Introduction
Alcohol consumption is a global concern due to its high potential to cause dependence
and its connection to a wide range of disorders and diseases. According to the World
Health Organization (WHO), alcohol consumption causes more than three million deaths
each year, accounting for 7.2 % of premature deaths in people under 69 years of age
and 13.5 °% of premature deaths in young people between 20 and 29 years of age 1,2.
Some authors highlight that there is a greater probability of consuming alcohol during
youth, i.e., in the first 20 years of life; therefore, this period is considered of
the highest risk 3-6. It is documented that, despite cultural differences, reasons for alcohol consumption
among young people are similar in many countries 7, such as the search for entertainment, excitement, fun, and bonding with friends
8.
The state of the art on alcohol consumption shows that young people also ingest this
substance in an attempt to experience emotions of pleasure, which implies fun, joy,
enjoyment, feeling good, relaxing, having a good time, laughing, and being sociable
8-10. Therefore, alcohol consumption must be understood as a social practice that is embodied
and integrated into gender relations and social environments 11,12.
The literature indicates that its consumption plays an important role in friendship
building and consolidation, as well as gender identity formation 13-15. Gender identity is understood as "how being a man or woman is socially prescribed
by the combination of role and status attributed to a person based on their sex, which
is internalized by each person. The identities and roles attributed to one of the
sexes are complementary and interdependent with those assigned to the other" 16, hence the differences that exist between femininity and masculinity.
In this regard, Wilsnack and Wilsnack 17 have emphasized that alcohol is involved in the process of building gender identities
since it is an important part of the interactions between women and men. Therefore,
gender influences both alcohol consumption and the act of drinking itself, being a
way of "doing gender" and achieving traditional and non-traditional gender identities
18.
In terms of gender norms and their relationship to health, research has revealed that
most behaviors and practices that promote care are associated with femininity, whereas
those that involve taking risks are associated with masculinity 19. Gender is considered a relational theoretical approach that focuses on social processes
and structures, encompassing cultural factors that influence individual and social
understanding of masculinities and femininities 20,21.
In this context, gender determines behavior limits, defining what is considered appropriate
or inappropriate in our daily routine 19,22. Therefore, alcohol consumption patterns are not independent of gender, meaning that
participating and sharing in "drinking events" also become a way of constructing masculinities
and femininities, and potentially gender identity 23.
In relation to the above, there are a variety of studies that have identified differences
in alcohol consumption respecting consumer gender. However, studies do not explore
the extent to which alcohol consumption and its impact on youth health are mediated
by masculinity and femininity performance; for this reason, this scoping review aimed
to identify and describe available evidence on the influence of gender on youth alcohol
consumption.
Materials and methods
In the present review, JBI 24 guidelines were followed to identify the breadth and nature of existing literature
on a particular topic to contribute to research and decision-making in the field of
health 25. Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Extension for
Scoping Reviews (PRIS-MA-ScR) guidelines were adopted when developing the manuscript
as a scoping review 26.
The Population, Concept and Context (PCC) mnemonic method was used to define the review
parameters. In this case, the Population of interest was men and women (young adults);
the Concept referred to gender, and the Context focused on alcohol consumption. The
guiding question of this review was: How does gender influence youth alcohol consumption?
Likewise, original full-text articles, published in indexed databases without language
limitations, with a quantitative and qualitative research approach, that included
a young population between 18 and 29 years old and addressed alcohol consumption according
to the gender variable, were included.
The search strategy aimed to locate studies published in the literature between 2018
and 2023 in databases such as Virtual Health Library (VHL), PubMed, EBSCOhost, Web
of Science, Epistemonikos, ScienceDirect, and ProQuest. Search protocols were established
from the Medical Subject Headings (MeSH) 27, as shown in Table 1. Consultations were carried out from February to May 2023.
