sample weights from each mode, bivariable and adjusted multivariable logistic regressions were used to analyse differences in rates of AHTO by participant gender, age, residence in rural or metropolitan regions, country of birth, education and employment. FINDINGS: In 2021, 23.6% reported being negatively affected by strangers' drinking and 21.3% by the drinking of someone they knew, with 34.3% reporting being negatively affected a lot or a little by either; 42.4% of respondents reported specific harms from strangers' drinking. Thus, 48.1% of respondents reported any harm (negative effects or specific harms) from others' drinking. Women, younger people, Australian-born and heavier episodic drinkers reported significantly higher rates of AHTO compared with other respondents. Smaller percentages (7.5%) of participants reported being harmed substantially by others' drinking, including by people they knew (5.8%) or strangers (2.3%). Stratified analyses showed that heavier drinking, furloughed, younger men who were born overseas in English-speaking countries were affected by others' drinking, whereas women were affected regardless of these factors (apart from age). CONCLUSIONS: More than one-third of Australian adults appear to have been negatively affected by others' drinking in 2021, with women, younger people and heavier drinkers at greater risk. Substantial harm appears to be more likely to arise from the drinking of people Australians know than from strangers' drinking.

The Effects of a Web-Based Intervention to Reduce Alcohol Consumption Among Middle-Aged Women: Protocol for a Randomized Controlled Trial.

BACKGROUND: In the last decade, alcohol consumption among middle-aged women (40-65 years old) in Australia increased, despite declines in overall population consumption. Web-based, brief interventions are promising for reducing alcohol consumption, with efficacy shown in a wide range of populations. However, no published interventions have been designed specifically for and tested with middle-aged women. OBJECTIVE: This study aims to design and implement a web-based intervention intended to reduce alcohol consumption among middle-aged women. METHODS: The study is a 3-arm randomized controlled trial with a web-based intervention plus ecological momentary assessment (EMA) group compared to an EMA-only and a pre-post only control group. The study is aimed at middle-aged women, defined as women aged between 40 and 65 years, who consume alcohol at least weekly or who have consumed 4 or more drinks on 1 occasion in the last month. The intervention aims to reduce alcohol consumption through 4 modules that provide information on the health impacts of alcohol, mindfulness, social influences, and alcohol marketing. Intervention participants will also fill out biweekly EMA assessments. The comparators are EMA-only and pre-post control only. The primary outcome is alcohol consumption at 8 weeks compared between groups. Secondary outcomes are awareness of alcohol-related harms, readiness to change alcohol consumption, health status, mental health, and social support. RESULTS: Ethics approval for this project was received on September 11, 2019. The trial was registered on August 14, 2020. Recruitment has commenced, and the expected results will be available in 2022. CONCLUSIONS: This web-based intervention aims to reduce alcohol consumption among middle-aged women, a currently understudied cohort in alcohol research. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000814976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000814976. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34842.

Validation of the revised Alcohol Expectancy Task [rAET].

Alcohol expectancies are well-established determinants of alcohol consumption. Traditionally, expectancies were assessed using self-report questionnaires. However, researchers have increasingly begun to explore the use of pictographic assessments, for example, the revised Alcohol Expectancy Task [rAET]. The current research aimed to examine the factor structure of the task in relation to the hypothesised expectancy dimensions, participants' endorsement of these dimensions, and whether rAET scores are associated with drinking patterns. The rAET presents participants with several illustrated scenarios in which people are displaying emotions, following the Circumplex Model of Affect. For each scenario, participants select which type of drink the person presented in the illustration was most likely to have drunk. The rAET was administered online to a convenience sample (n = 1,192, female: 50.7%, Mage = 36.8, SD = 13.7). The confirmatory factor analysis demonstrated adequate fit of the hypothesised four-factor model. Mean comparisons demonstrated that positive expectancies were more pronounced than negative expectancies, and a distinction between arousal and sedation expectancies was found. Results of a structural equation model found that positive sedation and positive arousal were related to high drinking frequency. There were no links between usual quantity of alcohol use or binge drinking. It appears that the rAET can be successfully used to assess alcohol expectancies in terms of the emotions that are expected to occur from alcohol consumption. Future research is needed to establish the tool's assessment properties in different settings, and its utility in predicting alcohol consumption in different age groups, particularly children and young adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sex differences in young children's perceptions of situational drinking norms over time.

