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

2. 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.

3. Agenda Background Prevalence and trends Evidence-based policy options for reducing risky drinking by women of childbearing age www.ccsa.ca www.cclt.ca3

4. 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 2012. –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. www.ccsa.ca www.cclat.ca4

5. 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. www.ccsa.ca www.cclat.ca5

6. 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” www.ccsa.ca www.cclat.ca6

7. 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. www.ccsa.ca www.cclat.ca7 Distribution of alcohol-related risk, 2009/10

8. 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. www.ccsa.ca www.cclat.ca8

9. Background (cont.) Shifting the culture = shifting the curve www.ccsa.ca www.cclat.ca9

10. Prevalence and Trends www.ccsa.ca www.cclt.ca10

11. 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. www.ccsa.ca www.cclt.ca11 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).

12. 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 2012. www.ccsa.ca www.cclt.ca12 Source: Statistics Canada, Canadian Community Health Survey.

13. 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 17/18-44. Women ages 18/19-24 account for ~18% of births in Canada Women ages 25-34 account for 62% of births. www.ccsa.ca www.cclat.ca13 Source: Statistics Canada, Canadian Community Health Survey

14. 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 15-44 in Canada. www.ccsa.ca www.cclt.ca14 CADUMS 2010CADUMS 2009CADUMS 2008CAS 2004 Avg. % Difference > 3 drinks> 4 drinks> 3 drinks> 4 drinks> 3 drinks> 4 drinks> 3 drinks> 4 drinks Underage29.317.324.012.530.024.521.116.453.1 Young Adult37.123.041.634.043.729.346.440.736.7 25-3422.613.419.414.122.714.421.315.849.7 35-4419.28.418.112.014.97.817.613.176.2 15-4424.713.624.217.625.116.325.320.249.6

15. Comparison of rates of binge drinking using >4 and >3 drinks/occasion, 2011/12 www.ccsa.ca www.cclat.ca15 Source: Statistics Canada, Canadian Community Health Survey with further analysis by the authors.

16. Comparison of rates of monthly binge drinking using sex-specific criteria www.ccsa.ca www.cclat.ca16 Underage Young Adult Adults 25-34 Adults 35-44 Females (more than 3 drinks/occasion) 25.457.831.824.4 Males (more than 4 drinks/occasion) 26.253.144.230.7 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

17. 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 2012. An estimated 58% of young adult women age 18/19- 24 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%). www.ccsa.ca www.cclt.ca17

18. 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 2012. Binge drinking among women has very likely been substantially underestimated in some surveys because of non-sex-specific criteria for identifying risky drinking. www.ccsa.ca www.cclat.ca18

19. Evidence-based policies for reducing alcohol- related harms: Managing alcohol availability www.ccsa.ca www.cclt.ca19 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

20. 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. www.ccsa.ca www.cclat.ca20

21. Contact information Gerald Thomas: gthomas@ccsa.cagthomas@ccsa.ca www.ccsa.ca www.cclt.ca21