Table 1
Search strategies in databases for research, Mexico, 2023
|
Database
|
Search protocol
|
|
VHL
|
(“alcohol drinking”) AND (“young adult”) AND (“Gender Identity”) OR (“gender role”)
AND (“young adult”) AND (“alcohol drinking”) AND (year_cluster:[2018 TO 2023])
|
|
PubMed
|
(((((Alcohol Drinking) AND (Young Adult)) AND (Gender Identity)) OR (Gender role))
AND (Young Adult)) AND (Alcohol Drinking) Filters applied: in the last 5 years
|
|
EBSCOhost
|
alcohol drinking AND adult young AND gender identity OR gender role AND adult young
AND alcohol drinking. Publicaciones académicas (arbitradas); Fecha de publicación:
20180101-20231231
|
|
Web of Science
|
Results for (((((ALL=(Alcohol drinking )) AND ALL=(Adult young)) AND ALL=(Gender identity))
OR ALL=(Gender role)) AND ALL=(Adult young)) AND ALL=(Alcohol drinking ) and 2023
or 2022 or 2021 or 2020 or 2019 or 2018 (Publication Years) Document Types: Article
or Review Article
|
|
Epistemonikos
|
(title:((title:(alcohol drinking) OR abstract:(alcohol drinking)) AND (title:(adult
young) OR abstract:(adult young)) AND (title:(Gender identity) OR abstract:(Gender
identity)) OR (title:(Gender role) OR abstract:(Gender role)) AND (title:(adult young)
OR abstract:(adult young))
|
|
ScienceDirect
|
“alcohol drinking” AND “young adult” AND “Gender Identity” OR “gender role” AND “young
adult” AND “alcohol drinking”
|
|
ProQuest
|
noft(Alcohol drinking) AND noft(Young Adult) AND noft(Gender Identity) OR noft(Gender
role) AND noft(Young Adult) AND noft(Alcohol drinking)Additional limits - Date: From
January 01 2018 to March 01 2023; Document type: Article
|
To assess qualitative articles, we used the study analysis tool Critical Appraisal
Skills Program in Spanish 28,29, which considers three general aspects for study assessment: Rigor, credibility,
and relevance. Furthermore, to assess and select quantitative articles, we used the
Research Article Eligibility Criteria Instrument 30, which made it possible to determine, based on the assessment of nine criteria, the
relevance of articles that had to be selected for the review, where the minimum value
is zero and the maximum value is nine, and the minimum value to be admitted is eight.
After the search, all identified citations were gathered and uploaded to the software
Rayyan (AI-Powered Tool for Systematic Literature Reviews) 31. The article selection process was completed in two phases to guarantee the inclusion
of relevant and high-quality studies. In the first phase, two independent reviewers
performed an exhaustive reading of the titles and abstracts of the articles identified
in the search. Duplicate articles and those that clearly did not meet the established
inclusion criteria were excluded.
In the second phase, potentially relevant articles were retrieved in their entirety
and were assessed in detail by the reviewers reading the full text. During this phase,
databases were compared and discussions were held to solve any discrepancies in article
selection. Finally, studies that met the inclusion criteria were selected for incorporation
into the review. Likewise, the study met the ethical criteria related to intellectual
property by preserving the integrity and authorship of the documents used.
Results
In the search, 403 studies were identified. After excluding 90 duplicate articles
and 272 due to eligibility criteria, the full text of 41 articles was analyzed with
selection instruments, and those that did
not meet the score and criteria were eliminated. In the end, a total of 12 documents
were selected, four of them quantitative and eight qualitative (Figure 1).
Figure 1
Flowchart of Selected Articles according to PRISMA-ScR
Source: Adapted from Page et al. 32.
Each of the selected articles was characterized based on content analysis. Table 2 presents the characteristics of the 12 studies selected in this scoping review, classified
by author, year of publication, journal, objective, method, and main results. The
results of this review showed the articles were written in the United States, the
United Kingdom, Canada, Spain, Nigeria, Denmark, England, the Czech Republic, Scotland,
and Australia. Correspondingly, all were published in English. The United States and
the United Kingdom presented the largest production related to the topic, with each
one having two studies.