OBJECTIVES: To date, there have been no previous studies examining sex differences in the development of alcohol-related perceptions over time, a potential avenue for targeted prevention and early intervention efforts. This article examines any potential sex differences in young children's development of situational drinking norms over time. METHOD: Two hundred ninety-eight children (aged 4-6 years at baseline) completed the Dutch electronic Appropriate Beverage Task-which involves attributing alcoholic beverages to adults in varying situational contexts-annually over 3 years (2015, 2016, 2017). Three-level regression models were estimated examining whether perceptions of situational drinking norms varied as a function of the sex of the participant and whether there were any changes over time. RESULTS: Over time children did not attribute more alcoholic beverages to adults in various situations, instead both boys and girls became more accurate at correctly identifying situations in which drinking is more common. Over time, both boys and girls attributed more alcoholic beverages in common situations and less in uncommon situations, with no significant sex differences in attributions of alcohol found. CONCLUSIONS: We identified no significant sex differences in the development of situational drinking norms over time, suggesting that education and prevention campaigns can be unified/nontargeted by sex. However, given our findings differ from previous studies that identify significant sex differences between children on the development of other alcohol-related cognitions beyond situational drinking norms, there is a need for more international research in this space to understand the importance and nature of the development of alcohol-related perceptions over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The relationship between fathers' heavy episodic drinking and fathering involvement in five Asia-Pacific countries: An individual participant data meta-analysis.

BACKGROUND: This study aims to increase understanding of the relationship between heavy episodic drinking (HED) and fathers' involvement in parenting in five countries. The potential moderating effect of fathers' experiences of childhood trauma is also studied, controlling for the possible confounding of the effect of HED by father's attitudes toward gender equality, father's age and father's education. METHOD: United Nations Multi-Country Study on Men and Violence (UNMCS) survey data from 4562 fathers aged 18-49 years from Cambodia, China, Indonesia and Papua New Guinea (PNG) and Sri Lanka were used to assess the relationship between fathering involvement (e.g., helping children with their homework) and self-reported HED of 6+ drinks in one occasion vs. non-HED and abstaining. Moderating effects of a 13-item fathers' childhood trauma (FCT) scale were tested and analyses were adjusted for gender-inequitable attitudes using the Gender-Equitable Men scale score. Bivariate and adjusted individual participant meta-analyses were used to determine effect estimates for each site and across all sites. RESULTS: Fathers' HED was associated with less positive parental involvement after adjusting for gender-equitable attitudes, FCT, age and education. No overall interaction between HED and FCT was identified. Gender equitable attitudes were associated with fathering involvement in some countries but not overall (p = 0.07). CONCLUSIONS: Heavy episodic drinking was associated with reduced positive fathering involvement. These findings suggest that interventions to increase fathers' involvement in parenting should include targeting reductions in fathers' HED. Structural barriers to fathers' involvement should be considered alongside HED in future studies of fathers' engagement with their children.

Effects of exposure to mother's and father's alcohol use on young children's normative perceptions of alcohol.

