Structural sexism moderates work and occupational risks for alcohol consumption and binge drinking among US women, 1989–2016

People in the labor force and in high-status careers consume alcohol at high rates. State-level structural sexism (sex inequality in political/economic status) is inversely related to alcohol use among women. We examine whether structural sexism modifies women's labor force characteristics and alcohol consumption. We surveyed frequency of alcohol consumption in the past month and any binge drinking in the past two weeks among women ages 19–45 in Monitoring the Future from 1989 to 2016 (N = 16,571) in relation to occupational characteristics (including employment status, high-status career, and occupational gender composition) and structural sexism (measured using state-level indicators of gender inequality) with multilevel interaction models controlled for state-level and individual confounders. Working women and women in high-status occupations had higher risks of alcohol consumption than non-working women; differences were most pronounced in lower-sexism states. At the lowest sexism levels, employed women consumed alcohol more frequently (2.61 occasions of use in past 30 days, 95% CI 2.57, 2.64) than unemployed women (2.32, 95% CI 2.27, 2.37). Patterns were more pronounced for frequency of alcohol consumption than binge drinking. Occupational gender composition did not influence alcohol consumption. In lower sexism states, working and having a high-status career are associated with increased alcohol consumption for women. Labor force engagement extends positive health benefits to women, but it also confers specific risks, which are sensitive to the broader social context; these findings contribute to a growing literature suggesting that alcohol risks are changing in relation to shifting social landscapes. •Labor force engagement and high-status careers are related to increased alcohol use.•It is unknown whether structural sexism impacts these associations for women.•Low sexism contexts exacerbated alcohol use among working women and those in high-status careers.•Findings varied by alcohol patterning and were less pronounce for binge drinking.•Structural sexism may be an important modifier of established risks for alcohol use.