Chinese Women’s Drinking Patterns Before and After the Hong Kong Alcohol Policy Changes

Chinese Women’s Drinking Patterns Before and After the Hong Kong Alcohol Policy Changes Abstract Aims To examine the patterns of alcohol consumption in Hong Kong Chinese women before and after a period of major alcohol policy amendments. Short summary This study compared alcohol consumption patterns in Hong Kong Chinese women before and after a period of major alcohol policy amendments and found increased drinking among certain subgroups, particularly middle-aged women. These increases are likely due to personal factors (e.g. changing perceptions) as well as environmental influences (e.g. greater marketing). Methods Cross-sectional telephone surveys were conducted on adult Chinese women prior to the 2007–2008 beer and wine tax eliminations in 2006 (n = 4946) and in 2011 (n = 2439). Results Over the study period, only women in the 36–45 year age stratum reported significant increases in all three drinking patterns: past-year drinking (38.1–45.2%), past-month binge drinking (2.3–5.2%) and weekly drinking (4.0–7.3%) (P < 0.05); middle-aged women, unemployed or retired women and those ascribing to alcohol’s health benefits emerged as new binge drinking risk groups. In 2011, 3.5% of all drinking-aged women (8.8% of past-year drinkers, 20.7% of binge drinkers and 23.1% of weekly drinkers) reported an increased drinking frequency after the tax policy changes. The main contexts of increased drinking were social events and with restaurant meals; moreover, beliefs of alcohol’s health benefits were common to all contexts of increased drinking. Of women who increased their drinking frequency, the largest proportion attributed it to peer effects/social environment conducive to drinking, and brand marketing/advertising influences. Conclusions Increased drinking among certain subgroups of Hong Kong Chinese women may be due to combined influences of: increased societal acceptance of social drinking, aggressive marketing promotions and personal beliefs in the health benefits of drinking that have recently emerged in the region. Hence, multi-prong strategies are required to combat potential drinking harms in these women. alcohol, policy, drinking, women, China, epidemiology INTRODUCTION Greater gender equality in education and employment along with the concomitant changes in social norms are considered to have improved women’s health in most areas of the world (Grown et al., 2005; WHO, 2009). Yet, previously uncommon health risk behaviors among females are becoming more prevalent. One major risk behavior that is showing global convergence between sexes is alcohol consumption, particularly in traditionally low alcohol consumption regions (Simons-Morton et al., 2009; Cheng et al., 2010; WHO, 2014). Given the greater physiological harms of heavy alcohol consumption on women than men (Nolen-Hoeksema, 2004; NIAAA, 2017) and due to the lack of public health policies in many low alcohol consumption countries, there is potential for an upsurge in alcohol-related burden of disease in the these regions (Diehl et al., 2007; Sugarman et al., 2009; Erol and Karpyak, 2015). Similar to many globalizing countries, China has been showing increasing levels of alcohol consumption (Li et al., 2015) in recent decades. Furthermore, increased drinking among Chinese women (Hao et al., 1999, 2004; Cochrane et al., 2003) has been diminishing the historically large gender disparities in drinking in the Asia region (Cho, 2004; Hao et al., 2004; Zhou et al., 2006). A study of five areas across China noted that a 13:1 male-to-female ratio of annual pure alcohol consumption in 2001 had diminished to a 5:1 ratio by 2010 (Hao et al., 1999, 2004; WHO, 2014). In Hong Kong, a globalized Chinese city, the heavy 80% import duties on wine and 40% duties on beer were gradually eliminated in 2007–2008 as part of an economic stimulus plan and as a territory-wide campaign to establish Hong Kong as the ‘wine capital of Asia’ (PR Newswire, 2010). In the years following the tax elimination, there was a dramatic increase in alcohol promotion through new product launches, wine-tasting classes and international alcohol expositions and festivals (Euromonitor International, 2010; Mintel International, 2011; InvestHK, 2016). By 2010, Hong Kong overtook New York as the largest wine auction center (InvestHK, 2016). As a possible consequence of these government policies, the prevalence of past-year drinkers increased (2006:47.3%, 2012:59.4%) (Chung et al., 2013) and the total consumption of alcohol in Hong Kong increased by more than 3.2 million liters of pure ethanol between 2006 and 2008 (Hong Kong Department of Health, 2011; Chung et al., 2013), with steady increases thereafter (Euromonitor International, 2010; Mintel International, 2011). Although research on heavy drinking has largely focused on men due to the higher likelihood of heavy alcohol consumption among males, in recent decades there have been increased interests in female drinking patterns. Studies on women’s drinking have been conducted to assess alcohol misuse patterns, adverse sequelae of heavy drinking and the factors associated with heavy drinking (Wilsnack et al., 1991; Graham et al., 2011; Wilsnack, 2012). Comparatively fewer studies have documented the changes in drinking motivations over time in women and, particularly, in non-Western populations (Wilsnack, 2012). Since, changes in Chinese women’s drinking behaviors have never been critically examined after a major alcohol policy amendment, this study aimed to explore any changes in drinking patterns and drinking motivations of Chinese women, a traditionally low alcohol consumption population, in a period following elimination of alcohol taxes. This study is underpinned by a socio-environmental framework in which changes in drinking patterns are influenced both by personal factors (e.g. sociodemographic attributes and personal beliefs) as well as environmental influences (e.g. increased selection and brand marketing of alcoholic beverages). This study examined the factors associated with changes in Hong Kong women’s alcohol drinking patterns in the period before and after the 2007–2008 alcohol tax elimination and explored the self-reported environmental influences that were associated with changes in consumption. The findings from this study may guide future alcohol policy and harms reduction programs for other globalizing cities in the region. METHODS This study consists of two cross-sectional surveys, using anonymous, telephone interviews using random selection of numbers from current telephone directories in April–June, 2006 (n = 9860, response rate = 65.2%) and April-September, 2011 (n = 4800, response rate = 62.8%). We define the response rate as the number of completed interviews divided by the number of eligible households. The study population comprised all Chinese-speaking permanent residents of Hong Kong between the ages of 18 and 70 years. In 2003, ~98% of the households had a fixed telephone line (Hong Kong Office of the Telecommunications Authority, personal communication, 2003), however, there are no official statistics of households that were reachable only by mobile phone during the study period. Other details of the sampling and data collection are outlined previously (Chung et al., 2013; Kim et al., 2013). We obtained ethics approval from the survey research ethics committee of The Chinese University of Hong Kong. MEASURES Both the 2006 and 2011 survey obtained information about the sociodemographics of respondents (Table 1). We classified those who reported a history of ever drinking a full-serving of alcohol, defined as a can of beer, glass of wine or shot of spirits, (Yes/No) as ‘ever drinkers’. We classified ‘ever drinkers’ who consumed alcohol in the past 12 months as ‘past-year drinkers’ and coded those who reported an average drinking frequency of at least once per week as ‘weekly drinkers’. We assessed past-month binge drinking by asking whether the respondent had consumed five servings of alcohol on one occasion in the preceding 30 days (Wechsler and Isaac, 1992). Alcohol dependence and alcohol abuse were determined from the Chinese Bilingual Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV (American Psychiatric Association, 2000) and has been shown to have a high degree of reliability (So et al., 2005). We did not explore alcohol abuse or alcohol dependence due to a small sample of these women (n = 24). Table 1. Background characteristics for Female Survey Respondentsa in Hong Kong in 2006 and 2011 2006 2011 χ2 P-value % (n = 4946) % (n = 2439) Age <0.001  18–25 13.9 (686) 13.9 (339)  26–35 20.0 (987) 18.5 (452)  36–45 27.7 (1362) 23.1 (562)  46–55 22.5 (1114) 24.8 (604)  56–70 15.8 (779) 19.7 (480) Educational attainment <0.001  Primary or less 20.3 (1000) 13.4 (327)  Secondary (Form 1–5) or  technical school 46.2 (2282) 48.7 (1184)  Matriculation (Form 6–7) 7.9 (390) 6.6 (161)  Tertiary or more 25.6 (1260) 31.2 (757) Marital status 0.151  Ever married (includes  divorced/widowed) 72.4 (3557) 70.8 (1721)  Never Married 27.6 (1354) 29.2 (709) Employment  Employed at least part-time 49.6 (2447) 49.2 (1201) 0.115  Retired 8.2 (402) 6.7 (162)  Unemployed and seeking  work 4.1 (202) 3.5 (84)  Full-time student 6.5 (322) 6.6 (159)  Full-time housewife 31.6 (1557) 33.3 (803) Lifetime drinking status  Ever drinker 59.2 (2928) 75.4 (1837) <0.001  Never consumed full- serving of alcohol 40.8 (2015) 24.6 (600) 2006 2011 χ2 P-value % (n = 4946) % (n = 2439) Age <0.001  18–25 13.9 (686) 13.9 (339)  26–35 20.0 (987) 18.5 (452)  36–45 27.7 (1362) 23.1 (562)  46–55 22.5 (1114) 24.8 (604)  56–70 15.8 (779) 19.7 (480) Educational attainment <0.001  Primary or less 20.3 (1000) 13.4 (327)  Secondary (Form 1–5) or  technical school 46.2 (2282) 48.7 (1184)  Matriculation (Form 6–7) 7.9 (390) 6.6 (161)  Tertiary or more 25.6 (1260) 31.2 (757) Marital status 0.151  Ever married (includes  divorced/widowed) 72.4 (3557) 70.8 (1721)  Never Married 27.6 (1354) 29.2 (709) Employment  Employed at least part-time 49.6 (2447) 49.2 (1201) 0.115  Retired 8.2 (402) 6.7 (162)  Unemployed and seeking  work 4.1 (202) 3.5 (84)  Full-time student 6.5 (322) 6.6 (159)  Full-time housewife 31.6 (1557) 33.3 (803) Lifetime drinking status  Ever drinker 59.2 (2928) 75.4 (1837) <0.001  Never consumed full- serving of alcohol 40.8 (2015) 24.6 (600) aOf women who were 18 years or older. Table 1. Background characteristics for Female Survey Respondentsa in Hong Kong in 2006 and 2011 2006 2011 χ2 P-value % (n = 4946) % (n = 2439) Age <0.001  18–25 13.9 (686) 13.9 (339)  26–35 20.0 (987) 18.5 (452)  36–45 27.7 (1362) 23.1 (562)  46–55 22.5 (1114) 24.8 (604)  56–70 15.8 (779) 19.7 (480) Educational attainment <0.001  Primary or less 20.3 (1000) 13.4 (327)  Secondary (Form 1–5) or  technical school 46.2 (2282) 48.7 (1184)  Matriculation (Form 6–7) 7.9 (390) 6.6 (161)  Tertiary or more 25.6 (1260) 31.2 (757) Marital status 0.151  Ever married (includes  divorced/widowed) 72.4 (3557) 70.8 (1721)  Never Married 27.6 (1354) 29.2 (709) Employment  Employed at least part-time 49.6 (2447) 49.2 (1201) 0.115  Retired 8.2 (402) 6.7 (162)  Unemployed and seeking  work 4.1 (202) 3.5 (84)  Full-time student 6.5 (322) 6.6 (159)  Full-time housewife 31.6 (1557) 33.3 (803) Lifetime drinking status  Ever drinker 59.2 (2928) 75.4 (1837) <0.001  Never consumed full- serving of alcohol 40.8 (2015) 24.6 (600) 2006 2011 χ2 P-value % (n = 4946) % (n = 2439) Age <0.001  18–25 13.9 (686) 13.9 (339)  26–35 20.0 (987) 18.5 (452)  36–45 27.7 (1362) 23.1 (562)  46–55 22.5 (1114) 24.8 (604)  56–70 15.8 (779) 19.7 (480) Educational attainment <0.001  Primary or less 20.3 (1000) 13.4 (327)  Secondary (Form 1–5) or  technical school 46.2 (2282) 48.7 (1184)  Matriculation (Form 6–7) 7.9 (390) 6.6 (161)  Tertiary or more 25.6 (1260) 31.2 (757) Marital status 0.151  Ever married (includes  divorced/widowed) 72.4 (3557) 70.8 (1721)  Never Married 27.6 (1354) 29.2 (709) Employment  Employed at least part-time 49.6 (2447) 49.2 (1201) 0.115  Retired 8.2 (402) 6.7 (162)  Unemployed and seeking  work 4.1 (202) 3.5 (84)  Full-time student 6.5 (322) 6.6 (159)  Full-time housewife 31.6 (1557) 33.3 (803) Lifetime drinking status  Ever drinker 59.2 (2928) 75.4 (1837) <0.001  Never consumed full- serving of alcohol 40.8 (2015) 24.6 (600) aOf women who were 18 years or older. The 2011 survey further asked whether the respondent increased their overall drinking frequency since the 2008 alcohol tax elimination. Respondents who increased their overall drinking frequencies were then asked to choose a reason (Table 5) with an option to give an open-ended response. Since these items asked about any drinking behaviors and preferences in the past 3 years, we removed respondents below the age of 21 (who, 3 years prior, would have been below the legal drinking age of 18) from the analysis of this item. The 2011 survey also asked about the contexts of their past-year drinking. All variables in the database were examined for incorrect values for response choices and missing data, and the original data entry forms were referenced to resolve possible data entry errors. No variables had more than 0.3% missing data. Values for missing responses were left as missing and not imputed for data analysis. Table 5. Comparison of influences on changes in drinking frequency among Chinese womena in Hong Kong after tax policy changes—2011 (n = 2307) Self-reported drinking-related influences Increased drinking frequency in the 3 years since alcohol policy changes (n = 80) Did not increase drinking frequency (n = 2227) P-value % (n) % (n) Felt drinking was affected by peers/social situations 61.3 (49) 3.0 (66) <0.001 Felt affected by Advertisements and Media 50.0 (40) 35.6 (792) 0.012 More familiar and used to certain types of alcohol 50.0 (40) 3.1 (69) <0.001 Felt that alcohol is cheaper because of tax reduction 48.1 (38) 61.8 (1376) 0.018 Felt that restaurants/bars/nightclubs have more drink promotions 45.0 (36) 25.6 (570) <0.001 Felt that restaurants/stores have greater selection of quality alcohol 41.3 (33) 23.3 (520) <0.001 Felt that drinking environment is influenced by working culture 36.3 (29) 1.3 (29) <0.001 Drank due to more expendable money 30.0 (24) 1.1 (24) <0.001 Drank due to financial stress 2.5 (2) 0.2 (4) <0.001 Self-reported drinking-related influences Increased drinking frequency in the 3 years since alcohol policy changes (n = 80) Did not increase drinking frequency (n = 2227) P-value % (n) % (n) Felt drinking was affected by peers/social situations 61.3 (49) 3.0 (66) <0.001 Felt affected by Advertisements and Media 50.0 (40) 35.6 (792) 0.012 More familiar and used to certain types of alcohol 50.0 (40) 3.1 (69) <0.001 Felt that alcohol is cheaper because of tax reduction 48.1 (38) 61.8 (1376) 0.018 Felt that restaurants/bars/nightclubs have more drink promotions 45.0 (36) 25.6 (570) <0.001 Felt that restaurants/stores have greater selection of quality alcohol 41.3 (33) 23.3 (520) <0.001 Felt that drinking environment is influenced by working culture 36.3 (29) 1.3 (29) <0.001 Drank due to more expendable money 30.0 (24) 1.1 (24) <0.001 Drank due to financial stress 2.5 (2) 0.2 (4) <0.001 aLimited to women aged 18 or older in 2008. Table 5. Comparison of influences on changes in drinking frequency among Chinese womena in Hong Kong after tax policy changes—2011 (n = 2307) Self-reported drinking-related influences Increased drinking frequency in the 3 years since alcohol policy changes (n = 80) Did not increase drinking frequency (n = 2227) P-value % (n) % (n) Felt drinking was affected by peers/social situations 61.3 (49) 3.0 (66) <0.001 Felt affected by Advertisements and Media 50.0 (40) 35.6 (792) 0.012 More familiar and used to certain types of alcohol 50.0 (40) 3.1 (69) <0.001 Felt that alcohol is cheaper because of tax reduction 48.1 (38) 61.8 (1376) 0.018 Felt that restaurants/bars/nightclubs have more drink promotions 45.0 (36) 25.6 (570) <0.001 Felt that restaurants/stores have greater selection of quality alcohol 41.3 (33) 23.3 (520) <0.001 Felt that drinking environment is influenced by working culture 36.3 (29) 1.3 (29) <0.001 Drank due to more expendable money 30.0 (24) 1.1 (24) <0.001 Drank due to financial stress 2.5 (2) 0.2 (4) <0.001 Self-reported drinking-related influences Increased drinking frequency in the 3 years since alcohol policy changes (n = 80) Did not increase drinking frequency (n = 2227) P-value % (n) % (n) Felt drinking was affected by peers/social situations 61.3 (49) 3.0 (66) <0.001 Felt affected by Advertisements and Media 50.0 (40) 35.6 (792) 0.012 More familiar and used to certain types of alcohol 50.0 (40) 3.1 (69) <0.001 Felt that alcohol is cheaper because of tax reduction 48.1 (38) 61.8 (1376) 0.018 Felt that restaurants/bars/nightclubs have more drink promotions 45.0 (36) 25.6 (570) <0.001 Felt that restaurants/stores have greater selection of quality alcohol 41.3 (33) 23.3 (520) <0.001 Felt that drinking environment is influenced by working culture 36.3 (29) 1.3 (29) <0.001 Drank due to more expendable money 30.0 (24) 1.1 (24) <0.001 Drank due to financial stress 2.5 (2) 0.2 (4) <0.001 aLimited to women aged 18 or older in 2008. Data Analysis We calculated age-specific prevalence and 95% confidence intervals (CI) for each drinking pattern (past-year drinking, past-month binge drinking, and weekly drinking) for both the 2006 and 2011 sample of women. In order to compare the change in drinking levels between the two time periods, we calculated direct age-standardized prevalence rates for 2006 and 2011 using the Hong Kong 2011 census population as reference and compared them using a chi-squared test and trend test. A multivariable logistic regression examined these drinking behaviors with gender as a covariate (males as reference category), adjusting for age, educational attainment, marital status, and employment status. To examine the factors associated with the drinking patterns, we conducted a factor analysis on the attitudinal variables that were common to both surveys. Two factors emerged: (a) Social Benefits of Drinking scale (Cronbach’s alpha = 0.85) and (b) Professional Benefits of Drinking scale (Cronbach’s alpha = 0.65). Each summative scale consisted of two items (1 = Disagree, 2 = No opinion, 3 = Agree). Due to the skewed data for the scale scores, we trichotomized the data based on the interquartile range (IQR) of the summative scale score (Low [<IQR] = 2 points, Medium [IQR] = 3–4 points, High [>IQR] = 5–6 points). The two trichotomized score variables were used in the multivariate models. Variables related to the health effects of alcohol did not form factors and were examined as stand-alone variables. We ran multivariable stepwise logistic regression models for all drinking patterns for both samples. After excluding individuals who were not of drinking age in 2008, we examined reported increases in overall drinking frequency in 2011 using multivariable stepwise logistic regression. We included sociodemographic and alcohol attitudinal variables that had a P < 0.20 in unadjusted analyses as candidate variables. We report our findings using odds ratios (OR) and 95% CI. Using Chi-squared tests, we examined increased frequency of drinking under various drinking contexts and compared women who increased their drinking versus those that did not with regard to various environmental factors. We considered all P-values<0.05 to be significant and used SPSS (Version 23) to conduct all analyses (IBM Corp. Released, 2015). RESULTS Characteristics of the study samples The background attributes of the samples (Table 1) showed that the 2011 sample had slightly older respondents, slightly more educated women, and greater proportion of ever drinkers than the 2006 sample, but there were no other statistically significant differences. Compared with the general population, both samples showed a somewhat higher representation of middle-aged women and higher levels of education. This is most likely attributable to the study’s exclusion criteria of respondents over the age of 70, who are generally less educated. Comparison of drinking patterns in 2006 versus 2011 The age-specific rates for past-year drinking, past-month binge drinking and weekly drinking are shown for the pre-tax elimination period (2006) and post-tax elimination period (2011) (Table 2) and revealed that in both periods, past-year drinking and past-month binge drinking showed strong inverse associations with age (trend test P < 0.0001), whereas weekly drinking was most prevalent among middle-aged women. Table 2. Age-specific prevalence of past-year drinking, past-month binge drinking and weekly drinking among Chinese womena in Hong Kong - 2006 (n = 4946) versus 2011 (n = 2439) 2006 (n) 2006 % (95% CI) 2011 (n) 2011 % (95% CI) Absolute Δ from 2006 Δ (95% CI) Past-year drinking  18–25 years 686 47.4 (43.6, 51.1) 339 51.0 (45.7, 56.4) +3.6% (−2.9, 10.1)  26–35 years 987 45.8 (42.7, 48.9) 452 41.8 (37.2, 46.4) −4.0% (−9.5,1.5)  36–45 years 1362 38.1 (35.5, 40.7) 562 45.2 (41.1, 49.3) +7.1% (2.2,11.9)*  46–55 years 1114 34.6 (31.8, 37.4) 604 40.7 (36.8, 44.7) +6.1% (1.3, 10.9)*  56–70 years 779 19.6 (16.8, 22.4) 480 28.5 (24.5, 32.6) +7.9% (4.0,13.8)**  All females 4928 37.2 (35.9, 38.6) 2437 41.0 (39.0, 42.9) +3.8% (1.4, 6.2)*  Age-adjusted prevalencea 38.3 (38.2, 38.4) 41.0 (40.9, 41.1) +2.7% (0.3, 5.1)*  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.44 (0.40, 0.49)** 0.53 (0.47, 0.61)** Past-month binge drinking  18–25 years 685 8.6 (6.5, 10.7) 339 6.2 (3.6, 8.8) −2.4% (−5.7, 0.9)  26–35 years 986 5.5 (4.1, 6.9) 452 7.3 (4.9, 9.7) +1.8% (−0.1, 4.6)  36–45 years 1362 2.3 (1.5, 3.1) 562 5.2 (3.3, 7.0) +2.9% (0.9, 4.9)**  46–55 years 1114 2.1 (1.2, 2.9) 604 2.0 (0.9, 3.1) −0.1% (−1.5, 1.3)  56–70 years 779 1.0 (0.3, 1.7) 480 1.3 (0.3, 2.2) +0.3% (−0.1, 1.5)  All females 4926 3.6 (3.0, 4.1) 2437 4.1 (3.4, 4.9) +0.6% (−0.3, 1.5)  Age-adjusted prevalencea 3.9 (3.8, 4.0) 4.3 (4.2, 4.4) +0.4% (−0.6, 1.4)  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.23 (0.19, 0.28)** 0.48 (0.37, 0.63)** Weekly drinking  18–25 years 686 3.1 (1.8,4.4) 339 4.1 (2.0, 6.3) +1.0% (−1.5, 3.5)  26–35 years 987 3.9 (2.6,5.1) 452 6.2 (4.0, 8.4) +2.3% (−0.2, 4.8)  36–45 years 1362 4.0 (2.9, 5.0) 562 7.3 (5.1,9.5) +3.3% (0.9, 5.7)a  46–55 years 1114 3.3 (2.3, 4.4) 604 5.0 (3.2, 6.7) +1.7% (−0.3, 3.7)  56–70 years 779 2.8 (1.7,4.0) 480 3.1 (1.6, 4.7) +0.3% (−1.6, 2.2)  All females 4928 3.5 (3.0,4.0) 2437 5.3 (4.4,6.1) +1.8% (0.8, 2.8)**  Age-adjusted prevalencea 3.4 (3.3, 3.5) 5.3 (5.2, 5.4) +1.8% (0.9, 2.9)**  P-value (χ2)/Trend test <0.0001/<0.0001 0.028/0.197  ORmv (95% CI)b (Males = ref) 0.24 (0.19, 0.29)** 0.36 (0.28, 0.46)** 2006 (n) 2006 % (95% CI) 2011 (n) 2011 % (95% CI) Absolute Δ from 2006 Δ (95% CI) Past-year drinking  18–25 years 686 47.4 (43.6, 51.1) 339 51.0 (45.7, 56.4) +3.6% (−2.9, 10.1)  26–35 years 987 45.8 (42.7, 48.9) 452 41.8 (37.2, 46.4) −4.0% (−9.5,1.5)  36–45 years 1362 38.1 (35.5, 40.7) 562 45.2 (41.1, 49.3) +7.1% (2.2,11.9)*  46–55 years 1114 34.6 (31.8, 37.4) 604 40.7 (36.8, 44.7) +6.1% (1.3, 10.9)*  56–70 years 779 19.6 (16.8, 22.4) 480 28.5 (24.5, 32.6) +7.9% (4.0,13.8)**  All females 4928 37.2 (35.9, 38.6) 2437 41.0 (39.0, 42.9) +3.8% (1.4, 6.2)*  Age-adjusted prevalencea 38.3 (38.2, 38.4) 41.0 (40.9, 41.1) +2.7% (0.3, 5.1)*  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.44 (0.40, 0.49)** 0.53 (0.47, 0.61)** Past-month binge drinking  18–25 years 685 8.6 (6.5, 10.7) 339 6.2 (3.6, 8.8) −2.4% (−5.7, 0.9)  26–35 years 986 5.5 (4.1, 6.9) 452 7.3 (4.9, 9.7) +1.8% (−0.1, 4.6)  36–45 years 1362 2.3 (1.5, 3.1) 562 5.2 (3.3, 7.0) +2.9% (0.9, 4.9)**  46–55 years 1114 2.1 (1.2, 2.9) 604 2.0 (0.9, 3.1) −0.1% (−1.5, 1.3)  56–70 years 779 1.0 (0.3, 1.7) 480 1.3 (0.3, 2.2) +0.3% (−0.1, 1.5)  All females 4926 3.6 (3.0, 4.1) 2437 4.1 (3.4, 4.9) +0.6% (−0.3, 1.5)  Age-adjusted prevalencea 3.9 (3.8, 4.0) 4.3 (4.2, 4.4) +0.4% (−0.6, 1.4)  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.23 (0.19, 0.28)** 0.48 (0.37, 0.63)** Weekly drinking  18–25 years 686 3.1 (1.8,4.4) 339 4.1 (2.0, 6.3) +1.0% (−1.5, 3.5)  26–35 years 987 3.9 (2.6,5.1) 452 6.2 (4.0, 8.4) +2.3% (−0.2, 4.8)  36–45 years 1362 4.0 (2.9, 5.0) 562 7.3 (5.1,9.5) +3.3% (0.9, 5.7)a  46–55 years 1114 3.3 (2.3, 4.4) 604 5.0 (3.2, 6.7) +1.7% (−0.3, 3.7)  56–70 years 779 2.8 (1.7,4.0) 480 3.1 (1.6, 4.7) +0.3% (−1.6, 2.2)  All females 4928 3.5 (3.0,4.0) 2437 5.3 (4.4,6.1) +1.8% (0.8, 2.8)**  Age-adjusted prevalencea 3.4 (3.3, 3.5) 5.3 (5.2, 5.4) +1.8% (0.9, 2.9)**  P-value (χ2)/Trend test <0.0001/<0.0001 0.028/0.197  ORmv (95% CI)b (Males = ref) 0.24 (0.19, 0.29)** 0.36 (0.28, 0.46)** OR = odds ratio; CI = confidence interval aAge-standardized against Hong Kong 2011 Census: 9.8% of women were 18–25 years, 17.0% were 26–35 years, 17.6% were 36–45 years, 17.8% were 46–55 years, 23.9% were 56–70 years. b Females versus males (ref) adjusted for age, education (Tertiary education versus Not), marital status (ever married versus never married), employed status (full-time/part-time worker versus all other). *P < 0.05, **P<0.001. Table 2. Age-specific prevalence of past-year drinking, past-month binge drinking and weekly drinking among Chinese womena in Hong Kong - 2006 (n = 4946) versus 2011 (n = 2439) 2006 (n) 2006 % (95% CI) 2011 (n) 2011 % (95% CI) Absolute Δ from 2006 Δ (95% CI) Past-year drinking  18–25 years 686 47.4 (43.6, 51.1) 339 51.0 (45.7, 56.4) +3.6% (−2.9, 10.1)  26–35 years 987 45.8 (42.7, 48.9) 452 41.8 (37.2, 46.4) −4.0% (−9.5,1.5)  36–45 years 1362 38.1 (35.5, 40.7) 562 45.2 (41.1, 49.3) +7.1% (2.2,11.9)*  46–55 years 1114 34.6 (31.8, 37.4) 604 40.7 (36.8, 44.7) +6.1% (1.3, 10.9)*  56–70 years 779 19.6 (16.8, 22.4) 480 28.5 (24.5, 32.6) +7.9% (4.0,13.8)**  All females 4928 37.2 (35.9, 38.6) 2437 41.0 (39.0, 42.9) +3.8% (1.4, 6.2)*  Age-adjusted prevalencea 38.3 (38.2, 38.4) 41.0 (40.9, 41.1) +2.7% (0.3, 5.1)*  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.44 (0.40, 0.49)** 0.53 (0.47, 0.61)** Past-month binge drinking  18–25 years 685 8.6 (6.5, 10.7) 339 6.2 (3.6, 8.8) −2.4% (−5.7, 0.9)  26–35 years 986 5.5 (4.1, 6.9) 452 7.3 (4.9, 9.7) +1.8% (−0.1, 4.6)  36–45 years 1362 2.3 (1.5, 3.1) 562 5.2 (3.3, 7.0) +2.9% (0.9, 4.9)**  46–55 years 1114 2.1 (1.2, 2.9) 604 2.0 (0.9, 3.1) −0.1% (−1.5, 1.3)  56–70 years 779 1.0 (0.3, 1.7) 480 1.3 (0.3, 2.2) +0.3% (−0.1, 1.5)  All females 4926 3.6 (3.0, 4.1) 2437 4.1 (3.4, 4.9) +0.6% (−0.3, 1.5)  Age-adjusted prevalencea 3.9 (3.8, 4.0) 4.3 (4.2, 4.4) +0.4% (−0.6, 1.4)  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.23 (0.19, 0.28)** 0.48 (0.37, 0.63)** Weekly drinking  18–25 years 686 3.1 (1.8,4.4) 339 4.1 (2.0, 6.3) +1.0% (−1.5, 3.5)  26–35 years 987 3.9 (2.6,5.1) 452 6.2 (4.0, 8.4) +2.3% (−0.2, 4.8)  36–45 years 1362 4.0 (2.9, 5.0) 562 7.3 (5.1,9.5) +3.3% (0.9, 5.7)a  46–55 years 1114 3.3 (2.3, 4.4) 604 5.0 (3.2, 6.7) +1.7% (−0.3, 3.7)  56–70 years 779 2.8 (1.7,4.0) 480 3.1 (1.6, 4.7) +0.3% (−1.6, 2.2)  All females 4928 3.5 (3.0,4.0) 2437 5.3 (4.4,6.1) +1.8% (0.8, 2.8)**  Age-adjusted prevalencea 3.4 (3.3, 3.5) 5.3 (5.2, 5.4) +1.8% (0.9, 2.9)**  P-value (χ2)/Trend test <0.0001/<0.0001 0.028/0.197  ORmv (95% CI)b (Males = ref) 0.24 (0.19, 0.29)** 0.36 (0.28, 0.46)** 2006 (n) 2006 % (95% CI) 2011 (n) 2011 % (95% CI) Absolute Δ from 2006 Δ (95% CI) Past-year drinking  18–25 years 686 47.4 (43.6, 51.1) 339 51.0 (45.7, 56.4) +3.6% (−2.9, 10.1)  26–35 years 987 45.8 (42.7, 48.9) 452 41.8 (37.2, 46.4) −4.0% (−9.5,1.5)  36–45 years 1362 38.1 (35.5, 40.7) 562 45.2 (41.1, 49.3) +7.1% (2.2,11.9)*  46–55 years 1114 34.6 (31.8, 37.4) 604 40.7 (36.8, 44.7) +6.1% (1.3, 10.9)*  56–70 years 779 19.6 (16.8, 22.4) 480 28.5 (24.5, 32.6) +7.9% (4.0,13.8)**  All females 4928 37.2 (35.9, 38.6) 2437 41.0 (39.0, 42.9) +3.8% (1.4, 6.2)*  Age-adjusted prevalencea 38.3 (38.2, 38.4) 41.0 (40.9, 41.1) +2.7% (0.3, 5.1)*  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.44 (0.40, 0.49)** 0.53 (0.47, 0.61)** Past-month binge drinking  18–25 years 685 8.6 (6.5, 10.7) 339 6.2 (3.6, 8.8) −2.4% (−5.7, 0.9)  26–35 years 986 5.5 (4.1, 6.9) 452 7.3 (4.9, 9.7) +1.8% (−0.1, 4.6)  36–45 years 1362 2.3 (1.5, 3.1) 562 5.2 (3.3, 7.0) +2.9% (0.9, 4.9)**  46–55 years 1114 2.1 (1.2, 2.9) 604 2.0 (0.9, 3.1) −0.1% (−1.5, 1.3)  56–70 years 779 1.0 (0.3, 1.7) 480 1.3 (0.3, 2.2) +0.3% (−0.1, 1.5)  All females 4926 3.6 (3.0, 4.1) 2437 4.1 (3.4, 4.9) +0.6% (−0.3, 1.5)  Age-adjusted prevalencea 3.9 (3.8, 4.0) 4.3 (4.2, 4.4) +0.4% (−0.6, 1.4)  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.23 (0.19, 0.28)** 0.48 (0.37, 0.63)** Weekly drinking  18–25 years 686 3.1 (1.8,4.4) 339 4.1 (2.0, 6.3) +1.0% (−1.5, 3.5)  26–35 years 987 3.9 (2.6,5.1) 452 6.2 (4.0, 8.4) +2.3% (−0.2, 4.8)  36–45 years 1362 4.0 (2.9, 5.0) 562 7.3 (5.1,9.5) +3.3% (0.9, 5.7)a  46–55 years 1114 3.3 (2.3, 4.4) 604 5.0 (3.2, 6.7) +1.7% (−0.3, 3.7)  56–70 years 779 2.8 (1.7,4.0) 480 3.1 (1.6, 4.7) +0.3% (−1.6, 2.2)  All females 4928 3.5 (3.0,4.0) 2437 5.3 (4.4,6.1) +1.8% (0.8, 2.8)**  Age-adjusted prevalencea 3.4 (3.3, 3.5) 5.3 (5.2, 5.4) +1.8% (0.9, 2.9)**  P-value (χ2)/Trend test <0.0001/<0.0001 0.028/0.197  ORmv (95% CI)b (Males = ref) 0.24 (0.19, 0.29)** 0.36 (0.28, 0.46)** OR = odds ratio; CI = confidence interval aAge-standardized against Hong Kong 2011 Census: 9.8% of women were 18–25 years, 17.0% were 26–35 years, 17.6% were 36–45 years, 17.8% were 46–55 years, 23.9% were 56–70 years. b Females versus males (ref) adjusted for age, education (Tertiary education versus Not), marital status (ever married versus never married), employed status (full-time/part-time worker versus all other). *P < 0.05, **P<0.001. In 2011, when compared to 2006, there were statistically significant increases in the overall age-adjusted prevalence of past-year drinking (+2.7%) and weekly drinking (+1.8%) but not binge drinking. The increase in past-year drinking was significant only for women above 35 years of age (+6.1–7.9%). The age stratum-specific results revealed that the only age stratum that had increased prevalence across all examined three drinking patterns were women between the ages of 36–45, showing significant increases in past-year drinking (2006:38.1%, 2011:45.2%), past-month binge drinking (2006:2.3%, 2011:5.2%) and weekly drinking (2006:4.0%, 2011:7.3%) after the policy changes. All three types of drinking patterns showed a convergence with male drinking levels by 2011. Changes in the sociodemographic and attitudinal factors associated with drinking patterns among Hong Kong women A comparison of factors associated with the studied drinking patterns in 2006 and 2011 (Table 3) revealed that many previous independent risk factors became non-significant by 2011, due to the convergence of drinking patterns across demographic subgroups. For example, women with lower education had caught up in their weekly drinking prevalence (2006:2.6%, 2011:5.1%) with their higher educated counterparts by 2011 (5.5%). Similarly, marital status and job-related drinking were not independently associated with any type of drinking behavior by 2011, and the Social Benefits of Drinking scale was not associated with past-year or weekly drinking by 2011. Table 3. Sociodemographic and attitudinal factors associated with various drinking patterns among Chinese womena in Hong Kong - 2006 (n = 4946) versus 2011 (n = 2439) Past-year drinkingb Past-month binge drinkingc Weekly drinkingd Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Sociodemographics  Age   18–25 years 47.4 1.0 51.0 1.0 8.6 1.0 6.2 1.0 3.1 4.1 1.0   26–35 years 45.8 1.19 (0.92–1.55) 41.8 0.84 (0.58–1.21) 5.5 0.73 (0.46–1.13) 7.3 1.23 (0.63–2.42) 3.9 6.2 1.65 (0.85–3.22)   36–45 years 38.1 1.10 (0.83–1.45) 45.2 1.14 (0.79–1.63) 2.3 0.33 (0.19–0.58)** 5.2 0.87(0.43–1.75) 4.0 7.3 1.95 (1.04–3.67)*   46–55 years 34.6 1.09 (0.82–1.46) 40.7 1.04 (0.72–1.50) 2.1 0.29 (0.16–0.55)** 2.0 0.30 (0.13–0.70)* 3.3 5.0 1.23 (0.64–2.37)   56–70 years 19.6 0.59 (0.43–0.83)* 28.5 0.61 (0.40–0.92)** 1.0 0.15 (0.06–0.35)** 1.3 0.11 (0.03–0.36)** 2.8 3.1 0.67 (0.31–1.41)  Education   Secondary or   lower 32.1 1.0 36.1 1.0 3.1 NS 3.3 NS 2.6 1.0 5.1   Post- secondary 52.1 1.72 (1.48–2.00)** 51.7 1.78 (1.45–2.17)** 4.9 5.9 5.2 2.11 (1.51–2.95)** 5.5  Marital Status   Ever married 32.8 1.0 38.2 NS 2.2 1.0 3.0 NS 2.8 4.9   Never married 48.9 1.37 (1.12–1.65)* 47.5 7.0 1.74 (1.13–2.68)* 6.8 3.9 5.2  Occupation   Housewife 27.4 1.0 33.3 1.0 1.9 NS 2.1 1.0 2.2 NS 4.9 NS   Working 44.8 1.53 (1.30–1.81)** 55.3 1.45 (1.17–1.80)* 4.6 5.2 1.70 (0.95–3.01) 4.4 6.2   Retired 24.9 1.43 (1.05–1.95)* 42.8 1.12 (0.74–1.67) 1.0 3.7 5.14 (1.65–16.0)* 3.5 3.7   Unemployed 31.7 0.90 (0.63–1.29) 47.3 0.95 (0.57–1.58) 3.0 10.7 4.11 (1.62–10.4)* 3.5 4.8   Student 45.3 1.19 (0.84–1.68) 54.7 1.40 (0.86–2.28) 6.5 4.4 1.24 (0.42–3.70) 2.5 1.9  Drinking for work   Not required 37.9 NS 41.0 3.5 1.0 3.9 NS 3.4 1.0 5.0 NS   Yes, required 50.0 40.8 13.8 3.29 (1.48–7.30)* 11.8 12.1 2.99 (1.31–6.82)* 12.0 Drinking beliefs  Social benefits   Score < IQR 39.6 1.0 39.9 2.9 1.0 2.9 1.0 2.6 1.0 3.7 NS   Within IQR 32.8 0.83 (0.71–0.98)* 42.6 3.1 1.38 (0.89–2.14) 4.0 1.53 (0.82–2.86) 3.4 1.43 (0.93–2.20) 5.0   Score > IQR 39.7 1.06 (0.90–1.24) 41.7 5.4 2.43 (1.68–3.53)** 5.8 2.10 (1.31–3.36)* 5.5 2.14 (1.48–3.11)** 7.4  Work benefits   Score < IQR 33.4 1.0 35.4 1.0 2.8 NS 2.8 NS 3.0 NS 3.9 NS   Within IQR 35.7 1.17 (1.00–1.37)* 37.6 1.12 (0.91–1.39) 3.0 3.5 3.0 5.0   Score > IQR 46.9 1.68 (1.43–1.98)** 50.9 1.64 (1.70–1.97)** 5.2 6.4 4.8 7.2  Drinking is healthy   Disagree 37.5 NS 33.2 1.0 3.3 NS 2.8 1.0 3.1 NS 2.2 1.0   Agree 41.0 46.5 1.64 (1.37–1.97)** 4.8 5.1 1.68 (1.04–2.71)* 5.6 7.4 3.07 (1.89–4.98)**  Causes GI issues   Agree 38.5 NS 40.9 3.5 3.8 1.0 3.6 5.0 1.0   Disagree 29.9 43.7 4.5 12.6 4.44 (2.17–9.12)** 2.7 11.6 3.38 (1.65–6.92)*  Helps one sleep   Disagree 34.9 1.0 35.3 1.0 2.7 1.0 2.8 1.0 2.4 1.0 3.3 1.0   Agree 44.9 1.42 (1.24–1.63)** 52.7 1.89 (1.57–2.28)** 5.6 1.92 (1.39–2.65)** 6.9 2.37 (1.54–3.64)** 6.0 2.38 (1.72–3.28)** 9.3 2.60 (1.79–3.78)** Past-year drinkingb Past-month binge drinkingc Weekly drinkingd Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Sociodemographics  Age   18–25 years 47.4 1.0 51.0 1.0 8.6 1.0 6.2 1.0 3.1 4.1 1.0   26–35 years 45.8 1.19 (0.92–1.55) 41.8 0.84 (0.58–1.21) 5.5 0.73 (0.46–1.13) 7.3 1.23 (0.63–2.42) 3.9 6.2 1.65 (0.85–3.22)   36–45 years 38.1 1.10 (0.83–1.45) 45.2 1.14 (0.79–1.63) 2.3 0.33 (0.19–0.58)** 5.2 0.87(0.43–1.75) 4.0 7.3 1.95 (1.04–3.67)*   46–55 years 34.6 1.09 (0.82–1.46) 40.7 1.04 (0.72–1.50) 2.1 0.29 (0.16–0.55)** 2.0 0.30 (0.13–0.70)* 3.3 5.0 1.23 (0.64–2.37)   56–70 years 19.6 0.59 (0.43–0.83)* 28.5 0.61 (0.40–0.92)** 1.0 0.15 (0.06–0.35)** 1.3 0.11 (0.03–0.36)** 2.8 3.1 0.67 (0.31–1.41)  Education   Secondary or   lower 32.1 1.0 36.1 1.0 3.1 NS 3.3 NS 2.6 1.0 5.1   Post- secondary 52.1 1.72 (1.48–2.00)** 51.7 1.78 (1.45–2.17)** 4.9 5.9 5.2 2.11 (1.51–2.95)** 5.5  Marital Status   Ever married 32.8 1.0 38.2 NS 2.2 1.0 3.0 NS 2.8 4.9   Never married 48.9 1.37 (1.12–1.65)* 47.5 7.0 1.74 (1.13–2.68)* 6.8 3.9 5.2  Occupation   Housewife 27.4 1.0 33.3 1.0 1.9 NS 2.1 1.0 2.2 NS 4.9 NS   Working 44.8 1.53 (1.30–1.81)** 55.3 1.45 (1.17–1.80)* 4.6 5.2 1.70 (0.95–3.01) 4.4 6.2   Retired 24.9 1.43 (1.05–1.95)* 42.8 1.12 (0.74–1.67) 1.0 3.7 5.14 (1.65–16.0)* 3.5 3.7   Unemployed 31.7 0.90 (0.63–1.29) 47.3 0.95 (0.57–1.58) 3.0 10.7 4.11 (1.62–10.4)* 3.5 4.8   Student 45.3 1.19 (0.84–1.68) 54.7 1.40 (0.86–2.28) 6.5 4.4 1.24 (0.42–3.70) 2.5 1.9  Drinking for work   Not required 37.9 NS 41.0 3.5 1.0 3.9 NS 3.4 1.0 5.0 NS   Yes, required 50.0 40.8 13.8 3.29 (1.48–7.30)* 11.8 12.1 2.99 (1.31–6.82)* 12.0 Drinking beliefs  Social benefits   Score < IQR 39.6 1.0 39.9 2.9 1.0 2.9 1.0 2.6 1.0 3.7 NS   Within IQR 32.8 0.83 (0.71–0.98)* 42.6 3.1 1.38 (0.89–2.14) 4.0 1.53 (0.82–2.86) 3.4 1.43 (0.93–2.20) 5.0   Score > IQR 39.7 1.06 (0.90–1.24) 41.7 5.4 2.43 (1.68–3.53)** 5.8 2.10 (1.31–3.36)* 5.5 2.14 (1.48–3.11)** 7.4  Work benefits   Score < IQR 33.4 1.0 35.4 1.0 2.8 NS 2.8 NS 3.0 NS 3.9 NS   Within IQR 35.7 1.17 (1.00–1.37)* 37.6 1.12 (0.91–1.39) 3.0 3.5 3.0 5.0   Score > IQR 46.9 1.68 (1.43–1.98)** 50.9 1.64 (1.70–1.97)** 5.2 6.4 4.8 7.2  Drinking is healthy   Disagree 37.5 NS 33.2 1.0 3.3 NS 2.8 1.0 3.1 NS 2.2 1.0   Agree 41.0 46.5 1.64 (1.37–1.97)** 4.8 5.1 1.68 (1.04–2.71)* 5.6 7.4 3.07 (1.89–4.98)**  Causes GI