Alexander Pabst

Changes in alcohol consumption and beverage preference among adolescents after the introduction of the alcopops tax in Germany

AIMS The aim of this study is to assess the contribution of the alcopops tax to changes in alcohol consumption and beverage preference among adolescents in Germany. We hypothesize that the decrease of alcohol intake by alcopops is substituted by an increase of alcohol intake by other alcoholic beverages. DESIGN Data came from the German 2003 (n = 10 551) and 2007 (n = 10 598) cross-sectional study of the European School Survey Project on Alcohol and other Drugs (ESPAD). PARTICIPANTS A propensity score-matched subsample of 9(th) and 10(th) graders (n = 4694) was used for the analyses. MEASUREMENT Alcohol consumption within the last 7 days was assessed by a beverage-specific quantity-frequency index. An individuals beverage preference was assigned for the beverage that had the highest share in total alcohol consumption. Multiple regression analyses were used to assess changes in alcohol consumption; changes in beverage preference were tested using multinomial logistic regression. FINDINGS While alcopop consumption declined after the alcopops tax was implemented, consumption of spirits increased. Changes in beverage preference revealed a decrease in alcopop preference and an increase in the preference for beer and spirits. CONCLUSIONS Results indicate a partial substitution of alcopops by spirits and a switch in preference to beverages associated with riskier drinking patterns. Effective alcohol policies to prevent alcohol-related problems should focus upon the reduction of total alcohol consumption instead of regulating singular beverages.

Direct and indirect effects of alcohol expectancies on alcohol-related problems.

This study investigates pathways from alcohol outcome expectancies to alcohol-related problems (ARPs), considering alcohol volume and episodic heavy drinking (EHD) as potential mediators. It is further examined whether these pathways vary by age. The population-based sample comprised 6,823 individuals aged 18 to 64 years reporting alcohol use in the past year. Direct and indirect effects of five alcohol expectancies (social assertiveness, tension reduction, sexual enhancement, cognitive impairment, aggression) and alcohol use (average daily intake, EHD) on a latent measure of ARPs (six items of the Alcohol Use Disorders Identification Test) were investigated. A multiple-group structural equation model with three age groups (18 to 24, 25 to 44, 45 to 64 years) was examined. In individuals aged 18 to 24 years, social assertiveness expectancies were positively associated with average intake and EHD, which in turn were associated with more ARPs. In addition, expectancies related to cognitive impairment and aggression were directly linked to more ARPs without mediation in this age group. In individuals aged 25 years and older, tension reduction expectancies were associated with more ARPs through increased average intake. In contrast, high scores on cognitive impairment were associated with lower average intake and in turn with fewer ARPs. Challenging expectancies of sociability in young and expectancies of relaxation in mid adulthood might help decrease high-risk drinking and subsequently ARPs. Considering negative alcohol expectancies may help to identify younger individuals at high risk for ARPs, even if they have not previously exhibited repeated excessive drinking. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Cannabis und andere illegale Drogen: Prävalenz, Konsummuster und Trends. Ergebnisse des Epidemiologischen Suchtsurveys 2006

Aims: The cross-sectional Epidemiological Survey on Substance Abuse (ESA) which has been conducted in the German adult population since 1980, was continued in 2006, providing current data on the prevalence of, patterns of, and trends in illegal drug use. Method: A representative sample of 7,912 18- to 64-year-old adults was drawn from the general population. The survey used selfadministered questionnaires and telephone interviews (mixed-mode design; 45% response rate). Results: After a continuous increase since the mid-1980s, the prevalence of illegal drug use among young adults decreased between 2003 and 2006. Whereas among 18- to 39year-olds, the 12-month prevalence rates of other illegal drugs has not changed across time, the proportion of cannabis users decreased significantly from 2003 (11.8%) to 2006 (9.2 %). However, the proportion of cannabis-use disorders increased somewhat occurring among 1,1 % the adult population (abuse 0.7 %; dependence 0.4 %). Conclusions: The observed trends indicate that the prevalence of illicit drug use has stabilized. The relatively constant prevalence rates of regular cannabis use (last 30-day prevalence) over time indicate that the recent variations in cannabisuse prevalence were due to changes in experimental use.

