Understanding women’s stories about drinking: implications for health interventions

Understanding women’s stories about drinking: implications for health interventions Abstract Alcohol consumption poses significant health and safety risks to women. Understanding why women drink and how they experience drinking is the first step in creating efficacious interventions and effective social support programs. Presented here is a qualitative study examining stories women told about drinking on a blog: drinkingdiariesk.com. Eighty-nine stories categorized as ‘in-depth, personal and insightful essays’ were analysed and four narratives were identified about women’s drinking in different stages in their lives: youth (narrative of good girl and narrative of bad girl), adulthood (narrative of pleasure) and old age (narrative of sin). Women constructed their relationships with alcohol in these different life stages, conforming to or rebelling against traditional gender roles. The narratives about drinking among young women and older women were inflicted with adultism and ageism. Practically, this study pointed out the specific stereotypes surrounding younger and older women with a drinking problem, which could inform future intervention campaigns about women’s drinking. Introduction Alcohol use poses increasing health and safety risks to women. In 2012, 4.0% of all deaths in women worldwide were attributable to alcohol consumption [1]. Excessive drinking inflicts increasing risk of sexual assaults [2] as well as negative health consequences, such as liver disease [3] and cancer [4]. Compared to men, women are more susceptible to the harmful effects of alcohol consumption, such as cognitive impairment and long-term changes in brain structure [5]. Furthermore, alcohol consumption during pregnancy poses severe health risks to the unborn child, including mental retardation, birth defects and sudden infant death [6]. In the United States, approximate 5.7 million women over 18 and 444 000 adolescent girls aged between 12 and 17 had alcohol use disorders (AUDs) [7]. A surge of prevention programs emerged in the past decades to reduce heavy drinking in the United States, adopting approaches such as moral exhortation, fear-appeal, informative education [8] and social-norm campaigns [9]. However, mixed findings were identified in field studies regarding the effectiveness of these interventions. For instance, in the context of interventions attacking drinking norms in young adults, many studies supported the effectiveness of such interventions [10, 11], while others failed to find significant changes in problematic drinking behaviors [12, 13] and even increases in binge drinking [14]. One major limitation of previous prevention programs is the lack of a gender-specific perspective [15]. Situated in well-established social and cultural contexts, drinking is a social practice through which identity and gender-specific experiences are constructed [16, 17]. Historically, women’s drinking is judged more harshly than men’s drinking [18]. As a result, women with drinking problems are less likely than men to seek and receive treatment due to the feeling of shame, powerlessness and the fear of losing their children [19, 20]. In addition, gender was also identified as an important moderator in field studies. For instance, perceived same-sex drinking norms have stronger correlations with women’s drinking behaviors than opposite-sex norms [21]. As such, understanding why women drink and how they experience drinking could contribute to creating efficacious interventions and social support programs in the future. Storytelling is a powerful way of communicating one’s opinions, experiences and identities [22]. Health communication scholars have examined the narratives associated with illness and health to gain insights into the pre-judices and unsaid pains about illness (e.g. Refs. [23–25]). Social media give women a new platform to share the experiences of drinking [26]. Among all types of social media, online blogs represent a unique venue for women to share and discuss personal experiences with rich descriptive information [27]. Bloggers reported feeling more comfortable sharing their experiences, especially undesirable ones, online than in face-to-face settings [28]. As such, stories published in blogs have been analysed to gain insights into health-related experiences (e.g. Ref. [29]). In order to understand how women tell stories about drinking in online blogs and to explore the underlying assumptions about gender norms in such stories, we proposed the following research question: RQ: What are the narratives about women and drinking on online blogs? Materials and methods Data collection Drinking dairies (http://www.drinkingdiaries.com) is a non-commercial blog created by two writers—Leah Odze Epstein and Caren Osten Gerszberg—to allow women to ‘share the details, the deep questions, the wide and wild range of experiences that pertain to women and alcohol’. Readers are encouraged to submit their own stories and commentaries about drinking to the blog. The blog contained about 687 entries as of 12 August 2015, which were classified by the owners of the blog into 31 categories, such as abstaining, addiction, bar series, college drinking and novel excerpt, to name a few. Eighty-nine stories were categorized as ‘in-depth, personal and insightful essays’. These stories were rich, complex and personal and thus were especially useful in understanding women’s beliefs about drinking and their lived experiences with alcohol. Most of these stories were about bloggers’ own drinking experiences. Sometimes, however, bloggers told stories about their family members, such as their mothers and sisters. These 89 stories thus constituted the corpus for the current study and were downloaded for analysis. Most of the stories were written by anonymous authors. Each story was assigned a unique identification number. The stories were posted between 1 July 2009 and 2 July 2014. Data analysis Ontologically, we took a social constructionist position, believing that experiences, beliefs and stereotypes are constructed inter-subjectively through communicative processes such as storytelling. However, such social constructions gradually become reified as people started to treat them as objective characteristics of society and started to be affected by them [30]. Hence, we used narrative analysis understand how women construct their experiences and beliefs about drinking. Narrative analysis is a powerful tool for obtaining in-depth understanding of individuals’ experiences and identities, as well as power structures, social roles and cultural norms in society [31]. Grounded theory building and constant comparative method are often used in narrative analysis to allow researchers to identify recurring themes and narratives [32]. The analysis of women’s stories about drinking was conducted in three steps. First, following the rationale of grounded theory building, two authors set out to inductively identity common themes in women’s drinking stories in terms of the following elements: character of the protagonist, motives of drinking, key events described, the locales of drinking and the moral lessons drawn by the narrator [33]. This initial reading suggested that stories about young women (especially high school and college students), adult women and older women demonstrated distinctive characteristics. Hence, in the second stage, stories were assigned into three categories based on the life stage when the stories about drinking happened: [1] youth, [2] adulthood and [3] old age. One blog entry could be assigned to multiple categories if it contains distinctive stories about drinking in different life stages. Finally, constant comparative method was used in comparing stories within each category to one another in identifying four most prominent narratives about women’s drinking [32]. During this process, the two authors continuously discussed their inter-pretations of the stories and resolved their differences. Results Woman bloggers used distinctive narratives to describe women’s drinking in different life stages. Four distinctive narratives were identified: two competing narratives about young women’s drinking (narrative of the good girl and narrative of the bad girl), one narrative about adult women’s alcohol consumption (narrative of pleasure) and one narrative about older women’s drinking (narrative of sin). Narratives about young women and drinking Stories regarding young women’s drinking mainly dealt with their first experience with alcohol, first time getting drunk and cultural norms regarding drinking in high schools and colleges. Two competing narratives were identified based on two opposing expectations of young women: narrative of the good girl and narrative of the bad girl. Narrative of the good girl One prominent narrative regarding young women, typically teenagers and college women’ use of alcohol, was centered around the traditional feminine gender role, or ‘being a good girl’. Bloggers often presented strong intention of abstinence from alcohol and expressed lamentation and shame after their first drinking experience. One narrator recounted, ‘We were underage and unsophisticated; we didn’t know there was a way to match the drink with the place. ‘The time came for me to put my head on the table. In any country, this is a bad sign. I panicked, lost, as I revisited all the drinks I’d mixed’. In the bathroom, I tried to wash my hair in the cracked, stained bachelor’s sink. I should not be here, was all I could think’ [No. 9 (Numbers after quotations represented the ID number of blog entries)]. In the narrative of the good girl, drinking was often associated with the betrayal of one’s religious beliefs and a loss of control. For instance, in another story, the narrator said, ‘I was a 16-year-old Catholic virgin, and brimming with a fear of sin and ideas about who and what was right for me, in spite of those entrancing eyes. ‘It was also the night that my friends and I decided that, despite my lack of drinking experience, it was time for me to become a Turtle (Become a Turtle is a drinking related slang, meaning a drinking game or joining a drinking club)’. I think about how I’m still afraid of that loss of control, how I still wake up inside the nightmare. ‘Because I was supposed to be among the best and the brightest, a girl with promise and ethics and intelligence. A good girl who is now dead’ (No. 8). In this excerpt, drinking was conceptualized as incompatible with the ideal of young women as religious, intelligent and capable of self-control. This narrative reflected the cultural belief that women’s reputation derived from self-control [34]. Moreover, women engaged in alcohol consumption were usually portrayed to be at the risk of sexual advances from men, which was consistent with the finding of existing studies (e.g. Ref. [35]). Feelings of regret and shame were embedded in narratives of the good girl. This was demonstrated in the following quote: ‘I remember being kissed, feeling the room spinning and swerving. I didn’t fight him until he undid the button on my white jeans. I remember saying no. I remember his hands pinning my wrists; my legs being held down by his. ‘I found my way back out to the beach and stumbled down to the shore. I put my hands in the lake, washing my face with the cold, clear water. When I looked down at my reflection it looked incomplete, broken. There was nothing; and there was something—pain and a red haze behind my eyes’ (No. 8). Overall, the narrative of the good girl was predominantly imbued with the feelings of shame and regret. Women’s drinking was generally perceived as unrespectable and immoral, which also revealed young women’s lack of knowledge, understanding about drinking and awareness of social support resources. Disclosure of drinking practices was nearly absent in this narrative. This stood in contrast with the second narrative about young women’s alcohol use: narrative of the bad girl. Narrative of the bad girl This narrative depicted women who drank as sociable and fun. Drinking was deemed as an expectation for young women, especially amidst the party culture on U.S. campuses. For instance, one woman wrote about her experience, saying, ‘Show up at eighth grade graduation, drunk. Show up at high school graduation drunk’ (No. 13). Another woman described how she had to live up to this expectation as a high school student, saying, Being able to drink with the big boys was a cultural expectation. ‘The beer tasted like it smelled, and I wasn’t good at drinking yet, so my stomach lurched and my throat constricted. But I couldn’t boot (Boot means vomit in this context) in front of everyone; I’d never live that one down’ (No. 7). Additionally, drinking was also frequently used as a coping strategy for stress. For example, a woman recalled how drinking served as an outlet for pressure, saying, So is it any wonder that when teen girls do drink now, they drink a lot–and quickly? Drinking is a central nervous system depressant, but it also lowers inhibitions and gives girls an outlet–as strange as it may sound–to relax. When you’re drunk–and if you’re really drunk–you don’t think about everything you’re facing, if only because you simply can’t (No. 19). Additionally, the disclosure of drinking was purposefully and strategically managed. She bragged to her friends about her drinking, while misrepresenting her true feelings and future intentions of drinking in front of her parents. For instance, one woman recounted, ‘In front of my dad, I feigned shame about what I’d done, but the next day I bragged to my friends about it. Of course I was getting drunk in non-family settings by that point, too and generally doing my best to develop a wild reputation’ (No. 17). Overall, in the narrative of the bad girl, women related more positive consequences to their drinking experiences than negative ones. Drinking made them more sociable and served as a coping strategy for stress. Morality is no longer at the center of this