Håkan Leifman

Drinking less but greater harm: could polarized drinking habits explain the divergence between alcohol consumption and harms among youth?

AIMS This paper describes changes in alcohol consumption among Swedish youth over the past decade with the aim of exploring the polarization hypothesis, which asserts that while a majority of young drinkers have reduced their alcohol consumption, a subgroup have increased their drinking substantially, resulting in greater harm. METHODS We analysed repeated cross-sectional self-report data from 45,841 15-16-year olds and 40,889 18-19-year-old high-school students living in the Stockholm municipality between 2000 and 2010. The questionnaire assessed alcohol and drug use, and risk factors for alcohol misuse. Changes over time at different levels of consumption are presented by age and gender. RESULTS We find evidence of a polarization effect in youth drinking, with consumption reducing significantly over the past 10 years among all young people, except the heaviest drinkers, where consumption and binge drinking tended to increase. The dispersion in per capita consumption also increased over time, indicating more heavy drinkers. The total number of risk factors for alcohol misuse decreased among most survey participants from 2000 to 2010, but with variability between years. CONCLUSION Polarized drinking habits are a likely explanation for the recent divergence between per capita alcohol consumption, which has decreased, and alcohol-related hospitalizations, which have increased sharply among Swedish youth in recent years. We suggest that ongoing social changes could be affecting young people in the form of greater disparities, which are associated with a higher incidence of social problems generally, including heavy drinking.

Alcohol Habits in Sweden during 1997–2009 with Particular Focus on 2005 and 2009, Assessed with the AUDIT: A Repeated Cross-Sectional Study

Aim: This study aimed to survey the changes in alcohol habits during a period with the European Union legal practices. Methods: Alcohol habits in Sweden were surveyed in the general Swedish population at four timepoints, in 1997, 2001, 2005 and 2009, using the 10-item AUDIT questionnaire. Design: Four separate randomly drawn cross-sectional samples of 1,250 individuals were surveyed at each timepoint. Results: An average of 70% of the sampled individuals responded to the AUDIT questionnaire. Men had higher total AUDIT scores than women in 2005 and 2009, but scores increased among women 61–71 years old and decreased among men 61–71 years old. Younger men and women 17–27 years old decreased their AUDIT-C consumption scores by almost 20% between 2005 and 2009. An analysis of problem drinkers (+8 for men/+6 for women) indicated that a larger proportion of elderly women drank moderately in 2009 compared with 2005, but fewer elderly women drank hazardously. Conclusions: Earlier increases in drinking levels between 1997 and 2001 may reflect a latent high demand that was restricted by low availability. When availability due to European Union harmonization increased, alcohol consumption followed suit. After a period of adaptation, alcohol consumption appears to have stabilized.

Declining Trends in Alcohol Consumption Among Swedish Youth—Does the Theory of Collectivity of Drinking Cultures Apply?

AIMS To analyse trends in alcohol consumption among young people in Sweden between 2004 and 2012, to test whether the theory of collectivity of drinking cultures is valid for a population of young people and to investigate the impact of an increasing proportion of abstainers on the overall per capita trends. METHODS Data were drawn from an annual survey of a nationally representative sample of students in year 11 (17-18 years old). The data covered 9 years and the total sample comprised 36,141 students. Changes in the overall per capita consumption were tested using linear regression on log-transformed data, and changes in abstention rates were tested using logistic regression. The analyses were then continued by calculating average consumption in deciles. RESULTS Alcohol consumption among year 11 students declined significantly among both boys and girls between 2004 and 2012. These changes were reflected at all levels of consumption, and the same results were found when abstainers were excluded from the analyses. The increasing proportion of abstainers had a minimal effect on the overall decline in consumption; rather, this was driven by a decline in consumption among the heaviest drinkers. CONCLUSION The theory of collectivity of drinking cultures seems valid for understanding changes in alcohol consumption among Swedish year 11 students. No support was found for a polarization of alcohol consumption in this nationally representative sample.

Who Is Not Drinking Less in Sweden? An Analysis of the Decline in Consumption for the Period 2004–2011

AIMS This study aimed to analyse if changes in drinking in Sweden have been similar in different population subgroups between 2004 and 2011, a period when per capita consumption declined significantly. METHOD The analysis starts out from monthly alcohol survey data including 1500 telephone interviews every month. The population is divided into 20 equally large consumption groups separately for men and women and two broad age groups. Both absolute and relative changes in drinking are studied. RESULTS Most findings confirmed a collectivity of change in drinking: a decline was found at all consumption levels overall, among men and women, and among those under 50 years of age. The decline was smaller in groups with the highest consumption, and among those over 50 years consumption rather increased among the heaviest drinkers. CONCLUSION Support was obtained for the conception of a social component in recent consumption changes in Sweden. This finding has an important policy message in line with the total consumption model, namely that measures that reduce per capita consumption are likely to imply fewer heavy drinkers. Some exceptions from the collectivity theory that deserves attention in future studies were also noted, e.g. the development among heavier drinkers above 50 years of age.

ESPAD report 2015 results from the European School Survey Project on Alcohol and Other Drugs.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends ...

Reducing youth violence related to student parties: Findings from a community intervention project in Stockholm.

