Study profiles alcohol users in São Paulo

One in three inhabitants of the metropolitan area who consume alcoholic beverages are hazardous drinkers, according to a mental health survey.

By Diego Freire

Agência FAPESP – Twenty-nine percent of consumers of alcoholic beverages living in the São Paulo metropolitan area regularly indulge in heavy drinking, defined by the World Health Organization (WHO) as the consumption of five or more drinks in a row for men and four or more drinks for women at least once a week.

This is one finding from a study by researchers at the University of São Paulo’s Psychiatry Institute (IPq-USP) that assessed the risks run by the substantial proportion of the population who consume levels of alcohol exceeding what are considered moderate.

The researchers analyzed data from interviews with 5,037 men and women older than 18 years of age and living in the 39 municipalities of Greater São Paulo. The men and women were interviewed as part of the São Paulo Megacity Mental Health Survey, which was supported by FAPESP and carried out in conjunction with the World Mental Health Survey of the WHO.

The analysis was part of a research project entitled Identification of subgroups of alcohol users and related factors in the São Paulo Metropolitan Area: gender differences, sociodemographic characteristics and psychiatric comorbidities conducted by Laura Helena Silveira Guerra de Andrade, head of IPq-USP’s Psychiatric Epidemiology Unit, and also supported by FAPESP.

Andrade said the aim of the study was to discover more information about alcohol users in the area and to offer input for public policy to address the damage caused by excessive drinking.

“There are many alcohol-related comorbidities such as anxiety, depression, and mortality from heart disease and cancer. Effective public measures to prevent and control the problem require in-depth knowledge of the associated socio-demographic factors,” Andrade told Agência FAPESP.

The researchers found that 20% of individuals who are considered regular alcohol users (at least one drink per month) drink heavily and often (more than three times per month). Only 9% drink both heavily and infrequently.

“It’s important to take the frequency of consumption into account because the more often you drink heavily, the more you’re exposed to the risks associated with this pattern of consumption,” Andrade said.

Women

For women, the risks are even greater, researchers warn. “It’s a major surprise to find that women drink as heavily as men,” said Camila Magalhães Silveira, who is also a researcher at IPq’s Psychiatric Epidemiology Unit.

Among subjects who regularly consume alcohol, the same proportion of men and women drink heavily and infrequently (9%).

“The difference between genders appears among those who drink heavily and often; even so, it’s very small – 22% for men and 16% for women. Both drink twice a week on average and have six or seven drinks on each occasion,” Silveira added.

The data points to a change in women’s relationship to drinking. “This is a relatively recent phenomenon showing an increased acceptance of alcohol consumption by women,” she said. “Higher incomes earned by women and a redefinition of their role in society have also contributed. Generally speaking, drinking is no longer taboo for women, and alcohol consumption is now nearly the same for both men and women.”

A particularly negative aspect of the increase in heavy drinking by women is the much wider age range of females than that of males who drink heavily: heavy drinking is common among males aged 18-34 years, whereas the age range for frequent female heavy drinkers extends up to 54 years.

“This is aggravating because it indicates that women of almost all ages are exposed to the hazards of heavy drinking, whereas society and public policy frame alcohol as a problem affecting the youth,” Silveira said.

Women are more vulnerable because it is harder for their bodies to metabolize alcohol. They have less of the enzymes that help to break down alcohol, less body fluid and less muscle, among other factors, than men. “Habitual drinking can be more harmful to women, and understanding this can be of assistance in healthcare and for the wellbeing of women,” she said.

The research also found that episodic heavy drinking is more highly associated with unemployed or working women and less with female homemakers or retirees. The odds of heavy drinking are twice as high among unemployed women.

Social deprivation

In addition to factors such as gender and age, the researchers also took into account the neighborhoods where alcohol users live to identify the link between socio-demographic factors and drinking patterns to map social deprivation indicators. This was performed in partnership with the Center for Metropolitan Studies, which is one of the Research, Innovation and Dissemination Centers (RIDCs) supported by FAPESP. The map combines indicators of socio-economic deprivation – income, schooling, family size and percentage of households headed by a woman with a low level of schooling – with the age groups of the survey sample.

They identified three major groups of areas: no or low social deprivation, comprising neighborhoods with relatively high incomes and educational levels and households with few children or young adults; medium social deprivation, with below-average income, many children and high adolescent mortality rates; and high social depreciation, with very low income and very young women with little schooling as the heads of household.

According to Silveira, heavy drinking is mostly found in neighborhoods with high social deprivation. “Individuals who live in disadvantaged areas with high levels of exclusion and social deprivation may be exposed to more stress, have fewer resources with which to address adversity, and have fewer leisure options in neighborhoods with more bars. Thus, they are potentially more likely to be heavy drinkers as well as to suffer from alcohol abuse and dependence,” she said.

With regard to income, most heavy drinkers belong to households with annual incomes of less than US$3,918 (approximately R$840 per month).

“This is even stronger evidence of the close correlation between alcohol abuse and socio-economic conditions,” Silveira said. “The more limiting the conditions, the greater the likelihood of exposure to the risks of heavy drinking.”

Some of the research findings were published in an article in the journal PLoS One, available at journals.plos.org/plosone/article?id=10.1371/journal.pone.0108355.