issues   Agree 38.5 NS 40.9 3.5 3.8 1.0 3.6 5.0 1.0   Disagree 29.9 43.7 4.5 12.6 4.44 (2.17–9.12)** 2.7 11.6 3.38 (1.65–6.92)*  Helps one sleep   Disagree 34.9 1.0 35.3 1.0 2.7 1.0 2.8 1.0 2.4 1.0 3.3 1.0   Agree 44.9 1.42 (1.24–1.63)** 52.7 1.89 (1.57–2.28)** 5.6 1.92 (1.39–2.65)** 6.9 2.37 (1.54–3.64)** 6.0 2.38 (1.72–3.28)** 9.3 2.60 (1.79–3.78)** OR, odds ratios; CI, confidence interval; IQR, interquartile range; GI, gastrointestinal; Variables with dashes were not included in the multivariate model. Candidate variables had a significance of P < 0.20 in unadjusted analyses. NS, not significant, these variables were removed in the backwards elimination process. aAll respondents who were <18-years old in 2008 were removed from analysis of this variable since they would not be of legal drinking age. bVariables in backwards elimination were removed in the following order for the 2006 current drinking model: GI issues (OR = 0.84; 95% CI = 0.62, 1.15; P = 0.28), Job Drinking (OR = 1.39; 95% CI = 0.80, 2.42; P = 0.239), Drinking is good for health (OR = 1.15; 95% CI = 0.97, 1.36; P = 0.11); Variables in backwards elimination were removed in the following order for the 2011 current drinking model: Marital status (OR = 1.04; 95% CI = 0.79, 1.36; P = 0.79). cVariables in backwards elimination were removed in the following order for the 2006 past-month binge drinking model: Educational status (OR = 0.96; 95% CI = 0.67, 1.39; P = 0.83), Work Benefits Score (P = 0.51), Occupational status (P = 0.16), Drinking is good for health (OR = 1.37; 95% CI = 0.89, 1.95; P = 0.17); Variables in backwards elimination were removed in the following order for the 2011 past-month binge drinking model: Educational status (OR = 1.28; 95% CI = 0.80, 2.05; P = 0.30), Drinking for work (OR = 1.83; 95% CI = 0.79, 4.26; P = 0.16), Marital status (OR = 1.54; 95% CI = 0.87, 2.71; P = 0.14), Work Benefits Score (P = 0.08). dVariables in backwards elimination were removed in the following order for the 2006 weekly drinking model: Work Benefits Score (P = 0.38), Occupational status (P = 0.08), Drinking is good for health (OR = 1.44; 95% CI = 0.99, 2.09; P = 0.05); Variables in backwards elimination were removed in the following order for the 2011 weekly drinking model: Occupational status (P = 0.47), Work Benefits Score (P = 0.29), Job Drinking (OR = 1.90; 95% CI = 0.89, 4.04; P = 0.09), Social Benefits Score (P = 0.08). *P < 0.05; **P < 0.001. Table 3. Sociodemographic and attitudinal factors associated with various drinking patterns among Chinese womena in Hong Kong - 2006 (n = 4946) versus 2011 (n = 2439) Past-year drinkingb Past-month binge drinkingc Weekly drinkingd Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Sociodemographics  Age   18–25 years 47.4 1.0 51.0 1.0 8.6 1.0 6.2 1.0 3.1 4.1 1.0   26–35 years 45.8 1.19 (0.92–1.55) 41.8 0.84 (0.58–1.21) 5.5 0.73 (0.46–1.13) 7.3 1.23 (0.63–2.42) 3.9 6.2 1.65 (0.85–3.22)   36–45 years 38.1 1.10 (0.83–1.45) 45.2 1.14 (0.79–1.63) 2.3 0.33 (0.19–0.58)** 5.2 0.87(0.43–1.75) 4.0 7.3 1.95 (1.04–3.67)*   46–55 years 34.6 1.09 (0.82–1.46) 40.7 1.04 (0.72–1.50) 2.1 0.29 (0.16–0.55)** 2.0 0.30 (0.13–0.70)* 3.3 5.0 1.23 (0.64–2.37)   56–70 years 19.6 0.59 (0.43–0.83)* 28.5 0.61 (0.40–0.92)** 1.0 0.15 (0.06–0.35)** 1.3 0.11 (0.03–0.36)** 2.8 3.1 0.67 (0.31–1.41)  Education   Secondary or   lower 32.1 1.0 36.1 1.0 3.1 NS 3.3 NS 2.6 1.0 5.1   Post- secondary 52.1 1.72 (1.48–2.00)** 51.7 1.78 (1.45–2.17)** 4.9 5.9 5.2 2.11 (1.51–2.95)** 5.5  Marital Status   Ever married 32.8 1.0 38.2 NS 2.2 1.0 3.0 NS 2.8 4.9   Never married 48.9 1.37 (1.12–1.65)* 47.5 7.0 1.74 (1.13–2.68)* 6.8 3.9 5.2  Occupation   Housewife 27.4 1.0 33.3 1.0 1.9 NS 2.1 1.0 2.2 NS 4.9 NS   Working 44.8 1.53 (1.30–1.81)** 55.3 1.45 (1.17–1.80)* 4.6 5.2 1.70 (0.95–3.01) 4.4 6.2   Retired 24.9 1.43 (1.05–1.95)* 42.8 1.12 (0.74–1.67) 1.0 3.7 5.14 (1.65–16.0)* 3.5 3.7   Unemployed 31.7 0.90 (0.63–1.29) 47.3 0.95 (0.57–1.58) 3.0 10.7 4.11 (1.62–10.4)* 3.5 4.8   Student 45.3 1.19 (0.84–1.68) 54.7 1.40 (0.86–2.28) 6.5 4.4 1.24 (0.42–3.70) 2.5 1.9  Drinking for work   Not required 37.9 NS 41.0 3.5 1.0 3.9 NS 3.4 1.0 5.0 NS   Yes, required 50.0 40.8 13.8 3.29 (1.48–7.30)* 11.8 12.1 2.99 (1.31–6.82)* 12.0 Drinking beliefs  Social benefits   Score < IQR 39.6 1.0 39.9 2.9 1.0 2.9 1.0 2.6 1.0 3.7 NS   Within IQR 32.8 0.83 (0.71–0.98)* 42.6 3.1 1.38 (0.89–2.14) 4.0 1.53 (0.82–2.86) 3.4 1.43 (0.93–2.20) 5.0   Score > IQR 39.7 1.06 (0.90–1.24) 41.7 5.4 2.43 (1.68–3.53)** 5.8 2.10 (1.31–3.36)* 5.5 2.14 (1.48–3.11)** 7.4  Work benefits   Score < IQR 33.4 1.0 35.4 1.0 2.8 NS 2.8 NS 3.0 NS 3.9 NS   Within IQR 35.7 1.17 (1.00–1.37)* 37.6 1.12 (0.91–1.39) 3.0 3.5 3.0 5.0   Score > IQR 46.9 1.68 (1.43–1.98)** 50.9 1.64 (1.70–1.97)** 5.2 6.4 4.8 7.2  Drinking is healthy   Disagree 37.5 NS 33.2 1.0 3.3 NS 2.8 1.0 3.1 NS 2.2 1.0   Agree 41.0 46.5 1.64 (1.37–1.97)** 4.8 5.1 1.68 (1.04–2.71)* 5.6 7.4 3.07 (1.89–4.98)**  Causes GI issues   Agree 38.5 NS 40.9 3.5 3.8 1.0 3.6 5.0 1.0   Disagree 29.9 43.7 4.5 12.6 4.44 (2.17–9.12)** 2.7 11.6 3.38 (1.65–6.92)*  Helps one sleep   Disagree 34.9 1.0 35.3 1.0 2.7 1.0 2.8 1.0 2.4 1.0 3.3 1.0   Agree 44.9 1.42 (1.24–1.63)** 52.7 1.89 (1.57–2.28)** 5.6 1.92 (1.39–2.65)** 6.9 2.37 (1.54–3.64)** 6.0 2.38 (1.72–3.28)** 9.3 2.60 (1.79–3.78)** Past-year drinkingb Past-month binge drinkingc Weekly drinkingd Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Sociodemographics  Age   18–25 years 47.4 1.0 51.0 1.0 8.6 1.0 6.2 1.0 3.1 4.1 1.0   26–35 years 45.8 1.19 (0.92–1.55) 41.8 0.84 (0.58–1.21) 5.5 0.73 (0.46–1.13) 7.3 1.23 (0.63–2.42) 3.9 6.2 1.65 (0.85–3.22)   36–45 years 38.1 1.10 (0.83–1.45) 45.2 1.14 (0.79–1.63) 2.3 0.33 (0.19–0.58)** 5.2 0.87(0.43–1.75) 4.0 7.3 1.95 (1.04–3.67)*   46–55 years 34.6 1.09 (0.82–1.46) 40.7 1.04 (0.72–1.50) 2.1 0.29 (0.16–0.55)** 2.0 0.30 (0.13–0.70)* 3.3 5.0 1.23 (0.64–2.37)   56–70 years 19.6 0.59 (0.43–0.83)* 28.5 0.61 (0.40–0.92)** 1.0 0.15 (0.06–0.35)** 1.3 0.11 (0.03–0.36)** 2.8 3.1 0.67 (0.31–1.41)  Education   Secondary or   lower 32.1 1.0 36.1 1.0 3.1 NS 3.3 NS 2.6 1.0 5.1   Post- secondary 52.1 1.72 (1.48–2.00)** 51.7 1.78 (1.45–2.17)** 4.9 5.9 5.2 2.11 (1.51–2.95)** 5.5  Marital Status   Ever married 32.8 1.0 38.2 NS 2.2 1.0 3.0 NS 2.8 4.9   Never married 48.9 1.37 (1.12–1.65)* 47.5 7.0 1.74 (1.13–2.68)* 6.8 3.9 5.2  Occupation   Housewife 27.4 1.0 33.3 1.0 1.9 NS 2.1 1.0 2.2 NS 4.9 NS   Working 44.8 1.53 (1.30–1.81)** 55.3 1.45 (1.17–1.80)* 4.6 5.2 1.70 (0.95–3.01) 4.4 6.2   Retired 24.9 1.43 (1.05–1.95)* 42.8 1.12 (0.74–1.67) 1.0 3.7 5.14 (1.65–16.0)* 3.5 3.7   Unemployed 31.7 0.90 (0.63–1.29) 47.3 0.95 (0.57–1.58) 3.0 10.7 4.11 (1.62–10.4)* 3.5 4.8   Student 45.3 1.19 (0.84–1.68) 54.7 1.40 (0.86–2.28) 6.5 4.4 1.24 (0.42–3.70) 2.5 1.9  Drinking for work   Not required 37.9 NS 41.0 3.5 1.0 3.9 NS 3.4 1.0 5.0 NS   Yes, required 50.0 40.8 13.8 3.29 (1.48–7.30)* 11.8 12.1 2.99 (1.31–6.82)* 12.0 Drinking beliefs  Social benefits   Score < IQR 39.6 1.0 39.9 2.9 1.0 2.9 1.0 2.6 1.0 3.7 NS   Within IQR 32.8 0.83 (0.71–0.98)* 42.6 3.1 1.38 (0.89–2.14) 4.0 1.53 (0.82–2.86) 3.4 1.43 (0.93–2.20) 5.0   Score > IQR 39.7 1.06 (0.90–1.24) 41.7 5.4 2.43 (1.68–3.53)** 5.8 2.10 (1.31–3.36)* 5.5 2.14 (1.48–3.11)** 7.4  Work benefits   Score < IQR 33.4 1.0 35.4 1.0 2.8 NS 2.8 NS 3.0 NS 3.9 NS   Within IQR 35.7 1.17 (1.00–1.37)* 37.6 1.12 (0.91–1.39) 3.0 3.5 3.0 5.0   Score > IQR 46.9 1.68 (1.43–1.98)** 50.9 1.64 (1.70–1.97)** 5.2 6.4 4.8 7.2  Drinking is healthy   Disagree 37.5 NS 33.2 1.0 3.3 NS 2.8 1.0 3.1 NS 2.2 1.0   Agree 41.0 46.5 1.64 (1.37–1.97)** 4.8 5.1 1.68 (1.04–2.71)* 5.6 7.4 3.07 (1.89–4.98)**  Causes GI issues   Agree 38.5 NS 40.9 3.5 3.8 1.0 3.6 5.0 1.0   Disagree 29.9 43.7 4.5 12.6 4.44 (2.17–9.12)** 2.7 11.6 3.38 (1.65–6.92)*  Helps one sleep   Disagree 34.9 1.0 35.3 1.0 2.7 1.0 2.8 1.0 2.4 1.0 3.3 1.0   Agree 44.9 1.42 (1.24–1.63)** 52.7 1.89 (1.57–2.28)** 5.6 1.92 (1.39–2.65)** 6.9 2.37 (1.54–3.64)** 6.0 2.38 (1.72–3.28)** 9.3 2.60 (1.79–3.78)** OR, odds ratios; CI, confidence interval; IQR, interquartile range; GI, gastrointestinal; Variables with dashes were not included in the multivariate model. Candidate variables had a significance of P < 0.20 in unadjusted analyses. NS, not significant, these variables were removed in the backwards elimination process. aAll respondents who were <18-years old in 2008 were removed from analysis of this variable since they would not be of legal drinking age. bVariables in backwards elimination were removed in the following order for the 2006 current drinking model: GI issues (OR = 0.84; 95% CI = 0.62, 1.15; P = 0.28), Job Drinking (OR = 1.39; 95% CI = 0.80, 2.42; P = 0.239), Drinking is good for health (OR = 1.15; 95% CI = 0.97, 1.36; P = 0.11); Variables in backwards elimination were removed in the following order for the 2011 current drinking model: Marital status (OR = 1.04; 95% CI = 0.79, 1.36; P = 0.79). cVariables in backwards elimination were removed in the following order for the 2006 past-month binge drinking model: Educational status (OR = 0.96; 95% CI = 0.67, 1.39; P = 0.83), Work Benefits Score (P = 0.51), Occupational status (P = 0.16), Drinking is good for health (OR = 1.37; 95% CI = 0.89, 1.95; P = 0.17); Variables in backwards elimination were removed in the following order for the 2011 past-month binge drinking model: Educational status (OR = 1.28; 95% CI = 0.80, 2.05; P = 0.30), Drinking for work (OR = 1.83; 95% CI = 0.79, 4.26; P = 0.16), Marital status (OR = 1.54; 95% CI = 0.87, 2.71; P = 0.14), Work Benefits Score (P = 0.08). dVariables in backwards elimination were removed in the following order for the 2006 weekly drinking model: Work Benefits Score (P = 0.38), Occupational status (P = 0.08), Drinking is good for health (OR = 1.44; 95% CI = 0.99, 2.09; P = 0.05); Variables in backwards elimination were removed in the following order for the 2011 weekly drinking model: Occupational status (P = 0.47), Work Benefits Score (P = 0.29), Job Drinking (OR = 1.90; 95% CI = 0.89, 4.04; P = 0.09), Social Benefits Score (P = 0.08). *P < 0.05; **P < 0.001. Certain subgroups emerged as new risk groups due to disproportionate increases in drinking behaviors by 2011. Retired and unemployed women became new risk groups for binge drinking due to increases (OR = 4.32–5.14), and middle-aged women (36–45-years-old) emerged as a risk group for weekly drinking. Although, the belief that drinking aids sleep showed positive associations with all drinking patterns across surveys, the perception that ‘drinking is healthy’ emerged as a new independent risk factor for current drinking (ORmv = 1.64, 95% CI = 1.37–1.97), past-month binge drinking (ORmv = 1.67, 95% CI = 1.04–2.69), and weekly drinking (ORmv = 3.07, 95% CI = 1.89–4.98) in 2011. Women who lacked awareness of adverse health effects of chronic drinking became a risk group for binge drinking and weekly drinking by 2011 (ORmv = 3.38–4.54). Age subgroup analysis of factors associated with drinking patterns among Hong Kong women To inform targeted alcohol health interventions, we conducted further subgroup analyses (untabulated) for the 2011 data after stratification by three age groups (18–35, 36–55 and 56–70 year olds). Across all age groups, current drinking had positive associations with the ‘drinking is healthy’ perception (OR = 1.56–1.89) and with post-secondary education (OR = 1.53–2.28). A high score on the Work Benefits of Drinking scale (OR = 1.58–1.91) and the belief that drinking aids sleep (OR = 2.01–2.15) were only associated with current drinking in women 18-55 years old. By contrast, current drinking was marginally associated (P < 0.10) with being employed in women above 35 years old (OR = 1.52-1.61). Women in the 18–35 and 36–55 age strata showed associations between weekly drinking and the belief in alcohol as a sleep aid (OR = 3.42–3.95) and the lack of awareness of health harms (OR = 3.42–3.95). Weekly drinking in these women had dissimilar associations with the ‘drinking is healthy’ perception (18–35 years: OR = 5.70, 95% CI = 2.17–14; 36–55 years: OR = 1.84, 95% CI = 1.03–3.31). In women aged 18–35 and 36–55 years, binge drinking was significantly associated with the belief that drinking aids sleep (OR = 2.61–2.91), lack of awareness of health harms of drinking (OR = 3.42–4.72), high scores in the Social Benefits of Drinking scale (OR = 2.15–2.48), and marginally significant (P < 0.10) with the ‘drinking is healthy’ perception (OR = 1.94–2.28). For women 56–70 years old, the only significant predictor of weekly drinking was the ‘drinking is healthy’ perception with an estimated OR = 8.26 (estimated due to zero cell count). The belief that drinking aids sleep only showed marginally significant associations (OR = 2.64, P<0.10). Past-month binge drinking was only significantly associated with unemployment status in this stratum (OR = 22.2, 95% CI: 2.65–185.3). These findings suggest that drinking contexts and motivations in older age women differ considerably from their younger-aged counterparts. Factors and contexts associated with increased overall frequency of drinking since the alcohol policy change period The proportion of Hong Kong women who reported increasing their overall drinking frequencies since the alcohol tax policy changes is shown (Table 4). While 3.5% of the sample had increased their drinking frequencies, greater proportions of past-year drinkers (8.8%), binge drinkers (20.7%), weekly drinkers (23.1%), alcohol abusers (16.7%) and all three of the alcohol dependent women reported increases in overall drinking frequency after the alcohol policy changes (untabulated). The unadjusted analysis revealed nearly all study factors were associated with increased drinking frequency in 2011 (P < 0.05). In the multivariable analyses, women who: had some university education, were employed or students, were unemployed, believed in the health benefits of drinking, or drank for alcohol’s sedative properties were shown to be more likely to have increased their drinking frequency (OR = 1.89–8.08) after the alcohol policy changes. Table 4. Sociodemographic and attitudinal factors associated with increased frequency of drinking among Chinese women in Hong Kong—2011 (n = 2308) Reported increased drinking frequency since 2007–08 alcohol tax eliminationa Drank more often at social events Drank more often at outside meals Drank more often with co-workers Drank more often at home Drank more often in solitude Row % Crude OR ORmv(95% CI)b Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Sociodemographics  All 8.1 8.6 5.8 4.4 4.2 2.4  Age 0.573 0.437 0.064 0.637 0.816   21–25 years 14.3 1.0 NS 11.6 6.3 9.5 4.2 2.1   26–35 years 9.6 0.44* 8.5 7.9 5.5 2.4 1.8   36–45 years 8.0 0.32* 10.0 6.0 4.0 5.0 3.5   46–55 years 6.7 0.31* 7.8 5.9 3.4 5.4 2.4   56–70 years 3.3 0.08** 5.8 2.5 1.7 3.3 1.7  Educational level 0.149 0.512 0.398 0.251 0.772   Secondary or lower 6.4 1.0 1.00 7.5 5.4 4.0 3.6 2.3   Post- secondary 10.6 3.33** 2.35 (1.40–3.93)* 10.5 6.6 5.2 5.2 2.6  Marital status 0.100 0.071 0.004 0.503 0.844   Ever married 6.1 1.0 NS 7.6 4.9 3.1 4.5 2.4   Never married 12.7 3.02** 11.3 8.2 7.8 3.5 2.6  Occupation 0.230 0.169 0.305 0.469 0.101   Housewife 3.1 1.0 1.00 5.3 3.5 3.1 2.2 0.9   Employed 10.1 6.49** 6.14 (2.79–13.59)** 10.3 7.0 5.3 5.2 3.6   Retired 2.3 0.60 0.59 (0.07–4.82) 6.8 2.3 0.0 4.5 0.0   Unemployed 20.8 8.52** 7.68 (2.41–24.49)** 12.5 12.5 8.3 4.2 0.0   Student 13.2 10.65** 5.57 (1.52–20.43)* 10.8 8.1 5.4 2.7 0.0  Job requires drinking 0.547 0.184 0.383 0.337 0.601   None required 7.7 1.0 NS 8.6 5.7 4.3 4.1 2.4   Yes, required 19.2 2.58* 12.0 12.0 8.0 8.0 4.0 Drinking beliefs  Social benefits 0.497 0.348 0.147 0.751 0.519   Score < IQR 6.8 1.0 NS 9.1 4.6 3.4 3.7 1.7   Score within IQR) 5.9 1.31 6.0 6.0 3.0 5.3 3.0   Score > IQR 10.4 1.62 9.2 7.2 6.3 4.3 3.0  Work benefits 0.898 0.498 0.063 0.902 0.368   Score < IQR (ref) 7.4 1.0 1.00 8.8 4.6 3.8 4.6 3.1   Score Within IQR) 5.4 0.94 0.92 (0.48–1.77) 8.0 5.9 2.5 3.8 1.3   Score > IQR 11.0 2.69** 2.41 (1.37–4.25)* 9.1 7.0 6.6 4.2 2.8  Drinking is healthy 0.419 0.142 0.033 0.119 0.030   Disagree 5.1 1.0 1.00 7.5 4.1 2.3 2.6 0.8   Agree 9.6 2.53** 1.92 (1.10–3.35)* 9.2 6.7 5.6 5.0 3.3  Causes GI issues 0.014 0.053 0.482 0.080 0.686   Agree 7.9 1.0 NS 8.2 5.5 4.4 4.0 2.4   Disagree 13.8 1.46 21.4 14.3 7.1 10.7 3.6  Drinking helps sleep 0.028 0.017 0.410 0.062 0.335   Disagree 5.4 1.0 1.00 6.8 4.2 3.9 3.1 2.0   Agree 11.8 4.09** 4.07 (2.46–6.73)** 11.2 8.2 5.2 5.8 3.0 Reported increased drinking frequency since 2007–08 alcohol tax eliminationa Drank more often at social events Drank more often at outside meals Drank more often with co-workers Drank more often at home Drank more often in solitude Row % Crude OR ORmv(95% CI)b Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Sociodemographics  All 8.1 8.6 5.8 4.4 4.2 2.4  Age 0.573 0.437 0.064 0.637 0.816   21–25 years 14.3 1.0 NS 11.6 6.3 9.5 4.2 2.1   26–35 years 9.6 0.44* 8.5 7.9 5.5 2.4 1.8   36–45 years 8.0 0.32* 10.0 6.0 4.0 5.0 3.5   46–55 years 6.7 0.31* 7.8 5.9 3.4 5.4 2.4   56–70 years 3.3 0.08** 5.8 2.5 1.7 3.3 1.7  Educational level 0.149 0.512 0.398 0.251 0.772   Secondary or lower 6.4 1.0 1.00 7.5 5.4 4.0 3.6 2.3   Post- secondary 10.6 3.33** 2.35 (1.40–3.93)* 10.5 6.6 5.2 5.2 2.6  Marital status 0.100 0.071 0.004 0.503 0.844   Ever married 6.1 1.0 NS 7.6 4.9 3.1 4.5 2.4   Never married 12.7 3.02** 11.3 8.2 7.8 3.5 2.6  Occupation 0.230 0.169 0.305 0.469 0.101   Housewife 3.1 1.0 1.00 5.3 3.5 3.1 2.2 0.9   Employed 10.1 6.49** 6.14 (2.79–13.59)** 10.3 7.0 5.3 5.2 3.6   Retired 2.3 0.60 0.59 (0.07–4.82) 6.8 2.3 0.0 4.5 0.0   Unemployed 20.8 8.52** 7.68 (2.41–24.49)** 12.5 12.5 8.3 4.2 0.0   Student 13.2 10.65** 5.57 (1.52–20.43)* 10.8 8.1 5.4 2.7 0.0  Job requires drinking 0.547 0.184 0.383 0.337 0.601   None required 7.7 1.0 NS 8.6 5.7 4.3 4.1 2.4   Yes, required 19.2 2.58* 12.0 12.0 8.0 8.0 4.0 Drinking beliefs  Social benefits 0.497 0.348 0.147 0.751 0.519   Score < IQR 6.8 1.0 NS 9.1 4.6 3.4 3.7 1.7   Score within IQR) 5.9 1.31 6.0 6.0 3.0 5.3 3.0   Score > IQR 10.4 1.62 9.2 7.2 6.3 4.3 3.0  Work benefits 0.898 0.498 0.063 0.902 0.368   Score < IQR (ref) 7.4 1.0 1.00 8.8 4.6 3.8 4.6 3.1   Score Within IQR) 5.4 0.94 0.92 (0.48–1.77) 8.0 5.9 2.5 3.8 1.3   Score > IQR 11.0 2.69** 2.41 (1.37–4.25)* 9.1 7.0 6.6 4.2 2.8  Drinking is healthy 0.419 0.142 0.033 0.119 0.030   Disagree 5.1 1.0 1.00 7.5 4.1 2.3 2.6 0.8   Agree 9.6 2.53** 1.92 (1.10–3.35)* 9.2 6.7 5.6 5.0 3.3  Causes GI issues 0.014 0.053 0.482 0.080 0.686   Agree 7.9 1.0 NS 8.2 5.5 4.4 4.0 2.4   Disagree 13.8 1.46 21.4 14.3 7.1 10.7 3.6  Drinking helps sleep 0.028 0.017 0.410 0.062 0.335   Disagree 5.4 1.0 1.00 6.8 4.2 3.9 3.1 2.0   Agree 11.8 4.09** 4.07 (2.46–6.73)** 11.2 8.2 5.2 5.8 3.0 OR, odds ratios; CI, confidence interval; IQR, interquartile range; GI, gastrointestinal; NS, not significant, these variables were removed in the backwards elimination process. aAll respondents who were less than 18 years old in 2008 were removed from analysis of this variable since they would not be of legal drinking age. bVariables in backwards elimination were removed in the following order: GI issues (P = 0.577), Marital status (OR = 1.38; 95% CI = 0.70, 2.74; P = 0.350), Social Benefits Score (P = 0.421), Age (P = 0.282), Job Drinking (OR = 2.13; 95% CI = 0.80, 5.67; P = 0.129). *P < 0.05, **P < 0.001. Table 4. Sociodemographic and attitudinal factors associated with increased frequency of drinking among Chinese women in Hong Kong—2011 (n = 2308) Reported increased drinking frequency since 2007–08 alcohol tax eliminationa Drank more often at social events Drank more often at outside meals Drank more often with co-workers Drank more often at home Drank more often in solitude Row % Crude OR ORmv(95% CI)b Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Sociodemographics  All 8.1 8.6 5.8 4.4 4.2 2.4  Age 0.573 0.437 0.064 0.637 0.816   21–25 years 14.3 1.0 NS 11.6 6.3 9.5 4.2 2.1   26–35 years 9.6 0.44* 8.5 7.9 5.5 2.4 1.8   36–45 years 8.0 0.32* 10.0 6.0 4.0 5.0 3.5   46–55 years 6.7 0.31* 7.8 5.9 3.4 5.4 2.4   56–70 years 3.3 0.08** 5.8 2.5 1.7 3.3 1.7  Educational level 0.149 0.512 0.398 0.251 0.772   Secondary or lower 6.4 1.0 1.00 7.5 5.4 4.0 3.6 2.3   Post- secondary 10.6 3.33** 2.35 (1.40–3.93)* 10.5 6.6 5.2 5.2 2.6  Marital status 0.100 0.071 0.004 0.503 0.844   Ever married 6.1 1.0 NS 7.6 4.9 3.1 4.5 2.4   Never married 12.7 3.02** 11.3 8.2 7.8 3.5 2.6  Occupation 0.230 0.169 0.305 0.469 0.101   Housewife 3.1 1.0 1.00 5.3 3.5 3.1 2.2 0.9   Employed 10.1 6.49** 6.14 (2.79–13.59)** 10.3 7.0 5.3 5.2 3.6   Retired 2.3 0.60 0.59 (0.07–4.82) 6.8 2.3 0.0 4.5 0.0   Unemployed 20.8 8.52** 7.68 (2.41–24.49)** 12.5 12.5 8.3 4.2 0.0   Student 13.2 10.65** 5.57 (1.52–20.43)* 10.8 8.1 5.4 2.7 0.0  Job requires drinking 0.547 0.184 0.383 0.337 0.601   None required 7.7 1.0 NS 8.6 5.7 4.3 4.1 2.4   Yes, required 19.2 2.58* 12.0 12.0 8.0 8.0 4.0 Drinking beliefs  Social benefits 0.497 0.348 0.147 0.751 0.519   Score < IQR 6.8 1.0 NS 9.1 4.6 3.4 3.7 1.7   Score within IQR) 5.9 1.31 6.0 6.0 3.0 5.3 3.0   Score > IQR 10.4 1.62 9.2 7.2 6.3 4.3 3.0  Work benefits 0.898 0.498 0.063 0.902 0.368   Score < IQR (ref) 7.4 1.0 1.00 8.8 4.6 3.8 4.6 3.1   Score Within IQR) 5.4 0.94 0.92 (0.48–1.77) 8.0 5.9 2.5 3.8 1.3   Score > IQR 11.0 2.69** 2.41 (1.37–4.25)* 9.1 7.0 6.6 4.2 2.8  Drinking is healthy 0.419 0.142 0.033 0.119 0.030   Disagree 5.1 1.0 1.00 7.5 4.1 2.3 2.6 0.8   Agree 9.6 2.53** 1.92 (1.10–3.35)* 9.2 6.7 5.6 5.0 3.3  Causes GI issues 0.014 0.053 0.482 0.080 0.686   Agree 7.9 1.0 NS 8.2 5.5 4.4 4.0 2.4   Disagree 13.8 1.46 21.4 14.3 7.1 10.7 3.6  Drinking helps sleep 0.028 0.017 0.410 0.062 0.335   Disagree 5.4 1.0 1.00 6.8 4.2 3.9 3.1 2.0   Agree 11.8 4.09** 4.07 (2.46–6.73)** 11.2 8.2 5.2 5.8 3.0 Reported increased drinking frequency since 2007–08 alcohol tax eliminationa Drank more often at social events Drank more often at outside meals Drank more often with co-workers Drank more often at home Drank more often in solitude Row % Crude OR ORmv(95% CI)b Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Sociodemographics  All 8.1 8.6 5.8 4.4 4.2 2.4  Age 0.573 0.437 0.064 0.637 0.816   21–25 years 14.3 1.0 NS 11.6 6.3 9.5 4.2 2.1   26–35 years 9.6 0.44* 8.5 7.9 5.5 2.4 1.8   36–45 years 8.0 0.32* 10.0 6.0 4.0 5.0 3.5   46–55 years 6.7 0.31* 7.8 5.9 3.4 5.4 2.4   56–70 years 3.3 0.08** 5.8 2.5 1.7 3.3 1.7  Educational level 0.149 0.512 0.398 0.251 0.772   Secondary or lower 6.4 1.0 1.00 7.5 5.4 4.0 3.6 2.3   Post- secondary 10.6 3.33** 2.35 (1.40–3.93)* 10.5 6.6 5.2 5.2 2.6  Marital status 0.100 0.071 0.004 0.503 0.844   Ever married 6.1 1.0 NS 7.6 4.9 3.1 4.5 2.4   Never married 12.7 3.02** 11.3 8.2 7.8 3.5 2.6  Occupation 0.230 0.169 0.305 0.469 0.101   Housewife 3.1 1.0 1.00 5.3 3.5 3.1 2.2 0.9   Employed 10.1 6.49** 6.14 (2.79–13.59)** 10.3 7.0 5.3 5.2 3.6   Retired 2.3 0.60 0.59 (0.07–4.82) 6.8 2.3 0.0 4.5 0.0   Unemployed 20.8 8.52** 7.68 (2.41–24.49)** 12.5 12.5 8.3 4.2 0.0   Student 13.2 10.65** 5.57 (1.52–20.43)* 10.8 8.1 5.4 2.7 0.0  Job requires drinking 0.547 0.184 0.383 0.337 0.601   None required 7.7 1.0 NS 8.6 5.7 4.3 4.1 2.4   Yes, required 19.2 2.58* 12.0 12.0 8.0 8.0 4.0 Drinking beliefs  Social benefits 0.497 0.348 0.147 0.751 0.519   Score < IQR 6.8 1.0 NS 9.1 4.6 3.4 3.7 1.7   Score within IQR) 5.9 1.31 6.0 6.0 3.0 5.3 3.0   Score > IQR 10.4 1.62 9.2 7.2 6.3 4.3 3.0  Work benefits 0.898 0.498 0.063 0.902 0.368   Score < IQR (ref) 7.4 1.0 1.00 8.8 4.6 3.8 4.6 3.1   Score Within IQR) 5.4 0.94 0.92 (0.48–1.77) 8.0 5.9 2.5 3.8 1.3   Score > IQR 11.0 2.69** 2.41 (1.37–4.25)* 9.1 7.0 6.6 4.2 2.8  Drinking is healthy 0.419 0.142 0.033 0.119 0.030   Disagree 5.1 1.0 1.00 7.5 4.1 2.3 2.6 0.8   Agree 9.6 2.53** 1.92 (1.10–3.35)* 9.2 6.7 5.6 5.0 3.3  Causes GI issues 0.014 0.053 0.482 0.080 0.686   Agree 7.9 1.0 NS 8.2 5.5 4.4 4.0 2.4   Disagree 13.8 1.46 21.4 14.3 7.1 10.7 3.6  Drinking helps sleep 0.028 0.017 0.410 0.062 0.335   Disagree 5.4 1.0 1.00 6.8 4.2 3.9 3.1 2.0   Agree 11.8 4.09** 4.07 (2.46–6.73)** 11.2 8.2 5.2 5.8 3.0 OR, odds ratios; CI, confidence interval; IQR, interquartile range; GI, gastrointestinal; NS, not significant, these variables were removed in the backwards elimination process. aAll respondents who were less than 18 years old in 2008 were removed from analysis of this variable since they would not be of legal drinking age. bVariables in backwards elimination were removed in the following order: GI issues (P = 0.577), Marital status (OR = 1.38; 95% CI = 0.70, 2.74; P = 0.350), Social Benefits Score (P = 0.421), Age (P = 0.282), Job Drinking (OR = 2.13; 95% CI = 0.80, 5.67; P = 0.129). *P < 0.05, **P < 0.001. Of the various contexts of drinking, relatively larger percentages of women reported drinking more often at social events (8.6%) and social meals at restaurants (5.8%). Smaller percentages reported drinking more frequently with co-workers (4.4 %), at home (4.2%) and in solitude (2.4%). Women who reported drinking more in social contexts showed similar sociodemographic profiles (younger, single, with higher education) and significantly more likely to ascribe to the social benefits of drinking. Women who reported increased drinking in solitude revealed that they were only more likely to ascribe to the beliefs of alcohol’s health benefits or sedative properties. Women who reported increased drinking at home showed patterns intermediate between these profiles. Notably, women who ascribed to alcohol’s health benefits or sedative properties were significantly more likely to have reported increased drinking frequencies in all drinking contexts by 2011. Self-reported drinking influences among women reporting increased drinking frequency in 2011 The comparison of self-reported influences on drinking behaviors between women who did and did not report increased frequency of drinking (Table 5) revealed that women with an increased frequency of drinking were most likely to state peer/social influences that encouraged drinking, widespread alcohol promotion, and their own greater familiarity with alcoholic beverages in the past 3 years (50.0–61.3%). Slightly smaller proportions of women who increased their drinking frequency (41.3–48.1%) cited economic reasons (lower prices and increased accessibility). About one-third reported that work culture or higher income influenced their drinking, and only 2.5% reported financial stress as an influence. All examined factors were significantly different between women who did and did not state increases in their drinking frequencies. The only influencing factor that was higher among women who did not report an increase in their drinking frequency was the lower price of alcohol. DISCUSSION The overall drinking patterns that emerged among Chinese women in the period following the alcohol policy changes generally reflected the uptake of moderate levels of drinking. The study noted small increases in the overall age-adjusted prevalence of past-year and weekly drinking but not binge drinking. Certain subgroups deviated from these general trends, and there were distinct profiles of women who increased their drinking frequencies, indicating the need for segmented alcohol harms reduction strategies. Comparable to a Singaporean study conducted during a similar time period (Lim et al., 2007), our study noted that middle-aged women rather than younger-aged women demonstrated significant increases in frequent and heavy drinking during this period. Since Singapore continued to impose high-alcohol duties and did not implement policy changes during this time, the consistency of regional findings indicates other macro-level forces are likely influencing middle-aged women’s drinking behaviors, as well as the policy change. Middle-aged women may have emerged as prime targets of regional marketing campaigns for their higher consumer spending power, particularly for luxury brands (Nelson, 2011b). In contrast to most areas in the West, which mainly target younger age ‘party’ drinkers, alcohol marketing in the China region often promotes an image of cultural sophistication. In Hong Kong, expensive spirits are common gifts to business associates, and high-end alcohol is commonly served at important festivities. Our study noted that middle-aged women were most likely to agree that there was greater availability of higher quality alcohol in recent years (untabulated). Unemployed women emerged as a major risk group for binge drinking and had the highest likelihood of overall increased drinking frequency by 2011. Previous research has noted associations between unemployment and heavy drinking and posited that financial stress, family discord and increased leisure time contribute to increased levels of drinking (Popovici and French, 2013; Bosque-Prous et al., 2015). Our results partly corroborate past findings by revealing that unemployed women who reported increased drinking frequencies were significantly more likely to be social drinkers. We speculate that unemployed women may have become a prime risk group due to the combined effect of a lack of participation in other social activities and greater leisure time to indulge in social drinking. Prior to 2011, small proportions of married women drank frequently (Kim et al., 2008), but after the tax policy change period there was no longer a disparity by marital status in any drinking pattern. This trend may indicate cultural shifts in married women’s perceived social norms of alcohol consumption and the cultural acceptability of frequent or heavy drinking in a traditionally low consumption region. As posited, the changes in drinking behaviors appeared to reflect a confluence of personal and socio-environmental factors. We noted two general contexts of increased drinking among Chinese women, indicating the need for segmented public health strategies (targeting different ages, professional status and drinking contexts) that address diverging and evolving drinking contexts. First, many women who increased their drinking frequency were social drinkers, who were more likely to cite influences from peers and alcohol marketing. Specifically, greater familiarity with alcohol, promotions of alcohol and improved selection of alcohol were cited by >40% of the women in 2011 who reported increased drinking. After the alcohol tax elimination, alcohol promotional events (e.g. wine festivals, Hong Kong Beertopia) were sponsored, encouraging a festive environment for socializing in Hong Kong (PR Newswire, 2016). During this time, there was an explosion of certified wine education and interest programs and greater coverage of wine topics in Hong Kong’s popular press (Poon, 2016). Post-hoc analysis noted that women were statistically more likely to have increased their consumption of wine, but not other types of alcohol by 2011. These facts lend credence to the influence of greater familiarity with alcohol in combination with promotion of drinking events contributing to increased levels of drinking among Hong Kong Chinese women. The second profile of women who increased their drinking frequencies was non-social drinkers who ascribed to the health and relaxation benefits of drinking. In fact, one of the more prominent trends is the predictive power of the belief that ‘drinking is healthy’. By 2011, this belief was significantly associated with all drinking patterns and increased frequency of drinking in nearly all drinking contexts. The purported beneficial effects of wine on cardiovascular health are widely publicized by the local media and the alcohol industry in both Hong Kong and China (Nelson, 2011a; Yoon and Lam, 2012). In high-alcohol consumption countries, excessive drinking is generally associated with a heavy disease burden, significant social problems and economic loss, while low alcohol consumption regions are traditionally much less affected by these harms and possess lower levels of awareness. In addition to limiting accessibility and alcohol promotions, increasing the knowledge of alcohol harms should be considered in order to counteract the aggressive marketing of health benefits of drinking by the alcohol industry. The 2007–2008 Hong Kong alcohol tax elimination did not appear to have a direct price effect on the changes in Hong Kong Chinese women’s drinking patterns. Less than half of women who increased their drinking reported that their drinking was directly influenced by price. In fact, women who drank more frequently were less likely to perceive that alcohol was cheaper after the tax changes. The gradual elimination of alcohol taxes appears to have increased drinking via indirect pathways since the Consumer Price Index of alcohol did not decline noticeably during these years despite the large tax reduction, suggesting high profit margins for retailers (Chung et al., 2013). The elimination of alcohol duties appears to have provided incentives for businesses to offer a wider range of alcoholic beverages and for bars to aggressively encourage social drinking. The resulting changes in the alcohol market such as publicized alcohol festivals and increased visibility from sponsorships in public events may have created an environment that is more conducive to social drinking in women. Policy changes may have indirectly contributed to increased women’s alcohol consumption by increasing alcohol product selection, altering the context of drinking and changing personal perceptions of alcohol consumption. Limitations of this study include the cross-sectional design whereby the directionality of significant associations remains unclear. Moreover, since the two samples used in our study were 5 years apart, whereas age was stratified by 10-year increments, this study could not unequivocally disentangle the cohort effects and period effects. It cannot be unequivocally stated that increases in drinking prevalence in most age strata between 2006 and 2011 were due to changes in the drinking environment. It is possible that younger cohorts of women, who are more likely to take up drinking, maintained their drinking habits as they grew older. Future studies on Chinese women’s drinking patterns should address this limitation with age, period and cohort analyses over a longer time period to clarify their independent effects on drinking patterns. The self-reported telephone survey methodology precludes validation of drinking levels, and there are no official statistics of households reachable only by mobile telephones in 2006–2011. The proportion is likely to have been higher in 2011. Moreover, people living alone or in dormitories, who likely only possess a mobile phone, are likely not included in the sampling frame. Despite these limitations, these cross-sectional studies captured a large, representative sample of Hong Kong Chinese women that can serve as baseline data for future alcohol policy studies. CONCLUSION Our study observed increases in the frequency of alcohol consumption among subgroups of Hong Kong Chinese women after a period of highly publicized alcohol tax eliminations. We speculate that these policy changes contributed to a shift in the sociocultural environment of alcohol consumption. In 2011, versus 2006, we now see that more women are drinking in social contexts and believe in the health benefits of alcohol consumption. Continuous public health surveillance and the development of targeted messages will likely be needed to ensure that alcohol harms and disease burden do not increase among Hong Kong women. Timely interventions to reduce the harmful use of alcohol should be considered prior to the proliferation of alcohol use disorders at the population-level. FUNDING Funding for the 2006 survey was provided by the Li Ka Shing Foundation. 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( 2006 ) A comparative survey on alcohol and tobacco use in urban and rural populations in the Huaihua District of Hunan Province, China . Alcohol 39 : 87 – 96 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Medical Council on Alcohol and Oxford University Press. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Alcohol and Alcoholism Oxford University Press

Chinese Women’s Drinking Patterns Before and After the Hong Kong Alcohol Policy Changes

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Oxford University Press
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© The Author(s) 2018. Medical Council on Alcohol and Oxford University Press. All rights reserved.
