Dr Belinda Lunnay, Postdoctoral Researcher in Public Health at Torrens University, along with Professor Paul Ward, is exploring women's perceptions and understandings of the health risks associated with alcohol consumption – a topic that is very relevant today, as midlife women increasingly turn to alcohol as a coping mechanism in their daily lives and are the target of alcohol product advertising. Talking about the broad scope of her research, Belinda says, ‘I think if you are a person living in Australia, you can see yourself or someone you know having an ongoing relationship with alcohol.’
Professor Ward and Dr Lunnay’s work at PHEHF
Based at our Wakefield Street Campus in South Australia, Belinda is working within Torrens University’s newly established Research Centre for Public Health, Equity and Human Flourishing (PHEHF), led by Professor Ward.
Belinda explains, ‘At PHEHF, we undertake transdisciplinary Public Health research with the view of improving equity in society and enabling all people to flourish. With our focus on Public Health, we study disease prevention and ways to improve health outcomes. We're particularly interested in population groups who experience structural disadvantage and to understand why they are not able to achieve the same health outcomes as other sections of the Australian and global population.’
Belinda’s research into women and alcohol is funded by the Australian Research Council (ARC) as part of the ARC’s Discovery Project program.
Raising women's awareness of the link between alcohol and breast cancer
The project that Belinda is working on with Professor Ward explores, in general, women's understanding of the health risks associated with alcohol consumption and, specifically, the increased risk drinking alcohol poses for breast cancer.
‘We are looking at midlife women [aged 45 to 64] because they're at the age where they have an increased risk of breast cancer anyway. When alcohol is also part of that picture, it increases the risk. So, we have a non-modifiable risk, which is age, and a modifiable risk, which is alcohol consumption.
‘In terms of breast cancer risk, the effects of alcohol are cumulative and build up over time and the number of drinks consumed across a lifetime.
‘In Australia, midlife women today are drinking more alcohol than previous generations of women have in their midlife years.
‘At a population level, alcohol consumption in Australia is trending toward a decrease. Young people in the past were drinking the most. Now their alcohol consumption is decreasing and it's the midlife population groups who are among Australia's heaviest drinkers. This shift led us to decide to explore the causes for this change.’
Belinda’s research interviews during COVID-19 lockdowns
‘Initially, we interviewed 50 women, and then the COVID-19 lockdowns occurred. Considering that the reasons women gave for why they drink were often linked to stress, coping and being social, we went back to those women and asked, “Now that we're experiencing the isolation of lockdowns, are there any changes in your alcohol consumption?” We recognised that with the lockdown conditions and disruptions to “normal life”, there could be an exacerbation of stress, and women could no longer consume alcohol in social situations.
‘Lots of women we spoke to were working from home and homeschooling children, et cetera. Also, even in non-Covid times, women often have multiple competing caring responsibilities by the nature of their gender. Some women said that when they drink alcohol, they feel it's almost nourishing. They spoke about having a drink as something that's for them, a treat, some time out, a way to calm down. They see it as a recognition of their hard work, giving them a sense of deservingness and recognition for that hard work – because of this, women describe alcohol as a form of self-care. During lockdowns, women’s drinking increased in frequency and these increases were linked to negative emotions like anxiety, uncertainty and depression.’
Exploring forms of inequity and alcohol consumption
‘In our study, we are looking at forms of inequity and one of the most common sources of inequity is social class.
‘We're interested in women’s access to financial resources, and also their access to social networks and their participation in social and cultural activities. We found that women who were living with the most privilege, with access to money, a range of activities, to social support, talked about alcohol as an enjoyed ritual, for example, demarcating the end of the day or feeling connected in social relationships. However, they have other support mechanisms in their lives they can draw on too. Whereas women who are living at a disadvantage really have very few resources, and alcohol is one of the only things they can use to feel a level of calm during difficult times – sometimes difficult times are women’s daily experience when they are living on very low incomes.