Table 2
Characteristics of the Articles Included in the Scoping Review. Mexico, 2023
|
Authors, Year
|
Country
|
Objective
|
Methodology
|
Main results
|
|
Romo-Aviles et al., 2023
|
Spain
|
To examine how images and stories about alcohol consumption are presented on Instagram,
the strategies for constructing them, and the impact of social norms, including gender
norms, on strategies to make alcohol consumption visible.
|
Qualitative research. Digital ethnography. 188 participants in 13 discussion groups
were selected by snowball technique.
|
Gender is a central element in understanding the differences in how Instagram posts
related to drinking and drunkenness affect young people. Young women are pressured
by physical image while young men are pressured to maintain a normative public image.
|
|
Dumbili, 2022
|
Nigeria
|
To explore alcohol consumption among youth in Nigeria according to their gender and
the health implications of their practices.
|
Qualitative research. Inductive and deductive thematic analysis. 72 participants were
selected by snowball technique.
|
Men used competitive rituals of excessive drinking and drunkenness to enact masculinity.
Most women constructed an anti-traditional/ normative femininity with episodes of
excessive alcohol consumption, whereas others maintained traditional femininity to
avoid stigmatization.
|
|
Wilkinson and Wilkinson, 2020
|
United Kingdom
|
To explore young people’s alcohol consumption practices and experiences.
|
Qualitative research. Multiple qualitative methods. 16 male participants.
|
Both conscious and unconscious gender performances shape and are shaped by drinking.
Young men draw on different coexisting versions of masculinity, one of which is based
on femininity exclusion, whereas another version is more inclusive and allows for
displays of care and emotion.
|
|
Jensen and Hunt, 2020
|
Denmark
|
To explore how young women use friends to negotiate their sexual boundaries and construct
the meaning of their sexual experiences in a context of heavy alcohol consumption.
|
Qualitative research. 33 in-depth interviews with young women.
|
The social norms reproduced in friendship groups have a high gender connotation and,
consequently, the enthusiasm for sharing funny stories with friends can make sexual
violence less visible in contexts of alcohol consumption.
|
|
Lojdová, 2020
|
Czech Republic
|
To understand the meaning of alcohol for emerging adults through stories about alcohol
poisoning.
|
Qualitative research. Narrative- oriented research method. 82 young adult narratives.
|
In terms of gender identity, stories include both confirmation of gender stereotypes
and efforts to break them. Traditional gender identity is associated with expectations
of what it means to be a man or a woman or with the construction of traditional gender
identities.
|
|
Leone and Parrott, 2019
|
United State of America
|
To examine the moderating effect of excessive alcohol consumption on the relationship
between traditional masculinity and bystander behavior in alcohol consumption contexts.
|
Quantitative research. Scope not specified. Sample of 148 male alcohol consumers,
convenience sampling.
|
A significant relationship between antifemininity and excessive alcohol consumption
was detected with b = −0.27, p = 0.048, 95% Confidence Interval.
|
|
Nicholls, 2019
|
United Kingdom
|
To explore the nuances around the negotiation of femininities today, particularly
through alcohol consumption practices.
|
Qualitative research. Narrative interviews with thematic analysis. 26 women participants.
|
Alcohol consumption plays an important role in female socialization and the negotiation
of both friendships and femininity in contemporary leisure contexts.
|
|
Lennox et al., 2018
|
Scotland
|
To explore young women’s drinking practices and how they construct their identities
through alcohol consumption and its display on social media.
|
Qualitative research. Thematic analysis of interviews in 16 focus groups of young
people.
|
Young women’s discussions revealed a difhcult “balancing act” between demonstrating
sexy femininity (but not too sexy) and “willing to do so” through their drinking and
appearance, while preserving control and respectability.
|
|
O’Brien et al., 2018
|
England
|
To examine the relationships between masculinity, alcohol consumption, and alcohol-related
aggression and antisocial behavior in athletes.
|
Correlational, cross-sectional quantitative research. Sample of 208 young athletes.
|
There were positive associations for men and women between masculinity and alcohol
consumption scores (r= 0.12 p<0.001; r=0.16, p<0.001).
|
|
Iwamoto et al., 2018
|
United State of America
|
To examine the relationship between multidimensional feminine norms, excessive alcohol
consumption, and alcohol-related problems.
|
Quantitative correlational research. Sample of 1,910 women.
|
The relationship between female norms and problematic alcohol use is complex. Norm
adherence and investment in appearance were positively associated with excessive alcohol
consumption, whereas adherence to sexual fidelity and the belief that one should be
sweet and pleasant were protective.
|
|
Hussman and Goldstein, 2019
|
Canada
|
To examine the relationship between traditional norms of femininity and alcohol- related
problems for young women, considering the social contexts of drinking.
