Women, alcohol and work: Interactions of gender, ethnicity and occupational culture

Pergamon S0277-9536(96)00081-0

Soc. Sci. Med. Vol. 43, No. 11, pp. 1649-1663, 1996 Copyright © 1996 Published by ElsevierScienceLtd Printed in Great Britain. All rights reserved 0277-9536/96 $15.00+ 0.00

WOMEN, ALCOHOL AND WORK: INTERACTIONS OF GENDER, ETHNICITY AND OCCUPATIONAL CULTURE GENEVIEVE M. AMES' and L. A. REBHUN -~ 'Prevention Research Center, 2150 Shanuck Avenue, Suite 900, Berkeley, CA 94704, U.S.A. and -'Yale University, Department of Anthropology, PO Box 208277, New Haven, CT 06520-8277, U.S.A. Abstract--Patterns of alcohol use are affected by culture and history and intertwined with the rhythms of work life. The 20th century economic shift toward industrial and service jobs coupled with the increasing presence of women in the workplace has revolutionized U.S. women's domestic and public roles [I], and these changes have impacted their drinking behavior [2]. In addition, in a multicultural society like the United States, subcultures, ethnic groups, socioeconomic classes, and even job categories have their own sets of gendered drinking norms. Patterns of alcohol use among women can be better understood with consideration of intricate interactions among gender, ethnicity, class, employment, and alcohol consumption. Stepping up to the need to learn more about these factors, we have reviewed literature about ethnic, class, occupational, and gender influences on women's workplace-related drinking. This report on that review will show both the complexity of the phenomenon and the inconsistent, incomplete nature of existing information, as well as pointing out directions for future research, We begin with a general discussion of women and workplace drinking. Copyright © 1996 Published by Elsevier Science Ltd

WOMEN, WORK AND DRINKING SURVEYS: AN INCONSISTENT RESEARCH PICTURE

National and localized surveys indicate that while employed men generally drink more heavily and frequently than employed women, women's drinking rates increase with certain types of employment. However, generalizations are difficult because studies use different variables: disparate measures of alcohol use, typing of occupations, and categories of workers (see Tables 1-3). The diversity of variables identified by researchers reflects the exploratory, preliminary nature of data on women and alcohol in the workplace. For example, Gleason et al. [3] point out the importance of ethnicity in women's workplace drinking, while Wilsnack et al. [4] draw attention to marital status and the differences between full-time and part-time employment, and provide statistics on those who are unemployed but seeking work. Differences in questionnaire design lead to dissimilar measures, as when Barnes and Welte [5] and Ames et al. [6] report the number of times employed female respondents used alcohol before and during work, while Mandell et al. [7] prefer a measure of alcohol abuse, and Parker and Harford [8] estimate the average daily consumption of ethanol in grams for occupational categories. Some researchers classify types of occupations by detailed job titles [7], while others (e.g. Hingson et al. and Hollinger) use broad classifications of types of occupations [9, 10]. Even where researchers use similar classification schemes, they differ in the degree to which they lump together or separate specific job titles. For example, both the Mandell and Parker studies provide detailed data on drinking rates by job category and gender, but while Parker and Harford lump together nurses, pharmacists

and dietitians, Mandell et al. separate licensed practitioner nurses (LPNs) from registered nurses while lumping nursing aides, orderlies and attendants together and ignoring pharmacists and dietitians. Rather than reflect faults with individual authors' approaches, these differences show a general lack of standardization in the field and point out the complexity of the relationships among gender, ethnicity, occupation and alcohol use.

IS WORK-RELATED DRINKING PROBLEMATIC FOR WOMEN?

Wilsnack and Wilsnack have called for more complex, contextualized approaches to the relationship between women, drinking and the workplace [11]. This essay is, in part, an attempt to show some of the directions such approaches would take. Researchers need to pay attention not only to the social, cultural and historical situations of the subjects of their research, but also to influences on their own research perspectives and personal attitudes. Too often, theorizing on women, work and drinking reflects biased stereotypes rather than realities. Some investigators posit that employment outside the home is in itself a general risk factor for problem drinking among women. Studies have shown that employment increases moderate drinking in some female populations [12], and that women are generally more likely to be drinkers rather than abstainers if they have sufficient salary to buy alcohol, have completed higher education, live in an urban environment, and are professionally employed [13]. However, national surveys fail to demonstrate any strong connection

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Genevieve M. Ames and L. A. Rebhun

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Table I. Noncomparability of measures, variables and scales Study population/sample

Measure/variable

Gleason et al. [31 1984 National Longitudinal Survey of Youth (12,069 respondents, response rate not available)~

Wilsnack et al. [4] National survey of women, 1981 (response rates between 83% and 89% for different categories)b

Findings

Percentage of young workers whose selfreported drinking interfered with work: Women 3.8% 1.7% 6.9%

Latino African-American European-American Percentage of women who had one or more symptoms of alcohol dependence: married, full-time paid employment married, part-time paid employment married, full-time housewife unemployed, seeking work Percentage of women who consumed I oz. or more of ethanol per day: married, full-time paid employment married, part-time paid employment married, full-time housewife unemployed, seeking work

14% 19% 10% 20% 12% 8% 14% 16%

Number of times in the past year that employed respondents used alcohol before work, during lunch, and during working hours:

Barnes and Welte [5] Survey of adults over 18 in New York State (6364 respondents) c

Women 9% 1% 2%

Men 13% 3% 6%

Women (n = 104) 5.8%

Men (n = 728) 5.5%

27.9%

22.8%

1-11 times 12-51 times 52 or more times

Ames et at. [61 1988 survey of 832 hourly workers in a heavy machinery assembly plant (74% response rate)

Percentage of hourly workers reporting having four or more drinks before work on at least one occasion in the previous 12 months: Percentage of hourly workers reporting drinking at work (including lunch and breaks) on at least one occasion in the previous 12 months:

Mandell et al. [7] Five site study of 18,572 individuals (response rates between 77% and 80% for different sites)d