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0735-0414
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1464-3502
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10.1093/alcalc/agy010
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Abstract

Abstract Aims To examine the patterns of alcohol consumption in Hong Kong Chinese women before and after a period of major alcohol policy amendments. Short summary This study compared alcohol consumption patterns in Hong Kong Chinese women before and after a period of major alcohol policy amendments and found increased drinking among certain subgroups, particularly middle-aged women. These increases are likely due to personal factors (e.g. changing perceptions) as well as environmental influences (e.g. greater marketing). Methods Cross-sectional telephone surveys were conducted on adult Chinese women prior to the 2007–2008 beer and wine tax eliminations in 2006 (n = 4946) and in 2011 (n = 2439). Results Over the study period, only women in the 36–45 year age stratum reported significant increases in all three drinking patterns: past-year drinking (38.1–45.2%), past-month binge drinking (2.3–5.2%) and weekly drinking (4.0–7.3%) (P < 0.05); middle-aged women, unemployed or retired women and those ascribing to alcohol’s health benefits emerged as new binge drinking risk groups. In 2011, 3.5% of all drinking-aged women (8.8% of past-year drinkers, 20.7% of binge drinkers and 23.1% of weekly drinkers) reported an increased drinking frequency after the tax policy changes. The main contexts of increased drinking were social events and with restaurant meals; moreover, beliefs of alcohol’s health benefits were common to all contexts of increased drinking. Of women who increased their drinking frequency, the largest proportion attributed it to peer effects/social environment conducive to drinking, and brand marketing/advertising influences. Conclusions Increased drinking among certain subgroups of Hong Kong Chinese women may be due to combined influences of: increased societal acceptance of social drinking, aggressive marketing promotions and personal beliefs in the health benefits of drinking that have recently emerged in the region. Hence, multi-prong strategies are required to combat potential drinking harms in these women. alcohol, policy, drinking, women, China, epidemiology INTRODUCTION Greater gender equality in education and employment along with the concomitant changes in social norms are considered to have improved women’s health in most areas of the world (Grown et al., 2005; WHO, 2009). Yet, previously uncommon health risk behaviors among females are becoming more prevalent. One major risk behavior that is showing global convergence between sexes is alcohol consumption, particularly in traditionally low alcohol consumption regions (Simons-Morton et al., 2009; Cheng et al., 2010; WHO, 2014). Given the greater physiological harms of heavy alcohol consumption on women than men (Nolen-Hoeksema, 2004; NIAAA, 2017) and due to the lack of public health policies in many low alcohol consumption countries, there is potential for an upsurge in alcohol-related burden of disease in the these regions (Diehl et al., 2007; Sugarman et al., 2009; Erol and Karpyak, 2015). Similar to many globalizing countries, China has been showing increasing levels of alcohol consumption (Li et al., 2015) in recent decades. Furthermore, increased drinking among Chinese women (Hao et al., 1999, 2004; Cochrane et al., 2003) has been diminishing the historically large gender disparities in drinking in the Asia region (Cho, 2004; Hao et al., 2004; Zhou et al., 2006). A study of five areas across China noted that a 13:1 male-to-female ratio of annual pure alcohol consumption in 2001 had diminished to a 5:1 ratio by 2010 (Hao et al., 1999, 2004; WHO, 2014). In Hong Kong, a globalized Chinese city, the heavy 80% import duties on wine and 40% duties on beer were gradually eliminated in 2007–2008 as part of an economic stimulus plan and as a territory-wide campaign to establish Hong Kong as the ‘wine capital of Asia’ (PR Newswire, 2010). In the years following the tax elimination, there was a dramatic increase in alcohol promotion through new product launches, wine-tasting classes and international alcohol expositions and festivals (Euromonitor International, 2010; Mintel International, 2011; InvestHK, 2016). By 2010, Hong Kong overtook New York as the largest wine auction center (InvestHK, 2016). As a possible consequence of these government policies, the prevalence of past-year drinkers increased (2006:47.3%, 2012:59.4%) (Chung et al., 2013) and the total consumption of alcohol in Hong Kong increased by more than 3.2 million liters of pure ethanol between 2006 and 2008 (Hong Kong Department of Health, 2011; Chung et al., 2013), with steady increases thereafter (Euromonitor International, 2010; Mintel International, 2011). Although research on heavy drinking has largely focused on men due to the higher likelihood of heavy alcohol consumption among males, in recent decades there have been increased interests in female drinking patterns. Studies on women’s drinking have been conducted to assess alcohol misuse patterns, adverse sequelae of heavy drinking and the factors associated with heavy drinking (Wilsnack et al., 1991; Graham et al., 2011; Wilsnack, 2012). Comparatively fewer studies have documented the changes in drinking motivations over time in women and, particularly, in non-Western populations (Wilsnack, 2012). Since, changes in Chinese women’s drinking behaviors have never been critically examined after a major alcohol policy amendment, this study aimed to explore any changes in drinking patterns and drinking motivations of Chinese women, a traditionally low alcohol consumption population, in a period following elimination of alcohol taxes. This study is underpinned by a socio-environmental framework in which changes in drinking patterns are influenced both by personal factors (e.g. sociodemographic attributes and personal beliefs) as well as environmental influences (e.g. increased selection and brand marketing of alcoholic beverages). This study examined the factors associated with changes in Hong Kong women’s alcohol drinking patterns in the period before and after the 2007–2008 alcohol tax elimination and explored the self-reported environmental influences that were associated with changes in consumption. The findings from this study may guide future alcohol policy and harms reduction programs for other globalizing cities in the region. METHODS This study consists of two cross-sectional surveys, using anonymous, telephone interviews using random selection of numbers from current telephone directories in April–June, 2006 (n = 9860, response rate = 65.2%) and April-September, 2011 (n = 4800, response rate = 62.8%). We define the response rate as the number of completed interviews divided by the number of eligible households. The study population comprised all Chinese-speaking permanent residents of Hong Kong between the ages of 18 and 70 years. In 2003, ~98% of the households had a fixed telephone line (Hong Kong Office of the Telecommunications Authority, personal communication, 2003), however, there are no official statistics of households that were reachable only by mobile phone during the study period. Other details of the sampling and data collection are outlined previously (Chung et al., 2013; Kim et al., 2013). We obtained ethics approval from the survey research ethics committee of The Chinese University of Hong Kong. MEASURES Both the 2006 and 2011 survey obtained information about the sociodemographics of respondents (Table 1). We classified those who reported a history of ever drinking a full-serving of alcohol, defined as a can of beer, glass of wine or shot of spirits, (Yes/No) as ‘ever drinkers’. We classified ‘ever drinkers’ who consumed alcohol in the past 12 months as ‘past-year drinkers’ and coded those who reported an average drinking frequency of at least once per week as ‘weekly drinkers’. We assessed past-month binge drinking by asking whether the respondent had consumed five servings of alcohol on one occasion in the preceding 30 days (Wechsler and Isaac, 1992). Alcohol dependence and alcohol abuse were determined from the Chinese Bilingual Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV (American Psychiatric Association, 2000) and has been shown to have a high degree of reliability (So et al., 2005). We did not explore alcohol abuse or alcohol dependence due to a small sample of these women (n = 24). Table 1. Background characteristics for Female Survey Respondentsa in Hong Kong in 2006 and 2011 2006 2011 χ2 P-value % (n = 4946) % (n = 2439) Age <0.001  18–25 13.9 (686) 13.9 (339)  26–35 20.0 (987) 18.5 (452)  36–45 27.7 (1362) 23.1 (562)  46–55 22.5 (1114) 24.8 (604)  56–70 15.8 (779) 19.7 (480) Educational attainment <0.001  Primary or less 20.3 (1000) 13.4 (327)  Secondary (Form 1–5) or  technical school 46.2 (2282) 48.7 (1184)  Matriculation (Form 6–7) 7.9 (390) 6.6 (161)  Tertiary or more 25.6 (1260) 31.2 (757) Marital status 0.151  Ever married (includes  divorced/widowed) 72.4 (3557) 70.8 (1721)  Never Married 27.6 (1354) 29.2 (709) Employment  Employed at least part-time 49.6 (2447) 49.2 (1201) 0.115  Retired 8.2 (402) 6.7 (162)  Unemployed and seeking  work 4.1 (202) 3.5 (84)  Full-time student 6.5 (322) 6.6 (159)  Full-time housewife 31.6 (1557) 33.3 (803) Lifetime drinking status  Ever drinker 59.2 (2928) 75.4 (1837) <0.001  Never consumed full- serving of alcohol 40.8 (2015) 24.6 (600) 2006 2011 χ2 P-value % (n = 4946) % (n = 2439) Age <0.001  18–25 13.9 (686) 13.9 (339)  26–35 20.0 (987) 18.5 (452)  36–45 27.7 (1362) 23.1 (562)  46–55 22.5 (1114) 24.8 (604)  56–70 15.8 (779) 19.7 (480) Educational attainment <0.001  Primary or less 20.3 (1000) 13.4 (327)  Secondary (Form 1–5) or  technical school 46.2 (2282) 48.7 (1184)  Matriculation (Form 6–7) 7.9 (390) 6.6 (161)  Tertiary or more 25.6 (1260) 31.2 (757) Marital status 0.151  Ever married (includes  divorced/widowed) 72.4 (3557) 70.8 (1721)  Never Married 27.6 (1354) 29.2 (709) Employment  Employed at least part-time 49.6 (2447) 49.2 (1201) 0.115  Retired 8.2 (402) 6.7 (162)  Unemployed and seeking  work 4.1 (202) 3.5 (84)  Full-time student 6.5 (322) 6.6 (159)  Full-time housewife 31.6 (1557) 33.3 (803) Lifetime drinking status  Ever drinker 59.2 (2928) 75.4 (1837) <0.001  Never consumed full- serving of alcohol 40.8 (2015) 24.6 (600) aOf women who were 18 years or older. Table 1. Background characteristics for Female Survey Respondentsa in Hong Kong in 2006 and 2011 2006 2011 χ2 P-value % (n = 4946) % (n = 2439) Age <0.001  18–25 13.9 (686) 13.9 (339)  26–35 20.0 (987) 18.5 (452)  36–45 27.7 (1362) 23.1 (562)  46–55 22.5 (1114) 24.8 (604)  56–70 15.8 (779) 19.7 (480) Educational attainment <0.001  Primary or less 20.3 (1000) 13.4 (327)  Secondary (Form 1–5) or  technical school 46.2 (2282) 48.7 (1184)  Matriculation (Form 6–7) 7.9 (390) 6.6 (161)  Tertiary or more 25.6 (1260) 31.2 (757) Marital status 0.151  Ever married (includes  divorced/widowed) 72.4 (3557) 70.8 (1721)  Never Married 27.6 (1354) 29.2 (709) Employment  Employed at least part-time 49.6 (2447) 49.2 (1201) 0.115  Retired 8.2 (402) 6.7 (162)  Unemployed and seeking  work 4.1 (202) 3.5 (84)  Full-time student 6.5 (322) 6.6 (159)  Full-time housewife 31.6 (1557) 33.3 (803) Lifetime drinking status  Ever drinker 59.2 (2928) 75.4 (1837) <0.001  Never consumed full- serving of alcohol 40.8 (2015) 24.6 (600) 2006 2011 χ2 P-value % (n = 4946) % (n = 2439) Age <0.001  18–25 13.9 (686) 13.9 (339)  26–35 20.0 (987) 18.5 (452)  36–45 27.7 (1362) 23.1 (562)  46–55 22.5 (1114) 24.8 (604)  56–70 15.8 (779) 19.7 (480) Educational attainment <0.001  Primary or less 20.3 (1000) 13.4 (327)  Secondary (Form 1–5) or  technical school 46.2 (2282) 48.7 (1184)  Matriculation (Form 6–7) 7.9 (390) 6.6 (161)  Tertiary or more 25.6 (1260) 31.2 (757) Marital status 0.151  Ever married (includes  divorced/widowed) 72.4 (3557) 70.8 (1721)  Never Married 27.6 (1354) 29.2 (709) Employment  Employed at least part-time 49.6 (2447) 49.2 (1201) 0.115  Retired 8.2 (402) 6.7 (162)  Unemployed and seeking  work 4.1 (202) 3.5 (84)  Full-time student 6.5 (322) 6.6 (159)  Full-time housewife 31.6 (1557) 33.3 (803) Lifetime drinking status  Ever drinker 59.2 (2928) 75.4 (1837) <0.001  Never consumed full- serving of alcohol 40.8 (2015) 24.6 (600) aOf women who were 18 years or older. The 2011 survey further asked whether the respondent increased their overall drinking frequency since the 2008 alcohol tax elimination. Respondents who increased their overall drinking frequencies were then asked to choose a reason (Table 5) with an option to give an open-ended response. Since these items asked about any drinking behaviors and preferences in the past 3 years, we removed respondents below the age of 21 (who, 3 years prior, would have been below the legal drinking age of 18) from the analysis of this item. The 2011 survey also asked about the contexts of their past-year drinking. All variables in the database were examined for incorrect values for response choices and missing data, and the original data entry forms were referenced to resolve possible data entry errors. No variables had more than 0.3% missing data. Values for missing responses were left as missing and not imputed for data analysis. Table 5. Comparison of influences on changes in drinking frequency among Chinese womena in Hong Kong after tax policy changes—2011 (n = 2307) Self-reported drinking-related influences Increased drinking frequency in the 3 years since alcohol policy changes (n = 80) Did not increase drinking frequency (n = 2227) P-value % (n) % (n) Felt drinking was affected by peers/social situations 61.3 (49) 3.0 (66) <0.001 Felt affected by Advertisements and Media 50.0 (40) 35.6 (792) 0.012 More familiar and used to certain types of alcohol 50.0 (40) 3.1 (69) <0.001 Felt that alcohol is cheaper because of tax reduction 48.1 (38) 61.8 (1376) 0.018 Felt that restaurants/bars/nightclubs have more drink promotions 45.0 (36) 25.6 (570) <0.001 Felt that restaurants/stores have greater selection of quality alcohol 41.3 (33) 23.3 (520) <0.001 Felt that drinking environment is influenced by working culture 36.3 (29) 1.3 (29) <0.001 Drank due to more expendable money 30.0 (24) 1.1 (24) <0.001 Drank due to financial stress 2.5 (2) 0.2 (4) <0.001 Self-reported drinking-related influences Increased drinking frequency in the 3 years since alcohol policy changes (n = 80) Did not increase drinking frequency (n = 2227) P-value % (n) % (n) Felt drinking was affected by peers/social situations 61.3 (49) 3.0 (66) <0.001 Felt affected by Advertisements and Media 50.0 (40) 35.6 (792) 0.012 More familiar and used to certain types of alcohol 50.0 (40) 3.1 (69) <0.001 Felt that alcohol is cheaper because of tax reduction 48.1 (38) 61.8 (1376) 0.018 Felt that restaurants/bars/nightclubs have more drink promotions 45.0 (36) 25.6 (570) <0.001 Felt that restaurants/stores have greater selection of quality alcohol 41.3 (33) 23.3 (520) <0.001 Felt that drinking environment is influenced by working culture 36.3 (29) 1.3 (29) <0.001 Drank due to more expendable money 30.0 (24) 1.1 (24) <0.001 Drank due to financial stress 2.5 (2) 0.2 (4) <0.001 aLimited to women aged 18 or older in 2008. Table 5. Comparison of influences on changes in drinking frequency among Chinese womena in Hong Kong after tax policy changes—2011 (n = 2307) Self-reported drinking-related influences Increased drinking frequency in the 3 years since alcohol policy changes (n = 80) Did not increase drinking frequency (n = 2227) P-value % (n) % (n) Felt drinking was affected by peers/social situations 61.3 (49) 3.0 (66) <0.001 Felt affected by Advertisements and Media 50.0 (40) 35.6 (792) 0.012 More familiar and used to certain types of alcohol 50.0 (40) 3.1 (69) <0.001 Felt that alcohol is cheaper because of tax reduction 48.1 (38) 61.8 (1376) 0.018 Felt that restaurants/bars/nightclubs have more drink promotions 45.0 (36) 25.6 (570) <0.001 Felt that restaurants/stores have greater selection of quality alcohol 41.3 (33) 23.3 (520) <0.001 Felt that drinking environment is influenced by working culture 36.3 (29) 1.3 (29) <0.001 Drank due to more expendable money 30.0 (24) 1.1 (24) <0.001 Drank due to financial stress 2.5 (2) 0.2 (4) <0.001 Self-reported drinking-related influences Increased drinking frequency in the 3 years since alcohol policy changes (n = 80) Did not increase drinking frequency (n = 2227) P-value % (n) % (n) Felt drinking was affected by peers/social situations 61.3 (49) 3.0 (66) <0.001 Felt affected by Advertisements and Media 50.0 (40) 35.6 (792) 0.012 More familiar and used to certain types of alcohol 50.0 (40) 3.1 (69) <0.001 Felt that alcohol is cheaper because of tax reduction 48.1 (38) 61.8 (1376) 0.018 Felt that restaurants/bars/nightclubs have more drink promotions 45.0 (36) 25.6 (570) <0.001 Felt that restaurants/stores have greater selection of quality alcohol 41.3 (33) 23.3 (520) <0.001 Felt that drinking environment is influenced by working culture 36.3 (29) 1.3 (29) <0.001 Drank due to more expendable money 30.0 (24) 1.1 (24) <0.001 Drank due to financial stress 2.5 (2) 0.2 (4) <0.001 aLimited to women aged 18 or older in 2008. Data Analysis We calculated age-specific prevalence and 95% confidence intervals (CI) for each drinking pattern (past-year drinking, past-month binge drinking, and weekly drinking) for both the 2006 and 2011 sample of women. In order to compare the change in drinking levels between the two time periods, we calculated direct age-standardized prevalence rates for 2006 and 2011 using the Hong Kong 2011 census population as reference and compared them using a chi-squared test and trend test. A multivariable logistic regression examined these drinking behaviors with gender as a covariate (males as reference category), adjusting for age, educational attainment, marital status, and employment status. To examine the factors associated with the drinking patterns, we conducted