narrative. Adult women: narrative of pleasure Narrative of pleasure portrayed adult women’s drinking as a lifestyle choice closely related to personal enjoyment and tastes. In such stories, narrators viewed alcohol as an art form that brought enjoyment, delicacy and style. For example, one woman wrote, ‘You can experience wine–like poetry–alone, with a friend, with a beloved or with family. A glass or a bottle of wine is finite, but always meaningful. Like poetry, it is always transporting, romantic, sensual and personal’ (No. 53). Drinking was also frequently represented as an experience shared with their partners. For instance, one blogger commented that ‘wine is enjoyed with food by my husband and me as much and as frequently as a mug of hot cocoa or a chilled glass of lemonade’ (No. 29). Likewise, using we-language and associating drinking with relaxation, a woman said, ‘We’re married with children, a dog, a mortgage and a ton of bills and we do what most parents we know do to take the edge off at the end of the day: we drink’ (No. 30). Additionally, this narrative also stressed moderation in drinking, portraying it as a collective effort in a household. For instance, emphasizing the ‘very adult-like’ type of drinking at home, one narrator said, ‘We’ll pour some red wine on occasion for dinner, very adult-like and feel like we are running a pretty civilized home’ (No. 72). For adult women, social gatherings were still accompanied by drinking as they were in college. However, drinking was no longer something to brag about. Rather, it became a choice and a delightful addition to the beauty of friendship and inter-personal connectedness. For instance, one narrator said, I like everything but prefer nothing, and so many of my friendships have their own signature drink. I have my gin and tonic girlfriend. We love to have one in the summer, at the end of steamy days filled with work, carpooling, gardening, or whatever it is that gives us that particular exhaustion on July evenings. ‘With gimlets, we are girly and we gossip ruthlessly. We joke about the husbands we love while preparing dinner for them. The Rose’s is the candy, and the vodka shatters it with a hammer. Joined in a glass, our gimlet is tough and sweet, like us. Or at least, how we want to be, then and there, together’ (No. 72). For adult women, alcohol helped to create a positive and relaxing atmosphere in social gatherings. One woman wrote: And that’s when it hit me, live music makes people happy. And alcohol makes people less inhibited (or me, anyway) and freer to shake their booty. I watched these women strutting and waving their arms, and I knew exactly how they felt–free of judgment and inspired to move with the beat. It was beautiful (No. 80). Overall, adult women’s drinking experiences were embedded with a positive valance, associating drinking with healthy and intimate relationships. Older women: narrative of sin The narratives about older women’s drinking were often centered on AUDs, even though older women were found to drink less than all other age groups [6]. Interestingly, all stories about older women’s drinking were told by their daughters. Drinking was portrayed as a way to escape from depression, stress, or pressure, especially among those who have lost family members. For instance, one blogger attributed her mother’s alcohol dependence to a loss of a close family member: My mother was raised on an apple farm in Southern Quebec, the middle child of seven girls. She was the first ever in her family to go to college. She survived a bout with breast cancer, a stint in women’s prison for civil disobedience and Woodstock in the rain, but it was her despair from James’ death that triggered her descent into raging alcoholism (No. 16). Older women with AUDs were constructed as creating burden for and exerting negative influences on other family members. In addition, they were depicted as denying their drinking problems. A daughter wrote about her mother, who had suffered from alcohol dependence, She puffed herself up and said she had no alcohol problem and that was that. Except for the next 20 years that she spent in bed, Fox News on so loud you couldn’t talk to her, scotch at her side and an ever-present cigarillo. Took to her bed, literally. ‘My father, a farmer, managed the house, cooked for her and bought her booze. When he refused, she put a coat on over her nightgown and drove to the liquor store herself. When she came down with pellagra, a vitamin-deficiency caused by alcoholism, Dad reduced her intake to one drink after dinner. Since she weighed only 80 pounds, one drink still had the wanted effect’ (No. 58). Another excerpt demonstrated the social embarrassment caused by an older woman, who was a mother with alcohol addiction. My mother, a French native who has always loved wine, grew to love it too much about 10 years ago, and her love morphed into an addiction which continues to plague me at every event—both big and small, mundane and celebratory. Moments later, a friend was chasing me around the kitchen, clutching a glass and obviously uncomfortable as my mother anxiously followed her. Ten minutes later, I ushered her into a taxi. She complained but I stood firm. I was just trying to cut my losses before it got worse for both of us (No. 24). Overall, older women’s drinking was judged more harshly than that of younger women. Older women frequently used drinking to cope with severe and chronic stressors, such as the loss of a loved family member. However, social support was very limited, even within familial networks. This may also explain why they relied predominantly on avoidance coping for AUDs. Discussion The findings of this study highlighted the gendered drinking experiences of women. Our analysis found evidence for four distinctive narratives in describing women’s drinking in different life stages. Drinking narratives of younger and older women were predominantly negative, focusing on feelings of shame and regret. In addition, drinking was also a coping strategy for reducing stress. On the contrary, the narrative about adult women was typically associated with a positive tone, stressing the pleasure of drinking. Shame and stress in women’s drinking Negative emotional states were central to both young and older women’s experiences of drinking. These emotional states helped to explain why young women drink and how they relate to drinking. Narratives of the good girl and the bad girl were typically associated with stories about young women’s alcohol consumption. The former was predominately embedded with the feelings of shame and regrets, lamenting how drinking destroyed the perfectly moral and religious good girls. The latter stressed that women who drank were sociable and fun. Alcohol was also misused to reduce stress and social anxiety. This is consistent with epidemiological data that mental illnesses, such as anxiety and depression, tend to be concurrent with harmful alcohol use in college women [36]. Similarly, the most common reason for drinking mentioned by older