Björn Hibell

Episodic heavy drinking in four Nordic countries: a comparative survey.

AIMS The purpose of this study was to compare the phenomenon of episodic heavy drinking (binge drinking) and its different indicators in the Nordic countries. DESIGN A comparative survey of four Nordic countries. SETTING Telephone interviews in Denmark, 1997; Finland, 1996; Norway, 1996; and Sweden 1996-97. PARTICIPANTS Random samples of men and women aged 19-71 years. MEASUREMENTS Episodic heavy drinking was measured by the frequency of subjective intoxication, of drinking six or more drinks at a time (6+), and of negative consequences (mainly hangover symptoms). Additionally, annual consumption and measures of intake per occasion were used. FINDINGS Annual consumption, overall frequency of drinking and frequency of drinking 6+ were highest in Denmark and lowest in Norway. Frequency of subjectively defined intoxication was highest in Finland. There it was clearly higher than the frequency of drinking 6+, whereas in Denmark the contrary was observed. Finnish and Norwegian men and Danish women reported the largest quantities drunk per occasion. Results on 6+ frequency and the prevalence of negative consequences, with annual consumption held constant, suggest that Danes have the least concentrated drinking pattern. With annual consumption held constant, Norwegians report as high a frequency of intoxication, as do Finns. CONCLUSIONS The relations between subjective and more objective measures of episodic heavy drinking vary considerably between the Nordic countries. The results suggest that the definition, acceptability and experience of intoxication vary even when a set of relatively homogeneous countries are compared.

Alcohol use, heavy episodic drinking and subsequent problems among adolescents in 23 European countries: does the prevention paradox apply?

AIMS According to the prevention paradox, a majority of alcohol-related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems among adolescents in 23 European countries. DESIGN AND SETTING Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16-year-old students were analysed. PARTICIPANTS A total of 38,370 alcohol-consuming adolescents (19,936 boys and 18,434 girls) from 23 European countries were included. MEASUREMENTS The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol-related problems. FINDINGS Although the mean levels of consumption and alcohol-related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol-related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems. CONCLUSIONS The prevention paradox, based on measures of annual consumption and heavy episodic drinking, seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large proportion of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives combined with targeted interventions.

The ESPAD Study: implications for prevention

The European Schools Project on Alcohol and other Drugs (ESPAD) was concerned with the substance use, beliefs, attitudes and risk factors among over 50,000 16-year-olds in 26 European countries. Based on this data, the present paper focuses on critical issues in prevention and uses a country-level analysis with focus on the extent that contextual and cultural factors interact with factors influencing the use of alcohol and other drugs. The results indicate that: (i) an emphasis on risks and dangers may be a poor prevention strategy since many young people do not believe the widely accepted dangers of certain forms of substance use (e.g. cigarette smoking); (ii) misperception of norms in relation to substance use, that is, the belief that use of alcohol and other drugs is more common than it actually is, emerged in most countries with the exception of Nordic countries; (iii) the correlation between perceived access to substances and actual use depended on the substance involved; correlations were strongest...

Long-term trends in drinking habits among Swedish teenagers: National School Surveys 1971-1999.

The purpose of the study is to describe the long-term trends in drinking habits among Swedish students aged 15-16 years. Data were collected from 1971 to 1999, using self-administered questionnaires from nationally representative random cluster samples of school classes, totalling on average 6000 students per year. The highest proportion of alcohol consumers among both boys and girls, about 90%, was seen in the 1970s; this percentage decreased to about 80% in the 1980s and remained at that level through the 1990s. The estimated average annual consumption of pure alcohol was 4 litres for boys in 1977. It fell to 2.1 litres in 1988 and rose to 3.9 litres in 1999. The tendency was similar for girls, with 3.5 litres consumed in 1977, about 1.5 litres in the 1980s and 2.3 litres in 1999. Also frequent binge drinking and intoxication were reported by the largest proportions in the 1970s; the figures decreased in the 1980s and rose again among both boys and girls in the first part of the 1990s. Hence, although fewer of the students in this age group are alcohol consumers at the end of the 1990s compared with the 1970s, those who drink are approaching the high consumption levels of the 1970s. The beverages of choice are beer and spirits.

Cannabis use and drug related problems among adolescents in 27 European countries : The utility of the prevention paradox

Aims To study the prevalence of cannabis use and drug-related problems among European adolescents and the utility of the prevention paradox. Methods Survey data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) in 2007 in the 27 countries with information about drug use and drug-related problems was used. We analysed the proportion of all drug-related problems that occurred in a high risk group and among others who had used cannabis in the previous 12 months. The cut-off for the high risk group was chosen to include 10-15 % of the most frequent cannabis users. Results The high risk groups accounted for a substantial, but a minority, of drug-related problems among boys as well as girls. A minority of those who had used cannabis reported any drug-related problem. The proportion of adolescents with drug-related problems and the average number of problems increased with frequency of cannabis use. Conclusions We find support for policy measures of more general character, supported by the prevention paradox. However, this does not exclude a policy supporting frequent drug users if they can be identified

Whence and whither : strengths and future challenges of ESPAD

THE EUROPEAN SCHOOL SURVEY PROJECT on Alcohol and Other Drugs (ESPAD) collects comparable data on substance use among 15–16-year-old students since 1995. The purpose of the study is to monitor substance use behavior in adolescents in as many European countries as possible; i.e. including many states that are not members of the European Union (Hibell et al., 2012). With next year’s data collection the observation period in those countries that have participated in ESPAD since the project’s start will encompass 20 years, and analyses of temporal changes can then be based on six measurement points. Although the comparison of cross-sectional data on substance use across similar populations in countries of various social, economic and cultural origins is important, the possibility of investigating temporal changes over a 20 year period across the majority of European countries is quite unique. The distinctive possibilities for withinand between-country comparisons within ESPAD are the common methodology that has been applied since the beginning. The common approach to data collection goes far beyond just the use of the same questionnaire; it encompasses strict rules on sample selection, mode of administration and data cleaning. The strictness in study design and data collection procedures has undoubtedly contributed to the inestimable value of the survey. Single countries, particularly of the “old Europe” such as the United Kingdom, Germany and Sweden, have a long tradition in substance survey research in the adult population that reaches back to the 1970s and 1980s (Ahacic, Kennison, & Kåreholt, 2012; Meng, Holmes, Hill-McManus, Brennan & Meier, 2014; Piontek, Kraus, Müller, & Pabst, 2010) and time trends can only be observed within these countries. However, cross-country comparisons are difficult due to the lack of standardized procedures. Moreover, most of these surveys have not been designed for cross-sectional repetition and have undergone major changes in study design or data collection methodology, limiting comparability of substance use behavior over time. Due to its common methodology, analyses based on ESPAD data have substantially contributed to the field; for instance, regarding validity issues (Gmel, Kuntsche, Wicki & Labhart, 2010; Molinaro, Siciliano, Curzio, Denoth & Mariani, 2012; Steppan, Kraus, Piontek & Siciliano, 2013), policy evaluation (Müller, Piontek, Pabst, Baumeister & Kraus, 2010), risk factors (Kraus, Metzner & Piontek, 2010), attitudes (Beck, Legleye, Chomynova & Miller, 2014) or trends (Molinaro, Siciliano, Curzio, Denoth, Salvadori & Mariani, 2011), to name only a few. Editorial