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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 |
Source: Elaborated by the authors.
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).
Source: Adapted from Page et al. 32.
Figure 1 Flowchart of Selected Articles according to PRISMA-ScR
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. |
Source: Elaborated by the authors.
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.
