Nancy Poole: Gender-informed practice and young girls

Heavy Alcohol Use
Nancy Poole
BC Women’s Hospital
BC Centre of Excellence for Women’s Health
Building Bridges Symposium
May 31, 2010
The 2008 BC Adolescent Health Survey
found that male and female students
surveyed in grades 7 through 12 were
similarly likely to have ever tried
alcohol (53.8% and 54.8% respectively)
and equally likely to binge
Female students aged 15 or younger
had a higher rate of binge drinking in
the past month than their male
counterparts 13.4 % compared to
Canada - In the 2004 Canadian Addiction Survey:
over 85% of the alcohol consumption reported by
females aged 15–24 years of age was consumed in
excess of the Canadian guidelines.
1 in 10 women ages of 15- 24 yr engaged in heavy
weekly drinking (7.8% of girls 15-19 yr and 11.8% of
young women 20-24 yr)
15 % of young women 18–19 yr & 11% of those 20–
24 yr reported heavy, frequent drinking.
Study of trends in the prevalence of monthly alcohol
use and lifetime drunkenness in 20 European
countries, the Russian Federation, Israel, USA and
Canada found drunkenness rates rise strongly
between the ages of 13 and 15 in all countries
Girls appear to be catching up with boys in some
countries. Canada was 1 of 5 countries where there
were cases of rates of drunkenness more common
among girls than boys ( Canadian girls 13 yr and 15 yr)
Compared to heterosexual youth the same age,
bisexual females were two times more likely to
report binge-drinking
Among bisexual females , the rate of bingedrinking rose from 12% in 1992 to 37% in 1998 to
43% in 2003. Among bisexual males, the rate of
binge-drinking rose from 22% in 1992 to 32% in
1998 and remained at this rate in 2003.
Saewyc E, Poon C, Wang N, Homma Y, Smith A & the McCreary Centre
Society. (2007). Not Yet Equal: The Health of Lesbian, Gay, & Bisexual Youth
in BC. Vancouver, BC: McCreary Centre Society.
for girls/ young women
Girls are more vulnerable than boys to the health effects
of alcohol, for example some sex differences include :
Reproductive health problems
Interrelated smoking risks
Pregnancy- unwanted/ unplanned/ unintended
pregnancy & potential fetal harms (FASD)
Vulnerability to STI’s, HIV
of heavy drinking for women
Increased risk for accelerated development of:
 Liver disease (hepatitis/ cirrhosis)
 Cardiac diseases and heart problems
 Damage to stomach
 Brain damage
 Breast cancer
 Oropharyngeal, oesophageal and liver cancers
 Addiction
 Pregnancy- unintended pregnancy & potential fetal harms
Alcohol can be even more dangerous for young
women with body image or weight concerns. For
girls who may not eat properly or who have a low
daily caloric intake, drinking alcohol can place them
at higher risk of intoxication and in extreme cases,
of alcohol poisoning
McCarty, C.A., et al., Longitudinal associations among depression, obesity
and alcohol use disorders in young adulthood. General Hospital
Psychiatry, 2009. 31(5).
For 16 to 18 year old BC students:
Females were more likely than males to have self
harmed whatever age they started drinking or using
marijuana but the younger they were when they
started using, the more likely they were to have
deliberately injured themselves.
McCreary Centre Society (2010). What a difference a year can make: Early alcohol and
marijuana use among 16 to 18 year old BC students
The Formative Years report demonstrates that girls and young
women use cigarettes, alcohol and drugs for reasons different
from boys, that the signals and situations of high risk are different
and that girls are more vulnerable to substance use and abuse and
its consequences.
One of the gender specific influences on girls drinking is the
influence of exposure to the entertainment media and alcohol and
cigarette advertising - which shower girls and young women with
unhealthy and unrealistic messages about smoking, drinking and
weight loss.
National Center on Addiction and Substance Abuse. (February
2003). The Formative Years: Pathways to Substance Abuse Among
Girls and Young Women Ages 8-22. New York, NY: CASA.
Females overestimate the amount of alcohol males
want their female friends, dating partners, and sexual
partners to drink and this misperception was
associated with their drinking behaviour
LaBrie et al. (2009). What men want: The role of reflective opposite-sex normative preferences in
alcohol use among college women. Psychology of Addictive Behaviours, 23(1), 157-1262.
Adolescents and young women between the
ages of 16 and 24 are at greater risk of
woman abuse than any other age and gender
Tjaden & Thoennes, 2000, Extent Nature
and Consequences of Intimate Partner
Violence: finds from the National Violence
Against Women Survey
are closely linked to heavy drinking for young women.