Age, Period and Cohort Effects on Time Trends in Alcohol Consumption in the Swedish Adult Population 1979-2011

AIMS In Sweden, alcohol abstention has increased over the last 20 years and consumption has recently decreased after a peak in 2004. To understand the dynamics of these trends the present study aims at estimating age, period and cohort (APC) effects on trends in alcohol use prevalence as well as overall and beverage-specific volume of drinking over the last three decades. METHODS APC analysis of seven cross-sectional surveys from 1979 to 2011 was conducted using cross-classified random effects models (CCREMs) by gender. The nationally representative samples comprised 77,598 respondents aged 16-80 years. Outcome measures were 30-day prevalence of alcohol use and overall as well as beverage-specific alcohol volume. RESULTS Trends in prevalence, overall and beverage-specific volume were significantly affected by APC. The period effects of prevalence and overall volume show a small decline after an increase up to the year 2005. Mean beer and wine volume levelled off after a peak in 2005 and volume of spirits drinking decreased constantly. Predicted alcohol prevalence rates in male cohorts (1945-1985) remained generally at the same level, while they declined in post-World War II female generations. Results point to high overall and beverage-specific consumption among cohorts born in the 1940s, 1950s and 1980s. CONCLUSIONS High consuming cohorts of the 1940-1950s were key in rising consumption up to 2005. Progression through the life course of these cohorts, a decrease in prevalence and drinking volume in successive cohorts seem to have contributed to the recent downward trend in alcohol use in Sweden.

An age–period–cohort analysis of cannabis use prevalence and frequency in Germany, 1990–2009

Background In order to better understand trends in cannabis use, this study estimates independent and non-confounded age, period and cohort effects on 12-month cannabis use prevalence and frequency. Methods Data from seven waves of the German Epidemiological Survey of Substance Abuse (ESA) conducted between 1990 and 2009 were used. The total sample included 29 836 men and 34 877 women aged 18–65 years. Cross-classified random effects models were conducted to estimate fixed effects of age and random effects of periods and birth cohorts. Analyses were stratified by gender. Results With regard to 12-month prevalence, substantial age variations were identified with a peak of cannabis use in young adulthood. The overall effects of periods and birth cohorts were not significant. With regard to frequency of use, there were no significant influences of either variable. The results were largely identical for men and women. Conclusions This study identified little variation in trend data of current cannabis use. When confounding influences of period and ageing are controlled, the widely reported increases in cannabis consumption in recent birth cohorts cannot be demonstrated.

The Relationship between Alcohol Consumption and Perceived Drunkenness: a Multilevel Cross-National Comparison in Samples of Adolescents

AIMS Alcohol consumption seems to be the best predictor of drunkenness and evidence suggests that individual and country factors influence the perception of drunkenness. This study examines if the relationship between volume of alcohol consumption and perceived drunkenness varies across European countries in samples of adolescents. METHODS Data came from the 2007 European School Survey Project on Alcohol and other Drugs (ESPAD). The analytical sample consisted of n = 60,114 (93%) 15-16-year-old students in 24 countries reporting alcohol consumption on the last drinking occasion. At the individual level, perceived drunkenness on the last drinking occasion was measured with a 10-point scale, alcohol consumption on the last drinking occasion with a beverage-specific quantity index. Six individual characteristics were assessed and used as control variables. At the country level, a total of five country-level variables were included in the study. Data were analysed using multilevel regression models simultaneously considering both individual level (Level 1) and group (country) level (Level 2) variables. RESULTS The relationship between alcohol consumption and perceived drunkenness varied across countries. This variation could partly be explained by drinking patterns and geographical region. CONCLUSION The perception of the effects of alcohol in terms of drunkenness seems to vary across countries. Future studies should develop sound indicators of cultural differences accounting for this variation.