BACKGROUND: While consumption of alcohol does not often begin until early adolescence, young children are highly capable of internalizing normative information through observational learning. We used a longitudinal multiple-informant family study to examine the impact of exposure to mothers' and fathers' drinking on young children's normative perceptions of who drinks alcohol. METHODS: Three hundred twenty-nine children (4 to 6 years old at baseline [Mage 4.78 (SD = 0.725)], 51% girls) completed the Dutch electronic appropriate beverage task [eABT] where they attributed alcoholic beverages to a variety of persons depicted in an illustrated scenario. Their parents completed an online survey that included information on alcohol use and exposure. RESULTS: Children more frequently exposed to their mothers' drinking provided females shown in the eABT illustrations with alcohol significantly more often than children less frequently exposed to mothers' drinking. There was no effect of mother's exposure on providing males in the eABT with alcoholic beverages. Similarly, children more frequently exposed to their fathers' drinking provided fathers with alcoholic beverages significantly more often than children less frequently exposed to their fathers' drinking. There was no effect of father's exposure on providing the females with alcoholic beverages, nor was there an effect of father's exposure on providing "other males" with alcohol. These patterns held after adjusting for age and sex. CONCLUSIONS: This study demonstrates that there are gender-specific effects of exposure to parents' (particularly mothers') drinking on young children's perceptions of person-specific drinking norms. The findings provide unique evidence in a young population group of effects on an understudied dimension of alcohol-related perceptions with implications for future drinking behavior.

Men and Women's Alcohol Consumption by 4- to 8-Year-Olds: A Longitudinal Investigation of Gendered Drinking Norms.

INTRODUCTION: Evidence suggests an association between perceived alcohol-related norms and personal consumption. These perceptions develop over years of observation and exposure to alcohol, likely beginning in early childhood, and likely differing by sex. Understanding the early development of perceptions of drinking may provide insight into the development of gendered drinking practices. The aim of this study was to explore boys' and girls' perceptions about men and women's alcohol consumption and whether and how these change over time as children age. METHODS: 329 children (aged 4-6 years at baseline) completed the Dutch electronic Appropriate Beverage Task annually for three consecutive years (2015 [baseline], 2016, 2017). Regression models were used to examine whether perceptions of consumption varied as a function of the gender of the adult, the participants' sex, and any changes over time. RESULTS: In illustrated pictures, children perceived that men (39%) drank alcoholic beverages more often than women (24%). Men were perceived to drink alcohol more frequently than women at baseline and this difference increased with age. Girls were more likely to perceive men drinking at baseline (aged 4-6), but there were few sex differences by time point three (aged 6-8). DISCUSSION/CONCLUSION: From a young age, children perceive that men drink more than women. These perceptions strengthen as children grow older, with young girls perceiving these gender differences at earlier ages than boys. Understanding children's perceptions of gendered drinking norms and their development over time can enable targeted prevention efforts.

Double shifts, double trouble: Alcohol as a problematic panacea for working mothers.

Alcohol consumption among midlife women has become an area of research focus. We suggest it is important to examine the social roles that many midlife women take on - specifically working mothers. Working mothers balance both employment and the unequal burden of caring/domestic duties, leading to 'double shifts' of paid and unpaid labor. This creates unique stresses that may impact their drinking. This is particularly important as a growing number of mothers re-enter the workforce after childbirth. In this commentary, we suggest that working mothers' drinking tends to be overlooked or even endorsed as a means of managing the gendered stresses they face - stresses which have been exacerbated during the pandemic. We highlight the dearth of literature focusing on the drinking patterns, practices, and motives of working mothers and argue that gendered expectations placed on working mothers may be an increasingly important social determinant of health among this group.

Alcohol consumption trajectories over the Australian life course.