Excerpted from longer list

Crude prevalence of alcohol abuse using DIS/DSM-111 algorithm

Job category: sales workers retail and personal services waitresses and waiters health aides (except nurses) cashiers other food preparation occupations hairdressers/cosmetologists nursing aides, orderlies, attendants childcare (except private household) bookkeepers, accounting and auditing clerk typists maids and housemen secretaries teacher/NEC LPN (licensed practical nurses) teachers/eleme ntary teachers/secondary registered nurses

between problems

employment

per

se

Men 10.2% 6. 1% 12.7%

and

[11]. A t t i t u d e s t o w a r d

women's

drinking

d r i n k i n g in g e n e r a l

a n d f e m a l e d r i n k i n g in p a r t i c u l a r are f o r m e d

Unfortunately,

Women 0.00 7.19 6.82 5.88 4.29 1.45 3.93 2.17 2.86

Men 17.02 20.00 I1.11 e 17.39 13.73 28.57 e 4.00 20.00 e 12.00

2.70 4.04 2.1 I 2.33 1.43 0.71 0.00 1.04

100.00e 0.00 0.00e 0.00 0.00 e 4.76 2.86 0.00

theorizing

drinking has been

about

women,

work

and

influenced by unscientific stereo-

in the

t y p e s s u c h as the t w i n i d e a s t h a t a n y d r i n k i n g at all is

broader context of women's political and social subor-

h a r m f u l to w o m e n a n d that o u t s i d e - t h e - h o m e e m p l o y -

d i n a t i o n a n d are b o t h s y m b o l i c

and instrumental

in

ment

leads

to

heavier

drinking

for

c o n t i n u i n g t h a t s u b o r d i n a t i o n [14], T h e o r i s t s c a n b e as

because

i n f l u e n c e d b y t h e s e a t t i t u d e s as the p e o p l e t h e y s t u d y .

s t r e s s or b e c a u s e it e x p o s e s w o m e n

women

(either

it is s o u n n a t u r a l t h a t it c a u s e s u n b e a r a b l e to the d i s s o l u t e

Women, alcohol and work

1651

Table 1. Continued Parker and Harford [8] 43,809 respondents to 1988 National Survey in U.S., all states. Overall response rate was 85.5% t

Excerpted from longer list, findings on women in selected fields

Percent current drinker: 51.3% 53.7% 47.2% 51.2% 50.0% 48.5% 50.8% 33.1% 443%

Average daily volume of ethanol in grams: 7.8 8.1 6.2 8.6 7.3 7.3 11.2 7.3 6.2

Women 0.707 0.803 0.642 0.572 0.589 0.560 0.406 0.654

1.087 1.322 0.951 1.372 1.306 1.292 1.793 1.225

Job category: nurses, pharmacists, dietitians teachers, librarians health technicians secretaries and typists record processing clerks other clerical support workers food service workers health workers hairdressers, ushers, porters Hingson et al. [9] 1977 survey of 5314 individuals in 3079 households in Boston SMSA (response rate of 68%)g

Mean drinks per day by occupational group: professional/technical self-employed/managerial clerical/sales skilled semi-skilled service unskilled total

Hollinger [ 101 Study of counterproductive activity in the workplace in 47 businesses and hospitals in Cleveland, Minneapolis-St. Paul and Dallas-Fort Worth (9175 respondents, 53.8% response rate)

Percentage of all workers self-reporting some instances of working while under the influence by type of industry:

Men

All workers(women n = 6216) 7.6~ 12.8% 3.2%

Retail Manufacturing Hospital

~Findings drawn from 4874 employed women in the sample. bFindings drawn from 917 women in sample. ~Number of women not reported. dFindings drawn from 6465 employed women in the sample. en<10. tFindings drawn from 13,583 employed women in the sample. SFindings drawn from 1581 employed women in the sample. values

o f the

profane,

male

world).

This

approach

within

that

population

[15].

However,

ous,

moderate drinking among employed women and ignore

o f the h o m e ,

a n d the i m m o r a l

problem

many

researchers

female domain

fail to d i s t i n g u i s h b e t w e e n

too

r e f l e c t s the i d e a o f a m o r a l d i v i s i o n b e t w e e n the v i r t u -

and

m a l e d o m a i n o f the street, an u n s c i e n t i f i c s t e r e o t y p e o f

h o w w o m e n ' s d r i n k i n g is i n f l u e n c e d b y a c o m b i n a t i o n

g r e a t a n t i q u i t y [1 1].

o f e n v i r o n m e n t a l f a c t o r s in e t h n i c g r o u p s , o c c u p a t i o n a l

G r e a t e r a l c o h o l a c c e s s a n d s o c i a l f r e e d o m to d r i n k c a n b e s e e n as p o s i t i v e a s p e c t s o f w o m e n ' s

s u b c u l t u r e s a n d w o r k sites. A l s o , b e i n g a h o u s e w i f e is

liberation

n o t a p r o t e c t i v e f a c t o r a n d m a y e v e n b e a f a c t o r in the

from oppressive social strictures. Increased moderate

d e v e l o p m e n t o f a l c o h o l p r o b l e m s [16], [1 1], a l t h o u g h

drinking among employed women does not necessarily

not

i m p l y a s e r i o u s s o c i a l p r o b l e m , a l t h o u g h a r i s e in the

cases, employment

total

alcohol

consumption

of

any

given

population

d o e s p r o v i d e a n o p p o r t u n i t y for m o r e p r o b l e m d r i n k i n g

all w o m e n

are

affected

equally

[17].

In

d r i n k i n g p r o b l e m s at the s a m e t i m e t h a t it f a c i l i t a i e s o p p o r t u n i t i e s for n o n - p r o b l e m d r i n k i n g [ 11 ].

Table 2. Comparison of African-American, European-American and Mexican-American women's drinking Drinking pattern Abstainers (all categories)a Abstainers: full-time employed Abstainers: unemployed Frequent high maximum drinkers (FILM) (all categories)" FHM: part-time employed drinkers FHM: full-time employed drinkers FHM: housewives FILM: retired

A•can-American 45% (n = 1204) 39% (n = 455) 43% (n = 455) 4% (n = 1204) 6% (n = 120) 4% (n = 455) 3% (n = 252) 0% (n = 161)

some

may be a protective factor against

European-American 34% (n = 1029) 24% (n = 396) 37% (n = 396)

Mexican-American 46% (n = 842) 33% (n = 276) 57% (n = 276)

8% (n = 1029) 8% (n = 128) 12% (n = 396) 6% (n = 263) 2% (n = 184)

8% (n = 842) 5% (n = 64) 14% (n = 276) 3% (n = 346) 0% (n = 51)

"Includes full-time employed, part-time employed, unemployed, homemaker and retired. Source: Herd and Caetano [51].

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Genevieve M. Ames and L. A. Rebhun Table 3. Drinking rates for different U.S. Asian populations

Drinking category

Chinese-Americana

Abstaining men Abstaining women Moderate drinking men Moderate drinking women Heavy drinking men Heavy drinking women Sources: Suea et

al.

