Patterns of alcohol use among women of childbearing years in Canada: Implications for FASD prevention Public Health 2014 Toronto, Ontario Canada May 26-29

Contributors Gerald Thomas, Canadian Centre on Substance Abuse Nancy Poole, BC Centre for Excellence in Women’s Health Lorraine Greaves, BC Centre for Excellence in Women’s Health Lauren Bialystok, BC Centre for Excellence in Women’s Health Colleen Dell, University of Saskatchewan Financial assistance for this research was provided by the Public Health Agency of Canada. The views expressed herein are not necessarily those of PHAC.

Agenda Background Prevalence and trends Evidence-based policy options for reducing risky drinking by women of childbearing age

Background What we know: –An estimated 17% of women of childbearing ages (15-44) in Canada binge drink monthly or more often in the past year; this represented approximately 1.19 million women in –Most women stop drinking or drink very lightly after they become aware they are pregnant. –A very small proportion of women continue to drink in regular heavy patterns during pregnancy.

Background (cont.) What we don’t know: –The true prevalence of FASD (see previous presentation). –The relative proportion of FASD cases resulting from the small number of women who continue to drink in risky patterns after becoming aware that they are pregnant, and those resulting from the much larger number of women who inadvertently expose their fetus to alcohol before learning that they are pregnant.

Background (cont.) The prevention paradox (Geoffrey Rose): –“A large number of people exposed to a low risk can account for more cases of harm than a small number exposed to a high risk”

Background (cont.) Rose labelled situations where risk was spread over the population in this way as “public health disasters.” Note: women ages 18/19-34 account for approximately 80% of births in Canada. Distribution of alcohol-related risk, 2009/10

Background Based on the logic of the prevention paradox, a key component of FASD prevention is identifying effective approaches for reducing risky alcohol use among young adult and adult women drinking in moderate risk patterns. This goal requires a shift in the drinking culture.

Background (cont.) Shifting the culture = shifting the curve

Prevalence and Trends

Long-term trends in alcohol use Since 1989, self-reported rates of past-year alcohol use have averaged 81% for men and 73% for women. The gap in prevalence between men and women appears to be narrowing over the long term as rates for women have trended upward while rates for men are more stable. Sources: Statistics Canada: National Alcohol and Drug Survey (1989), Canadian Alcohol and Drug Survey (1994), Canadian Community Health Survey (2003, 2005, 2007/08, 2009/10 & 2011/12); Canadian Centre on Substance Abuse: Canadian Addiction Survey (2004).

Trends in self-reported past-year binge drinking, women age 15+ (>4 drinks/occasion) Overall women drinkers reported a statistically significant (p<0.05) increase in monthly or more often binge drinking from 12.1% to 15.2%. This level (15.2%) represented an estimated 2.25 million women age 15+ in Source: Statistics Canada, Canadian Community Health Survey.

Trends in current female drinkers reporting >4 drinks/occasion monthly or more often Statistically significant (p < 0.05) increases in rates of monthly or more often binge drinking for women ages 17/ Women ages 18/19-24 account for ~18% of births in Canada Women ages account for 62% of births. Source: Statistics Canada, Canadian Community Health Survey

Implications of using gender specific criteria for identifying risky drinking Lowering the threshold of binge drinking from >4 to >3 drinks/occasion increases the estimated prevalence of monthly binge drinking by an average of 49.6% for women ages in Canada. CADUMS 2010CADUMS 2009CADUMS 2008CAS 2004 Avg. % Difference > 3 drinks> 4 drinks> 3 drinks> 4 drinks> 3 drinks> 4 drinks> 3 drinks> 4 drinks Underage Young Adult

Comparison of rates of binge drinking using >4 and >3 drinks/occasion, 2011/ Source: Statistics Canada, Canadian Community Health Survey with further analysis by the authors.

Comparison of rates of monthly binge drinking using sex-specific criteria Underage Young Adult Adults Adults Females (more than 3 drinks/occasion) Males (more than 4 drinks/occasion) Source: Statistics Canada, Canadian Community Health Survey, 2011/12; custom tables on file with authors. Proportion of current (past-year) drinkers reporting monthly or more often binge drinking, 2011/12, Canada

Summary of epidemiological findings Self-reported risky alcohol use by women of childbearing ages in Canada appears to have increased in all age categories except underage girls between 2003 and An estimated 58% of young adult women age 18/ are binge drinking monthly or more often when sex-specific criteria are used. This rate of binge drinking exceeds the estimate for young adult males (53%).

Summary of epi findings (cont.) Women in prime childbearing ages (25-34) who account for the majority of births reported the fastest increase in monthly risky drinking of any age group male or female between 2003 and Binge drinking among women has very likely been substantially underestimated in some surveys because of non-sex-specific criteria for identifying risky drinking.

Evidence-based policies for reducing alcohol- related harms: Managing alcohol availability Three categories of evidence-based policies for reducing alcohol-related harm : –Physical availability: Outlet density Days and hours of sale –Social availability: Minimum purchase age Restrictions on advertising & promotion –Economic availability: Government monopolies Price policies

Summary The risky use of alcohol appears to be increasing for women of childbearing ages in Canada. The factors influencing this use vary from individual influences such as lack of awareness to systemic influences such as public policy, media/advertising, and societal norms around alcohol use. Given the various factors involved, a comprehensive approach that includes policy, education, support programs and advocacy is needed to address all forms of risk related to FASD.

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