Alcohol use (AU) and disorders (AUDs) have been increasing among women over the past decade, with the largest increases among women of child-bearing age. Unprecedented stressors during the COVID-19 pandemic may have impacted AU for women with and without children. Little is known about how these trends are impacting women in the military.
Methods:
Cross-sectional study of active-duty service women (ADSW) in the U.S. Army, Air Force, Navy, and Marine Corps during fiscal years (FY) 2016–2021. We report the prevalence of AU and AUD diagnoses by FY, before/during the COVID-19 pandemic (2016–2019; 2020–2021, respectively), and by parental status. Log-binomial and logistic regressions examined associations of demographics, military, and family structure characteristics, with AU and AUD, during pre-COVID-19 and COVID-19 timeframes.
Results:
We identified 281,567 ADSW in the pre-COVID-19 period and 237,327 ADSW in the during COVID-19 period. The prevalence of AU was lower during the COVID-19 period (47.9%) than during the pre-COVID-19 period (63.0%); similarly, the prevalence of AUD was lower during the COVID-19 period (2.7%) than during the pre-COVID period (4.0%). ADSW with children had larger percentage decreases during the COVID-19 period. ADSW with children had a consistently lower prevalence and odds of AUD compared with ADSW without children in the pre- and during COVID-19 periods.
Conclusion:
Decreasing trends in AU and AUD among ADSW were unexpected. However, the prevalence of AU and AUD may not have been accurately captured during the COVID-19 period due to reductions in access to care. Continued postpandemic comparison of AU/AUD among women by parental status and demographic factors may guide targeted health efforts.
Get full access to this article
View all access options for this article.
References
1.
GruczaRA, SherKJ, KerrWC, et al.Trends in adult alcohol use and binge drinking in the early 21st-century United States: A meta-analysis of 6 national survey series. Alcohol Clin Exp Res, 2018; 42(10):1939–1950; doi: 10.1111/acer.13859
WhiteAM, CastleIJP, HingsonRW, et al.Using death certificates to explore changes in alcohol-related mortality in the United States, 1999 to 2017. Alcohol Clin Exp Res, 2020; 44(1):178–187; doi: 10.1111/acer.14239
McKettaS, KeyesKM. Heavy and binge alcohol drinking and parenting status in the United States from 2006 to 2018: An analysis of nationally representative cross-sectional surveys. PLoS Med, 2019; 16(11):e1002954; doi: 10.1371/journal.pmed.1002954
6.
McCaulME, RoachD, HasinDS, et al.Alcohol and women: A brief overview. Alcohol Clin Exp Res, 2019; 43(5):774–779; doi: 10.1111/acer.13985
7.
AgabioR, CampesiI, PisanuC, et al.Sex differences in substance use disorders: Focus on side effects. Addict Biol, 2016; 21(5):1030–1042; doi: 10.1111/adb.12395
8.
DashGF, MartinNG, LynskeyMT, et al.Sex differences in the relative influence of marital status and parenthood on alcohol use disorder symptoms: A multilevel discordant twin design. J Abnorm Psychol, 2020; 129(7):737–747; doi: 10.1037/abn0000611
9.
FergussonDM, BodenJM, John HorwoodL. Transition to parenthood and substance use disorders: Findings from a 30-year longitudinal study. Drug Alcohol Depend, 2012; 125(3):295–300; doi: 10.1016/j.drugalcdep.2012.03.003
10.
AdamsRS, McKettaSC, JagerJ, et al.Cohort effects of women's mid-life binge drinking and alcohol use disorder symptoms in the United States: Impacts of changes in timing of parenthood. Addiction; 118(10):1932–1941; doi: 10.1111/add.16262
McKettaSC, KeyesKM. Trends in U.S. women’s binge drinking in middle adulthood by socioeconomic status, 2006–2018. Drug Alcohol Depend, 2020; 212:108026; doi: 10.1016/j.drugalcdep.2020.108026
13.
PetticrewM, ShemiltI, LorencT, et al.Alcohol advertising and public health: Systems perspectives versus narrow perspectives. J Epidemiol Community Health, 2017; 71(3):308–312; doi: 10.1136/jech-2016-207644
14.
CrawfordEC, DanielES, YakubovaM, et al.Connecting without connection: Using social media to analyze problematic drinking behavior among mothers. Journal of Current Issues & Research in Advertising, 2020; 41(2):121–143; doi: 10.1080/10641734.2019.1659195
15.
AdamsRS, LedinghamE, KeyesKM. Have we overlooked the influence of “wine-mom” culture on alcohol consumption among mothers? Addict Behav, 2022; 124:107119; doi: 10.1016/j.addbeh.2021.107119
16.
PollardMS, TuckerJS, GreenHDJr, Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA Netw Open, 2020; 3(9):e2022942; doi: 10.1001/jamanetworkopen.2020.22942
17.