BACKGROUND AND AIMS: Alcohol consumption changes markedly over the life course, with important implications for health and social development. Assessment of these patterns often relies on cross-sectional data, which cannot fully capture how individuals' drinking changes as they age. This study used data from 18 waves of a general population panel survey to measure drinking trajectories over the life course in Australia. DESIGN AND SETTING: Longitudinal survey data from the Household, Income and Labour Dynamics in Australia (HILDA) survey between 2001 and 2018. PARTICIPANTS: A total of 20 593 individuals ages 15 or above in two samples assessing quantity-frequency (n = 20 569, 52.0% female) and risky single occasion drinking (RSOD), respectively, (n = 17 340, 52.5% female), interviewed as part of HILDA. MEASUREMENTS: Usual quantity of alcohol consumed per drinking occasion; frequency of drinking occasions per week; average daily consumption, calculated by combining reported usual quantity and frequency; and average reported frequency of RSOD per week. FINDINGS: Multilevel, mixed effects models run with fractional polynomial terms found similar male and female alcohol consumption trajectories for quantity-frequency and RSOD measures. Usual quantity of alcohol consumed per drinking occasion (5.4 drinks for men, 3.8 for women) and RSOD frequency (0.56 occasions/week for men, 0.38 for women) peaked in young adulthood, whereas frequency of drinking occasions (2.5 occasions/week for men, 1.7 for women) peaked in middle age. Middle-age drinkers had the highest average daily consumption of alcohol (1.4 drinks/day for 54-year-old men, 0.6 drinks for 57-year-old women) and engaged in RSOD slightly less than young adults. CONCLUSIONS: Alcohol consumption in Australia appears to vary substantially over the life course, with usual quantity per drinking occasion and frequency of risky single occasion drinking peaking during early adulthood and average daily consumption and frequency of consumption peaking in middle age.

A gender-focused multilevel analysis of how country, regional and individual level factors relate to harm from others' drinking.

BACKGROUND: The aim of this study was to examine how gender, age and education, regional prevalence of male and female risky drinking and country-level economic gender equality are associated with harms from other people's drinking. METHODS: 24,823 adults in ten countries were surveyed about harms from drinking by people they know and strangers. Country-level economic gender equality and regional prevalence of risky drinking along with age and gender were entered as independent variables into three-level random intercept models predicting alcohol-related harm. FINDINGS: At the individual level, younger respondents were consistently more likely to report harms from others' drinking, while, for women, higher education was associated with lower risk of harms from known drinkers but higher risk of harms from strangers. Regional rate of men's risky drinking was associated with known and stranger harm, while regional-level women's risky drinking was associated with harm from strangers. Gender equality was only associated with harms in models in models that did not include risky drinking. CONCLUSIONS: Youth and regional levels of men's drinking was consistently associated with harm from others attributable to alcohol. Policies that decrease the risky drinking of men would be likely to reduce harms attributable to the drinking of others.

The who and what of women's drinking: Examining risky drinking and associated socio-demographic factors among women aged 40-65 years in Australia.

INTRODUCTION: Recent trends in Australian national survey data show an increase in alcohol use among middle-aged people, amidst declines in alcohol use among other population groups. There is limited research, however, on middle-aged women's alcohol use. This study aimed to examine patterns in alcohol use among Australian women aged 40-65 and the associated sociodemographic and contextual factors. METHODS: Cross-sectional data from six waves of the National Drug Strategy Household Survey (2001-2019). We estimated the prevalence of long-term risky drinking (>2 Australian standard drinks per day) and risky-single occasion drinking (>5 Australian standard drinks on one occasion) among middle-aged women. Logistic regression models were estimated using 2019 data to examine demographic characteristics and contextual factors associated with alcohol use. RESULTS: Since 2001, there has been a statistically significant increase in long-term risky drinking and risky-single occasion drinking amongst middle-aged women in Australia. Educational attainment, marital status and employment status were negatively associated with risky drinking, whereas rurality, age and location of use were positively associated with risky drinking. Beverage type was both positively and negatively associated with risky drinking. DISCUSSION AND CONCLUSIONS: Given the significant increase in alcohol use amongst middle-aged women in Australia, prevention efforts are needed for this group, which may focus in particular on home drinking and the impact of rurality on alcohol use.

'What makes up wine o'clock? Understanding social practices involved in alcohol use among women aged 40-65 years in Australia.