47.7% 73.8% 40.8% 26.3% 11.5% 0%

Japanese-American b 36.4% 63.3% 40.4% 25.0% 26.3% 11.7%

Korean-American a 55.5% 80.8% 20.6% 18.4% 23.9% 0.8%

[54]; bKitano et al. [55].

ETHNIC AND SOCIOECONOMICPOPULATIONS Anthropologists have studied drinking cross-culturally since the 1940s; but it was not until the 1970s and 1980s that they turned to studies of drinking among U.S. subcultures. Culture influences circumstances, occasions and rituals of drinking, kinds of beverages consumed, definitions of heavy and light drinking, and moral concepts around drinking--in short, almost every aspect of availability of alcohol, alcohol behavior and drinking motivation and consequences [18]. In most cultures, drinking norms are different for men and women. To complicate matters even further, cultures change over time, they are internally subdivided into subcultures, and individuals may be multicultural or vary in the degree to which they are acculturated [19]. The United States is one of the most multi-ethnic countries in the world. Starting with Native Americans who developed a variety of diverse cultures from the woodland hunter-gatherers of the East Coast to the settled horticulturalists of the Southwest, immigration has continually brought peoples from every part of the world. The interaction among these populations has produced new, syncretic subcultures. Although we tend to group United States people into broad subcultures or ethnic categories like "Latino," "AsianAmerican," "African-American," and "EuropeanAmerican," each of these categories is composed again of multiple subcultures which may have distinct gender roles and drinking patterns. Unfortunately, when alcohol researchers use ethnicity as a variable, they have tended to conceptualize it with a static, ascribed, homogeneous quality. In fact, ethnicity is a complex concept. It is too frequently seen either as a biological quality, as in the case of racial classifications, or else different characteristics like religion, national origin and social class are indiscriminately compared as if they were congruent [20], [21]. In fact, ethnicity is neither biological, static, nor equivalent to religion, social class, or national origin alone. Anthropologists no longer consider race to be a biological category: rather, it is seen as socially defined on the basis of physical characteristics [20], [21], [22]. Religion, national origin and social class all form part of ethnicity (e.g. Irish Catholic vs Irish Protestant), along with region of residence, native language, generation since immigration, and a variety of other cultural factors. Many individuals are interethnic, either because of acculturation, intermarriage

among groups, or because they fall into categories not recognized in the official language of classification. Another aspect of ethnicity often ignored by alcohol researchers is that it is not only an individual phenomenon of personal experience and subjective selfdescription, but it is also a collective phenomenon, part of the formation of political groups in the United States [20]. Labels such as "Asian," "Hispanic," or " b l a c k " are officially recognized U.S. government census classifications that subsume a great variety of cultures, national origins, social classes and disparate drinking patterns into single mega-categories. While researchers need to pay more attention to the importance of ethnicity in gendered drinking patterns, they also need to be aware that the conventional language used to describe ethnicity has more to do with the needs of the U.S. census than with the actual cultural patterns of groups in the U.S. population. Different ethnic groups in the United States also have a political identity, and they are arranged hierarchically in terms of access to political power, economic opportunities and social integration. This affects not only their alcohol-related behaviors and attitudes, but also the pattern of alcohol marketing in their communities, and the attitudes of elites toward their drinking, with resulting regulatory actions. Researchers who see ethnicity simply as a personal quality miss the political nature of ethnic identity. In the following sections, we show how membership in the commonly used classifications of "EuropeanAmerican", "Latino", "African-American", "Asian-American", and "Native American" groups affects women's drinking in general and work-related drinking in particular. European-Americans

The overwhelming majority of U.S. citizens and residents are European-American. Because of their numerical dominance, researchers are likely to class all European-Americans into a single broad category of " w h i t e " or else to regard them as the norm and thus ignore ethnicity as a factor in their drinking patterns. However, European-Americans are subdivided by religion, geographic residence, class and national origin. Disparate cultural drinking patterns have been identified for such religiously defined European-American groups as Jews [23], [24] and some Evangelical Protestants [14], [25], national groups such as IrishAmericans [26], [27], [28], Italian-Americans [29], [30], and Polish-Americans [31], regional groups such

Women, alcohol and work as Appalachians [32] and economic groups such as the working class [33], [34]. The extent to which these classifications are still important in influencing drinking patterns varies by the length of time since immigration for national groups, by geographic region, and by community cohesion within specific cultural boundaries. For example, Irish-American identity and traditional drinking customs may be stronger in Irish strongholds such as Boston, Chicago and San Francisco than in other cities. Drinking patterns vary within European-American ethnicities by gender, economic class and religious affiliation. There has been very little research on normative drinking among European-American ethnic and working-class women, perhaps because of the perception that these women drink less than men and have high percentages of abstainers [34]. However, historical studies show that urban working-class women have participated in work-related drinking for generations. Indeed, impoverished, enslaved, immigrant and working-class women have worked both inside and outside the home and for wages since the beginning of the colonial period. Working-class men and women alike drank fermented beverages with their meals, brewed beer and ran taverns [35], [36]. This disputes the assumption of many alcohol researchers that women did not work outside the home prior to the mid-20th century, and that the average woman was either an abstainer or an occasional, light drinker. Historical reviews of drinking patterns among Euro-American women show that neither of these assumptions is clearly supported. However, women generally drank lesser quantities than men and favored at- or near-home locations for drinking together with their families, while men favored all-male saloon or bar settings [37]. One recent study suggests that working-class EuroAmerican women tend to polarize into groups of abstainers and heavy drinkers with few moderate drinkers.* That study found that among the study sample both heavy drinking and abstinence were influenced by family factors: although a painful family history did influence some women to become life-long abstainers, women who had a family history of heavy drinking, long-term disruption in the family of origin, heavy drinking husbands, or other heavy drinking family members were most likely to themselves be heavy drinkers [34]. Female abstention and very light drinking patterns among white blue-collar women were also related to family and economic concerns: women tended to abandon pre- and early marriage "partying" **Different authors define heavy drinking differently, and some authors leave the term undefined. For example, in one of our studies, we defined heavy drinking as consuming 50 or more drinks in the past month plus six or more drinks on one or more days during the past month [33], [34] and in another as 10 or more drinks on one occasion during the past year for men and four or more for women [38]. The term is being used here and throughout the text in an approximate or relative way.