women was the loss of a family member. The protagonists of older women’s drinking stories were often those with AUDs. Older women with AUDs were frequently depicted as burdens on other family members. This shows the lack of social support for these women in dealing their drinking problems. Additionally, older women frequently adopted avoidance coping for AUDs. Research suggests that both avoidance coping and lack of social support are related to more drinking and negative consequences of drinking [37]. Contrary to young and older women, adult women generally perceived drinking as an enjoyable activity in both domestic and public settings. Drinking was a pleasure and indicated personal tastes. As such, the narratives also hinted at a necessity of moderation. Their choice of drinking was not dictated by the desire for peer approval, nor for reducing stress. When they drink, they control when, how much and with whom. Ageism, adultism and women’s drinking Age played a pivotal role in shaping the type and valence of the drinking narratives. Ageism is the stereotyping of people based on age and is typically associated with the discrimination against old people [38]. Ageism is gendered. For instance, women are considered to reach old age earlier than men [39], and older women are perceived as less attractive than their male counterparts [40]. Such ageist bias was evident in the narrative about older women’s drinking, which emphasized their dependence and lack of self-control. Older women were judged more harshly than younger women for their alcohol consumption. This is consistent with the findings of existing study based on women’s self-report (e.g. Ref. [41]). Interestingly, within this study, all stories about older women’s alcohol use were told by their daughters. Older women might be muted on social media due to their lack of expertise with new technologies. Such a lack of voice further prevented them from telling their own stories about drinking and their lives. Adultism, or the discrimination against young people, is another form of ageism as both discriminate people based on their ages. Adultism considers young people as immature, unreliable and unable to make decisions for themselves, and hence, in need of control and interventions from adults [42]. Such bias was evident in the narratives about young women where they were portrayed as insecure, unwise and eager to fit in. However, adult women seemed to enjoy greater freedom in relation to drinking based on the narrative identified in this study. As the primary caretaker of children or the breadwinner of the household, adult women were characterized as independent, determined and pleasure-seeking. As a consequence, women’s drinking narratives in this particular life stage exhibited dramatic differences compared to the dominant discourses about women’s drinking. Limitations and directions for future research One limitation of this study lies in the limited generalizability of its results due to the characteristics of the sample. In addition, the sample size was relatively small, which could also result in a limited generalizability of the findings. Future research could collect more stories about women and drinking from a more diverse population online. In addition, researchers should collect more drinking stories from women who are unlikely to post their stories online: older women, less educated women and minority women to gain insight into their perspectives about the relationship between women and drinking. Another issue worth considering is that of authenticity [43]. Since this study was based on the analysis of stories posted by anonymous users online, we cannot be sure of the age, racial and ethnic composition of the narrators who posted their drinking stories on the blog site and the authenticity of such stories. Practical implication The current study identified distinctive gendered experiences of drinking across different ages among women. Younger women and older women were subject to more pronounced prejudices related to ageism and adultism. Future clinical interactions, social support communication and intervention programs need to recognize these additional dimensions of discrimination in reaching women with drinking problems in different life stages. Adopting a gender-specific perspective may be a more fruitful approach to AUDs preventions and interventions. In terms of young women’s drinking, this study found evidence that drinking was commonly used as a coping mechanism for stress. This is consistent with the findings of epistemological studies that drinking is frequently concurrent with mental health issues in young people [36]. Individuals who use alcohol to deal with negative emotions are more likely to consume more alcohol and have alcohol-related problems [44]. In addition, research suggests that increasing the strength of health-related attitudes could lead to more stable behavioral changes [45]. As such, promoting the importance of health may help younger women to take control over their health by increasing their ability to counter-argue health-threatening norms. Within this study, the prevalent expressions of shame and regret may also raise concerns about whether women with AUDs would report their drinking behaviors and seek help. For instance, research suggests that college women reported feeling hesitant to include drinking-related references on social media [46]. In addition, research also suggests that women are less likely than men to seek help for AUDs due to the feelings of shame [20]. However, existing prevention programs often rely on negative and avoidance appeals, which may lead to heightened feelings of shame and fear among women [47]. Consequently, public health professionals may start by taking a gender-specific approach when designing prevention messages. Additionally, to date, rational choice models are widely used to examine behavioral changes in the context of drinking. Future research and interventions should take account of the emotional factors, such as shame, that may impact women’s disclosure and understanding of their drinking experiences. For older women, stressful life events were associated with problematic drinking behaviors. While AUDs were the least prevalent in older women comparing with all other age groups in women [6], older women were more susceptible to prejudices surrounding AUDs, even within familial networks. This may also contribute to the use of avoidance coping among older women with AUDs. In addition to promoting active coping, de-stigmatizing AUDs within familial and friendship networks may be of great importance in encouraging older women to seek help for their AUDs. Additionally, problem drinking in older women was primarily attributable to the loss of a loved family member. 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Understanding women’s stories about drinking: implications for health interventions

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© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com
