Elisabet E. Storvoll

Under double influence: Assessment of simultaneous alcohol and cannabis use in general youth populations

BACKGROUND/AIMS We assessed to what extent adolescents use alcohol and cannabis simultaneously and expanded previous research by estimating the proportion of all events of cannabis use that had occurred in relation to drinking. How the prevalence of this form of polysubstance use co-varied with the overall level of alcohol and cannabis use in different countries was also examined. METHOD We analysed individual level data from a survey of 14-20 year-olds in Norway (n=16 813) and population level data from the 2003 ESPAD study on substance use among 15-16 year-olds in 35 European countries. RESULTS The prevalence of simultaneous intake of alcohol and cannabis in the past year among Norwegian youth was 7%. The overall prevalence of cannabis use was only slightly higher (8%), implying that a majority (82%) of the cannabis users had taken the drug in combination with alcohol. Moreover, in about 80% of all incidents of cannabis use, alcohol had been consumed as well. Correspondingly, a majority of the cannabis users in most of the countries in the ESPAD study had used the drug in combination with alcohol. Such simultaneous polysubstance use was more prevalent in countries where cannabis use was relatively widespread and alcohol rather frequently consumed. CONCLUSION Because adolescents most often combine cannabis with alcohol, their use of the drug may be more harmful than assumed. The results also indicate that cannabis is a complement rather than a substitute for alcohol, suggesting that policies that reduce adolescent drinking may reduce the use of cannabis as well.

Gender Differences in Changes in and Stability of Conduct Problems from Early Adolescence to Early Adulthood.

The present paper examines whether there are gender differences in changes in the aggregate level and individual stability of conduct problems from early adolescence to early adulthood. We analysed self-reported data collected as part of a longitudinal general population study of Norwegian adolescents (n = 1,234). The analyses showed that involvement in conduct problems for both genders peaked in mid-adolescence. The extent to which this peak reflected changes in the number of participants or differences in the frequency of problems among the participants varied according to gender. In most cases, the individual stability of involvement in conduct problems was similar for girls and boys. However, in the long term, relative involvement was more stable for boys than for girls. Moreover, the proportion of boys who showed a high level of involvement both during adolescence and early adulthood was greater than for girls.

Wetter and Better

Background/Aims: The consumption of alcohol and the frequency of intoxication among Norwegian youth increased significantly from 1992 to 2002, and we thus asked what, if anything, can be expected to happen to rates of other problem behaviors when heavy drinking becomes more widespread? Do such aggregate level changes in alcohol use imply that individual level associations between drunkenness and behavioral deviance change as well? Method: School-based surveys of 16- to 19-year-old Norwegians that were carried out in 1992 (n = 4,744, response rate 97%) and 2002 (n = 5,458, response rate 92%). Results: Contrary to rates of drunkenness, the level of theft/pilfering declined from 1992 to 2002, while rates of aggressive behavior and school misconduct remained unchanged. We assumed that heavy-drinking adolescents were relatively less deviant with regard to non-violent problem behaviors when the youth culture was relatively ‘wet’ (2002) as compared to the period when it was much ‘drier’ (1992) and revealed that this was the case. However, the link between drunkenness and aggressive behavior was equally strong at both assessments. Conclusion: Differential temporal trends in the associations between drunkenness and various problem behaviors may reflect variations with respect to the etiological significance of alcohol use on such behaviors.

Long-term trends in alcohol policy attitudes in Norway

INTRODUCTION AND AIMS The aim of this study was to describe trends in attitudes to alcohol control policies in Norway over a period of 50 years and to discuss how these trends relate to developments in alcohol policy. DESIGN AND METHODS Survey data from 17 national population surveys, national statistics and previous publications were applied to describe trends in attitudes to alcohol control polices (access to alcohol and price) and changes in these policies over the period 1962 to 2012. RESULTS From 1962 to 1999, an increasing proportion of the population reported that regulations on availability of alcohol were too strict and that alcohol prices were too high, whereas in the 2000s this trend was reversed and support for existing control policies increased. Although the pillars of Norwegian alcohol policy--high prices, restricted access and a state monopoly on retail sales-remained, control policies were gradually relaxed throughout the entire period. DISCUSSION AND CONCLUSIONS Relaxation of strict alcohol control policies in Norway in the first four decades were probably, in part, the result of increasingly liberal public opinion. The subsequent reversed trend in opinions with increasing support for control policies may be due to several factors, for example, consumer-oriented changes in the monopoly system, increased availability and affordability, increased awareness of alcohol-related harm and the effectiveness of control policies. Thus, the dynamics of policies and attitudes may well change over time.

Alcohol-related sickness absence among young employees: Gender differences and the prevention paradox

BACKGROUND Few studies have examined alcohol-related sickness absence among young employees, although young adults are known to drink quite heavily. There are substantial differences in drinking patterns between men and women, yet gender differences have rarely been the main focus in research on alcohol-related sickness absence. Thus the present paper aims to examine gender differences in the prevalence of alcohol-related sickness absence among young employees in Norway, and in the associations between drinking patterns and such absence. Further, to examine whether the prevention paradox applies to alcohol-related sickness absence among both genders. METHODS A sample of employed young adults, 49.7% male (N = 1762, mean age = 28.3; SD = 1.9), was obtained from a general population survey of Norwegians. Self-reported measures on alcohol-related sickness absence and various drinking measures were applied. RESULTS Men reported absence from work due to drinking almost twice as often as women. There was a statistically significant gender difference in the drinking-absence association only for one of the three alcohol measures, indicating a stronger relationship among women. The heaviest drinkers (about 6% of the sample) reported a disproportionally large share of alcohol-related sickness absence (19%), yet the vast majority of such absence was found among the moderate drinkers (81%). CONCLUSIONS Alcohol-related sickness absence is more common among men than women. This gender difference may reflect differences in drinking habits rather than the likelihood of being absent after drinking. The results indicate that the prevention paradox applies to alcohol-related sickness absence among young employees of both genders.