|
Quantitative, clinical and experimental research. Sample of 132 women.
|
Specific aspects of traditional femininity are positively related, whereas others
are inversely related to alcohol problems. The desire to be thin emerged as the strongest
positive correlate, and sexual fidelity was negatively correlated to alcohol problems.
|
|
McLean et al., 2018
|
Australia
|
T explore how young drinkers negotiate the far edge of the “within limits” clause
for acceptable drunken behavior.
|
Qualitative research. Thematic analysis of interviews with 60 young people.
|
Participants were quick to activate gender stereotypes regarding alcohol consumption
to condemn women’s drunkenness, causing greater disgust, while men’s drunkenness is
more likely to generate fear. Being drunk in public was rarely admired.
|
On the other hand, a coding and categorization process was used, and relevant data
were extracted and grouped in a matrix, following a thematic approach. This integration
of the findings allowed us to identify key patterns and themes related to the influence
of gender on youth alcohol consumption, affirming masculinity with alcohol consumption,
femininity's relevance with alcohol consumption, double gender standards in women
alcohol consumers, and representation of women and drinking. Based on the above, the
discussion was conducted.
Discussion
Affirming Masculinity with Alcohol Consumption
Masculinity is a concept that refers to the external cultural or social standards
that sanction a man's actions in a particular place or time 33. It is a sociocultural construction composed of beliefs, traits and behaviors that
are considered important for being a man and that support the maintenance of dominance
and power over others 34.
According to the review by Patró-Hernández et al.35 on the relationship between gender norms and alcohol consumption, it is noted that
traditional gender stereotypes are present in situations of alcohol consumption and
that excessive alcohol consumption, aggressiveness and risk behaviors are associated
with male roles. Likewise, alcohol consumption and intoxication have long been associated
with masculinity. Furthermore, this type of behavior in men works to affirm masculinity
and increase bonds and solidarity between them 22.
In this regard, Leone and Parrot 36 assert that men may feel pressured to adhere to manly norms they proscribe, and alcohol
intoxication probably facilitates their attention to these signals, which strengthens
this association. An example of this is the study by Dumbili et al. 37, in which men agreed that drinking is for social reasons, and for other reasons such
as engaging in sexual negotiations, displaying masculinity, and obtaining social attention.
It is important to note that male identity is performatively constituted and that
men are only as masculine as their last display of manhood 38.
On the other hand, alcohol consumption has always been related to masculinity as a
"male domain" in society 39. This stereotype has been reinforced by traditional views, where drinking is associated
with masculinity and abstention with femininity 40. This association has also led to a significant interaction between antifemininity
and excessive alcohol consumption 36. In some cases, male identity is constructed through the role of protector of women,
which involves a discussion of physical strength 41. However, this stereotype has also been associated with greater odds of insulting,
humiliating, and attacking others while intoxicated in both men and women. Additionally,
higher levels of masculinity have been linked to greater odds of being involved in
alcohol-related assaults and antisocial behaviors 42.
Alcohol consumption culture in men is a topic that has been widely studied. Public
leisure contexts have been found to be sites where masculinity is (re)produced and
the ability to consume large quantities of alcohol without showing signs of intoxication
is a significant social achievement, determining status in male hierarchies 40. These alcohol consumption patterns in men are a reflection of existing gender stereotypes,
as pointed out by Lobjova 43. Gender stereotype support can be seen in the way men relate to alcohol and how they
are encouraged to drink in party contexts. Under these conditions, men are often encouraged
to consume alcohol in large quantities, and those who do not may be questioned about
their masculinity by their peers 44.
In addition to the above, when men are challenged in their ability to drink large
amounts of alcohol, they feel obligated to demonstrate to their peers that they are
"real men", who can tolerate excessive alcohol consumption without becoming intoxicated.
Therefore, for members of the male social network, it is mandatory to consume alcohol
and participate in the social (reproduction of masculinity every time they meet for
entertainment 40.
On the other hand, non-drinking men may be at risk of being excluded from their own
friendship groups 45. Consequences for non-drinkers are real and can include exclusion, social isolation,
or even verbal abuse and physical harassment 46,47. Based on the above, it can be seen that male alcohol consumption culture is problematic
and has negative consequences for both drinkers and non-drinkers.