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and drinking to meet the demands of childrearing, housework and employment. Their working-class husbands, on the other hand, tended to maintain youthful patterns of socialization and drinking, enjoying social forgiveness by their wives for expected irresponsibility toward their families [34]. Similar patterns have also been found in working-class women of some nonEuropean ethnicities [ 12]. It was not until the early 19th century that sharply different gendered drinking patterns became common in the Euro-American middle class, influenced by the increasing segregation of a feminized domestic sphere from the masculine, public world of work. In addition, drinking was increasingly associated with the work sphere, either in the form of on-the-job drinking among manual laborers in the 19th century, or the increasingly popular 20th century habit of respite drinking after work [37]. The increasing association of drinking with work rhythms, combined with the rise of the so-called "cult of domesticity" in which women, especially middle- and upper-class women, were seen as pure, chaste and delicate, led to the stereotype of the abstaining woman [37]. However, this stereotype, to the extent that it is accurate at all, is only accurate for a small group of mostly European-American, middle- and upper-class women in the beginning of the 20th century. It is inaccurate for researchers to take this stereotype as a norm for all women of that time, yet all too frequently, that is precisely what they do. Since the 1970s, women of middle and upper-middle classes have been entering the work force in great numbers. Many Euro-Americans work in managerial and professional occupations, a domain formerly dominated by men. The change in drinking patterns and environmental influences on drinking by women in such positions are discussed in a later section of this paper that focuses on occupational types. Working EuroAmerican drinking patterns are compared with those of African-Americans in the next section.

African-Americans At 12% of the population, African-Americans constitute the largest minority group in the U.S. [39]. African-American drinking patterns are heavily influenced by both historical and continuing economic and social discrimination. African-Americans are subdivided by religious affiliation, geographic residence and economic class. In addition, a growing number of recent immigrants from Africa, the Caribbean and Latin America have increased the diversity of the African-American category. The gains of the 1960s Civil Rights movement opened opportunities for some African-Americans to advance to higher paid, more prestigious jobs, but a large percentage of the population was left behind, mired either in rural poverty or the urban underclass, increasingly beset by violent crime, drug and alcohol abuse, and other social manifestations of despair. While the prevalence o f Evangelical Protestant churches in this population may

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Genevieve M. Ames and L. A. Rebhun

serve as a strong protective factor against problem drinking [40], poverty, the effects of racism, and the current trend towards targeted alcohol advertising and higher density of alcohol outlets in African-American communities [41] may be influencing heavier drinking patterns, especially in Northern urban settings. African-American women are understudied in the alcohol literature. Most surveys examine the behavior of African-American men, especially low-income men, or compare African-American drinking patterns with those of European-Americans in general. The 1984 National Survey, for example, revealed similar drinking patterns among African-American and European-American men, but differing patterns among women in these populations (see Table 4). Although most research shows high rates of abstention among African-American women, the data are contradictory on rates of heavy drinking over time. In the 1960 National Survey, 11% of African-American women reported heavy drinking compared to 4% of EuropeanAmerican women [42]. In contrast, the 1984 National Survey found that African-American women had higher rates of abstention and lower rates of drinkingrelated problems than European-American women [43]. Part of the difference between these two surveys can be attributed to geography: the 1984 National Survey drew heavily from the South, while previous surveys were almost exclusively from the North. Increased consumption patterns occur when African-Americans migrate from the " d r y " cultures of the South to the "wetter" cultures of the Northeast [43]. For example, one study of 1128 women in New York State (57.8% employed, 474 European-American, 654 AfricanAmerican including 28.9% Southern migrants) found that 30% of Northern African-American women were abstainers vs almost 50% of Southern migrants with 12% of Northern vs 4% of Southern AfricanAmerican women classified as heavy drinkers [44]. Abstinence rates are also affected by affiliation with Evangelical Protestant churches which are stronger in the South [40]. The 1984 National Survey found that both AfricanAmerican and European-American employed women had lower rates of abstention than non-employed women. However, the relationship between employment and drinking pattern differed. EuropeanAmerican working women were significantly more likely than homemakers or retired women to be frequent, high-quantity drinkers. Empirical studies on African-American women in the workplace are scanty, if nonexistent. The challenge is to determine the interrelationship of ethnic, socioeconomic and workplace factors in drinking patterns among this population. Latinos

Among the most heavily studied drinking subcultures are several distinct Latino groups, who together constitute about 7% of the U.S. population [39].

Latino subcultures in the U.S. vary by region of ancestry (Mexico 60%, Cuba 6%, Puerto Rico 15%, other 19%) [39], [45], [46], generation after immigration, state of residence within the U.S., social class, citizenship status, religious affiliation, racial identity and occupation. Not all Latinos are immigrants or within a few generations of immigration. Some areas of the current United States were captured from Mexico, along with their residents, in the 19th century, and some families' U.S. residence goes back a century or more. Such Latinos are fully integrated into U.S. culture. In contrast, successive waves of Mexicans have migrated to the United States, where anti-immigrant sentiment, ethnic bias and economic discrimination have impeded their economic progress and social integration. Because of the wide diversity in migration and immigration patterns, we use the term "U.S. Mexican" for populations with Mexican heritage. This term more adequately describes the sample population than other terms. The drinking patterns of each of these groups reflect the interaction of cultural elements from their home countries with U.S. culture and drinking customs. U.S. Mexicans in California and Texas are most heavily studied, and we will concentrate on studies from these geographical regions here. Drinking patterns vary among different U.S. Mexican subgroups [47]; however, some alcohol-related beliefs and behaviors are shared across populations. For example, studies of U.S. Mexicans in Texas [48] and California [49] found that women are primarily abstainers or occasional drinkers, while men show higher drinking levels than women and more alcohol-related problems. A national survey showed that more U.S. Mexican women are abstainers than women in the U.S. general population (46% vs 36%), with the highest rates of abstention among women in California (51%) and Texas (55%) [50]. In general, employed U.S. Mexican women are more likely to drink unless they are migrant farm workers. The 1984 National Survey showed abstention rates of 33% for full-time employed "Latino" women (32% for part-time employed) in contrast to 57% for unemployed, 68% for housewives, and 65% for retired women [51]. In contrast, the abstention rate among migrant farm worker women is 85% [52]. This is consistent with studies showing a relationship between abstention among U.S. Mexican women and recent immigration, lower levels of education and low household income [47]. U.S. Mexican women's abstention rates are affected by employment status, being lowest among MexicanAmerican women who are employed, having higher household incomes and education levels and being of third or later generation immigrants [47], [48], [49]. Here, only the addition of the generation since immigration differs from findings for working-class women in other ethnic groups. Ethnographic studies provide answers as to why the drinking practices of the women who work and are more highly acculturated are higher than all other

