Cohabitation, gender, and alcohol consumption in 19 countries: a multilevel analysis.

We used an ecological paradigm and multilevel analytic techniques to analyze gender-specific relationships of cohabitation (versus marriage) to drinking in 19 countries (n = 32,922) and to "heavy episodic drinking" (HED) in 17 countries (n = 24,525) in surveys (1996-2004) from Gender, Alcohol, and Culture: An International Study. Cohabitation was associated with elevated risk of HED among drinkers of both genders, controlling for age, education, and societal characteristics. The association between cohabitation and HED tended to be stronger for female drinkers than for male drinkers. HED was more prevalent among younger drinkers, especially among younger women in countries with higher per capita gross domestic product. Cross-culturally, cohabiters deserve special attention in prevention efforts for hazardous drinking, considering both individual-level and societal factors.