Relevance of Femininity with Alcohol Consumption
Femininity ideologies refer to the norms and restrictions that establish what is considered
normal and ideal for a woman, highlighting characteristics such as passivity, conformity,
and kindness 48. Although alcohol consumption has traditionally been seen as a male activity, nowadays
young women can participate in it and have greater autonomy in their consumption 49,50. However, they still face pressure to conform to gender expectations, and alcohol
consumption can help them achieve different types of traditional and non-traditional
femininities 51,52.
The relationship between women and alcohol consumption has been studied from different
perspectives. One of the most interesting findings is how women frame the act of drinking
alcoholic beverages, because, for many, drinking is a way to socialize, become intimate
and build trust with other women, according to Nicholls 53. Having a "girl's night" is an important opportunity to socialize, and some even
see it as their main or only form of socialization. However, not all women actually
enjoy binge drinking and some attribute this to peer pressure and expectations.
Similarly, excessive alcohol consumption by women has become an increasingly relevant
issue, because it is often presented as an attempt to imitate men and transgress traditional
gender roles 54. In this regard, in studies such as that of Lobjová et al. 43, it is documented that women consume alcoholic beverages to break gender stereotypes,
achieve non-traditional identities and emancipate themselves from male alcohol consumption
culture. However, other studies show that women who support traditional gender norms,
such as sexual fidelity and domestic norms, are less likely to report excessive alcohol
consumption 55. In the United States of America, Iwamoto et al. 56 reported that women who adhere to these norms are less likely to engage in risky
behaviors related to alcohol consumption.
Furthermore, women recognize the importance of maintaining control of their drinking
to achieve an appropriate "female" identity. Social norms that reinforce traditional
codes of femininity prohibit women from consuming alcohol as they may expose themselves
to greater health risks. For instance, some young women in Africa consume this substance
secretly so as not to be seen as violating traditional codes of femininity 40. Likewise, women also recognize the importance of mutual care as another way to build
friendship and trust. For instance, on a girls' night out, friends always support
and take care of each other 53. This suggests that the way women perceive their gender identity also plays an important
role in their relationship with alcohol.
Double Gender Standard in Women Alcohol Consumers
There is a double standard regarding alcohol consumption in women since male drunkenness
is accepted while female drunkenness is condemned 57 due, in part, to imbalanced gender-specific consumption norms and social sanctions
attributed to women who consume alcohol 55. Furthermore, women who consume alcohol excessively tend to be judged as promiscuous
and unfaithful, whereas men who consume this substance are perceived as sexually experienced
and capable 58-60.
This double standard reflects the way social norms and gender stereotypes influence
perceptions and attitudes toward alcohol consumption. According to some studies, alcohol
is seen as something good only for men, so women should not consume it 40,61. Likewise, both young men and women perceive female drunkenness as more shocking
and unacceptable than that of men, i.e., women who are seen in public in a state of
intoxication are judged negatively and are given an unfavorable sexual reputation
62.
Alcohol consumption is commonly considered an indicator of sexual availability and
interest in young women, making them more susceptible to sexual advances, although
they are expected to handle these situations when intoxicated 63. Evidence shows that women who consume alcohol are aware of the stereotypical risks
that position them as vulnerable 64. According to recent research, the combination of alcohol and sexualization only
occurs in young women 21.
Furthermore, there is a culturally persistent gender double standard surrounding female
intoxication, justified by discourses about women's greater vulnerability to sexual
or physical assault compared to men. This leads women to consider going out to consume
alcoholic beverages and being victims of lascivious looks as well as physical contact
without consent in nightclubs as a common situation 62, which is also reflected in the perception of sexual experiences 63,65.
Furthermore, when young women talk about their sexual experiences in the context of
excessive alcohol consumption, feelings of regret prevail 66. However, in narratives about excessive alcohol consumption, the good experiences
always outweigh the bad ones 43, which may make sexual violence less visible in contexts of alcohol consumption 66.
In these circumstances, women attempt to convey an image of respectable femininity
while engaging in a practice that has traditionally been framed as masculine 53. However, despite these strategies, smearing still occurs when women consume alcohol
excessively. In fact, young women are judged more than young men when they exhibit
"inappropriate" alcohol behavior in real life as well as on social media 21.