Women, alcohol and work groups of U.S. Mexican women. The U.S. practice of "girls' night out" in bars and drinking at public social outings diverges from customary sanctions against drinking for U.S. Mexican women. Traditionally, women are expected to restrict their drinking, if any, to family or home-based parties where both sexes are present and strict norms control women's drinking I47]. As a rule, women do not engage in single-sex group drinking. However, U.S. Mexican men and women alike view after-work drinking by men as a respite from and reward for work, and see drinking as deviant only when it interferes with the ability to work. As more women join the work force, they take on the male practice of respite drinking, albeit with a feminine pattern, such as buying a six-pack after work to consume at home while preparing dinner. Only in the more acculturated middle class do women drink together with men in commercial establishments [47]. Mexican-American women working in more ethnically diverse urban settings may be adopting a pattern more like that of the non-Latino population. Some occupational categories and drinking patterns of women are more typical of non-citizen, new immigrant, or impoverished workers. For example, studies of migrant farm workers in both Texas [52] and California [53] reflect the more conservative norms for women's drinking. Here, men show frequent drinking both on and off the job, while the majority of women (85%) abstain from alcohol except for small amounts at certain family functions, despite their employed status I53]. The above referenced ethnographic studies illustrate the importance of looking at the context of drinking. They also point to a need for better understanding of drinking context among employed, more acculturated, middle-class Mexican-American women. In particular, more research is needed into rates of problem drinking in this population and the interaction of cultural and workplace environmental issues in their drinking patterns. In addition, any prevention or treatment program should take into account the problems of acculturation, ethnic discrimination and rapidly changing gender norms in this population. Asian-Americans

Asian-Americans comprise a diverse group including descendants of Japanese and Chinese laborers who immigrated to the United States starting in the 19th century, and the more recent refugees from the Korean and Vietnam wars. These groups include both urban peoples and tribal peoples, whose contact with modern technology was limited before war swept them from their homes. As among Latinos, generation since immigration is an important factor in drinking behavior among Asian-Americans, and attitudes toward women's drinking are more conservative in less acculturated groups. Until recently, studies of drinking patterns of AsianAmerican women were scarce, and the lack of research on U.S. Asian subcultures in general resulted in mis-

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conceptions about drinking patterns. Asian women were typically described as non-drinkers, with few alcohol problems. Researchers focused on debates over biological bases for Asian abstinence such as the socalled "Asian flush" in which light drinking causes uncontrolled blushing, ignoring diversity among Asian groups [54]. However, surveys among Asian groups in Los Angeles [54], [55] provide a different picture of drinking patterns for some Asian-American groups (see Table 3). These studies found a relatively high rate of abstention among women in three Asian-American groups, but varying rates of abstention among men. Other surprising findings were the relatively high rate of heavy drinking women in Japanese-American populations, and that among Japanese-Americans, recent immigrants had higher drinking levels than Americanborn Japanese: 51.8% of Japan-born males were heavy drinkers, compared to 17.3% of U.S.-born Japanese males. Unfortunately, differences of drinking rates among recently arrived Japanese women were not reported. This finding suggests that higher male consumption styles of modern Japan have been brought over by immigrants and that higher female consumption styles of more recent immigrants may be reflected in the 11.7% of heavy drinking Japanese-American women [54]. Clearly, we need more research on this fast-growing population wherein women of Asian background are entering the work force in great numbers. If the Asian-American women follow the drinking patterns of women from other populations who are entering the work force in great numbers, they may be at risk for alcohol-related problems. Native Americans

Native Americans, who comprise less than 1% of the U.S. population [39], are divided into numerous culturally distinct tribes. In addition, intermarriage among tribes and with European- and AfricanAmericans have left comparatively few full-blooded tribal members. While about half of Native Americans live on reservations, an increasing number live and work in cities [39]. An enormous body of research literature attests to the prevalence of drinking problems among Native Americans in general, although the severity of the problem varies from tribe to tribe [56], [57], [58] and by social environment [59]. For example, the Hopi and Navaho, who occupy nearly the same territory, have very different drinking rates, with the Hopi tending to be abstainers except for a small minority of heavy drinkers, and the Navaho tending to be heavy binge drinkers [60]. There have been no broad-scale comparative studies of all Native American tribes, and Native Americans are not included as a specific subculture in the national surveys. Native American drinking patterns are influenced by the history of conquest, relocation and confinement to reservations suffered by various tribes. Lurie has

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characterized Native American drinking as "the world's oldest on-going protest demonstration" [61] in reference to their history and current conditions. Alcoholic beverages were introduced to Native American tribes by Europeans, who quickly developed a persistent stereotype of the "firewater myth" that Native Americans were constitutionally incapable of holding their liquor. Historically, Native American drinking has been as influenced by the despair of cultural destruction, conquest, massacre, epidemics and continuing poverty as by any biological propensity to drunkenness [62]. Drinking problems are severe among Native Americans as a group: Native Americans die of alcohol-related causes at five times the rate of any other U.S. ethnic group [63]. In 1960, for example, 60% of all deaths from alcoholism and 25% of all deaths from cirrhosis of the liver in Alaska were among Native Americans [64], despite their relatively small percentage of the state's population. The range of risk of fetal alcohol damage in all Southwestern tribes ranges from 3.9 to 33.3 per 1000 women of childbearing age [65]. Native Americans constitute a group in extreme distress: 27.5% of the population lives below the poverty line, suffering high infant mortality and low life expectancy; only 5.2% of Native Americans are 65 years of age or older, and unemployment on reservations is very high [60]. Many of the unemployed subsist on a combination of welfare [66] and hunting or subsistence farming. Reliable data on frequency, quantities and varieties of drinks among Native American women are scant [60]. The severity of drinking problems for Native American men has been documented but very little on types of drinking patterns [67]. Generally, youth, maleness, Plains tribal affiliation, lower social status and low integration into tribal traditions are correlated with alcohol abuse [56]. In addition, unemployment is a major factor [68], [69]. Findings on the Sioux tribe are one of the few studies that look at alcohol and employment and includes women. In 1961, Whittaker found that 17% of Sioux women described themselves as regular drinkers, 32% as occasional drinkers, while 50% were abstainers. However, of the abstainers, 18% were recovered alcoholics [70]. Only 20% of the women reported that their mothers had been drinkers [71], suggesting that alcohol use is increasing among Sioux women [72]. At the time of this study, more than 50% of all employed men and women were drinkers, although their employment was seasonal or temporary for the most part. Twenty-two years later, Weibel-Orlando found that women drank more frequently than men in rural Sioux areas. At the time of her survey, only 25% of reservation Sioux were employed [66]. Waddell's study of the Papago tribe suggests that employment is a protective factor. Ethnographic findings showed that women drank less than men because they were more employable due to the availability of domestic servant jobs. Also, women maintained strong