Effect and Process Evaluation of a Norwegian Community Prevention Project Targeting Alcohol Use and Related Harm

Based on a combination of effect and process evaluation, we aimed to (a) assess whether a community prevention project succeeded in curbing alcohol use and related harm among adolescents and (b) explain the results of the effect evaluation. School surveys among adolescents (n = 20,000) and purchase trials (n = 162) were carried out in intervention and control communities before and after the intervention. Qualitative data from key actors and documents were collected throughout the 3-year project period. The effect evaluation revealed no impact of the intervention on the availability of alcohol, drinking, and alcohol-related harm. The process evaluation showed how and why the prevention project was delayed, that the preventive programs implemented were not likely to be effective, and why these programs were chosen. The latter was essential to explain the finding of the effect evaluation and illustrates the utility and necessity of mixed-method approaches when evaluating a complex intervention.

Changes in attitudes towards restrictive alcohol policy measures: the mediating role of changes in beliefs.

Aim: From 2005 to 2009, increased support for restrictive alcohol policy measures was observed in the Norwegian population. This article addresses whether this increase was mediated by changes in belief about the effectiveness of restrictive measures and belief about the harm caused by drinking. Method: The data were derived from five surveys conducted during the period 2005–2009 (N = 7244). In each survey, we used identical measures of attitudes towards regulation of price and availability, belief in the effectiveness of such measures and belief in the association between overall consumption and harm. Results: During the period, there was an increase in support for restrictive policy measures; in belief in the effectiveness of these measures and in belief in the harm caused by drinking. Increased support for restrictive measures was partly mediated by changes in beliefs in terms of statistically significant indirect effects from both belief in the effectiveness of such measures and belief in the harm caused by drinking. Half of the increased support for restrictive measures could be attributed to changes in beliefs. Conclusion: Strengthening people’s belief in the effectiveness of restrictive measures and in the harm caused by drinking may increase public support for restrictive alcohol policy measures.

Gender differences in the association between conduct problems and other problems among adolescents

The present paper examines whether there are gender differences in the associations between various dimensions of conduct problems and other problems in adolescence. Other problems studied are both of an externalizing nature (substance use) and an internalizing nature (suicidal behavior and emotional problems). Data stemmed from a large general population sample of Norwegian adolescents (N=9 342). On the basis of earlier studies, conduct problems were decomposed into three dimensions, labeled ‘Theft and vandalism’, ‘School opposition’ and ‘Covert behavior’. The first dimension includes different kinds of stealing and violence against objects, whereas the second includes school-related conduct problems of an overt aggressive kind. The last dimension reflects avoidance of arenas under adult control. Whether or not gender differences were detected, depended on the kind of conduct problems considered. We observed stronger associations between two dimensions of conduct problems, theft and vandalism and school opposition, and other problems among girls than among boys. There were no male/female differences in the associations between covert behavior and other problems.

Structure of conduct problems in adolescence

Scholars disagree about whether adolescent conduct problems (CPs) form a single behavioral syndrome or whether such problems are better conceptualized as different dimensions. The arguments raised by both sides are addressed and tested empirically by analysing data from a large general population sample of Norwegian adolescents (n = 9,342). Confirmatory factor analyses show that a single syndrome of CPs may be subdivided into three highly correlated factors. The first dimension, destructive covert, includes theft and vandalism, whereas the second, nondestructive covert, reflects avoidance of arenas under adult control. The last dimension, overt, includes school opposition and fighting. This three-factor model fits well for both girls and boys, and individuals in their early and late teens. Results from scale analyses are modestly to moderately indicative of a developmental continuum of severity of CPs ranging from nondestructive covert to overt to destructive covert. Taken together the findings imply that both a unidimensional and a multidimensional perspective on CPs are applicable in the general youth population.

Experienced Harm from Other People's Drinking: A Comparison of Northern European Countries.

Objective This study addresses how experienced harm from other peoples drinking varies between six Northern European countries by comparing 1) the prevalence of experienced harm and 2) the correlates of harm. Method The data comprise 18ȓ69-year olds who participated in general population surveys in Denmark, Finland, Iceland, Norway, Sweden, and Scotland during the period 2008–2013. Comparative data were available on five types of harm: physical abuse, damage of clothes/belongings, verbal abuse, being afraid, and being kept awake at night. Results This study shows that harms from others drinking are commonly experienced in all six countries. Being kept awake at night is the most common harm, while being physically harmed is the least common. The proportions that reported at least one of the five problems were highest in Finland and Iceland and lowest in Norway, but also relatively low in Sweden. Across countries, the level of harm was highest among young, single, urban residents, and for some countries among women and those who frequently drank to intoxication themselves. Conclusions The study revealed large differences in the prevalence of harm in countries with fairly similar drinking cultures. However, the correlates of such experiences were similar across countries. Possible explanations of the findings are discussed, including differences in study design.