Girls & Young Women

1. Heavy Alcohol Use Girls & Young Women Nancy Poole BC Women’s Hospital BC Centre of Excellence for Women’s Health Building Bridges Symposium May 31, 2010

2. Trends

3. BC • 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 11.8%.

4. Canada 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.

5. Internationally 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)

6. Sub-groups of girls at risk • Compared to heterosexual youth the same age, bisexual females were two times more likely to report binge-drinking • Among bisexual females , the rate of binge-drinking 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.

7. Health impacts

8. for girls/ young women Health impacts Girls are more vulnerable than boys to the health effects of alcohol, for example some sex differences include : • Hypertension • Osteoporosis • Reproductive health problems • Interrelated smoking risks • Pregnancy- unwanted/ unplanned/ unintended pregnancy & potential fetal harms (FASD) • Vulnerability to STI’s, HIV

9. of heavy drinking for women Health impacts • 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 (FASD)

10. Higher risk for those with low daily calorie intake 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).

11. Higher risk with younger age for self harm 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

12. Influences on girls’/ young women’s drinking

13. Gendered pathways to use • The Formative Yearsreport 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.

14. Influences - perceptions of alcohol use 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.

15. Influences – experience of violence • Adolescents and young women between the ages of 16 and 24 are at greater risk of woman abuse than any other age and gender group Tjaden & Thoennes, 2000, Extent Nature and Consequences of Intimate Partner Violence: finds from the National Violence Against Women Survey

16. Depression, anxiety, eating disorders 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.

17. Connections – sexuality • 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)

18. Multiple intersecting interconnections

19. Gender-specific risk and protective factors for girls and young women Risks Protective Factors • 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 • 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

20. Preventionframeworks

21. Move from “fix a girl” to “prepare a girl”(Watkins)

22. Girl-centred, resiliency-based interventions Support girls to: • Learn how to form close relationships • Find a value place in a constructive group • Feel a sense of worth • Achieve a reliable basis for making informed choices • Know how to use the available support systems • Express constructive curiousity and exploratory behaviours • Find ways of being useful to others • 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

23. Prevention based on developmental tasks for girls • 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 making • 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. http://www.public.asu.edu/~lecroy/gogrrrls/body.htm

24. Resiliency Relational Developmental Harm reduction oriented Trauma-informed Culturally informed / safe Elements of girl-centred approaches to prevention? Developmental Culturally competent

25. Programexamples

26. Universal prevention http://www.public.asu.edu/~lecroy/gogrrrls/gogrrrls.htm

27. Go Grrrls 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. http://www.public.asu.edu/~lecroy/gogrrrls/body.htm National/ USA 12- session school-based group for girls 11- 14 yrs Curriculum based on key developmental tasks Relational Empowering Companion parent curriculum Girls Workbook

28. Secondary prevention Girls Talk Program (VALIDITY project - CAMH) Young women support groups that that focus on everyday problems of young women Hearing vs. treating Taking advice from girls & young women ‘Hear Me, Understand Me, Support Me: What young women want you to know about depression’ (VALIDITY project) www.camh.net

29. Tertiary prevention Voices • Group program for girls at varying levels of risk, can be run in different settings • Grounded in gender-responsive principles & key theoretical foundations • Gives girls a safe space, encouragement, structure and support • 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. http://www.stephaniecovington.com/books.asp

30. BC example provides marginalized and at-risk 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 non-threatening environment. Bell-Gadsby, C., Clark, N., & Hunt, S. (2006). It's a Girl Thang!

31. Key elements of gender-responsive approaches • Celebrating strengths • Safety • 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.