networks of mutual support with female relatives, whereas men tended to socialize with unemployed drinking buddies [73]. In 1974, Levy and Kunitz published a study of drinking among the Navajo [74]; in 1994, they published a follow-up study [75] that provides a unique longitudinal look at drinking in this Native American tribe. Kunitz and Levy argue that heavy intermittent binge drinking observed among Navajos, rather than a reaction to a biological condition, reflects a culturally defined stage of life among young adult males. Although their studies focused more on men than on women, the data from the small, statistically insignificant sample of women they followed suggest that a high percentage of Navajo women are abstainers, but among women who do drink, social consequences and alcohol-related health problems are severe. In general, indicators of problem drinking such as death rates from alcoholic cirrhosis and motor vehicle accidents declined from 1974 to 1990 on the reservation they studied, but the reasons for these declines are unclear [75]. In summary, what little research there is on Native American women suggests that drinking practices of women (and men) vary by tribal culture, and that strictly biologically based explanations for heavy drinking among Native Americans cannot account for observed drinking patterns. It proposes that women's integration into a workplace and assumption of the clear social role of employee could be a protective factor because it replaces heavy drinking as a means of social cohesion for Native Americans. However, as with other populations with continuing poverty and cultural destruction, we must be aware that while stable employment decreases drinking problems for the group, employment alone may not be sufficient as either a risk for, or protection against, problem drinking.

OCCUPATIONALCULTURE Anthropologists use the term "culture" to mean an organized set of understandings and behaviors shared among members of a group. Increasingly, social scientists are recognizing that members of occupations and workers at particular work sites share what has been termed an "occupational culture," which includes its own formal and informal structure, vocabulary, social rules, folklore, social organization, history and collective beliefs. These aspects of work culture are generated in response to working conditions, shape the way work is done, and affect the behavior of workers both on and off the job [76], [77], [78]. In addition, some researchers are turning their attention to the penumbra of work: the time that workers spend off the job but with their fellow workers. This time is especially important in alcohol-related behavior, when workers drink together during lunch, before or after work, or in non-work-related social situations [33], [16].

Women, alcohol and work Culture influences how and under what circumstances people drink, which particular drink or drinks they choose to consume and on which occasions, how to behave when drinking, what the consequences of either too much or too little drinking will be for their social standing or access to opportunities, definitions of heavy and light drinking, and moral concepts around drinking; in short, almost every aspect of availability of alcohol, motivation for drinking, and reaction to drunken behavior [77], [79]. These influences are as pertinent for occupational cultures as they are for cultural aspects of ethnicity, socioeconomic class and gender. Recent studies show a relationship between occupational culture and employee drinking patterns (see [77] and [78] for a review of this literature). For example, one study showed that for women, employment outside the home in certain job categories not only increases their access to alcohol but also tends to pull them into the alcohol use pattern of men in their occupation and work site [801. Researchers are just beginning to pay attention to the alcohol culture of the particular occupations and work sites of women [80], [81], [821. Occupational culture may be as great an influence on individual drinking patterns as ethnicity and family background, and should be considered as an important variable in considerations of cultural influences on work-related drinking. The cultures of some occupations are heavily influenced by gender. This is especially true for occupations in which the majority of workers have historically been of one gender. For example, the majority of nurses were men until the Civil War, when a professionalization movement inspired by Florence Nightingale redefined nursing as a woman's occupation [76], [1]. From the 1870s until the present, the vast majority of U.S. nurses have been women, with men constituting only some 3-5% of all nurses in any given year [831. The feminization of nursing was not happenstance: it was rather part of a deliberate strategy of activists looking not only to establish honorable outside-the-home occupations for women, but also to impose particular concepts of purity, cleanliness, domesticity and order on the U.S. hospital system: concepts that reflected 19th century cultural ideas about male and female roles. These assumptions about gender were incorporated into nursing's institutional structures; today they remain part of the very definition of the job of a nurse [i]. Similarly, the female domination of flight attending, librarianship, elementary school teaching and social work is the result of historical processes that have heavily marked the cultures of these occupations. The dominance of men in the occupations of physician, business manager, construction worker and longshoreman, for example, is equally important to the nature of the jobs and the patterns of alcohol consumption among workers employed in these occupations. In the mid- to late 20th century, the political leaders of some of the female-dominated occupations began to

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try to recruit men as a strategy for improving pay and status; at the same time, in response to changes in education, access and the politics of gender, more and more women entered formerly male-dominated occupations. Researchers are just beginning to look at the special problems faced by women in primarily maledominated occupations and how these problems affect drinking. Equally interesting are drinking patterns of both men and women in primarily women-dominated occupations. Although literature on environmental elements of women's drinking behaviors in specific occupations is scanty, we offer here reviews on women's drinking in two examples each of (1) primarily femaledominated occupations and, (2) male-dominated occupations.

Nurses As stated above, nursing is an overwhelmingly female profession. Nurse drinking, while not prevalent, is considered serious because of nurses' high responsibility in patient care [821, [83], [84]. Estimates of the numbers of substance-abusing nurses range from 2% [85], [86] to 16% of all nurses [87]. The American Nurses Association estimates that 6-8% of all nurses may have a drag or alcohol problem [88]. There is some evidence that alcohol is the drug of choice among nurses [89] and that nurses may drink more frequently but not more heavily per sitting than other employed women [90]. Critical care nurses are more likely to self-report alcohol and/or drug problems than any other specialty [91]. Although there are strict, if inconsistently enforced, official penalties for nurses identified as problem drinkers [83], [84], social drinking is not only accepted as normative among nurses, but there may be work-related social pressure to drink

[831. Most studies of nurses' drinking are based on surveys of alcohol impaired nurses. There are few surveys of drinking in the general population of nurses, or studies of the impact on clinical functioning of impairment, or the professional consequences of impairment on nurses [84]. Also, while researchers may speculate that the profession of nursing must be stressful enough to encourage drinking, no studies have examined work-related stress and nurse drinking in any detail.