BACKGROUND: In the context of global declines in alcohol consumption, studies have recently shown that middle-aged women's alcohol use has increased in the past decade. Limited research has focused on this demographic group. We aimed to understand the perspectives of women aged 40-65 years on the role of alcohol in their lives and their motivations for consuming alcohol. We used social practice theory to identify distinctive assemblages of meanings, materials, competences and temporalities relating to alcohol use. METHODS: We used qualitative methods incorporating Human Centred-Design principles into activity-based workshops. We conducted ten 3-hour workshops with a total of 39 women aged 40-65 years. We coded the transcribed data using the three original components of social practice theory - meanings, materials, competences as well as the fourth component of temporality. RESULTS: Women described their alcohol use as nuanced, with different meanings across contexts and settings. 'Wine o'clock' was the term used by many women to describe the practice of consuming wine as soon as they finished their day's duties. Women appeared conscious of representing their drinking as rational, measured and safe, particularly when discussing weekday use, and drinking alone. Women described it as an act of relaxation, and rationalised it as earned. Alcohol consumption on weekends was strongly tied to social connection. Alcohol was explicitly described as the means to see people socially and was also implicitly present in social gatherings such as lunches, barbecues and dinners on weekends. Although women rejected the notion of experiencing social pressures to consume alcohol, they also described needing excuses for not consuming alcohol, such as partaking in temporary abstinence periods such as Dry July. CONCLUSIONS: Our study describes how midlife women use alcohol to demarcate between duty and pleasure and for social connection. Prevention efforts which focus on social connection, relaxation and changing the discourse on alcohol's role in women's social lives may be beneficial for reducing women's alcohol consumption.

Improving measurement of harms from others' drinking: Using item-response theory to scale harms from others' heavy drinking in 10 countries.

INTRODUCTION: The heavy drinking of others may negatively affect an individual on several dimensions of life. Until now, there is scarce research about how to judge the severity of various experiences of such harms. This study aims to empirically scale the severity of such harm items and to determine who is at most risk of these harms. METHODS: We used population-based survey data from 10 countries of the GENAHTO project (Gender and Alcohol's Harms to Others, data collection: 2011-2016). Questions about harms from others' drinking asked about verbal and physical harm, damage of belongings, traffic accidents, harassment, threatening behaviour, family and financial problems. We used item response theory methods (IRT) to scale severity of the aforementioned items. To acknowledge culturally based variations in different countries, we assessed 'differential item functioning'. RESULTS: The items 'family problems', 'financial problems' and 'clothes and property damage' as well as 'physical harm' were scaled as more severe in most countries compared to other items. Substantial differential item functioning was present in more than half of the country pairings. The item 'financial problems' was most often differentially scaled. Younger people who drank more, as well as women (compared to men), reported more harm. DISCUSSION AND CONCLUSIONS: Using IRT, we were able to evaluate grades of severity in harms from others' drinking. IRT scaling yielded in similar rankings of items as reported from other studies. However, empirical scaling allows for more differentiated severity scaling than simple summary scores and is more sensitive to cultural differences.

A multi-country analysis of informal caregiving due to others' drinking.

The burden of caring for drinkers is seldom articulated as a social concern, or integrated in service planning or alcohol policy. This study aims to examine prevalence and predictors of informal caregiving due to others' drinking cross-nationally by surveying 20,728 respondents (18-64 years) in 11 countries. The outcome variable was respondent-reported informal caregiving due to others' drinking, analysed by socio-demographic factors and drinking pattern using logistic regression and meta-analysis. Estimated overall prevalence of informal caregiving due to others' drinking ranged from 9% in Nigeria to 47% in Thailand. In most countries, females reported a higher rate than males of caring for children and other dependents, but males reported a higher rate of driving family or friends somewhere or picking them up. Logistic regression analysis found differences between high-income countries and low- and middle-income countries in the relationship of caregiving with employment and household composition. Respondent's own drinking was positively correlated with the prevalence of caregiving in 10 out of 11 countries. In general, younger adults and those who are themselves risky drinkers are more likely to have had caring responsibilities. Although problematic drinking is concentrated in specific subpopulations, the burden of care for others' drinking extends widely across the population.