BACKGROUND During the spring of 2007, the police reported a marked increase in violence and binge drinking related to high school student graduation parties on weekday nights at restaurants in Stockholm city. This spurred a multi-component community intervention project to reduce these problems. AIMS This study aims to evaluate the impact of the intervention on youth-related violence on weekday nights in 2008-2010. DESIGN AND METHOD The outcome measure entailed the number of violence-related emergency room visits on weekday nights (10:00 pm-6:00 am) by adolescents aged 18-20 years. The study period was 1 April-31 May, which is when most student graduation parties took place. The data covered the years 2005-2010, with three data points before the intervention, and three after the intervention was introduced. Because the intervention was expected to apply to weekdays only, the control series involved a corresponding indicator pertaining to weekend nights (10:00 pm-6:00 am). The intervention effect was assessed by means of difference-in-differences estimation. RESULTS The estimated intervention effect according to the difference-in-differences estimation models was a statistically significant 23% reduction of violence among young people. DISCUSSION AND CONCLUSION This type of intervention is a promising measure of preventing youth violence and deserves to be continued. Such continuation would also provide additional data required for a more conclusive assessment.

Hazardous drinking among restaurant workers

Background/aims: We address three research questions pertaining to Swedish restaurant workers: (i) What is the prevalence of hazardous drinking? (ii) How is the consumption of alcohol distributed? (iii) Does the prevention paradox apply? Methods: Data were collected by administering the Alcohol Use Disorders Identification Test (AUDIT) among restaurant workers who attended a 2-day Responsible Beverage Service training in Stockholm during the period from October 2008 to December 2009. The control group comprised a sample representative of the general Swedish population. We restricted the analyses to the age span 18–59 years, which yielded a sample size of 579 for restaurant workers and 434 for the general population. Results: The prevalence of hazardous drinking as measured by AUDIT (8+ for men and 6+ for women) was markedly higher among restaurant workers than in the general population. The difference was especially pronounced among females below 30 years of age. We found no difference between restaurant workers and the general population in the distribution of alcohol consumption. About 76% of the drinking problems were found in the lower part of the consumption distribution (bottom 88%), which supports the prevention paradox. Conclusions: Restaurant workers comprise a high-risk group with respect to drinking.

Prevalence of adolescents who perceive their parents to have alcohol problems: A Swedish national survey using a web panel

Aims: The primary aim is to estimate the prevalence of Swedish adolescents who perceive their parent(s) to have alcohol problems. Additional research questions pertain to the prevalence of adolescents who think someone close to them drinks too much alcohol and if this has hurt them or caused them problems. Methods: A cross-sectional design was employed using a web-based survey targeted to 1000 Swedish 16–19-year-olds randomly selected from a web panel. The questionnaire included the CAST-6 scale, used to assess whether or not participants perceived their parents’ alcohol consumption as problematic, and questions relating to whether or not they think someone close to them drinks too much and if this has caused them problems. Data was weighted using a post-stratification procedure. Results: The proportion of adolescents classified as having parents with alcohol problems was 20.1%. Further, 44.0% reported that they think someone close to them drinks too much alcohol and 9.6% that this has hurt them or caused them problems. Conclusions: These results indicate that the problem is widespread. Our findings are similar to previous research where a more indirect methodology has been adopted, using either psychiatric interviews or self-reported alcohol consumption of adults, to estimate the magnitude of the problem.

Evaluation of an Alcohol Risk Reduction Program (PRIME for Life) in Young Swedish Military Conscripts.

Purpose – The purpose of this paper is to evaluate the effectiveness of the PRIME for Life risk reduction program in reducing alcohol consumption and improving knowledge and attitudes towards alcohol use in male Swedish military conscripts, aged 18 to 22 years.Design/methodology/approach – A quasi‐experimental design was used in which 1,371 military conscripts from ten regimens were assigned to either a control or program intervention group. Changes in alcohol consumption, knowledge and attitudes towards alcohol use were assessed with self‐report questionnaires at baseline, and again 5 months and 20 months after the program.Findings – Pre to post program reductions in total alcohol consumption and “high risk” consumption were reported in both the control and intervention group. There were no statistically significant group interactions over time, indicating that factors beyond the intervention alone were responsible for the reductions in alcohol consumption. Attitudes towards consumption improved signific...

Monitoring local alcohol prevention in Sweden: Application of Alcohol Prevention Magnitude Measure (APMM)

Aims National alcohol policy in Sweden has to a certain extent grown weaker, and there has instead been an increased focus on strengthening local alcohol prevention. Swedish municipalities carry out a variety of alcohol prevention activities, but there is little knowledge of how the magnitude of all these activities has developed over time. One reason for this lack of information is the limitation of tools for monitoring prevention activities locally. The aim of this study is 1) to develop an Alcohol Prevention Magnitude Measure (APMM) based on local data and 2) to analyse the development of local alcohol prevention by using APMM. Data The APMM is based on 37 different indicators of local prevention. Data derives from web-based surveys comprising all Swedish municipalities and from information on licensed premises at the local level. Results The results reveal that local alcohol prevention in Sweden, as measured by the APMM, has increased generally between 2006 and 2010. The increase is the result of more local policies and activities. Conclusion The results indicate that the APMM captures real changes at the local level, as the APMM increased significantly in community intervention municipalities compared to others.