title: Social inequalities and gender differences in the experience of alcohol-related problems.
abstract: OBJECTIVE
  To examine the influence of country-level characteristics and individual socio-economic status (SES) on individual alcohol-related consequences.
  
  
  METHODS
  Data from 42,655 men and women collected by cross-sectional surveys in 25 countries of the Gender, Alcohol and Culture: An International Study study were used. The individual SES was measured by the highest attained educational level. Alcohol-related consequences were defined as the self-report of at least one internal or one external consequence in the last year. The relationship between individuals' education and alcohol-related consequences was examined by meta-analysis. In a second step, the individual level data and country data were combined in multilevel models. As country-level indicators, we used the purchasing power parity of the gross national income (GNI), the Gini coefficient and the Gender Gap Index.
  
  
  RESULTS
  Lower educated men and women were more likely to report consequences than higher educated men and women even after controlling for drinking patterns. For men, this relation was significant for both internal and external problems. For women, it was only significant for external problems. The GNI was significantly associated with reporting external consequences for men such that in lower income countries men were more likely to report social problems.
  
  
  CONCLUSIONS
  The fact that problems accrue more quickly for lower educated persons even if they drink in the same manner can be linked to the social or environmental dimension surrounding problems. That is, those of fewer resources are less protected from the experience of a problem or the impact of a stressful life event.
authors.affiliation: Department for Biostatistics and Clinical Epidemiology, Charité—University Medicine Berlin, Berlin D-12203, Germany. ulrike.grittner@charite.de
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grittner
authors.forename: Sandra
authors.initials: S
authors.lastname: Kuntsche
authors.forename: Kathryn
authors.initials: K
authors.lastname: Graham
authors.forename: Kim
authors.initials: K
authors.lastname: Bloomfield
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors