Structural sexism and Women's alcohol use in the United States, 1988–2016

Women's alcohol consumption and binge drinking have increased concurrent with socio-economic gains and may be related to structural sexism. We examined associations between structural sexism (state-level sex inequality in political/economic status), and alcohol outcomes among women in Monitoring the Future (N = 20,859) from 1988 to 2016 (ages 27–45 in 2016). We controlled for state and individual confounders and tested three mediators: depressive symptoms, restrictive alcohol norms, and college completion. Increased structural sexism was associated with decreased alcohol consumption frequency (RR: 0.974, 95% CI: 0.971, 0.976) and binge drinking probability (OR: 0.917, 95% CI: 0.909, 0.926). Norms and education but not depressive symptoms partially mediated these relationships. Among women in the midlife in recent years, lower levels of state structural sexism were associated with greater alcohol consumption and binge drinking. These findings suggest that as states become more gender-equal—which confer numerous benefits for women's rights and health—additional resources and messaging may be required to prevent harmful alcohol use among women. •Alcohol use has increased for women, concurrent with changes in social status.•Structural sexism may be determinant of changes in women's alcohol use.•We show that decreases in structural sexism are related to increased alcohol use.•These associations are partially mediated through college completion and norms.