The Representation of Women and Drink
The relationship between gender and alcoholic beverages is a topic that has been studied
by several researchers in recent years. According to Lojdová 43, in women's stories, gender stereotype confirmation is connected with the structure
of alcoholic beverages, since the narratives serve to concretize traditional gender
identities. In this regard, in the research carried out by Dumbili 40, men consider women to be vulnerable, which is why they recommend wine and other
sugary/flavored brands described as less "strong" for women.
Regarding alcoholic beverages appropriate for women, those perceived as sweetened
or "light" are believed to be more appropriate 40. Nicholls 53 points out that several participants associate beer with masculinity, whereas the
supposedly most "feminine" drinks, such as cocktails and wine, are also considered
more "elegant," "luxurious," and "less clunky" than beer. Additionally, women are
expected to consume alcohol in small, dainty glasses, as the emphasis is placed more
on how a drink looks and feels than on the taste itself. Hence, certain drinks can
function as "accessories" in social contexts and become identity signals driven by
consumption 67,68. This happens, in part, because women who adhere to appearance norms are more aware
of how others view them and therefore place more emphasis on integrating with their
peers and obtaining social attention 40.
Unfortunately, during youth, when excessive alcohol consumption is most normative
by peers, social pressure to attract and maintain social relationships has continually
exposed young women to media images of unrealistic standards of physical appearance
56. According to Hussman and Goldstein 55, the ideal of a thin body and social relationships is associated with an increase
in alcohol consumption. Additionally, women appear to be much more aware than men
of how they are represented online, as suggested by Lennoxx et al. 62, and they spend time and effort ensuring that their virtual identity projects the
image they want to show to others. This may include carefully editing and curating
the photos they share on social media, as well as updating their profiles and managing
their online presence.
The discourse of alcohol consumption on social media is more than just a social practice,
as this is reflected in people's behavior in public spaces, influenced by awareness
of how this is represented on social media 62. This is expressed by Belova and Fadeeva 69) when representing a series of sociocultural meanings that include social normativity,
accessibility, daily routine, normalization, sacredness, sociocultural integration,
and orientation towards stereotypes. However, the discourse also reflects a gender
double standard around appearance and alcohol consumption 70.
Because of this, some young women have found specific ways to present a fun and "up
to par" online identity without compromising their respectability, as described by
Lenoxx et al. 62. Unfortunately, young women continue to experience significant stress when expressing
their "alcoholic femininities" both in public and online. In other words, they minimize
the appearance of drunkenness to (un)known audiences and walk a fine line to comply
with acceptable femininities under the predominant patriarchal regime 57.
Conclusions
The present review systematically assessed quantitative and qualitative studies that
identified four themes related to the influence of gender on alcohol consumption.
These findings allow for a better understanding of alcohol consumption among young
people. Moreover, they enable intervention components that can be incorporated into
future gender-based prevention programs.
The review showed that gender constructions, particularly masculinity conceptualization,
carry significant health risks by promoting excessive consumption and its subsequent
associated social risks. In this regard, interventions aimed at destigmatizing gender
stereotypes, addressing long-held beliefs, supporting the disapproval of masculine
norms and re-assessing the perspective of masculinity and virility could raise awareness
of the way men relate to alcohol consumption. Likewise, these interventions could
impact the way alcohol consumption is encouraged in various social contexts.
Alternatively, interventions targeting women could focus on promoting responsible
alcohol consumption, emphasizing concerns related to image and reputation. It is crucial
to consider female alcohol consumers' inherent biological vulnerability, underscoring
the need for specific preventive strategies that address physiological and metabolic
differences.
Normalization of alcohol consumption and the social pressure exerted on young women
emerge as additional factors that require special attention in interventions, recognizing
the significant influence that these elements have on alcohol consumption-related
decisions. Furthermore, a comprehensive approach that addresses both gender constructions
and biological and social aspects will be essential to promote healthy behavior and
mitigate risks associated with alcohol consumption.
Therefore, alcohol consumption analyzed according to consumer gender allows us to
observe and determine how this influences its increase. In short, considering gender
in research design and nursing prevention and intervention strategies could ensure
an understanding of gender differences in alcohol use and success in them.
