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Doctors less likely to ask women about their drinking

Kaiser Permanente study finds gender difference in intervention, despite increasing alcohol use by women

Among patients who reported problem levels of drinking alcohol, women were less likely than men to have a conversation with their doctors about it, according to a study in the journal Addiction from Kaiser Permanent researchers.

The gender difference is consistent with findings of other research suggesting that alcohol problems may be perceived as more prevalent among men, though both genders are equally likely to use more alcohol than guidelines recommend.

Stacy Sterling, DrPH, MSW

“Other research shows alcohol consumption by women is increasing, particularly through the pandemic,“ said senior author Stacy Sterling, DrPH, MSW, a senior research scientist with the Kaiser Permanente Division of Research. “Our study identifies a potential gap in counseling of women who may have moderate drinking problems, which can worsen quickly.”

The study examined a large group of 287,551 patients of Kaiser Permanente Northern California (KPNC) who screened positive for unhealthy alcohol use during a doctor’s visit between 2014 and 2017. KPNC primary care teams use the Alcohol as a Vital Sign screening, which involves a medical assistant asking screening questions, and the physician following up with a conversation with the patient, known as a brief intervention (part of KPNC’s screening, brief intervention, and referral to treatment — SBIRT — protocols in behavioral health).

The analysis found differences in which patients received the brief intervention — women were less likely to receive it, particularly if they were middle aged (35 to 65 years old). Older men who reported problem drinking levels were less likely to get an intervention than similar younger men.

Sujaya Parthasarathy, PhD

The results may reflect outdated assumptions about alcohol use. While the genders tend to have different patterns of drinking, they are similarly likely to have problem drinking. Women reporting problem drinking tend to exceed guidelines for weekly limits on alcohol (34% of women in the study vs. 21% of men), while men are more likely to have more drinks in one sitting (66% of men in the study exceeding daily limits vs. 52% of women).

Similar percentages (about 13% for both genders) report exceeding both daily and weekly limits, suggesting a more serious drinking problem.

Federal health recommendations limit women to no more than 3 drinks on any day or 7 drinks per week; and for men no more than 4 drinks on any day or 14 drinks per week.

The lower intervention rates for middle-aged women could relate to their having more potential health questions to review for a primary care doctor visit, said lead author Sujaya Parthasarathy, PhD, a health economist with the Division of Research. “There may be 10 other things to discuss, such as diabetes or obesity, so talking about their drinking may take lower priority,” she said. Women may also feel more stigma in talking about their drinking.

But physiologically, women are at greater risk from drinking, particularly as they age, Sterling noted. “There are real health impacts on women, such as just a single glass of wine on a regular basis that raises risk of breast cancer,” she said. “Women run into health problems related to alcohol use at lower levels because of different body composition.”

“Women metabolize alcohol differently, getting higher blood alcohol content than men from the same number of drinks, even at similar weights,” Sterling added. “Women also progress to serious alcohol use problems much more quickly than men do, and tend to enter specialty treatment later. So, it’s just not a good situation for women.”

Asma Asyyed, MD

Primary care clinicians need to be aware that their female patients may benefit from advice about healthy levels of alcohol use, said co-author Asma Asyyed, MD, KPNC chair of addiction medicine and recovery services. “Our findings really underscore the opportunity to include the topic of low-risk alcohol use in our conversations with women patients about overall health behaviors and reducing risk across the board,” she said.

The study was funded by the National Institute on Alcohol Abuse and Alcoholism.

Additional co-authors were Felicia Chi, MPH, Andrea Kline-Simon, MS, Cynthia Campbell, PhD, MPH, and Verena Metz, PhD, all of the Division of Research.

About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit or follow us @KPDOR.

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