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0268-1153
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1465-3648
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10.1093/her/cyy016
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Abstract

Abstract Alcohol consumption poses significant health and safety risks to women. Understanding why women drink and how they experience drinking is the first step in creating efficacious interventions and effective social support programs. Presented here is a qualitative study examining stories women told about drinking on a blog: drinkingdiariesk.com. Eighty-nine stories categorized as ‘in-depth, personal and insightful essays’ were analysed and four narratives were identified about women’s drinking in different stages in their lives: youth (narrative of good girl and narrative of bad girl), adulthood (narrative of pleasure) and old age (narrative of sin). Women constructed their relationships with alcohol in these different life stages, conforming to or rebelling against traditional gender roles. The narratives about drinking among young women and older women were inflicted with adultism and ageism. Practically, this study pointed out the specific stereotypes surrounding younger and older women with a drinking problem, which could inform future intervention campaigns about women’s drinking. Introduction Alcohol use poses increasing health and safety risks to women. In 2012, 4.0% of all deaths in women worldwide were attributable to alcohol consumption [1]. Excessive drinking inflicts increasing risk of sexual assaults [2] as well as negative health consequences, such as liver disease [3] and cancer [4]. Compared to men, women are more susceptible to the harmful effects of alcohol consumption, such as cognitive impairment and long-term changes in brain structure [5]. Furthermore, alcohol consumption during pregnancy poses severe health risks to the unborn child, including mental retardation, birth defects and sudden infant death [6]. In the United States, approximate 5.7 million women over 18 and 444 000 adolescent girls aged between 12 and 17 had alcohol use disorders (AUDs) [7]. A surge of prevention programs emerged in the past decades to reduce heavy drinking in the United States, adopting approaches such as moral exhortation, fear-appeal, informative education [8] and social-norm campaigns [9]. However, mixed findings were identified in field studies regarding the effectiveness of these interventions. For instance, in the context of interventions attacking drinking norms in young adults, many studies supported the effectiveness of such interventions [10, 11], while others failed to find significant changes in problematic drinking behaviors [12, 13] and even increases in binge drinking [14]. One major limitation of previous prevention programs is the lack of a gender-specific perspective [15]. Situated in well-established social and cultural contexts, drinking is a social practice through which identity and gender-specific experiences are constructed [16, 17]. Historically, women’s drinking is judged more harshly than men’s drinking [18]. As a result, women with drinking problems are less likely than men to seek and receive treatment due to the feeling of shame, powerlessness and the fear of losing their children [19, 20]. In addition, gender was also identified as an important moderator in field studies. For instance, perceived same-sex drinking norms have stronger correlations with women’s drinking behaviors than opposite-sex norms [21]. As such, understanding why women drink and how they experience drinking could contribute to creating efficacious interventions and social support programs in the future. Storytelling is a powerful way of communicating one’s opinions, experiences and identities [22]. Health communication scholars have examined the narratives associated with illness and health to gain insights into the pre-judices and unsaid pains about illness (e.g. Refs. [23–25]). Social media give women a new platform to share the experiences of drinking [26]. Among all types of social media, online blogs represent a unique venue for women to share and discuss personal experiences with rich descriptive information [27]. Bloggers reported feeling more comfortable sharing their experiences, especially undesirable ones, online than in face-to-face settings [28]. As such, stories published in blogs have been analysed to gain insights into health-related experiences (e.g. Ref. [29]). In order to understand how women tell stories about drinking in online blogs and to explore the underlying assumptions about gender norms in such stories, we proposed the following research question: RQ: What are the narratives about women and drinking on online blogs? Materials and methods Data collection Drinking dairies (http://www.drinkingdiaries.com) is a non-commercial blog created by two writers—Leah Odze Epstein and Caren Osten Gerszberg—to allow women to ‘share the details, the deep questions, the wide and wild range of experiences that pertain to women and alcohol’. Readers are encouraged to submit their own stories and commentaries about drinking to the blog. The blog contained about 687 entries as of 12 August 2015, which were classified by the owners of the blog into 31 categories, such as abstaining, addiction, bar series, college drinking and novel excerpt, to name a few. Eighty-nine stories were categorized as ‘in-depth, personal and insightful essays’. These stories were rich, complex and personal and thus were especially useful in understanding women’s beliefs about drinking and their lived experiences with alcohol. Most of these stories were about bloggers’ own drinking experiences. Sometimes, however, bloggers told stories about their family members, such as their mothers and sisters. These 89 stories thus constituted the corpus for the current study and were downloaded for analysis. Most of the stories were written by anonymous authors. Each story was assigned a unique identification number. The stories were posted between 1 July 2009 and 2 July 2014. Data analysis Ontologically, we took a social constructionist position, believing that experiences, beliefs and stereotypes are constructed inter-subjectively through communicative processes such as storytelling. However, such social constructions gradually become reified as people started to treat them as objective characteristics of society and started to be affected by them [30]. Hence, we used narrative analysis understand how women construct their experiences and beliefs about drinking. Narrative analysis is a powerful tool for obtaining in-depth understanding of individuals’ experiences and identities, as well as power structures, social roles and cultural norms in society [31]. Grounded theory building and constant comparative method are often used in narrative analysis to allow researchers to identify recurring themes and narratives [32]. The analysis of women’s stories about drinking was conducted in three steps. First, following the rationale of