a factor analysis on the attitudinal variables that were common to both surveys. Two factors emerged: (a) Social Benefits of Drinking scale (Cronbach’s alpha = 0.85) and (b) Professional Benefits of Drinking scale (Cronbach’s alpha = 0.65). Each summative scale consisted of two items (1 = Disagree, 2 = No opinion, 3 = Agree). Due to the skewed data for the scale scores, we trichotomized the data based on the interquartile range (IQR) of the summative scale score (Low [<IQR] = 2 points, Medium [IQR] = 3–4 points, High [>IQR] = 5–6 points). The two trichotomized score variables were used in the multivariate models. Variables related to the health effects of alcohol did not form factors and were examined as stand-alone variables. We ran multivariable stepwise logistic regression models for all drinking patterns for both samples. After excluding individuals who were not of drinking age in 2008, we examined reported increases in overall drinking frequency in 2011 using multivariable stepwise logistic regression. We included sociodemographic and alcohol attitudinal variables that had a P < 0.20 in unadjusted analyses as candidate variables. We report our findings using odds ratios (OR) and 95% CI. Using Chi-squared tests, we examined increased frequency of drinking under various drinking contexts and compared women who increased their drinking versus those that did not with regard to various environmental factors. We considered all P-values<0.05 to be significant and used SPSS (Version 23) to conduct all analyses (IBM Corp. Released, 2015). RESULTS Characteristics of the study samples The background attributes of the samples (Table 1) showed that the 2011 sample had slightly older respondents, slightly more educated women, and greater proportion of ever drinkers than the 2006 sample, but there were no other statistically significant differences. Compared with the general population, both samples showed a somewhat higher representation of middle-aged women and higher levels of education. This is most likely attributable to the study’s exclusion criteria of respondents over the age of 70, who are generally less educated. Comparison of drinking patterns in 2006 versus 2011 The age-specific rates for past-year drinking, past-month binge drinking and weekly drinking are shown for the pre-tax elimination period (2006) and post-tax elimination period (2011) (Table 2) and revealed that in both periods, past-year drinking and past-month binge drinking showed strong inverse associations with age (trend test P < 0.0001), whereas weekly drinking was most prevalent among middle-aged women. Table 2. Age-specific prevalence of past-year drinking, past-month binge drinking and weekly drinking among Chinese womena in Hong Kong - 2006 (n = 4946) versus 2011 (n = 2439) 2006 (n) 2006 % (95% CI) 2011 (n) 2011 % (95% CI) Absolute Δ from 2006 Δ (95% CI) Past-year drinking  18–25 years 686 47.4 (43.6, 51.1) 339 51.0 (45.7, 56.4) +3.6% (−2.9, 10.1)  26–35 years 987 45.8 (42.7, 48.9) 452 41.8 (37.2, 46.4) −4.0% (−9.5,1.5)  36–45 years 1362 38.1 (35.5, 40.7) 562 45.2 (41.1, 49.3) +7.1% (2.2,11.9)*  46–55 years 1114 34.6 (31.8, 37.4) 604 40.7 (36.8, 44.7) +6.1% (1.3, 10.9)*  56–70 years 779 19.6 (16.8, 22.4) 480 28.5 (24.5, 32.6) +7.9% (4.0,13.8)**  All females 4928 37.2 (35.9, 38.6) 2437 41.0 (39.0, 42.9) +3.8% (1.4, 6.2)*  Age-adjusted prevalencea 38.3 (38.2, 38.4) 41.0 (40.9, 41.1) +2.7% (0.3, 5.1)*  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.44 (0.40, 0.49)** 0.53 (0.47, 0.61)** Past-month binge drinking  18–25 years 685 8.6 (6.5, 10.7) 339 6.2 (3.6, 8.8) −2.4% (−5.7, 0.9)  26–35 years 986 5.5 (4.1, 6.9) 452 7.3 (4.9, 9.7) +1.8% (−0.1, 4.6)  36–45 years 1362 2.3 (1.5, 3.1) 562 5.2 (3.3, 7.0) +2.9% (0.9, 4.9)**  46–55 years 1114 2.1 (1.2, 2.9) 604 2.0 (0.9, 3.1) −0.1% (−1.5, 1.3)  56–70 years 779 1.0 (0.3, 1.7) 480 1.3 (0.3, 2.2) +0.3% (−0.1, 1.5)  All females 4926 3.6 (3.0, 4.1) 2437 4.1 (3.4, 4.9) +0.6% (−0.3, 1.5)  Age-adjusted prevalencea 3.9 (3.8, 4.0) 4.3 (4.2, 4.4) +0.4% (−0.6, 1.4)  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.23 (0.19, 0.28)** 0.48 (0.37, 0.63)** Weekly drinking  18–25 years 686 3.1 (1.8,4.4) 339 4.1 (2.0, 6.3) +1.0% (−1.5, 3.5)  26–35 years 987 3.9 (2.6,5.1) 452 6.2 (4.0, 8.4) +2.3% (−0.2, 4.8)  36–45 years 1362 4.0 (2.9, 5.0) 562 7.3 (5.1,9.5) +3.3% (0.9, 5.7)a  46–55 years 1114 3.3 (2.3, 4.4) 604 5.0 (3.2, 6.7) +1.7% (−0.3, 3.7)  56–70 years 779 2.8 (1.7,4.0) 480 3.1 (1.6, 4.7) +0.3% (−1.6, 2.2)  All females 4928 3.5 (3.0,4.0) 2437 5.3 (4.4,6.1) +1.8% (0.8, 2.8)**  Age-adjusted prevalencea 3.4 (3.3, 3.5) 5.3 (5.2, 5.4) +1.8% (0.9, 2.9)**  P-value (χ2)/Trend test <0.0001/<0.0001 0.028/0.197  ORmv (95% CI)b (Males = ref) 0.24 (0.19, 0.29)** 0.36 (0.28, 0.46)** 2006 (n) 2006 % (95% CI) 2011 (n) 2011 % (95% CI) Absolute Δ from 2006 Δ (95% CI) Past-year drinking  18–25 years 686 47.4 (43.6, 51.1) 339 51.0 (45.7, 56.4) +3.6% (−2.9, 10.1)  26–35 years 987 45.8 (42.7, 48.9) 452 41.8 (37.2, 46.4) −4.0% (−9.5,1.5)  36–45 years 1362 38.1 (35.5, 40.7) 562 45.2 (41.1, 49.3) +7.1% (2.2,11.9)*  46–55 years 1114 34.6 (31.8, 37.4) 604 40.7 (36.8, 44.7) +6.1% (1.3, 10.9)*  56–70 years 779 19.6 (16.8, 22.4) 480 28.5 (24.5, 32.6) +7.9% (4.0,13.8)**  All females 4928 37.2 (35.9, 38.6) 2437 41.0 (39.0, 42.9) +3.8% (1.4, 6.2)*  Age-adjusted prevalencea 38.3 (38.2, 38.4) 41.0 (40.9, 41.1) +2.7% (0.3, 5.1)*  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.44 (0.40, 0.49)** 0.53 (0.47, 0.61)** Past-month binge drinking  18–25 years 685 8.6 (6.5, 10.7) 339 6.2 (3.6, 8.8) −2.4% (−5.7, 0.9)  26–35 years 986 5.5 (4.1, 6.9) 452 7.3 (4.9, 9.7) +1.8% (−0.1, 4.6)  36–45 years 1362 2.3 (1.5, 3.1) 562 5.2 (3.3, 7.0) +2.9% (0.9, 4.9)**  46–55 years 1114 2.1 (1.2, 2.9) 604 2.0 (0.9, 3.1) −0.1% (−1.5, 1.3)  56–70 years 779 1.0 (0.3, 1.7) 480 1.3 (0.3, 2.2) +0.3% (−0.1, 1.5)  All females 4926 3.6 (3.0, 4.1) 2437 4.1 (3.4, 4.9) +0.6% (−0.3, 1.5)  Age-adjusted prevalencea 3.9 (3.8, 4.0) 4.3 (4.2, 4.4) +0.4% (−0.6, 1.4)  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.23 (0.19, 0.28)** 0.48 (0.37, 0.63)** Weekly drinking  18–25 years 686 3.1 (1.8,4.4) 339 4.1 (2.0, 6.3) +1.0% (−1.5, 3.5)  26–35 years 987 3.9 (2.6,5.1) 452 6.2 (4.0, 8.4) +2.3% (−0.2, 4.8)  36–45 years 1362 4.0 (2.9, 5.0) 562 7.3 (5.1,9.5) +3.3% (0.9, 5.7)a  46–55 years 1114 3.3 (2.3, 4.4) 604 5.0 (3.2, 6.7) +1.7% (−0.3, 3.7)  56–70 years 779 2.8 (1.7,4.0) 480 3.1 (1.6, 4.7) +0.3% (−1.6, 2.2)  All females 4928 3.5 (3.0,4.0) 2437 5.3 (4.4,6.1) +1.8% (0.8, 2.8)**  Age-adjusted prevalencea 3.4 (3.3, 3.5) 5.3 (5.2, 5.4) +1.8% (0.9, 2.9)**  P-value (χ2)/Trend test <0.0001/<0.0001 0.028/0.197  ORmv (95% CI)b (Males = ref) 0.24 (0.19, 0.29)** 0.36 (0.28, 0.46)** OR = odds ratio; CI = confidence interval aAge-standardized against Hong Kong 2011 Census: 9.8% of women were 18–25 years, 17.0% were 26–35 years, 17.6% were 36–45 years, 17.8% were 46–55 years, 23.9% were 56–70 years. b Females versus males (ref) adjusted for age, education (Tertiary education versus Not), marital status (ever married versus never married), employed status (full-time/part-time worker versus all other). *P < 0.05, **P<0.001. Table 2. Age-specific prevalence of past-year drinking, past-month binge drinking and weekly drinking among Chinese womena in Hong Kong - 2006 (n = 4946) versus 2011 (n = 2439) 2006 (n) 2006 % (95% CI) 2011 (n) 2011 % (95% CI) Absolute Δ from 2006 Δ (95% CI) Past-year drinking  18–25 years 686 47.4 (43.6, 51.1) 339 51.0 (45.7, 56.4) +3.6% (−2.9, 10.1)  26–35 years 987 45.8 (42.7, 48.9) 452 41.8 (37.2, 46.4) −4.0% (−9.5,1.5)  36–45 years 1362 38.1 (35.5, 40.7) 562 45.2 (41.1, 49.3) +7.1% (2.2,11.9)*  46–55 years 1114 34.6 (31.8, 37.4) 604 40.7 (36.8, 44.7) +6.1% (1.3, 10.9)*  56–70 years 779 19.6 (16.8, 22.4) 480 28.5 (24.5, 32.6) +7.9% (4.0,13.8)**  All females 4928 37.2 (35.9, 38.6) 2437 41.0 (39.0, 42.9) +3.8% (1.4, 6.2)*  Age-adjusted prevalencea 38.3 (38.2, 38.4) 41.0 (40.9, 41.1) +2.7% (0.3, 5.1)*  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.44 (0.40, 0.49)** 0.53 (0.47, 0.61)** Past-month binge drinking  18–25 years 685 8.6 (6.5, 10.7) 339 6.2 (3.6, 8.8) −2.4% (−5.7, 0.9)  26–35 years 986 5.5 (4.1, 6.9) 452 7.3 (4.9, 9.7) +1.8% (−0.1, 4.6)  36–45 years 1362 2.3 (1.5, 3.1) 562 5.2 (3.3, 7.0) +2.9% (0.9, 4.9)**  46–55 years 1114 2.1 (1.2, 2.9) 604 2.0 (0.9, 3.1) −0.1% (−1.5, 1.3)  56–70 years 779 1.0 (0.3, 1.7) 480 1.3 (0.3, 2.2) +0.3% (−0.1, 1.5)  All females 4926 3.6 (3.0, 4.1) 2437 4.1 (3.4, 4.9) +0.6% (−0.3, 1.5)  Age-adjusted prevalencea 3.9 (3.8, 4.0) 4.3 (4.2, 4.4) +0.4% (−0.6, 1.4)  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.23 (0.19, 0.28)** 0.48 (0.37, 0.63)** Weekly drinking  18–25 years 686 3.1 (1.8,4.4) 339 4.1 (2.0, 6.3) +1.0% (−1.5, 3.5)  26–35 years 987 3.9 (2.6,5.1) 452 6.2 (4.0, 8.4) +2.3% (−0.2, 4.8)  36–45 years 1362 4.0 (2.9, 5.0) 562 7.3 (5.1,9.5) +3.3% (0.9, 5.7)a  46–55 years 1114 3.3 (2.3, 4.4) 604 5.0 (3.2, 6.7) +1.7% (−0.3, 3.7)  56–70 years 779 2.8 (1.7,4.0) 480 3.1 (1.6, 4.7) +0.3% (−1.6, 2.2)  All females 4928 3.5 (3.0,4.0) 2437 5.3 (4.4,6.1) +1.8% (0.8, 2.8)**  Age-adjusted prevalencea 3.4 (3.3, 3.5) 5.3 (5.2, 5.4) +1.8% (0.9, 2.9)**  P-value (χ2)/Trend test <0.0001/<0.0001 0.028/0.197  ORmv (95% CI)b (Males = ref) 0.24 (0.19, 0.29)** 0.36 (0.28, 0.46)** 2006 (n) 2006 % (95% CI) 2011 (n) 2011 % (95% CI) Absolute Δ from 2006 Δ (95% CI) Past-year drinking  18–25 years 686 47.4 (43.6, 51.1) 339 51.0 (45.7, 56.4) +3.6% (−2.9, 10.1)  26–35 years 987 45.8 (42.7, 48.9) 452 41.8 (37.2, 46.4) −4.0% (−9.5,1.5)  36–45 years 1362 38.1 (35.5, 40.7) 562 45.2 (41.1, 49.3) +7.1% (2.2,11.9)*  46–55 years 1114 34.6 (31.8, 37.4) 604 40.7 (36.8, 44.7) +6.1% (1.3, 10.9)*  56–70 years 779 19.6 (16.8, 22.4) 480 28.5 (24.5, 32.6) +7.9% (4.0,13.8)**  All females 4928 37.2 (35.9, 38.6) 2437 41.0 (39.0, 42.9) +3.8% (1.4, 6.2)*  Age-adjusted prevalencea 38.3 (38.2, 38.4) 41.0 (40.9, 41.1) +2.7% (0.3, 5.1)*  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.44 (0.40, 0.49)** 0.53 (0.47, 0.61)** Past-month binge drinking  18–25 years 685 8.6 (6.5, 10.7) 339 6.2 (3.6, 8.8) −2.4% (−5.7, 0.9)  26–35 years 986 5.5 (4.1, 6.9) 452 7.3 (4.9, 9.7) +1.8% (−0.1, 4.6)  36–45 years 1362 2.3 (1.5, 3.1) 562 5.2 (3.3, 7.0) +2.9% (0.9, 4.9)**  46–55 years 1114 2.1 (1.2, 2.9) 604 2.0 (0.9, 3.1) −0.1% (−1.5, 1.3)  56–70 years 779 1.0 (0.3, 1.7) 480 1.3 (0.3, 2.2) +0.3% (−0.1, 1.5)  All females 4926 3.6 (3.0, 4.1) 2437 4.1 (3.4, 4.9) +0.6% (−0.3, 1.5)  Age-adjusted prevalencea 3.9 (3.8, 4.0) 4.3 (4.2, 4.4) +0.4% (−0.6, 1.4)  P-value (χ2)/Trend test <0.0001/<0.0001 <0.0001/<0.0001  ORmv (95% CI)b (Males = ref) 0.23 (0.19, 0.28)** 0.48 (0.37, 0.63)** Weekly drinking  18–25 years 686 3.1 (1.8,4.4) 339 4.1 (2.0, 6.3) +1.0% (−1.5, 3.5)  26–35 years 987 3.9 (2.6,5.1) 452 6.2 (4.0, 8.4) +2.3% (−0.2, 4.8)  36–45 years 1362 4.0 (2.9, 5.0) 562 7.3 (5.1,9.5) +3.3% (0.9, 5.7)a  46–55 years 1114 3.3 (2.3, 4.4) 604 5.0 (3.2, 6.7) +1.7% (−0.3, 3.7)  56–70 years 779 2.8 (1.7,4.0) 480 3.1 (1.6, 4.7) +0.3% (−1.6, 2.2)  All females 4928 3.5 (3.0,4.0) 2437 5.3 (4.4,6.1) +1.8% (0.8, 2.8)**  Age-adjusted prevalencea 3.4 (3.3, 3.5) 5.3 (5.2, 5.4) +1.8% (0.9, 2.9)**  P-value (χ2)/Trend test <0.0001/<0.0001 0.028/0.197  ORmv (95% CI)b (Males = ref) 0.24 (0.19, 0.29)** 0.36 (0.28, 0.46)** OR = odds ratio; CI = confidence interval aAge-standardized against Hong Kong 2011 Census: 9.8% of women were 18–25 years, 17.0% were 26–35 years, 17.6% were 36–45 years, 17.8% were 46–55 years, 23.9% were 56–70 years. b Females versus males (ref) adjusted for age, education (Tertiary education versus Not), marital status (ever married versus never married), employed status (full-time/part-time worker versus all other). *P < 0.05, **P<0.001. In 2011, when compared to 2006, there were statistically significant increases in the overall age-adjusted prevalence of past-year drinking (+2.7%) and weekly drinking (+1.8%) but not binge drinking. The increase in past-year drinking was significant only for women above 35 years of age (+6.1–7.9%). The age stratum-specific results revealed that the only age stratum that had increased prevalence across all examined three drinking patterns were women between the ages of 36–45, showing significant increases in past-year drinking (2006:38.1%, 2011:45.2%), past-month binge drinking (2006:2.3%, 2011:5.2%) and weekly drinking (2006:4.0%, 2011:7.3%) after the policy changes. All three types of drinking patterns showed a convergence with male drinking levels by 2011. Changes in the sociodemographic and attitudinal factors associated with drinking patterns among Hong Kong women A comparison of factors associated with the studied drinking patterns in 2006 and 2011 (Table 3) revealed that many previous independent risk factors became non-significant by 2011, due to the convergence of drinking patterns across demographic subgroups. For example, women with lower education had caught up in their weekly drinking prevalence (2006:2.6%, 2011:5.1%) with their higher educated counterparts by 2011 (5.5%). Similarly, marital status and job-related drinking were not independently associated with any type of drinking behavior by 2011, and the Social Benefits of Drinking scale was not associated with past-year or weekly drinking by 2011. Table 3. Sociodemographic and attitudinal factors associated with various drinking patterns among Chinese womena in Hong Kong - 2006 (n = 4946) versus 2011 (n = 2439) Past-year drinkingb Past-month binge drinkingc Weekly drinkingd Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Sociodemographics  Age   18–25 years 47.4 1.0 51.0 1.0 8.6 1.0 6.2 1.0 3.1 4.1 1.0   26–35 years 45.8 1.19 (0.92–1.55) 41.8 0.84 (0.58–1.21) 5.5 0.73 (0.46–1.13) 7.3 1.23 (0.63–2.42) 3.9 6.2 1.65 (0.85–3.22)   36–45 years 38.1 1.10 (0.83–1.45) 45.2 1.14 (0.79–1.63) 2.3 0.33 (0.19–0.58)** 5.2 0.87(0.43–1.75) 4.0 7.3 1.95 (1.04–3.67)*   46–55 years 34.6 1.09 (0.82–1.46) 40.7 1.04 (0.72–1.50) 2.1 0.29 (0.16–0.55)** 2.0 0.30 (0.13–0.70)* 3.3 5.0 1.23 (0.64–2.37)   56–70 years 19.6 0.59 (0.43–0.83)* 28.5 0.61 (0.40–0.92)** 1.0 0.15 (0.06–0.35)** 1.3 0.11 (0.03–0.36)** 2.8 3.1 0.67 (0.31–1.41)  Education   Secondary or   lower 32.1 1.0 36.1 1.0 3.1 NS 3.3 NS 2.6 1.0 5.1   Post- secondary 52.1 1.72 (1.48–2.00)** 51.7 1.78 (1.45–2.17)** 4.9 5.9 5.2 2.11 (1.51–2.95)** 5.5  Marital Status   Ever married 32.8 1.0 38.2 NS 2.2 1.0 3.0 NS 2.8 4.9   Never married 48.9 1.37 (1.12–1.65)* 47.5 7.0 1.74 (1.13–2.68)* 6.8 3.9 5.2  Occupation   Housewife 27.4 1.0 33.3 1.0 1.9 NS 2.1 1.0 2.2 NS 4.9 NS   Working 44.8 1.53 (1.30–1.81)** 55.3 1.45 (1.17–1.80)* 4.6 5.2 1.70 (0.95–3.01) 4.4 6.2   Retired 24.9 1.43 (1.05–1.95)* 42.8 1.12 (0.74–1.67) 1.0 3.7 5.14 (1.65–16.0)* 3.5 3.7   Unemployed 31.7 0.90 (0.63–1.29) 47.3 0.95 (0.57–1.58) 3.0 10.7 4.11 (1.62–10.4)* 3.5 4.8   Student 45.3 1.19 (0.84–1.68) 54.7 1.40 (0.86–2.28) 6.5 4.4 1.24 (0.42–3.70) 2.5 1.9  Drinking for work   Not required 37.9 NS 41.0 3.5 1.0 3.9 NS 3.4 1.0 5.0 NS   Yes, required 50.0 40.8 13.8 3.29 (1.48–7.30)* 11.8 12.1 2.99 (1.31–6.82)* 12.0 Drinking beliefs  Social benefits   Score < IQR 39.6 1.0 39.9 2.9 1.0 2.9 1.0 2.6 1.0 3.7 NS   Within IQR 32.8 0.83 (0.71–0.98)* 42.6 3.1 1.38 (0.89–2.14) 4.0 1.53 (0.82–2.86) 3.4 1.43 (0.93–2.20) 5.0   Score > IQR 39.7 1.06 (0.90–1.24) 41.7 5.4 2.43 (1.68–3.53)** 5.8 2.10 (1.31–3.36)* 5.5 2.14 (1.48–3.11)** 7.4  Work benefits   Score < IQR 33.4 1.0 35.4 1.0 2.8 NS 2.8 NS 3.0 NS 3.9 NS   Within IQR 35.7 1.17 (1.00–1.37)* 37.6 1.12 (0.91–1.39) 3.0 3.5 3.0 5.0   Score > IQR 46.9 1.68 (1.43–1.98)** 50.9 1.64 (1.70–1.97)** 5.2 6.4 4.8 7.2  Drinking is healthy   Disagree 37.5 NS 33.2 1.0 3.3 NS 2.8 1.0 3.1 NS 2.2 1.0   Agree 41.0 46.5 1.64 (1.37–1.97)** 4.8 5.1 1.68 (1.04–2.71)* 5.6 7.4 3.07 (1.89–4.98)**  Causes GI issues   Agree 38.5 NS 40.9 3.5 3.8 1.0 3.6 5.0 1.0   Disagree 29.9 43.7 4.5 12.6 4.44 (2.17–9.12)** 2.7 11.6 3.38 (1.65–6.92)*  Helps one sleep   Disagree 34.9 1.0 35.3 1.0 2.7 1.0 2.8 1.0 2.4 1.0 3.3 1.0   Agree 44.9 1.42 (1.24–1.63)** 52.7 1.89 (1.57–2.28)** 5.6 1.92 (1.39–2.65)** 6.9 2.37 (1.54–3.64)** 6.0 2.38 (1.72–3.28)** 9.3 2.60 (1.79–3.78)** Past-year drinkingb Past-month binge drinkingc Weekly drinkingd Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Sociodemographics  Age   18–25 years 47.4 1.0 51.0 1.0 8.6 1.0 6.2 1.0 3.1 4.1 1.0   26–35 years 45.8 1.19 (0.92–1.55) 41.8 0.84 (0.58–1.21) 5.5 0.73 (0.46–1.13) 7.3 1.23 (0.63–2.42) 3.9 6.2 1.65 (0.85–3.22)   36–45 years 38.1 1.10 (0.83–1.45) 45.2 1.14 (0.79–1.63) 2.3 0.33 (0.19–0.58)** 5.2 0.87(0.43–1.75) 4.0 7.3 1.95 (1.04–3.67)*   46–55 years 34.6 1.09 (0.82–1.46) 40.7 1.04 (0.72–1.50) 2.1 0.29 (0.16–0.55)** 2.0 0.30 (0.13–0.70)* 3.3 5.0 1.23 (0.64–2.37)   56–70 years 19.6 0.59 (0.43–0.83)* 28.5 0.61 (0.40–0.92)** 1.0 0.15 (0.06–0.35)** 1.3 0.11 (0.03–0.36)** 2.8 3.1 0.67 (0.31–1.41)  Education   Secondary or   lower 32.1 1.0 36.1 1.0 3.1 NS 3.3 NS 2.6 1.0 5.1   Post- secondary 52.1 1.72 (1.48–2.00)** 51.7 1.78 (1.45–2.17)** 4.9 5.9 5.2 2.11 (1.51–2.95)** 5.5  Marital Status   Ever married 32.8 1.0 38.2 NS 2.2 1.0 3.0 NS 2.8 4.9   Never married 48.9 1.37 (1.12–1.65)* 47.5 7.0 1.74 (1.13–2.68)* 6.8 3.9 5.2  Occupation   Housewife 27.4 1.0 33.3 1.0 1.9 NS 2.1 1.0 2.2 NS 4.9 NS   Working 44.8 1.53 (1.30–1.81)** 55.3 1.45 (1.17–1.80)* 4.6 5.2 1.70 (0.95–3.01) 4.4 6.2   Retired 24.9 1.43 (1.05–1.95)* 42.8 1.12 (0.74–1.67) 1.0 3.7 5.14 (1.65–16.0)* 3.5 3.7   Unemployed 31.7 0.90 (0.63–1.29) 47.3 0.95 (0.57–1.58) 3.0 10.7 4.11 (1.62–10.4)* 3.5 4.8   Student 45.3 1.19 (0.84–1.68) 54.7 1.40 (0.86–2.28) 6.5 4.4 1.24 (0.42–3.70) 2.5 1.9  Drinking for work   Not required 37.9 NS 41.0 3.5 1.0 3.9 NS 3.4 1.0 5.0 NS   Yes, required 50.0 40.8 13.8 3.29 (1.48–7.30)* 11.8 12.1 2.99 (1.31–6.82)* 12.0 Drinking beliefs  Social benefits   Score < IQR 39.6 1.0 39.9 2.9 1.0 2.9 1.0 2.6 1.0 3.7 NS   Within IQR 32.8 0.83 (0.71–0.98)* 42.6 3.1 1.38 (0.89–2.14) 4.0 1.53 (0.82–2.86) 3.4 1.43 (0.93–2.20) 5.0   Score > IQR 39.7 1.06 (0.90–1.24) 41.7 5.4 2.43 (1.68–3.53)** 5.8 2.10 (1.31–3.36)* 5.5 2.14 (1.48–3.11)** 7.4  Work benefits   Score < IQR 33.4 1.0 35.4 1.0 2.8 NS 2.8 NS 3.0 NS 3.9 NS   Within IQR 35.7 1.17 (1.00–1.37)* 37.6 1.12 (0.91–1.39) 3.0 3.5 3.0 5.0   Score > IQR 46.9 1.68 (1.43–1.98)** 50.9 1.64 (1.70–1.97)** 5.2 6.4 4.8 7.2  Drinking is healthy   Disagree 37.5 NS 33.2 1.0 3.3 NS 2.8 1.0 3.1 NS 2.2 1.0   Agree 41.0 46.5 1.64 (1.37–1.97)** 4.8 5.1 1.68 (1.04–2.71)* 5.6 7.4 3.07 (1.89–4.98)**  Causes GI issues   Agree 38.5 NS 40.9 3.5 3.8 1.0 3.6 5.0 1.0   Disagree 29.9 43.7 4.5 12.6 4.44 (2.17–9.12)** 2.7 11.6 3.38 (1.65–6.92)*  Helps one sleep   Disagree 34.9 1.0 35.3 1.0 2.7 1.0 2.8 1.0 2.4 1.0 3.3 1.0   Agree 44.9 1.42 (1.24–1.63)** 52.7 1.89 (1.57–2.28)** 5.6 1.92 (1.39–2.65)** 6.9 2.37 (1.54–3.64)** 6.0 2.38 (1.72–3.28)** 9.3 2.60 (1.79–3.78)** OR, odds ratios; CI, confidence interval; IQR, interquartile range; GI, gastrointestinal; Variables with dashes were not included in the multivariate model. Candidate variables had a significance of P < 0.20 in unadjusted analyses. NS, not significant, these variables were removed in the backwards elimination process. aAll respondents who were <18-years old in 2008 were removed from analysis of this variable since they would not be of legal drinking age. bVariables in backwards elimination were removed in the following order for the 2006 current drinking model: GI issues (OR = 0.84; 95% CI = 0.62, 1.15; P = 0.28), Job Drinking (OR = 1.39; 95% CI = 0.80, 2.42; P = 0.239), Drinking is good for health (OR = 1.15; 95% CI = 0.97, 1.36; P = 0.11); Variables in backwards elimination were removed in the following order for the 2011 current drinking model: Marital status (OR = 1.04; 95% CI = 0.79, 1.36; P = 0.79). cVariables in backwards elimination were removed in the following order for the 2006 past-month binge drinking model: Educational status (OR = 0.96; 95% CI = 0.67, 1.39; P = 0.83), Work Benefits Score (P = 0.51), Occupational status (P = 0.16), Drinking is good for health (OR = 1.37; 95% CI = 0.89, 1.95; P = 0.17); Variables in backwards elimination were removed in the following order for the 2011 past-month binge drinking model: Educational status (OR = 1.28; 95% CI = 0.80, 2.05; P = 0.30), Drinking for work (OR = 1.83; 95% CI = 0.79, 4.26; P = 0.16), Marital status (OR = 1.54; 95% CI = 0.87, 2.71; P = 0.14), Work Benefits Score (P = 0.08). dVariables in backwards elimination were removed in the following order for the 2006 weekly drinking model: Work Benefits Score (P = 0.38), Occupational status (P = 0.08), Drinking is good for health (OR = 1.44; 95% CI = 0.99, 2.09; P = 0.05); Variables in backwards elimination were removed in the following order for the 2011 weekly drinking model: Occupational status (P = 0.47), Work Benefits Score (P = 0.29), Job Drinking (OR = 1.90; 95% CI = 0.89, 4.04; P = 0.09), Social Benefits Score (P = 0.08). *P < 0.05; **P < 0.001. Table 3. Sociodemographic and attitudinal factors associated with various drinking patterns among Chinese womena in Hong Kong - 2006 (n = 4946) versus 2011 (n = 2439) Past-year drinkingb Past-month binge drinkingc Weekly drinkingd Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Sociodemographics  Age   18–25 years 47.4 1.0 51.0 1.0 8.6 1.0 6.2 1.0 3.1 4.1 1.0   26–35 years 45.8 1.19 (0.92–1.55) 41.8 0.84 (0.58–1.21) 5.5 0.73 (0.46–1.13) 7.3 1.23 (0.63–2.42) 3.9 6.2 1.65 (0.85–3.22)   36–45 years 38.1 1.10 (0.83–1.45) 45.2 1.14 (0.79–1.63) 2.3 0.33 (0.19–0.58)** 5.2 0.87(0.43–1.75) 4.0 7.3 1.95 (1.04–3.67)*   46–55 years 34.6 1.09 (0.82–1.46) 40.7 1.04 (0.72–1.50) 2.1 0.29 (0.16–0.55)** 2.0 0.30 (0.13–0.70)* 3.3 5.0 1.23 (0.64–2.37)   56–70 years 19.6 0.59 (0.43–0.83)* 28.5 0.61 (0.40–0.92)** 1.0 0.15 (0.06–0.35)** 1.3 0.11 (0.03–0.36)** 2.8 3.1 0.67 (0.31–1.41)  Education   Secondary or   lower 32.1 1.0 36.1 1.0 3.1 NS 3.3 NS 2.6 1.0 5.1   Post- secondary 52.1 1.72 (1.48–2.00)** 51.7 1.78 (1.45–2.17)** 4.9 5.9 5.2 2.11 (1.51–2.95)** 5.5  Marital Status   Ever married 32.8 1.0 38.2 NS 2.2 1.0 3.0 NS 2.8 4.9   Never married 48.9 1.37 (1.12–1.65)* 47.5 7.0 1.74 (1.13–2.68)* 6.8 3.9 5.2  Occupation   Housewife 27.4 1.0 33.3 1.0 1.9 NS 2.1 1.0 2.2 NS 4.9 NS   Working 44.8 1.53 (1.30–1.81)** 55.3 1.45 (1.17–1.80)* 4.6 5.2 1.70 (0.95–3.01) 4.4 6.2   Retired 24.9 1.43 (1.05–1.95)* 42.8 1.12 (0.74–1.67) 1.0 3.7 5.14 (1.65–16.0)* 3.5 3.7   Unemployed 31.7 0.90 (0.63–1.29) 47.3 0.95 (0.57–1.58) 3.0 10.7 4.11 (1.62–10.4)* 3.5 4.8   Student 45.3 1.19 (0.84–1.68) 54.7 1.40 (0.86–2.28) 6.5 4.4 1.24 (0.42–3.70) 2.5 1.9  Drinking for work   Not required 37.9 NS 41.0 3.5 1.0 3.9 NS 3.4 1.0 5.0 NS   Yes, required 50.0 40.8 13.8 3.29 (1.48–7.30)* 11.8 12.1 2.99 (1.31–6.82)* 12.0 Drinking beliefs  Social benefits   Score < IQR 39.6 1.0 39.9 2.9 1.0 2.9 1.0 2.6 1.0 3.7 NS   Within IQR 32.8 0.83 (0.71–0.98)* 42.6 3.1 1.38 (0.89–2.14) 4.0 1.53 (0.82–2.86) 3.4 1.43 (0.93–2.20) 5.0   Score > IQR 39.7 1.06 (0.90–1.24) 41.7 5.4 2.43 (1.68–3.53)** 5.8 2.10 (1.31–3.36)* 5.5 2.14 (1.48–3.11)** 7.4  Work benefits   Score < IQR 33.4 1.0 35.4 1.0 2.8 NS 2.8 NS 3.0 NS 3.9 NS   Within IQR 35.7 1.17 (1.00–1.37)* 37.6 1.12 (0.91–1.39) 3.0 3.5 3.0 5.0   Score > IQR 46.9 1.68 (1.43–1.98)** 50.9 1.64 (1.70–1.97)** 5.2 6.4 4.8 7.2  Drinking is healthy   Disagree 37.5 NS 33.2 1.0 3.3 NS 2.8 1.0 3.1 NS 2.2 1.0   Agree 41.0 46.5 1.64 (1.37–1.97)** 4.8 5.1 1.68 (1.04–2.71)* 5.6 7.4 3.07 (1.89–4.98)**  Causes GI issues   Agree 38.5 NS 40.9 3.5 3.8 1.0 3.6 5.0 1.0   Disagree 29.9 43.7 4.5 12.6 4.44 (2.17–9.12)** 2.7 11.6 3.38 (1.65–6.92)*  Helps one sleep   Disagree 34.9 1.0 35.3 1.0 2.7 1.0 2.8 1.0 2.4 1.0 3.3 1.0   Agree 44.9 1.42 (1.24–1.63)** 52.7 1.89 (1.57–2.28)** 5.6 1.92 (1.39–2.65)** 6.9 2.37 (1.54–3.64)** 6.0 2.38 (1.72–3.28)** 9.3 2.60 (1.79–3.78)** Past-year drinkingb Past-month binge drinkingc Weekly drinkingd Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Row % 2006 ORmv(95% CI) Row % 2011 ORmv(95% CI) Sociodemographics  Age   18–25 years 47.4 1.0 51.0 1.0 8.6 1.0 6.2 1.0 3.1 4.1 1.0   26–35 years 45.8 1.19 (0.92–1.55) 41.8 0.84 (0.58–1.21) 5.5 0.73 (0.46–1.13) 7.3 1.23 (0.63–2.42) 3.9 6.2 1.65 (0.85–3.22)   36–45 years 38.1 1.10 (0.83–1.45) 45.2 1.14 (0.79–1.63) 2.3 0.33 (0.19–0.58)** 5.2 0.87(0.43–1.75) 4.0 7.3 1.95 (1.04–3.67)*   46–55 years 34.6 1.09 (0.82–1.46) 40.7 1.04 (0.72–1.50) 2.1 0.29 (0.16–0.55)** 2.0 0.30 (0.13–0.70)* 3.3 5.0 1.23 (0.64–2.37)   56–70 years 19.6 0.59 (0.43–0.83)* 28.5 0.61 (0.40–0.92)** 1.0 0.15 (0.06–0.35)** 1.3 0.11 (0.03–0.36)** 2.8 3.1 0.67 (0.31–1.41)  Education   Secondary or   lower 32.1 1.0 36.1 1.0 3.1 NS 3.3 NS 2.6 1.0 5.1   Post- secondary 52.1 1.72 (1.48–2.00)** 51.7 1.78 (1.45–2.17)** 4.9 5.9 5.2 2.11 (1.51–2.95)** 5.5  Marital Status   Ever married 32.8 1.0 38.2 NS 2.2 1.0 3.0 NS 2.8 4.9   Never married 48.9 1.37 (1.12–1.65)* 47.5 7.0 1.74 (1.13–2.68)* 6.8 3.9 5.2  Occupation   Housewife 27.4 1.0 33.3 1.0 1.9 NS 2.1 1.0 2.2 NS 4.9 NS   Working 44.8 1.53 (1.30–1.81)** 55.3 1.45 (1.17–1.80)* 4.6 5.2 1.70 (0.95–3.01) 4.4 6.2   Retired 24.9 1.43 (1.05–1.95)* 42.8 1.12 (0.74–1.67) 1.0 3.7 5.14 (1.65–16.0)* 3.5 3.7   Unemployed 31.7 0.90 (0.63–1.29) 47.3 0.95 (0.57–1.58) 3.0 10.7 4.11 (1.62–10.4)* 3.5 4.8   Student 45.3 1.19 (0.84–1.68) 54.7 1.40 (0.86–2.28) 6.5 4.4 1.24 (0.42–3.70) 2.5 1.9  Drinking for work   Not required 37.9 NS 41.0 3.5 1.0 3.9 NS 3.4 1.0 5.0 NS   Yes, required 50.0 40.8 13.8 3.29 (1.48–7.30)* 11.8 12.1 2.99 (1.31–6.82)* 12.0 Drinking beliefs  Social benefits   Score < IQR 39.6 1.0 39.9 2.9 1.0 2.9 1.0 2.6 1.0 3.7 NS   Within IQR 32.8 0.83 (0.71–0.98)* 42.6 3.1 1.38 (0.89–2.14) 4.0 1.53 (0.82–2.86) 3.4 1.43 (0.93–2.20) 5.0   Score > IQR 39.7 1.06 (0.90–1.24) 41.7 5.4 2.43 (1.68–3.53)** 5.8 2.10 (1.31–3.36)* 5.5 2.14 (1.48–3.11)** 7.4  Work benefits   Score < IQR 33.4 1.0 35.4 1.0 2.8 NS 2.8 NS 3.0 NS 3.9 NS   Within IQR 35.7 1.17 (1.00–1.37)* 37.6 1.12 (0.91–1.39) 3.0 3.5 3.0 5.0   Score > IQR 46.9 1.68 (1.43–1.98)** 50.9 1.64 (1.70–1.97)** 5.2 6.4 4.8 7.2  Drinking is healthy   Disagree 37.5 NS 33.2 1.0 3.3 NS 2.8 1.0 3.1 NS 2.2 1.0   Agree 41.0 46.5 1.64 (1.37–1.97)** 4.8 5.1 1.68 (1.04–2.71)* 5.6 7.4 3.07 (1.89–4.98)**  Causes GI issues   Agree 38.5 NS 40.9 3.5 3.8 1.0 3.6 5.0 1.0   Disagree 29.9 43.7 4.5 12.6 4.44 (2.17–9.12)** 2.7 11.6 3.38 (1.65–6.92)*  Helps one sleep   Disagree 34.9 1.0 35.3 1.0 2.7 1.0 2.8 1.0 2.4 1.0 3.3 1.0   Agree 44.9 1.42 (1.24–1.63)** 52.7 1.89 (1.57–2.28)** 5.6 1.92 (1.39–2.65)** 6.9 2.37 (1.54–3.64)** 6.0 2.38 (1.72–3.28)** 9.3 2.60 (1.79–3.78)** OR, odds ratios; CI, confidence interval; IQR, interquartile range; GI, gastrointestinal; Variables with dashes were not included in the multivariate model. Candidate variables had a significance of P < 0.20 in unadjusted analyses. NS, not significant, these variables were removed in the backwards elimination process. aAll respondents who were <18-years old in 2008 were removed from analysis of this variable since they would not be of legal drinking age. bVariables in backwards elimination were removed in the following order for the 2006 current drinking model: GI issues (OR = 0.84; 95% CI = 0.62, 1.15; P = 0.28), Job Drinking (OR = 1.39; 95% CI = 0.80, 2.42; P = 0.239), Drinking is good for health (OR = 1.15; 95% CI = 0.97, 1.36; P = 0.11); Variables in backwards elimination were removed in the following order for the 2011 current drinking model: Marital status (OR = 1.04; 95% CI = 0.79, 1.36; P = 0.79). cVariables in backwards elimination were removed in the following order for the 2006 past-month binge drinking model: Educational status (OR = 0.96; 95% CI = 0.67, 1.39; P = 0.83), Work Benefits Score (P = 0.51), Occupational status (P = 0.16), Drinking is good for health (OR = 1.37; 95% CI = 0.89, 1.95; P = 0.17); Variables in backwards elimination were removed in the following order for the 2011 past-month binge drinking model: Educational status (OR = 1.28; 95% CI = 0.80, 2.05; P = 0.30), Drinking for work (OR = 1.83; 95% CI = 0.79, 4.26; P = 0.16), Marital status (OR = 1.54; 95% CI = 0.87, 2.71; P = 0.14), Work Benefits Score (P = 0.08). dVariables in backwards elimination were removed in the following order for the 2006 weekly drinking model: Work Benefits Score (P = 0.38), Occupational status (P = 0.08), Drinking is good for health (OR = 1.44; 95% CI = 0.99, 2.09; P = 0.05); Variables in backwards elimination were removed in the following order for the 2011 weekly drinking model: Occupational status (P = 0.47), Work Benefits Score (P = 0.29), Job Drinking (OR = 1.90; 95% CI = 0.89, 4.04; P = 0.09), Social Benefits Score (P = 0.08). *P < 0.05; **P < 0.001. Certain subgroups emerged as new risk groups due to disproportionate increases in drinking behaviors by 2011. Retired and unemployed women became new risk groups for binge drinking due to increases (OR = 4.32–5.14), and middle-aged women (36–45-years-old) emerged as a risk group for weekly drinking. Although, the belief that drinking aids sleep showed positive associations with all drinking patterns across surveys, the perception that ‘drinking is healthy’ emerged as a new independent risk factor for current drinking (ORmv = 1.64, 95% CI = 1.37–1.97), past-month binge drinking (ORmv = 1.67, 95% CI = 1.04–2.69), and weekly drinking (ORmv = 3.07, 95% CI = 1.89–4.98) in 2011. Women who lacked awareness of adverse health effects of chronic drinking became a risk group for binge drinking and weekly drinking by 2011 (ORmv = 3.38–4.54). Age subgroup analysis of factors associated with drinking patterns among Hong Kong women To inform targeted alcohol health interventions, we conducted further subgroup analyses (untabulated) for the 2011 data after stratification by three age groups (18–35, 36–55 and 56–70 year olds). Across all age groups, current drinking had positive associations with the ‘drinking is healthy’ perception (OR = 1.56–1.89) and with post-secondary education (OR = 1.53–2.28). A high score on the Work Benefits of Drinking scale (OR = 1.58–1.91) and the belief that drinking aids sleep (OR = 2.01–2.15) were only associated with current drinking in women 18-55 years old. By contrast, current drinking was marginally associated (P < 0.10) with being employed in women above 35 years old (OR = 1.52-1.61). Women in the 18–35 and 36–55 age strata showed associations between weekly drinking and the belief in alcohol as a sleep aid (OR = 3.42–3.95) and the lack of awareness of health harms (OR = 3.42–3.95). Weekly drinking in these women had dissimilar associations with the ‘drinking is healthy’ perception (18–35 years: OR = 5.70, 95% CI = 2.17–14; 36–55 years: OR = 1.84, 95% CI = 1.03–3.31). In women aged 18–35 and 36–55 years, binge drinking was significantly associated with the belief that drinking aids sleep (OR = 2.61–2.91), lack of awareness of health harms of drinking (OR = 3.42–4.72), high scores in the Social Benefits of Drinking scale (OR = 2.15–2.48), and marginally significant (P < 0.10) with the ‘drinking is healthy’ perception (OR = 1.94–2.28). For women 56–70 years old, the only significant predictor of weekly drinking was the ‘drinking is healthy’ perception with an estimated OR = 8.26 (estimated due to zero cell count). The belief that drinking aids sleep only showed marginally significant associations (OR = 2.64, P<0.10). Past-month binge drinking was only significantly associated with unemployment status in this stratum (OR = 22.2, 95% CI: 2.65–185.3). These findings suggest that drinking contexts and motivations in older age women differ considerably from their younger-aged counterparts. Factors and contexts associated with increased overall frequency of drinking since the alcohol policy change period The proportion of Hong Kong women who reported increasing their overall drinking frequencies since the alcohol tax policy changes is shown (Table 4). While 3.5% of the sample had increased their drinking frequencies, greater proportions of past-year drinkers (8.8%), binge drinkers (20.7%), weekly drinkers (23.1%), alcohol abusers (16.7%) and all three of the alcohol dependent women reported increases in overall drinking frequency after the alcohol policy changes (untabulated). The unadjusted analysis revealed nearly all study factors were associated with increased drinking frequency in 2011 (P < 0.05). In the multivariable analyses, women who: had some university education, were employed or students, were unemployed, believed in the health benefits of drinking, or drank for alcohol’s sedative properties were shown to be more likely to have increased their drinking frequency (OR = 1.89–8.08) after the alcohol policy changes. Table 4. Sociodemographic and attitudinal factors associated with increased frequency of drinking among Chinese women in Hong Kong—2011 (n = 2308) Reported increased drinking frequency since 2007–08 alcohol tax eliminationa Drank more often at social events Drank more often at outside meals Drank more often with co-workers Drank more often at home Drank more often in solitude Row % Crude OR ORmv(95% CI)b Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Sociodemographics  All 8.1 8.6 5.8 4.4 4.2 2.4  Age 0.573 0.437 0.064 0.637 0.816   21–25 years 14.3 1.0 NS 11.6 6.3 9.5 4.2 2.1   26–35 years 9.6 0.44* 8.5 7.9 5.5 2.4 1.8   36–45 years 8.0 0.32* 10.0 6.0 4.0 5.0 3.5   46–55 years 6.7 0.31* 7.8 5.9 3.4 5.4 2.4   56–70 years 3.3 0.08** 5.8 2.5 1.7 3.3 1.7  Educational level 0.149 0.512 0.398 0.251 0.772   Secondary or lower 6.4 1.0 1.00 7.5 5.4 4.0 3.6 2.3   Post- secondary 10.6 3.33** 2.35 (1.40–3.93)* 10.5 6.6 5.2 5.2 2.6  Marital status 0.100 0.071 0.004 0.503 0.844   Ever married 6.1 1.0 NS 7.6 4.9 3.1 4.5 2.4   Never married 12.7 3.02** 11.3 8.2 7.8 3.5 2.6  Occupation 0.230 0.169 0.305 0.469 0.101   Housewife 3.1 1.0 1.00 5.3 3.5 3.1 2.2 0.9   Employed 10.1 6.49** 6.14 (2.79–13.59)** 10.3 7.0 5.3 5.2 3.6   Retired 2.3 0.60 0.59 (0.07–4.82) 6.8 2.3 0.0 4.5 0.0   Unemployed 20.8 8.52** 7.68 (2.41–24.49)** 12.5 12.5 8.3 4.2 0.0   Student 13.2 10.65** 5.57 (1.52–20.43)* 10.8 8.1 5.4 2.7 0.0  Job requires drinking 0.547 0.184 0.383 0.337 0.601   None required 7.7 1.0 NS 8.6 5.7 4.3 4.1 2.4   Yes, required 19.2 2.58* 12.0 12.0 8.0 8.0 4.0 Drinking beliefs  Social benefits 0.497 0.348 0.147 0.751 0.519   Score < IQR 6.8 1.0 NS 9.1 4.6 3.4 3.7 1.7   Score within IQR) 5.9 1.31 6.0 6.0 3.0 5.3 3.0   Score > IQR 10.4 1.62 9.2 7.2 6.3 4.3 3.0  Work benefits 0.898 0.498 0.063 0.902 0.368   Score < IQR (ref) 7.4 1.0 1.00 8.8 4.6 3.8 4.6 3.1   Score Within IQR) 5.4 0.94 0.92 (0.48–1.77) 8.0 5.9 2.5 3.8 1.3   Score > IQR 11.0 2.69** 2.41 (1.37–4.25)* 9.1 7.0 6.6 4.2 2.8  Drinking is healthy 0.419 0.142 0.033 0.119 0.030   Disagree 5.1 1.0 1.00 7.5 4.1 2.3 2.6 0.8   Agree 9.6 2.53** 1.92 (1.10–3.35)* 9.2 6.7 5.6 5.0 3.3  Causes GI issues 0.014 0.053 0.482 0.080 0.686   Agree 7.9 1.0 NS 8.2 5.5 4.4 4.0 2.4   Disagree 13.8 1.46 21.4 14.3 7.1 10.7 3.6  Drinking helps sleep 0.028 0.017 0.410 0.062 0.335   Disagree 5.4 1.0 1.00 6.8 4.2 3.9 3.1 2.0   Agree 11.8 4.09** 4.07 (2.46–6.73)** 11.2 8.2 5.2 5.8 3.0 Reported increased drinking frequency since 2007–08 alcohol tax eliminationa Drank more often at social events Drank more often at outside meals Drank more often with co-workers Drank more often at home Drank more often in solitude Row % Crude OR ORmv(95% CI)b Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Sociodemographics  All 8.1 8.6 5.8 4.4 4.2 2.4  Age 0.573 0.437 0.064 0.637 0.816   21–25 years 14.3 1.0 NS 11.6 6.3 9.5 4.2 2.1   26–35 years 9.6 0.44* 8.5 7.9 5.5 2.4 1.8   36–45 years 8.0 0.32* 10.0 6.0 4.0 5.0 3.5   46–55 years 6.7 0.31* 7.8 5.9 3.4 5.4 2.4   56–70 years 3.3 0.08** 5.8 2.5 1.7 3.3 1.7  Educational level 0.149 0.512 0.398 0.251 0.772   Secondary or lower 6.4 1.0 1.00 7.5 5.4 4.0 3.6 2.3   Post- secondary 10.6 3.33** 2.35 (1.40–3.93)* 10.5 6.6 5.2 5.2 2.6  Marital status 0.100 0.071 0.004 0.503 0.844   Ever married 6.1 1.0 NS 7.6 4.9 3.1 4.5 2.4   Never married 12.7 3.02** 11.3 8.2 7.8 3.5 2.6  Occupation 0.230 0.169 0.305 0.469 0.101   Housewife 3.1 1.0 1.00 5.3 3.5 3.1 2.2 0.9   Employed 10.1 6.49** 6.14 (2.79–13.59)** 10.3 7.0 5.3 5.2 3.6   Retired 2.3 0.60 0.59 (0.07–4.82) 6.8 2.3 0.0 4.5 0.0   Unemployed 20.8 8.52** 7.68 (2.41–24.49)** 12.5 12.5 8.3 4.2 0.0   Student 13.2 10.65** 5.57 (1.52–20.43)* 10.8 8.1 5.4 2.7 0.0  Job requires drinking 0.547 