An investigation of sex differences in excessive alcohol use in young adulthood and middle age: Characterizing the influence of multiple social roles, stress, and poor mental health - Over the last several decades, rates of excessive alcohol use among women (i.e., binge drinking, heavy episodic drinking) have been increasing faster than among men. Alcohol related disease and death are also increasing among women, raising concerns among health professionals, policy makers, and even the White House. Trajectories of binge drinking in young adulthood have shifted; young people are beginning to binge drink later, faster, and longer into their twenties. Women are steadily and significantly increasing their alcohol use into their 30s and 40s, but men’s alcohol use either decreases or remains stable as they age. Globally, men drink more than women, but the difference in those rates vary over time and by contexts. Biological differences between men and women and well-established risk factors of excessive alcohol use are unable to sufficiently explain developmental, cultural, and historical trends in alcohol use. Unique social-cultural and psychological factors contributing to differential trends of alcohol use between men and women in middle-age have yet to be fully delineated. In the U.S., cultural changes have elongated the period of young adulthood (i.e., emerging adulthood) and middle-age is increasingly when adults are getting married and having children. Women are participating in the workforce more than ever before yet are still responsible for the bulk of childcare and household duties. Compared to men, women experience more of the “mental load” associated with these tasks and social roles, are more susceptible to resulting stress and depression, and are more likely to self-medicate their stress and depression with alcohol and other drugs. This study will use the National Longitudinal Study of Adolescent to Adult Health (Add Health) to assess whether and how occupancy of multiple social roles, stress, and negative affect influence excessive alcohol use in two unique stages of life and how those factors form differential pathways to excessive alcohol use (binge drinking, average number of drinks per sitting, and frequency of drinking in past month) among women compared to men. Aim 1 will compare rates of excessive alcohol use between men and women in young adulthood (ages 24-32) and early middle-age (ages 33-43). Aim 2 will delineate the role of these social and psychological factors (stress, negative affect, and occupancy of multiple social roles) as predictors of excessive alcohol use in young adulthood and middle-age and determine if the influence of these predictors is moderated by sex. Aim 3 will characterize mediating and moderating pathways between these hypothesized risk factors and excessive alcohol use using structural equation modeling and traditional moderator analyses. Results will fill critical gaps in our knowledge about how and why the historical gap between men and women in excessive alcohol use is narrowing and uncover potential targets of age- and sex-specific interventions to reduce excessive drinking patterns in early middle age, especially among women.