Properties of the Cannabis Abuse Screening Test (CAST) in the general population

This paper explores the DSM‐IV latent structure of cannabis users (especially its invariance towards gender and age) and assesses the psychometric properties of the Cannabis Abuse Screening Test (CAST) by confrontation with the theoretical diagnoses [dependence and cannabis use disorders (CUD)] and the latent class structure of the DSM‐IV. The random sample comprised 550 French cannabis smokers aged 15–62 years interviewed by telephone. DSM‐IV diagnoses were assessed with the Munich Composite International Diagnostic Interview. Internal structures of both instruments were assessed using factor analysis and latent class analysis. Optimal CAST cutoffs were determined by sensitivity, specificity and area under the receiver operating curve (AUC). CAST and DSM‐IV were unidimensional (Cronbachs α = 0.742 and 0.752, respectively), although a two‐factor solution showed a better fit for the CAST. CAST cutoffs for screening CUD and dependence were three (AUC = 0.851) and five (AUC = 0.868), respectively. DSM‐IV latent class structure varied only marginally in age and gender. Three classes of cannabis smokers were determined, ordered along a continuum of symptoms: non‐symptomatic (61.1%), moderate (32.9%) and severe (6.0%). CAST cutoff scores for screening moderate/severe and severe were, respectively, three (AUC = 0.869) and eight (AUC = 0.952). Results are compared to those obtained in previous CAST studies and discussed in line with the DSM‐5. Copyright

Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany

Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18-64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

Patterns of concurrent alcohol, tobacco, and cannabis use in Germany : prevalence and correlates

Aims: This study investigated past month patterns and risk factors of alcohol, tobacco and cannabis use by level of intensity in the German general population. Methods: Data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used. The cross-sectional random sample consisted of N = 7912 adults aged 18–64 years. The response rate was 45%. Intensive use of each substance was measured applying substance-specific cut-off points: alcohol: >20/30 g pure ethanol daily for women/men; tobacco: ≥20 cigarettes daily; cannabis: on ≥6 occasions monthly. Findings: The majority of substance users reported no intensive use of any of the three substances (77.5%) and 19.4% had used one of the three substances intensively. A total of 3.1% engaged in intensive use of multiple substances with alcohol and tobacco (2.3%) as the most prevalent pattern. A higher risk for intensive use of multiple substances was found among males, older individuals and those with a substance use disorder. Conclusions: Results of this study call for an integrated view on substance use and related disorders in prevention and treatment, taking diverse use patterns and specific needs of substance abusers into account.

[Acute alcohol intoxication in adolescents: preliminary results of a pilot project in Munich]

OBJECTIVE To present preliminary results of a pilot project on the prevention of alcohol-associated problems in adolescents with acute alcohol intoxication. METHOD Questionnaires were filled in by 110 of 128 adolescents (85.9% response rate) who had been admitted to a hospital in Munich, Germany, between December 2007 and July 2008, because of alcohol intoxication. Data were obtained on sociodemographic characteristics, alcohol intoxication and drinking patterns, and were analysed using descriptive methods. RESULTS Half of these adolescents mainly suffered from moderate to severe degrees of alcohol intoxication. Drinking patterns leading to alcohol intoxication were characterized by relatively low drinking frequency interspersed by episodes of excessive alcohol intake (binge drinking). Thirteen (14.8%) of the adolescents reported previous hospital admissions for alcohol intoxication, nine (17.3%) did not know about the life-threatening danger of alcohol intoxication and twelve (22.2%) reported taking illegal drugs within the last 12 months. CONCLUSION Adolescents who had been admitted to hospital because of alcohol intoxication had a drinking pattern which put them at a higher risk for alcohol intoxication and acute alcohol-related problems than adolescents in the general population. Re-admission to hospital within 12 months because of alcohol intoxication, revealing a lack of knowledge about the life-threatening danger of alcohol intoxications and of consuming illegal drugs, may indicate an increased risk for alcohol-related problems. This points to the need for preventive action in adolescents showing these indicators, a need that was met within this pilot project by brief intervention.