Alcohol Consumption and Perceptions of Health Risks During COVID-19: A Qualitative Study of Middle-Aged Women in South Australia

Abstract

Australian women's alcohol consumption has increased in frequency during COVID-19. Research suggests this is to cope with stress resulting from the pandemic and COVID-19 countermeasures that require social distancing. This is a critical public health concern because increased alcohol consumption, even for a short period, increases the myriad longer-term health risks associated with cumulative exposure to alcohol. This paper provides unique qualitative evidence of how health risk perceptions are re-focused toward the shorter-term during the pandemic, through analysis of interviews with 40 middle-aged Australian women (aged 45–64) representing a range of self-perceived drinking status' (“occasional”/“light”/“moderate”/“heavy”) before and then during the pandemic (n = 80 interviews). Our analysis captures women's risk horizons drifting away from the uncertain longer-term during COVID-19, toward the immediate need to “get through” the pandemic. We show how COVID-19 has increased the perceived value of consuming alcohol among women, particularly when weighed up against the social and emotional “costs” of reducing consumption. Our findings have implications for the delivery of alcohol-related health risk messages designed for middle-aged women both during, and into the recovery phases of the pandemic, who already consume more alcohol and experience more alcohol-related health risk than women in other age groups.

COVID-19, Alcohol Consumption and Stockpiling Practises in Midlife Women: Repeat Surveys During Lockdown in Australia and the United Kingdom

“…Alcohol has a dose-response relationship with the development of breast cancer, and has been identified as the biggest modifiable risk factor for breast cancer globally ( 20 ). Our work suggests that alcohol consumption in midlife women is mediated by both external and internal factors including socioeconomic status, work and societal role pressures, coping styles, and risk perceptions ( 14 , 15 , 21 ). A further significant stressor in midlife women are the psychological, emotional, physical and role transitions occurring throughout the perimenopausal period ( 19 , 22 ).…”

“…The pandemic represents a potential modifier of alcohol behaviour and perceptions of the longer-term risk of breast cancer, particularly in the presence of a new and more immediate health risk. In our recent qualitative analyses, we describe how the risk horizons of midlife women contract from the uncertainties of the longer-term and refocus on the more pressing need to “get through” the pandemic ( 21 ). In the context of the COVID-19 lockdowns, it has been reported that women have increased their frequency of alcohol consumption in Australia, with managing stress being the most commonly reported reason ( 24 ).…”

How Are the Links between Alcohol Consumption and Breast Cancer Portrayed in Australian Newspapers?: A Paired Thematic and Framing Media Analysis

“…The survey findings also revealed that, regardless of their consumption levels, many Australians thought of themselves as an "occasional, light or social drinker" (p. 47), believing alcohol consumption that exceeded the Australian guidelines would not pose a health risk. Meyer et al [2] showed that middle-aged (45-64 years) women's awareness of the alcohol-breast cancer link is low and women consume alcohol for various purposes, many of which were viewed by the women as health enhancing [8,14]. Adults in another study perceived cancer as 'inevitable', seeing little or no reason to change consumption behaviours despite the knowledge that 'alcohol causes cancer' [15].…”

Revisiting Candidacy: What Might It Offer Cancer Prevention?

“…Epidemiological evidence demonstrates an increased risk of cancer of the oropharynx, larynx, oesophagus, liver, colon, rectum and female breast resulting from consuming alcohol, with alcohol-attributable cancers at these sites comprising 5.8% of all cancer deaths world-wide [ 8 ]. Of current concern is the dose–response relationship between alcohol and increased breast cancer risk among women [ 9 , 10 , 11 , 12 ], as breast cancer is the most common cause of cancer mortality among women. In Australia, ‘mid-life’ women (aged between 45 and 64 years) are among the ‘heaviest’ drinkers, consuming alcohol at levels that pose harm more than in any other female age group [ 13 ].…”

“…Three decades ago the seminal work of Davison et al [ 37 ] introduced this concept of candidacy in the context of coronary heart disease (CHD). Up to 2001 the work of Davison et al [ 37 ] was the second most cited paper in ‘Sociology of Health and Illness’ [ 38 ] and to date has over 700 citations across extensive health research including: risk factors such as smoking [ 39 , 40 ], alcohol [ 41 , 42 ], obesity [ 43 , 44 ], issues such as injecting drug use [ 45 ], suicide prevention [ 46 , 47 ], primary health care [ 48 ], vaccination [ 49 , 50 ], and the exploration of women’s lived experience during the COVID-19 pandemic, what the authors termed ‘COVID-19 candidacy’ [ 51 ] and their alcohol consumption during this time [ 11 ], among others. When traversing these citations, it is apparent that concepts articulated within the candidacy framework continue to resonate in health research.…”