Flight attendants The majority of flight attendants are women, although in recent years, men have been entering this occupational field in growing numbers. Flight attendants represent a particularly important primarily female occupation for this review because their work environment contains a number of health-related risk factors. Even the occasional traveler recognizes that flight :attendants have intensive work schedules, breathe recycled air and work in cramped conditions for 10ng hours in which boredom alternates with frenzied activity, suffer sleep disruption and changing time zones, have frequent periods of separation from family and friends, are often obligated to share rooms and meals

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with co-workers on layovers, and have had salary and benefit reductions and job insecurity. All of these elements of the work environment may exacerbate alcohol problem development. In addition, employees work in an environment with social control factors that other studies have related to risk for heavier drinking: high mobility and low visibility to supervisors [92], and weak or unenforceable alcohol policy [77]. Supervisors of flight attendants are based in corporate or regional offices and rarely observe attendants on board aircraft or during their layovers between flights. In this kind of management system, signs of alcohol use, including hangovers and deteriorating job performance, are not easily observed. An additional occupational risk factor for the development of heavier drinking is a flight attendant's involvement in wide work-related social networks. Many flight attendants change flight routes monthly, using a strictly monitored seniority bidding system. As a result, they work with a changing and wide network of flight crews (including cockpit personnel) throughout the year, but with small networks on each flight. Groups are age-regulated: for example, older flight attendants end up working together due to seniority rights for the most desirable schedules. These forced work networks may create a risk factor if they become work-related drinking networks, as has occurred in other occupations. For example, research with a population of factory workers described how and why work-related social networks develop into drinking networks and thereby put workers at risk for heavier and problem drinking [33]. Hochschild's [93] analysis of flight attendants' work describes role expectations that often require staged performances, especially for women. Because the flight attendant has most contact with the passenger, rules about feelings, personal appearance and "work-up" warmth are set by management and if ignored lead to dismissal. Attendants are forced to deal with disappointed expectations of passengers (e.g. weather, oversold flights, mechanical and other delays, etc.) and in effect become targets for frontal attacks on problems out of their control. In their zeal to compete for the richest segment of the market--the male business clie n t e l e - s o m e airlines (but not all) have sexualized this job role through advertisements to the extent that flight attendants often have to deal with subtle and overt sexual harassment on the job [93]. Little is known about the effects of these risk factors on drinking rates and problems or of rates of problem drinking, for that matter. One small indication of the prevalence of alcohol problems can be found in U.S. Department of Labor data that report 3.6% of the flight attendants currently utilize employee assistance programs (EAP) for substance abuse [94]. Further, union personnel of two of the largest U.S. airline companies reported a higher rate of EAP use for 1989 averaging 4% and 6.2% [95, 96]. Clearly, drinking rates, incidence of drinking problems and occupational risk factors related to drinking

among both nurses and flight attendants (as well as other occupational groups) are understudied and, we believe, in great need.

Physicians While research has shown comparatively high rates of alcohol abuse problems among physicians [97], the historically male-dominated practice of medicine may put women in particular at an especially high risk for alcohol problems. Although female physicians have not received much attention from alcohol researchers, longitudinal studies of occupational stress and drinking behavior among medical students are providing valuable insights into possible precursors of alcohol abuse among practising women physicians. For example, in their ongoing studies of medical school students, Richman and Rospenda [81] investigated whether women tend to take on male drinking patterns that lead to alcohol abuse in this male-dominated profession. Their findings linked alcohol abuse with three possible risk factors: (1) social-relational deficits as a consequence of professional socialization processes, (2) patient care-related stressors, and (3) lack of social support in the workplace. Alcohol abuse was assessed in a population of medical students at year 1 and 4 by use of the Michigan Alcoholism Screening Test (MAST), a 24-item self-report instrument. The expectation that women would conform to pressure to accept male norms over a period of time was confirmed in the study findings. Although firstyear women students showed lower scores in both social-relational deficits and alcohol abuse, by the end of clinical training (year four), these same women showed no differences from men in these areas [81]. During the first two years of medical school both male and female drinking problems decreased from premedical school levels, but this decline reversed by the third year after entry into clinical training [81]. Further, by the clinical training stage, abusive experiences during training that were significantly more likely to be reported by females were "unfair treatment due to gender, gender-related exclusion from informal settings, discomfort from sexual humor and unwanted sexual advances" [81]. Findings showed an interactional effect of gender-by-abuse in terms of problem drinking, and women experiencing at least one of these abuses were more likely to be problem drinkers. These findings strongly suggest that socializationbased problems, occupational role constraints, and sexual discrimination exist in medical training, and that alcohol is used to cope with them. This information is particularly useful for understanding the influence of occupational characteristics on drinking practices of women physicians in particular, and of women in male-dominated work sites in general.

Managerial and white collar Over the past two decades, greater numbers of women have entered a variety of previously male-

Women, alcohol and work dominated professional and managerial business positions. Studies suggest that women are socialized to the norms and social processes of such work environments to the degree that some feel pressure to drink in order to fit into the workplace culture [98]. Pressures around social conformity, coupled with work-related stressors, may create risks for problem drinking. As with other occupations, there are very little data on specific aspects of women's work-related drinking in business and professional settings (e.g. law, medicine, academia). One such study of women and men working in business managerial positions, however, provides some insights. Studies by Shore et aL found that 93.6% of female respondents reported drinking at least occasionally, and that these rates were strikingly similar to rates for male respondents (96.6%). However, the proportion of male heavy drinkers (19.1%) was nearly twice that of females (10.9%). The lower number of heavy drinkers in Shore's sample shows that women are not adopting male heavier drinking patterns entirely [98]. The high number of women who drink suggests that women may indeed be accepting professional and managerial drinking norms of males, and the prevalence of drinking is higher than in the total adult population (94% vs 59.4%) and in heavy drinking (11% vs 1.4%) [99]. Women in this study who had multiple roles (wife, mother, community involvement) had, surprisingly, lower consumption rates. These findings support findings of Wilsnack and Cheloha [17] that a number of roles do not correlate in drinking problems for women. Women respondents' levels of consumption were positively correlated with drinking levels of friends and spouses (e.g. women with heavier drinking spouses or friends tended to drink more than women with spouses or friends with lower drinking levels). Further, being in a work environment where drinking was expected or where drinking norms were permissive was correlated with negative consequences of drinking for women (e.g. drinking and driving) [98]. These findings support other workplace researchers' calls for more attention to both home and workplace environments when assessing occupational influences on drinking practices and problems [33]. Shore's study does not account for ethnic differences. CONCLUSIONS