McCarty et al. 2009 Longitudinal associations among depression, obesity
and alcohol use disorders in young adulthood.
8-10% of teens reported that using drugs or alcohol
was the reason that they had intercourse for the
first time (Council of Ministers of Education,
Canada, 2002)
 Girls 15-19 yrs have the highest rates of chlamydia
and gonorrhea (PHAC 2004)
Multiple intersecting interconnections
Girls who experience physical & sexual abuse by dating partners are more
likely to be at risk for harmful substance use.
(Note: Odds of 2.0 mean a girl is twice as likely to engage in the behavior as one
who was not abused.)
Heavy smoking (within 30 days)
Binge drinking (within 30 days)
Cocaine use (ever)
Diet pill use (within 30 days)
Laxative use & / or vomiting (within 30 days)
More than three sex partners (within 90 days)
Pregnancy (ever)
Considered suicide (within 1 year)
Attempted suicide (within 1 year)
Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. (2001). Dating violence against adolescent
girls and associated substance use, unhealthy weight control, sexual risk behaviour, pregnancy,
and suicidality. The Journal of the American Medical Association, 286, 572-579
Low self-esteem
History of trauma
Depression, anxiety,
eating disorder
 Early onset of puberty
 Lack of coping skills
 Teen pregnancy
 Poor relationships with
family, peers
 Peer and parental
substance use
 School transitions,
frequent moving
 Marketing, media
Protective Factors
Healthy self esteem
Positive body image
Religiosity/ spirituality
Parent-child attachment
Family rules against substance use
Parents encouraged their children
to abstain
 Peers with healthy attitudes
toward risky behaviours
 School connectedness
 Social support
 Support during key transitions
Move from
“fix a girl” to “prepare a girl” (Watkins)
Support girls to:
1) Learn how to form close relationships
2) Find a value place in a constructive group
3) Feel a sense of worth
4) Achieve a reliable basis for making informed choices
5) Know how to use the available support systems
6) Express constructive curiousity and exploratory behaviours
7) Find ways of being useful to others
8) Believe in a promising future with real opportunities
From Marie L Watkins “Listening to Girls: a study in resilience” in Resiliency: An
Integrated Approach to Practice, Policy, and Research, Roberta R Greene (Ed.) 2001
Achieve a competent gender-role identification
Establish an acceptable body image
Develop a positive self-image
Develop satisfactory peer relationships
Establish independence through responsible decision
Understand sexuality
Learn to obtain and find access to resources
Plan for the future
LeCroy, C. W. & Daley, J. (2001). Empowering adolescent girls: Examining the
present and building skills for the future with the Go Grrls program.
Harm reduction oriented
Culturally informed / safe
Resiliency, strengths
Culturally competent
Harm reduction
National/ USA
12- session school-based
group for girls 11- 14 yrs
Curriculum based on key
developmental tasks
Companion parent curriculum
Girls Workbook
LeCroy, C. W. & Daley, J. (2001). Empowering adolescent girls: Examining the present and building
skills for the future with the Go Grrls program. New York: W.W. Norton & Company. (Facilitator guide)
LeCroy, C.W. & Daley, J. (2001). The Go Grrls Workbook. New York: W.W. Norton & Company.
Girls Talk Program (VALIDITY project
Young women support groups
that that focus on everyday
problems of young women
Hearing vs. treating
Taking advice from girls & young
‘Hear Me, Understand Me,
Support Me: What young women
want you to know about
depression’ (VALIDITY project)
Group program for girls at varying levels of risk, can be run in
different settings
Grounded in gender-responsive principles & key theoretical
Gives girls a safe space, encouragement, structure and
Focus is on 4 areas in lives of girls: self, connecting with
others, healthy living, the journey ahead
Covington, S. (2004). Voices: A program for self-discovery and empowerment for girls. Facilitator
guide. Carson City, NV; The Change Companies.
provides marginalized and atrisk girls ages 12-19 with a
space to explore a wide range
of issues that impact their
daily lives, as well as their
strengths and daily lived
realities in a safe and nonthreatening environment.
Bell-Gadsby, C., Clark, N., & Hunt, S. (2006). It's a
Girl Thang!
Celebrating strengths
Female mentors and role models
Developing and supporting leadership skills
Empowering girls to be forces for social change
Media literacy
Physical, sexual and mental health information
Cultural connections
Solidarity between girls and women
Covington, S. (2004). Voices: A program for self-discovery and empowerment for
girls. Facilitator guide. Carson City, NV; The Change Companies. Pg. 18.
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