grounded theory building, two authors set out to inductively identity common themes in women’s drinking stories in terms of the following elements: character of the protagonist, motives of drinking, key events described, the locales of drinking and the moral lessons drawn by the narrator [33]. This initial reading suggested that stories about young women (especially high school and college students), adult women and older women demonstrated distinctive characteristics. Hence, in the second stage, stories were assigned into three categories based on the life stage when the stories about drinking happened: [1] youth, [2] adulthood and [3] old age. One blog entry could be assigned to multiple categories if it contains distinctive stories about drinking in different life stages. Finally, constant comparative method was used in comparing stories within each category to one another in identifying four most prominent narratives about women’s drinking [32]. During this process, the two authors continuously discussed their inter-pretations of the stories and resolved their differences. Results Woman bloggers used distinctive narratives to describe women’s drinking in different life stages. Four distinctive narratives were identified: two competing narratives about young women’s drinking (narrative of the good girl and narrative of the bad girl), one narrative about adult women’s alcohol consumption (narrative of pleasure) and one narrative about older women’s drinking (narrative of sin). Narratives about young women and drinking Stories regarding young women’s drinking mainly dealt with their first experience with alcohol, first time getting drunk and cultural norms regarding drinking in high schools and colleges. Two competing narratives were identified based on two opposing expectations of young women: narrative of the good girl and narrative of the bad girl. Narrative of the good girl One prominent narrative regarding young women, typically teenagers and college women’ use of alcohol, was centered around the traditional feminine gender role, or ‘being a good girl’. Bloggers often presented strong intention of abstinence from alcohol and expressed lamentation and shame after their first drinking experience. One narrator recounted, ‘We were underage and unsophisticated; we didn’t know there was a way to match the drink with the place. ‘The time came for me to put my head on the table. In any country, this is a bad sign. I panicked, lost, as I revisited all the drinks I’d mixed’. In the bathroom, I tried to wash my hair in the cracked, stained bachelor’s sink. I should not be here, was all I could think’ [No. 9 (Numbers after quotations represented the ID number of blog entries)]. In the narrative of the good girl, drinking was often associated with the betrayal of one’s religious beliefs and a loss of control. For instance, in another story, the narrator said, ‘I was a 16-year-old Catholic virgin, and brimming with a fear of sin and ideas about who and what was right for me, in spite of those entrancing eyes. ‘It was also the night that my friends and I decided that, despite my lack of drinking experience, it was time for me to become a Turtle (Become a Turtle is a drinking related slang, meaning a drinking game or joining a drinking club)’. I think about how I’m still afraid of that loss of control, how I still wake up inside the nightmare. ‘Because I was supposed to be among the best and the brightest, a girl with promise and ethics and intelligence. A good girl who is now dead’ (No. 8). In this excerpt, drinking was conceptualized as incompatible with the ideal of young women as religious, intelligent and capable of self-control. This narrative reflected the cultural belief that women’s reputation derived from self-control [34]. Moreover, women engaged in alcohol consumption were usually portrayed to be at the risk of sexual advances from men, which was consistent with the finding of existing studies (e.g. Ref. [35]). Feelings of regret and shame were embedded in narratives of the good girl. This was demonstrated in the following quote: ‘I remember being kissed, feeling the room spinning and swerving. I didn’t fight him until he undid the button on my white jeans. I remember saying no. I remember his hands pinning my wrists; my legs being held down by his. ‘I found my way back out to the beach and stumbled down to the shore. I put my hands in the lake, washing my face with the cold, clear water. When I looked down at my reflection it looked incomplete, broken. There was nothing; and there was something—pain and a red haze behind my eyes’ (No. 8). Overall, the narrative of the good girl was predominantly imbued with the feelings of shame and regret. Women’s drinking was generally perceived as unrespectable and immoral, which also revealed young women’s lack of knowledge, understanding about drinking and awareness of social support resources. Disclosure of drinking practices was nearly absent in this narrative. This stood in contrast with the second narrative about young women’s alcohol use: narrative of the bad girl. Narrative of the bad girl This narrative depicted women who drank as sociable and fun. Drinking was deemed as an expectation for young women, especially amidst the party culture on U.S. campuses. For instance, one woman wrote about her experience, saying, ‘Show up at eighth grade graduation, drunk. Show up at high school graduation drunk’ (No. 13). Another woman described how she had to live up to this expectation as a high school student, saying, Being able to drink with the big boys was a cultural expectation. ‘The beer tasted like it smelled, and I wasn’t good at drinking yet, so my stomach lurched and my throat constricted. But I couldn’t boot (Boot means vomit in this context) in front of everyone; I’d never live that one down’ (No. 7). Additionally, drinking was also frequently used as a coping strategy for stress. For example, a woman recalled how drinking served as an outlet for pressure, saying, So is it any wonder that when teen girls do drink now, they drink a lot–and quickly? Drinking is a central nervous system depressant, but it also lowers inhibitions and gives girls an outlet–as strange as it may sound–to relax. When you’re drunk–and if you’re really drunk–you don’t think about everything you’re facing, if only because you simply can’t (No. 19). Additionally, the disclosure of drinking was purposefully and strategically managed. She bragged to her friends about her drinking, while misrepresenting her true feelings and future intentions of drinking in front of her parents. For instance, one woman recounted, ‘In front of my dad, I feigned shame about what I’d done, but the next day I bragged to my friends about it. Of course I was getting drunk in non-family settings by that point, too and generally doing my best to develop a wild reputation’ (No. 17). Overall, in the narrative of the bad girl, women related more positive consequences to their drinking experiences than negative ones. Drinking made them more sociable and served as