This review raises a number of questions about drinking patterns of women who work, the relationships between work and women's drinking patterns, and the interaction of various cultural environments with drinking patterns. These questions could be addressed with more research emphasis on the following issues. First, survey data on the prevalence of drinking-related problems among employed women are fragmented, inconsistent and difficult to compare or summarize. Much more work is needed to understand the epidemiology of working women's drinking proSSM 43'1[

F

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blems in reaction to interacting variables of gender, socioeconomic status, ethnicity, occupational culture and personal consumption rates. Additionally, the field would benefit from greater standardization of these variables and of job classification. Second, too frequently, gender differences in occupational influences on drinking practices and problem drinking are not clearly specified. The above research on women in male-dominated occupations points to gender similarities and differences in consumption rates. The study of future physicians highlights interrelationships among psychosocial factors, demands of work, and drinking and how these differ by gender. Similarly, studies of female-dominated human service occupations such as nursing and flight attendants would benefit from more comparative input on the drinking patterns of the male minority. Third, women entering formerly all-male work environments appear to be influenced by workplace drinking norms. However, the drinking norm risk needs to be more clearly delineated, and more attention needs to be paid to influences of cultural factors outside the workplace, in particular influences of socioeconomic and family norms. For example, as we have seen in the review of ethnic groups, spousal effects of drinking differ by socioeconomic level and ethnicity. Where women in the sample from higher socioeconomic environments had drinking levels similar to their spouses [98], in another study of a population of Euro-American factory workers and their spouses, women with heavy drinking husbands drank much less than their spouse or abstained from alcohol [34]. The low or no alcohol consumption pattern was explained in terms of traditional beliefs that heavy drinking among husbands is an expected, if regrettable, cultural norm, just as women are expected to carry major parental role responsibilities if the husband is a heavy drinker. In yet another study of a U.S. Mexican mostly blue-collar population, within husband and wife pairs the differences in drinking levels and problems were consistent with males reporting higher levels of drinking and problems, but husbands who drank heavily tended to have wives who also drank [49]. Clearly, when we attempt to identify and explicate the infl'uence of work factors on women's drinking patterns, equal attention must be paid to other social environments as well. In addition, factors such as workplace stress and socialization to workplace drinking practices need to be explored in comparison with family influences. Are high female drinking rates a result of psychosocial pressures at work, social pressure outside o f work, or a combination of these? More research is needed. Next and most importantly, the data on relationships among women, work, ethnicity and drinking behavior are understudied. As the above-mentioned example :of blue-collar Euro-American and blue-collar U.S. Mexican studies showed, more research is needed on the intertwined categories of ethnicity, work and drinking. As we learned in the above reviews of drinking

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Genevieve M. Ames and L. A. Rebhun

~ /

/

~

GENDERED ~

~P'ER SON

~

AND FAMILY

\

DRINKING

~_~)IVI DUAL.~

"~ /

ETHNIC

Fig. 1. Interactions of influences on women's drinking.

patterns of women in specific ethnic populations, traditional beliefs about the context of drinking and consequences of alcohol abuse do indeed affect women's work-related drinking patterns. However, as was so evident in the reports on African-American and U.S. Mexican women's drinking, no culture is static, and drinking norms and social patterns change in accordance with geographical region, migration patterns, acculturation level and socialization to expectations of white-dominated social organizations. In all of the ethnic groups discussed here, consumption rates are lower for women than for men. However, it appears that women's drinking in specific ethnic groups increases slightly with level of acculturation and entry into more culturally diversified workplaces. Exceptions to the acculturation theory are Asian-Americans and Native Americans, and those exceptions are due to lack of research on these populations. For example, we do not know if the higher rate of heavier drinkers among Japanese-American women (11.7%) is reflective of higher consumption styles of modem Japan brought over by recent immigrants, a result of acculturation in the workplace and other social environments, or other stress factors inherent to Japanese-American culture. Similarly, the extremely low consumption rates of Chinese- and Korean-American women appear to follow cultural norms, but as was found among the more acculturated U.S. Mexican women, drinking rates of these groups may increase as women become more integrated into culturally diversified work environments. It is hoped that another group left out of the studies we reviewed, the immigrant Vietnamese population, will receive more research attention in the near future. Heavier drinking patterns of Native American women varied in several studies among the employed and unemployed, suggesting that ethnicity, and/or socioeconomic situ-

ation, as well as biological factors, may come into play over and above, or as well as, the workplace. It should be noted, however, that because of the history of widespread intermarriage, many people classed as "Native American" by the U.S. census and by researchers have significant European and/or African ancestry, so that the nature and provenience of biological factors are difficult to determine. In addition--and regardless of ethnic background-alcohol attitudes and behaviors of employed and unemployed women may be adversely affected by lower socioeconomic status, both because drinkers react to the despair and anomie of poverty and discrimination, and because lower status groups may be targeted for both advertising campaigns and oppressive legislation [100]. Finally, there is a need for more studies utilizing the ethnographic approach for understanding the trends that come into focus through large-scale surveys, and equally important, for explaining the cultural framework within which those trends are played out. While epidemiology and other survey-oriented studies provide information on the causal links between interacting variables and alcohol problems, these approaches alone cannot reveal the underlying processes at work in the drinking behavior of working women. In sum, the actual observed drinking behavior of individual women results from the intertwined effects of personal and family drinking patterns, ethnic drinking patterns and their attendant gendered drinking norms, and the norms of the occupational subculture, which are also gendered (see Fig. 1). All of these factors are themselves multifaceted and interact in complex ways. Bivariate models cannot capture the intricate synergism of influences that produce drinking behavior [11]. Researchers need to find more multifaceted, holistic models, recognizing the

Women, alcohol and work diversity of influences on drinking behavior. In some cases, research on work and women's drinking has been characterized by stereotypical thinking, social conservatism or well-meaning activism masquerading as science, and profound ignorance of the realities of women's lives. Ethnographic research, given its open, holistic nature, can help to dispel some of this ignorance. Only with more, better, and more ethnographically grounded research will we be able to identify pattems of and motivations for work-related drinking and thereby assist employers in setting up effective, responsive intervention and treatment programs for impaired employees. Acknowledgements---Research and preparation of this article were supported by the National Institute on Alcohol Abuse and Alcoholism Grant R01 AA08989-01 to the Prevention Research Center, Pacific Institute for Research and Evaluation.

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