CapassoA, JonesAM, AliSH, et al.Increased alcohol use during the COVID-19 pandemic: The effect of mental health and age in a cross-sectional sample of social media users in the U.S. Prev Med, 2021; 145:106422; doi: 10.1016/j.ypmed.2021.106422
18.
AdamsRS, DietrichEJ, GrayJC, et al.Post-deployment screening in the military health system: An opportunity to intervene for possible alcohol use disorder. Health Aff (Millwood), 2019; 38(8):1298–1306; doi: 10.1377/hlthaff.2019.00284
19.
LarsonMJ, WootenNR, AdamsRS, et al.Military combat deployments and substance use: Review and future directions. J Soc Work Pract Addict, 2012; 12(1):6–27; doi: 10.1080/1533256x.2012.647586
20.
Institute of Medicine. Substance use disorders in the U.S. armed forces. Washington, DC: National Academies Press (US); 2013. 416 p.
21.
MeadowsSO, EngelCC, CollinsRL, et al.2015 Department of Defense Health Related Behaviors Survey (HRBS). Rand Health Q, 2018; 8(2):5.
22.
JefferyDD, MattikoM. Alcohol use among active duty women: Analysis AUDIT scores from the 2011 health-related behavior survey of active duty military personnel. Mil Med, 2016; 181(1 Suppl):99–108; doi: 10.7205/milmed-d-15-00222
23.
AdamsRS, NikitinRV, WootenNR, et al.The association of combat exposure with postdeployment behavioral health problems among U.S. army enlisted women returning from Afghanistan or Iraq. J Trauma Stress, 2016; 29(4):356–364; doi: 10.1002/jts.22121
HenryAJ, HeveloneND, LipsitzS, et al.Comparative methods for handling missing data in large databases. J Vasc Surg, 2013; 58(5):1353–1359.e6; doi: 10.1016/j.jvs.2013.05.008
26.
WhaleyCM, PeraMF, CantorJ, et al.Changes in health services use among commercially insured us populations during the COVID-19 pandemic. JAMA Netw Open, 2020; 3(11):e2024984; doi: 10.1001/jamanetworkopen.2020.24984
27.
GilderT, BanaagA, MadsenC, et al.Trends in telehealth care during the COVID-19 pandemic for the military health system. Telemed Rep, 2023; 4(1):147–155; doi: 10.1089/tmr.2022.0042
28.
SafkoJ, BanaagA, MadsenC, et al.Analysis of telehealth equity for the Military Health System during the COVID-19 pandemic. Telemedicine and eHealth, in press.
29.
CalvanoC, EngelkeL, Di BellaJ, et al.Families in the COVID-19 pandemic: Parental stress, parent mental health and the occurrence of adverse childhood experiences-results of a representative survey in Germany. Eur Child Adolesc Psychiatry, 2022; 31(7):1–13; doi: 10.1007/s00787-021-01739-0
30.
GuinleMIB, SinhaR. The role of stress, trauma, and negative affect in alcohol misuse and alcohol use disorder in women. Alcohol Res, 2020; 40(2):05–17; doi: 10.35946/arcr.v40.2.05
31.
KeyesKM, HatzenbuehlerML, GrantBF, et al.Stress and alcohol: Epidemiologic evidence. Alcohol Res, 2012; 34(4):391–400.
32.
SallieSN, RitouV, Bowden-JonesH, et al.Assessing international alcohol consumption patterns during isolation from the COVID-19 pandemic using an online survey: Highlighting negative emotionality mechanisms. BMJ Open, 2020; 10(11):e044276; doi: 10.1136/bmjopen-2020-044276
33.
SolomonCA, LaditkaSB, ForthoferM, et al.Black-white disparities in alcohol consumption trends among women in the United States, 1990–2015. J Ethn Subst Abuse, 2021; 20(4):625–646; doi: 10.1080/15332640.2019.1685049
34.
MuliaN, BensleyKM. Alcohol-related disparities among women: Evidence and potential explanations. Alcohol Res, 2020; 40(2):09; doi: 10.35946/arcr.v40.2.09
35.
RansomeY, CartyDC, CogburnCD, et al.Racial disparities in the association between alcohol use disorders and health in black and white women. Biodemography Soc Biol, 2017; 63(3):236–252; doi: 10.1080/19485565.2017.1335589
36.
Vickers-SmithR, JusticeAC, BeckerWC, et al.Racial and ethnic bias in the diagnosis of alcohol use disorder in Veterans. Am J Psychiatry, 2023; 180(6):426–436; doi: 10.1176/appi.ajp.21111097
37.
WilliamsEC, GuptaS, RubinskyAD, et al.Racial/ethnic differences in the prevalence of clinically recognized alcohol use disorders among patients from the U.S. Veterans Health Administration. Alcohol Clin Exp Res, 2016; 40(2):359–366; doi: 10.1111/acer.12950
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