a coping strategy for stress. Morality is no longer at the center of this narrative. Adult women: narrative of pleasure Narrative of pleasure portrayed adult women’s drinking as a lifestyle choice closely related to personal enjoyment and tastes. In such stories, narrators viewed alcohol as an art form that brought enjoyment, delicacy and style. For example, one woman wrote, ‘You can experience wine–like poetry–alone, with a friend, with a beloved or with family. A glass or a bottle of wine is finite, but always meaningful. Like poetry, it is always transporting, romantic, sensual and personal’ (No. 53). Drinking was also frequently represented as an experience shared with their partners. For instance, one blogger commented that ‘wine is enjoyed with food by my husband and me as much and as frequently as a mug of hot cocoa or a chilled glass of lemonade’ (No. 29). Likewise, using we-language and associating drinking with relaxation, a woman said, ‘We’re married with children, a dog, a mortgage and a ton of bills and we do what most parents we know do to take the edge off at the end of the day: we drink’ (No. 30). Additionally, this narrative also stressed moderation in drinking, portraying it as a collective effort in a household. For instance, emphasizing the ‘very adult-like’ type of drinking at home, one narrator said, ‘We’ll pour some red wine on occasion for dinner, very adult-like and feel like we are running a pretty civilized home’ (No. 72). For adult women, social gatherings were still accompanied by drinking as they were in college. However, drinking was no longer something to brag about. Rather, it became a choice and a delightful addition to the beauty of friendship and inter-personal connectedness. For instance, one narrator said, I like everything but prefer nothing, and so many of my friendships have their own signature drink. I have my gin and tonic girlfriend. We love to have one in the summer, at the end of steamy days filled with work, carpooling, gardening, or whatever it is that gives us that particular exhaustion on July evenings. ‘With gimlets, we are girly and we gossip ruthlessly. We joke about the husbands we love while preparing dinner for them. The Rose’s is the candy, and the vodka shatters it with a hammer. Joined in a glass, our gimlet is tough and sweet, like us. Or at least, how we want to be, then and there, together’ (No. 72). For adult women, alcohol helped to create a positive and relaxing atmosphere in social gatherings. One woman wrote: And that’s when it hit me, live music makes people happy. And alcohol makes people less inhibited (or me, anyway) and freer to shake their booty. I watched these women strutting and waving their arms, and I knew exactly how they felt–free of judgment and inspired to move with the beat. It was beautiful (No. 80). Overall, adult women’s drinking experiences were embedded with a positive valance, associating drinking with healthy and intimate relationships. Older women: narrative of sin The narratives about older women’s drinking were often centered on AUDs, even though older women were found to drink less than all other age groups [6]. Interestingly, all stories about older women’s drinking were told by their daughters. Drinking was portrayed as a way to escape from depression, stress, or pressure, especially among those who have lost family members. For instance, one blogger attributed her mother’s alcohol dependence to a loss of a close family member: My mother was raised on an apple farm in Southern Quebec, the middle child of seven girls. She was the first ever in her family to go to college. She survived a bout with breast cancer, a stint in women’s prison for civil disobedience and Woodstock in the rain, but it was her despair from James’ death that triggered her descent into raging alcoholism (No. 16). Older women with AUDs were constructed as creating burden for and exerting negative influences on other family members. In addition, they were depicted as denying their drinking problems. A daughter wrote about her mother, who had suffered from alcohol dependence, She puffed herself up and said she had no alcohol problem and that was that. Except for the next 20 years that she spent in bed, Fox News on so loud you couldn’t talk to her, scotch at her side and an ever-present cigarillo. Took to her bed, literally. ‘My father, a farmer, managed the house, cooked for her and bought her booze. When he refused, she put a coat on over her nightgown and drove to the liquor store herself. When she came down with pellagra, a vitamin-deficiency caused by alcoholism, Dad reduced her intake to one drink after dinner. Since she weighed only 80 pounds, one drink still had the wanted effect’ (No. 58). Another excerpt demonstrated the social embarrassment caused by an older woman, who was a mother with alcohol addiction. My mother, a French native who has always loved wine, grew to love it too much about 10 years ago, and her love morphed into an addiction which continues to plague me at every event—both big and small, mundane and celebratory. Moments later, a friend was chasing me around the kitchen, clutching a glass and obviously uncomfortable as my mother anxiously followed her. Ten minutes later, I ushered her into a taxi. She complained but I stood firm. I was just trying to cut my losses before it got worse for both of us (No. 24). Overall, older women’s drinking was judged more harshly than that of younger women. Older women frequently used drinking to cope with severe and chronic stressors, such as the loss of a loved family member. However, social support was very limited, even within familial networks. This may also explain why they relied predominantly on avoidance coping for AUDs. Discussion The findings of this study highlighted the gendered drinking experiences of women. Our analysis found evidence for four distinctive narratives in describing women’s drinking in different life stages. Drinking narratives of younger and older women were predominantly negative, focusing on feelings of shame and regret. In addition, drinking was also a coping strategy for reducing stress. On the contrary, the narrative about adult women was typically associated with a positive tone, stressing the pleasure of drinking. Shame and stress in women’s drinking Negative emotional states were central to both young and older women’s experiences of drinking. These emotional states helped to explain why young women drink and how they relate to drinking. Narratives of the good girl and the bad girl were typically associated with stories about young women’s alcohol consumption. The former was predominately embedded with the feelings of shame and regrets, lamenting how drinking destroyed the perfectly moral and religious good girls. The latter stressed that women who drank were sociable and fun. Alcohol was also misused to reduce stress and social anxiety. This is consistent with epidemiological data that mental illnesses, such as anxiety and depression, tend to be concurrent with harmful alcohol use in college