0.184 0.383 0.337 0.601   None required 7.7 1.0 NS 8.6 5.7 4.3 4.1 2.4   Yes, required 19.2 2.58* 12.0 12.0 8.0 8.0 4.0 Drinking beliefs  Social benefits 0.497 0.348 0.147 0.751 0.519   Score < IQR 6.8 1.0 NS 9.1 4.6 3.4 3.7 1.7   Score within IQR) 5.9 1.31 6.0 6.0 3.0 5.3 3.0   Score > IQR 10.4 1.62 9.2 7.2 6.3 4.3 3.0  Work benefits 0.898 0.498 0.063 0.902 0.368   Score < IQR (ref) 7.4 1.0 1.00 8.8 4.6 3.8 4.6 3.1   Score Within IQR) 5.4 0.94 0.92 (0.48–1.77) 8.0 5.9 2.5 3.8 1.3   Score > IQR 11.0 2.69** 2.41 (1.37–4.25)* 9.1 7.0 6.6 4.2 2.8  Drinking is healthy 0.419 0.142 0.033 0.119 0.030   Disagree 5.1 1.0 1.00 7.5 4.1 2.3 2.6 0.8   Agree 9.6 2.53** 1.92 (1.10–3.35)* 9.2 6.7 5.6 5.0 3.3  Causes GI issues 0.014 0.053 0.482 0.080 0.686   Agree 7.9 1.0 NS 8.2 5.5 4.4 4.0 2.4   Disagree 13.8 1.46 21.4 14.3 7.1 10.7 3.6  Drinking helps sleep 0.028 0.017 0.410 0.062 0.335   Disagree 5.4 1.0 1.00 6.8 4.2 3.9 3.1 2.0   Agree 11.8 4.09** 4.07 (2.46–6.73)** 11.2 8.2 5.2 5.8 3.0 OR, odds ratios; CI, confidence interval; IQR, interquartile range; GI, gastrointestinal; NS, not significant, these variables were removed in the backwards elimination process. aAll respondents who were less than 18 years old in 2008 were removed from analysis of this variable since they would not be of legal drinking age. bVariables in backwards elimination were removed in the following order: GI issues (P = 0.577), Marital status (OR = 1.38; 95% CI = 0.70, 2.74; P = 0.350), Social Benefits Score (P = 0.421), Age (P = 0.282), Job Drinking (OR = 2.13; 95% CI = 0.80, 5.67; P = 0.129). *P < 0.05, **P < 0.001. Table 4. Sociodemographic and attitudinal factors associated with increased frequency of drinking among Chinese women in Hong Kong—2011 (n = 2308) Reported increased drinking frequency since 2007–08 alcohol tax eliminationa Drank more often at social events Drank more often at outside meals Drank more often with co-workers Drank more often at home Drank more often in solitude Row % Crude OR ORmv(95% CI)b Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Sociodemographics  All 8.1 8.6 5.8 4.4 4.2 2.4  Age 0.573 0.437 0.064 0.637 0.816   21–25 years 14.3 1.0 NS 11.6 6.3 9.5 4.2 2.1   26–35 years 9.6 0.44* 8.5 7.9 5.5 2.4 1.8   36–45 years 8.0 0.32* 10.0 6.0 4.0 5.0 3.5   46–55 years 6.7 0.31* 7.8 5.9 3.4 5.4 2.4   56–70 years 3.3 0.08** 5.8 2.5 1.7 3.3 1.7  Educational level 0.149 0.512 0.398 0.251 0.772   Secondary or lower 6.4 1.0 1.00 7.5 5.4 4.0 3.6 2.3   Post- secondary 10.6 3.33** 2.35 (1.40–3.93)* 10.5 6.6 5.2 5.2 2.6  Marital status 0.100 0.071 0.004 0.503 0.844   Ever married 6.1 1.0 NS 7.6 4.9 3.1 4.5 2.4   Never married 12.7 3.02** 11.3 8.2 7.8 3.5 2.6  Occupation 0.230 0.169 0.305 0.469 0.101   Housewife 3.1 1.0 1.00 5.3 3.5 3.1 2.2 0.9   Employed 10.1 6.49** 6.14 (2.79–13.59)** 10.3 7.0 5.3 5.2 3.6   Retired 2.3 0.60 0.59 (0.07–4.82) 6.8 2.3 0.0 4.5 0.0   Unemployed 20.8 8.52** 7.68 (2.41–24.49)** 12.5 12.5 8.3 4.2 0.0   Student 13.2 10.65** 5.57 (1.52–20.43)* 10.8 8.1 5.4 2.7 0.0  Job requires drinking 0.547 0.184 0.383 0.337 0.601   None required 7.7 1.0 NS 8.6 5.7 4.3 4.1 2.4   Yes, required 19.2 2.58* 12.0 12.0 8.0 8.0 4.0 Drinking beliefs  Social benefits 0.497 0.348 0.147 0.751 0.519   Score < IQR 6.8 1.0 NS 9.1 4.6 3.4 3.7 1.7   Score within IQR) 5.9 1.31 6.0 6.0 3.0 5.3 3.0   Score > IQR 10.4 1.62 9.2 7.2 6.3 4.3 3.0  Work benefits 0.898 0.498 0.063 0.902 0.368   Score < IQR (ref) 7.4 1.0 1.00 8.8 4.6 3.8 4.6 3.1   Score Within IQR) 5.4 0.94 0.92 (0.48–1.77) 8.0 5.9 2.5 3.8 1.3   Score > IQR 11.0 2.69** 2.41 (1.37–4.25)* 9.1 7.0 6.6 4.2 2.8  Drinking is healthy 0.419 0.142 0.033 0.119 0.030   Disagree 5.1 1.0 1.00 7.5 4.1 2.3 2.6 0.8   Agree 9.6 2.53** 1.92 (1.10–3.35)* 9.2 6.7 5.6 5.0 3.3  Causes GI issues 0.014 0.053 0.482 0.080 0.686   Agree 7.9 1.0 NS 8.2 5.5 4.4 4.0 2.4   Disagree 13.8 1.46 21.4 14.3 7.1 10.7 3.6  Drinking helps sleep 0.028 0.017 0.410 0.062 0.335   Disagree 5.4 1.0 1.00 6.8 4.2 3.9 3.1 2.0   Agree 11.8 4.09** 4.07 (2.46–6.73)** 11.2 8.2 5.2 5.8 3.0 Reported increased drinking frequency since 2007–08 alcohol tax eliminationa Drank more often at social events Drank more often at outside meals Drank more often with co-workers Drank more often at home Drank more often in solitude Row % Crude OR ORmv(95% CI)b Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Row % χ2 P-value Sociodemographics  All 8.1 8.6 5.8 4.4 4.2 2.4  Age 0.573 0.437 0.064 0.637 0.816   21–25 years 14.3 1.0 NS 11.6 6.3 9.5 4.2 2.1   26–35 years 9.6 0.44* 8.5 7.9 5.5 2.4 1.8   36–45 years 8.0 0.32* 10.0 6.0 4.0 5.0 3.5   46–55 years 6.7 0.31* 7.8 5.9 3.4 5.4 2.4   56–70 years 3.3 0.08** 5.8 2.5 1.7 3.3 1.7  Educational level 0.149 0.512 0.398 0.251 0.772   Secondary or lower 6.4 1.0 1.00 7.5 5.4 4.0 3.6 2.3   Post- secondary 10.6 3.33** 2.35 (1.40–3.93)* 10.5 6.6 5.2 5.2 2.6  Marital status 0.100 0.071 0.004 0.503 0.844   Ever married 6.1 1.0 NS 7.6 4.9 3.1 4.5 2.4   Never married 12.7 3.02** 11.3 8.2 7.8 3.5 2.6  Occupation 0.230 0.169 0.305 0.469 0.101   Housewife 3.1 1.0 1.00 5.3 3.5 3.1 2.2 0.9   Employed 10.1 6.49** 6.14 (2.79–13.59)** 10.3 7.0 5.3 5.2 3.6   Retired 2.3 0.60 0.59 (0.07–4.82) 6.8 2.3 0.0 4.5 0.0   Unemployed 20.8 8.52** 7.68 (2.41–24.49)** 12.5 12.5 8.3 4.2 0.0   Student 13.2 10.65** 5.57 (1.52–20.43)* 10.8 8.1 5.4 2.7 0.0  Job requires drinking 0.547 0.184 0.383 0.337 0.601   None required 7.7 1.0 NS 8.6 5.7 4.3 4.1 2.4   Yes, required 19.2 2.58* 12.0 12.0 8.0 8.0 4.0 Drinking beliefs  Social benefits 0.497 0.348 0.147 0.751 0.519   Score < IQR 6.8 1.0 NS 9.1 4.6 3.4 3.7 1.7   Score within IQR) 5.9 1.31 6.0 6.0 3.0 5.3 3.0   Score > IQR 10.4 1.62 9.2 7.2 6.3 4.3 3.0  Work benefits 0.898 0.498 0.063 0.902 0.368   Score < IQR (ref) 7.4 1.0 1.00 8.8 4.6 3.8 4.6 3.1   Score Within IQR) 5.4 0.94 0.92 (0.48–1.77) 8.0 5.9 2.5 3.8 1.3   Score > IQR 11.0 2.69** 2.41 (1.37–4.25)* 9.1 7.0 6.6 4.2 2.8  Drinking is healthy 0.419 0.142 0.033 0.119 0.030   Disagree 5.1 1.0 1.00 7.5 4.1 2.3 2.6 0.8   Agree 9.6 2.53** 1.92 (1.10–3.35)* 9.2 6.7 5.6 5.0 3.3  Causes GI issues 0.014 0.053 0.482 0.080 0.686   Agree 7.9 1.0 NS 8.2 5.5 4.4 4.0 2.4   Disagree 13.8 1.46 21.4 14.3 7.1 10.7 3.6  Drinking helps sleep 0.028 0.017 0.410 0.062 0.335   Disagree 5.4 1.0 1.00 6.8 4.2 3.9 3.1 2.0   Agree 11.8 4.09** 4.07 (2.46–6.73)** 11.2 8.2 5.2 5.8 3.0 OR, odds ratios; CI, confidence interval; IQR, interquartile range; GI, gastrointestinal; NS, not significant, these variables were removed in the backwards elimination process. aAll respondents who were less than 18 years old in 2008 were removed from analysis of this variable since they would not be of legal drinking age. bVariables in backwards elimination were removed in the following order: GI issues (P = 0.577), Marital status (OR = 1.38; 95% CI = 0.70, 2.74; P = 0.350), Social Benefits Score (P = 0.421), Age (P = 0.282), Job Drinking (OR = 2.13; 95% CI = 0.80, 5.67; P = 0.129). *P < 0.05, **P < 0.001. Of the various contexts of drinking, relatively larger percentages of women reported drinking more often at social events (8.6%) and social meals at restaurants (5.8%). Smaller percentages reported drinking more frequently with co-workers (4.4 %), at home (4.2%) and in solitude (2.4%). Women who reported drinking more in social contexts showed similar sociodemographic profiles (younger, single, with higher education) and significantly more likely to ascribe to the social benefits of drinking. Women who reported increased drinking in solitude revealed that they were only more likely to ascribe to the beliefs of alcohol’s health benefits or sedative properties. Women who reported increased drinking at home showed patterns intermediate between these profiles. Notably, women who ascribed to alcohol’s health benefits or sedative properties were significantly more likely to have reported increased drinking frequencies in all drinking contexts by 2011. Self-reported drinking influences among women reporting increased drinking frequency in 2011 The comparison of self-reported influences on drinking behaviors between women who did and did not report increased frequency of drinking (Table 5) revealed that women with an increased frequency of drinking were most likely to state peer/social influences that encouraged drinking, widespread alcohol promotion, and their own greater familiarity with alcoholic beverages in the past 3 years (50.0–61.3%). Slightly smaller proportions of women who increased their drinking frequency (41.3–48.1%) cited economic reasons (lower prices and increased accessibility). About one-third reported that work culture or higher income influenced their drinking, and only 2.5% reported financial stress as an influence. All examined factors were significantly different between women who did and did not state increases in their drinking frequencies. The only influencing factor that was higher among women who did not report an increase in their drinking frequency was the lower price of alcohol. DISCUSSION The overall drinking patterns that emerged among Chinese women in the period following the alcohol policy changes generally reflected the uptake of moderate levels of drinking. The study noted small increases in the overall age-adjusted prevalence of past-year and weekly drinking but not binge drinking. Certain subgroups deviated from these general trends, and there were distinct profiles of women who increased their drinking frequencies, indicating the need for segmented alcohol harms reduction strategies. Comparable to a Singaporean study conducted during a similar time period (Lim et al., 2007), our study noted that middle-aged women rather than younger-aged women demonstrated significant increases in frequent and heavy drinking during this period. Since Singapore continued to impose high-alcohol duties and did not implement policy changes during this time, the consistency of regional findings indicates other macro-level forces are likely influencing middle-aged women’s drinking behaviors, as well as the policy change. Middle-aged women may have emerged as prime targets of regional marketing campaigns for their higher consumer spending power, particularly for luxury brands (Nelson, 2011b). In contrast to most areas in the West, which mainly target younger age ‘party’ drinkers, alcohol marketing in the China region often promotes an image of cultural sophistication. In Hong Kong, expensive spirits are common gifts to business associates, and high-end alcohol is commonly served at important festivities. Our study noted that middle-aged women were most likely to agree that there was greater availability of higher quality alcohol in recent years (untabulated). Unemployed women emerged as a major risk group for binge drinking and had the highest likelihood of overall increased drinking frequency by 2011. Previous research has noted associations between unemployment and heavy drinking and posited that financial stress, family discord and increased leisure time contribute to increased levels of drinking (Popovici and French, 2013; Bosque-Prous et al., 2015). Our results partly corroborate past findings by revealing that unemployed women who reported increased drinking frequencies were significantly more likely to be social drinkers. We speculate that unemployed women may have become a prime risk group due to the combined effect of a lack of participation in other social activities and greater leisure time to indulge in social drinking. Prior to 2011, small proportions of married women drank frequently (Kim et al., 2008), but after the tax policy change period there was no longer a disparity by marital status in any drinking pattern. This trend may indicate cultural shifts in married women’s perceived social norms of alcohol consumption and the cultural acceptability of frequent or heavy drinking in a traditionally low consumption region. As posited, the changes in drinking behaviors appeared to reflect a confluence of personal and socio-environmental factors. We noted two general contexts of increased drinking among Chinese women, indicating the need for segmented public health strategies (targeting different ages, professional status and drinking contexts) that address diverging and evolving drinking contexts. First, many women who increased their drinking frequency were social drinkers, who were more likely to cite influences from peers and alcohol marketing. Specifically, greater familiarity with alcohol, promotions of alcohol and improved selection of alcohol were cited by >40% of the women in 2011 who reported increased drinking. After the alcohol tax elimination, alcohol promotional events (e.g. wine festivals, Hong Kong Beertopia) were sponsored, encouraging a festive environment for socializing in Hong Kong (PR Newswire, 2016). During this time, there was an explosion of certified wine education and interest programs and greater coverage of wine topics in Hong Kong’s popular press (Poon, 2016). Post-hoc analysis noted that women were statistically more likely to have increased their consumption of wine, but not other types of alcohol by 2011. These facts lend credence to the influence of greater familiarity with alcohol in combination with promotion of drinking events contributing to increased levels of drinking among Hong Kong Chinese women. The second profile of women who increased their drinking frequencies was non-social drinkers who ascribed to the health and relaxation benefits of drinking. In fact, one of the more prominent trends is the predictive power of the belief that ‘drinking is healthy’. By 2011, this belief was significantly associated with all drinking patterns and increased frequency of drinking in nearly all drinking contexts. The purported beneficial effects of wine on cardiovascular health are widely publicized by the local media and the alcohol industry in both Hong Kong and China (Nelson, 2011a; Yoon and Lam, 2012). In high-alcohol consumption countries, excessive drinking is generally associated with a heavy disease burden, significant social problems and economic loss, while low alcohol consumption regions are traditionally much less affected by these harms and possess lower levels of awareness. In addition to limiting accessibility and alcohol promotions, increasing the knowledge of alcohol harms should be considered in order to counteract the aggressive marketing of health benefits of drinking by the alcohol industry. The 2007–2008 Hong Kong alcohol tax elimination did not appear to have a direct price effect on the changes in Hong Kong Chinese women’s drinking patterns. Less than half of women who increased their drinking reported that their drinking was directly influenced by price. In fact, women who drank more frequently were less likely to perceive that alcohol was cheaper after the tax changes. The gradual elimination of alcohol taxes appears to have increased drinking via indirect pathways since the Consumer Price Index of alcohol did not decline noticeably during these years despite the large tax reduction, suggesting high profit margins for retailers (Chung et al., 2013). The elimination of alcohol duties appears to have provided incentives for businesses to offer a wider range of alcoholic beverages and for bars to aggressively encourage social drinking. The resulting changes in the alcohol market such as publicized alcohol festivals and increased visibility from sponsorships in public events may have created an environment that is more conducive to social drinking in women. Policy changes may have indirectly contributed to increased women’s alcohol consumption by increasing alcohol product selection, altering the context of drinking and changing personal perceptions of alcohol consumption. Limitations of this study include the cross-sectional design whereby the directionality of significant associations remains unclear. Moreover, since the two samples used in our study were 5 years apart, whereas age was stratified by 10-year increments, this study could not unequivocally disentangle the cohort effects and period effects. It cannot be unequivocally stated that increases in drinking prevalence in most age strata between 2006 and 2011 were due to changes in the drinking environment. It is possible that younger cohorts of women, who are more likely to take up drinking, maintained their drinking habits as they grew older. Future studies on Chinese women’s drinking patterns should address this limitation with age, period and cohort analyses over a longer time period to clarify their independent effects on drinking patterns. The self-reported telephone survey methodology precludes validation of drinking levels, and there are no official statistics of households reachable only by mobile telephones in 2006–2011. The proportion is likely to have been higher in 2011. Moreover, people living alone or in dormitories, who likely only possess a mobile phone, are likely not included in the sampling frame. Despite these limitations, these cross-sectional studies captured a large, representative sample of Hong Kong Chinese women that can serve as baseline data for future alcohol policy studies. CONCLUSION Our study observed increases in the frequency of alcohol consumption among subgroups of Hong Kong Chinese women after a period of highly publicized alcohol tax eliminations. We speculate that these policy changes contributed to a shift in the sociocultural environment of alcohol consumption. In 2011, versus 2006, we now see that more women are drinking in social contexts and believe in the health benefits of alcohol consumption. Continuous public health surveillance and the development of targeted messages will likely be needed to ensure that alcohol harms and disease burden do not increase among Hong Kong women. Timely interventions to reduce the harmful use of alcohol should be considered prior to the proliferation of alcohol use disorders at the population-level. FUNDING Funding for the 2006 survey was provided by the Li Ka Shing Foundation. 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Alcohol and AlcoholismOxford University Press

Published: Feb 23, 2018

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