‘The moral judgements that exist around women’s alcohol consumption are concerning. As a society we accept drinking done in the “right ways” and for the “right purposes” – to be social, for example – but we shame drinking done “wrongly”. During COVID-19, we did some research on stockpiling behaviour and found that it was middle-class women who were able to afford to stockpile alcohol. Women who were living in what we might call a working-class position, or were living in poverty or very difficult circumstances with limited incomes, weren't stockpiling at all. They couldn't afford to. In some instances, they began to drink less. So we found that drinking alcohol is quite sporadic for women on low incomes.’
Strategies to reduce alcohol consumption among women
‘While working on this project, I was surprised to discover the level of alcohol consumption for some women. Such as two bottles of wine per evening, or tumblers of mixed vodka, like half a bottle of vodka – very high volumes. I am not casting a judgment over these women, but the research made me realise that they had this strong need for alcohol in their lives.
‘In many situations, alcohol consumption for women is expected. In fact, we found that some women said they felt like a more authentic version of a midlife woman, who is doing the hard juggle of work and family and doing a good job of that juggle if they needed a glass of wine to celebrate that achievement.
‘And that's a reflection of what we see in alcohol marketing directed at midlife women. It tells them: “You've done the big juggle, you have a hard life, so have a drink.”
‘I think many women realise they're drinking too much and would actually prefer to drink less. But the volume and the nature of their alcohol consumption, I believe, is still relatively hidden. And a reason for that is a woman’s feelings of shame.
‘One of our main aims in this research project is not to perpetuate that shame but to inform the Public Health messaging, so it looks to the social environment and the social context of women's alcohol consumption. That is, rather than pointing the finger of blame at the individual woman. After all, we know that feelings of shame can lead to poor mental health outcomes.
‘We want to encourage change in the advertising and social space to reduce the pressure women feel to drink alcohol. A finding of our study is that there are not many leisure opportunities for midlife women that are not partnered with drinking. You go to a bar or cellar door for a drink with friends, or you go for a haircut and you’re offered champagne. You go to an art class and it's combined with a glass of wine.
‘Women’s leisure space is being saturated with alcohol and you're the anomaly if you decline a drink. The women we interviewed told us they wanted alternatives to alcohol and to feel okay about choosing not to drink. And that's why we are working on an additional study looking at the sober curious movement.’
What is the Sober Curious Movement?
‘This movement is focused on reducing alcohol consumption in a way that’s not only possible but desirable. Showing that it's actually fun not to feel tired at the end of a drinking session. It's spoken about as mindful drinking, and it is supported by a new and expanding proliferation of low and no-alcohol products, bars and bottle shops. Also, you can go to a licensed bar now and order many more drinks that are no or low alcohol than were previously available. That's all part of this movement towards sober curiosity. We interviewed another 30 midlife women about their decision to reduce or stop their alcohol consumption. This research will help us to understand what the facilitators and barriers are to reducing alcohol consumption for women.’
Why women turn to alcohol and strategies to help reduce alcohol consumption
‘The root cause needs to be addressed, not the outcome, which is drinking alcohol. In our interviews and surveys, women say they drink more when they experience negative emotions. These include sadness, depression, anxiety, feeling overwhelmed and feelings of uncertainty. So mental-health support offering women a reason not to turn to alcohol is key to reducing alcohol consumption. But we know that mental health support isn't necessarily affordable for some women, even with bulk billing. For women on very low incomes, if not in poverty, paying for public transport and childcare is a barrier to going to mental healthcare appointments. Literacy is another barrier. When you realise how desperate some women's circumstances are becoming, it is quite daunting.’
The next stage for Belinda’s alcohol consumption and breast cancer risk research project
‘We're about to begin the final stage of this research study, which is to collect all the evidence from women about the reasons why they consume alcohol and their perceptions of breast cancer risk. We will take this evidence to health professionals and other stakeholder groups and to the media and say, “This is what women said is a barrier to reducing alcohol consumption.” “This is what they said about needing help to reduce their alcohol intake.” We will encourage these groups to use the research findings for policy development and practice. And at the end of that process, we'll come up with a set of recommendations that can be actioned to help women reduce their alcohol consumption.
‘Hopefully, through our process of listening to women and taking on board what they said, we can then speak with people who are capable of making change and achieving positive outcomes for Australian women.’