women [36]. Similarly, the most common reason for drinking mentioned by older women was the loss of a family member. The protagonists of older women’s drinking stories were often those with AUDs. Older women with AUDs were frequently depicted as burdens on other family members. This shows the lack of social support for these women in dealing their drinking problems. Additionally, older women frequently adopted avoidance coping for AUDs. Research suggests that both avoidance coping and lack of social support are related to more drinking and negative consequences of drinking [37]. Contrary to young and older women, adult women generally perceived drinking as an enjoyable activity in both domestic and public settings. Drinking was a pleasure and indicated personal tastes. As such, the narratives also hinted at a necessity of moderation. Their choice of drinking was not dictated by the desire for peer approval, nor for reducing stress. When they drink, they control when, how much and with whom. Ageism, adultism and women’s drinking Age played a pivotal role in shaping the type and valence of the drinking narratives. Ageism is the stereotyping of people based on age and is typically associated with the discrimination against old people [38]. Ageism is gendered. For instance, women are considered to reach old age earlier than men [39], and older women are perceived as less attractive than their male counterparts [40]. Such ageist bias was evident in the narrative about older women’s drinking, which emphasized their dependence and lack of self-control. Older women were judged more harshly than younger women for their alcohol consumption. This is consistent with the findings of existing study based on women’s self-report (e.g. Ref. [41]). Interestingly, within this study, all stories about older women’s alcohol use were told by their daughters. Older women might be muted on social media due to their lack of expertise with new technologies. Such a lack of voice further prevented them from telling their own stories about drinking and their lives. Adultism, or the discrimination against young people, is another form of ageism as both discriminate people based on their ages. Adultism considers young people as immature, unreliable and unable to make decisions for themselves, and hence, in need of control and interventions from adults [42]. Such bias was evident in the narratives about young women where they were portrayed as insecure, unwise and eager to fit in. However, adult women seemed to enjoy greater freedom in relation to drinking based on the narrative identified in this study. As the primary caretaker of children or the breadwinner of the household, adult women were characterized as independent, determined and pleasure-seeking. As a consequence, women’s drinking narratives in this particular life stage exhibited dramatic differences compared to the dominant discourses about women’s drinking. Limitations and directions for future research One limitation of this study lies in the limited generalizability of its results due to the characteristics of the sample. In addition, the sample size was relatively small, which could also result in a limited generalizability of the findings. Future research could collect more stories about women and drinking from a more diverse population online. In addition, researchers should collect more drinking stories from women who are unlikely to post their stories online: older women, less educated women and minority women to gain insight into their perspectives about the relationship between women and drinking. Another issue worth considering is that of authenticity [43]. Since this study was based on the analysis of stories posted by anonymous users online, we cannot be sure of the age, racial and ethnic composition of the narrators who posted their drinking stories on the blog site and the authenticity of such stories. Practical implication The current study identified distinctive gendered experiences of drinking across different ages among women. Younger women and older women were subject to more pronounced prejudices related to ageism and adultism. Future clinical interactions, social support communication and intervention programs need to recognize these additional dimensions of discrimination in reaching women with drinking problems in different life stages. Adopting a gender-specific perspective may be a more fruitful approach to AUDs preventions and interventions. In terms of young women’s drinking, this study found evidence that drinking was commonly used as a coping mechanism for stress. This is consistent with the findings of epistemological studies that drinking is frequently concurrent with mental health issues in young people [36]. Individuals who use alcohol to deal with negative emotions are more likely to consume more alcohol and have alcohol-related problems [44]. In addition, research suggests that increasing the strength of health-related attitudes could lead to more stable behavioral changes [45]. As such, promoting the importance of health may help younger women to take control over their health by increasing their ability to counter-argue health-threatening norms. Within this study, the prevalent expressions of shame and regret may also raise concerns about whether women with AUDs would report their drinking behaviors and seek help. For instance, research suggests that college women reported feeling hesitant to include drinking-related references on social media [46]. In addition, research also suggests that women are less likely than men to seek help for AUDs due to the feelings of shame [20]. However, existing prevention programs often rely on negative and avoidance appeals, which may lead to heightened feelings of shame and fear among women [47]. Consequently, public health professionals may start by taking a gender-specific approach when designing prevention messages. Additionally, to date, rational choice models are widely used to examine behavioral changes in the context of drinking. Future research and interventions should take account of the emotional factors, such as shame, that may impact women’s disclosure and understanding of their drinking experiences. For older women, stressful life events were associated with problematic drinking behaviors. While AUDs were the least prevalent in older women comparing with all other age groups in women [6], older women were more susceptible to prejudices surrounding AUDs, even within familial networks. This may also contribute to the use of avoidance coping among older women with AUDs. In addition to promoting active coping, de-stigmatizing AUDs within familial and friendship networks may be of great importance in encouraging older women to seek help for their AUDs. Additionally, problem drinking in older women was primarily attributable to the loss of a loved family member. 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Health Education ResearchOxford University Press

Published: Jun 2, 2018

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