Heli Mustonen

Effects of a community intervention to reduce the serving of alcohol to intoxicated patrons

AIMS To assess the effects of an alcohol prevention programme to reduce the serving of alcoholic beverages to intoxicated clients on licensed premises. RESEARCH DESIGN A controlled pre- (2004) and post-intervention study (2006) design. INTERVENTION A community-based programme combining law enforcement, responsible beverage service training, information campaigns and policy initiatives in one Finnish town (Jyväskylä). PARTICIPANTS AND MEASUREMENTS A male actor pretended to be clearly under the influence of alcohol and tried to buy a pint of beer at licensed premises. For the baseline measurement, every bar and nightclub was visited in the intervention and the control areas (94 licensed premises in total). Post-intervention data were gathered with the same principles (100 licensed premises in total). A researcher observed every visit and documented the results. RESULTS In the post-intervention study there was a statistically significant increase in refusals to serve denials alcohol to the actor in the intervention area (from 23% to 42% of the licensed premises) compared to refusals in the control area (from 36% to 27% of the licensed premises). CONCLUSION Previous research has documented that multi-component community-based interventions can have a significant impact on over-serving of alcohol when training and house policies are combined with effective law enforcement. The present findings also demonstrate that comprehensive Responsible Beverage Service (RBS) interventions applied at a local community level can be effective in decreasing service to intoxicated clients in a Nordic context.

People are buying and importing more alcohol than ever before. Where is it all going

Aims: Removal of import quotas for alcoholic beverages from other EU countries and cuts on alcohol taxes by one third on average resulted in approximately a 10% increase in per capita alcohol consumption in 2004, and a further 3% in 2005. Our aim was to study which population groups accounted for this increase, and what happened to self-reported alcohol-related harm. Methods: A panel survey with a general population random sample was carried out. The current data are the first and third waves of the panel. A questionnaire was sent in autumn 2003 to 4000 Finns aged 15 to 69. In 2005, the questinnaire was mailed to 1209 persons who responded both in 2003 and in 2004 and who agreed to participate in the follow-up. Findings: The respondents themselves reported no increase in either their own consumption or in alcohol-related harm from 2003 to 2005, and there were few changes by subgroup of the population either. Conclusions: The survey data did not capture the increase in consumption that has been observed in per capita consumption. The permanent consequences of the changes in the alcohol situation in 2004 remain to be seen in future statistics and studies.

Relationships between characteristics of drinking occasions and negative and positive experiences related to drinking.

The relationships between characteristics of drinking occasions and experiences related to drinking were studied. Interviews were conducted in 1992 with a representative sample of the Finnish population between 15 and 69 years of age. The analyses were based on 10,039 drinking occasions of 1,483 male and 1,373 female drinkers. Intake of alcohol and the frequency of drunkenness were the most important predictors of both negative and positive experiences related to drinking. Characteristics of the drinking situations contributed significantly to the explanatory models, but their predictive power was small. Public and large-group drinking situations tended to increase and private and intimate situations tended to decrease the number of both negative and positive experiences related to single drinking occasions. The same situations that lead to increased positive experiences with drinking also increase the risk for negative experiences.

Toward a typology of drinking occasions: Latent classes of an autumn week's drinking occasions

Drinking occasions are important determinants of the quantity and effects of alcohol consumption. We examine the Finnish drinking culture by identifying a typology of typical autumn weeks drinking occasions and by determining the central characteristics of drinking occasions that differentiate one occasion from another. The data come from the 2008 Finnish Drinking Habits Survey (n = 2725, response rate 73.6%) on a general population sample aged 15–69 years. A total of 1566 past-week drinkers reported 3120 past-week drinking occasions. Key measurements were the circumstance, location, company, and timing of the drinking occasion. Latent class analysis was used to model the underlying structure of drinking occasions. A typology of drinking occasions consisting of eight-latent classes was identified. Five of these latent classes took place at home: light drinking with family at home (prevalence 30%), non-light drinking with family at home (12%), daytime family meals (6%), alone at home (15%), evenings with friends at home (13%). Three classes took place mainly at licensed premises (prevalence): light drinking out together (9%), out drinking with friends (9%), and heavy drinking parties (5%). The same latent structure of drinking occasions was found to be valid for men and women. The typology indicates the dominance of light-drinking occasions in Finland. Heavy drinking occurs mostly in occasions when friends are present, but also at home, with mainly family present. The study findings indicate that important themes for Finnish alcohol policy include drinking in the presence of children, and attention to restrictions on retail sales of alcohol.

Changes in Finnish drinking occasions between 1976 and 2008 – The waxing and waning of drinking contexts

A deeper understanding of drinking practices of a population requires a study of the situations in which people drink, i.e. the context of drinking. This study explores the changes and continuities in the prevalence and nature of drinking in terms of place, company, time and the social drinking context, during a period when overall alcohol consumption in Finland grew by half and drinking culture at large was transformed radically. Analyses were based on two national drinking habits surveys with a representative sample of the Finnish population aged 15–69 years in 1976 (N = 2835) and 2008 (N = 2725). In addition, original semi-qualitative data in 2008 were utilized, using a 15-category social drinking context typology, with the results contrasted to previously reported results from 1976. Overall, the number of drinking occasions increased between 1976 and 2008. A major part of the increase comprised drinking in home settings and with ones partner. The weekly rhythm of drinking was also concentrated on weekends even more than before. Changes in the nature of drinking showed that the typical degree of intoxication decreased for men and increased for women. The proportion of heavy drinking occasions decreased for men especially in home settings and for women, remained the same across drinking contexts except for single gender contexts. Changes in social drinking contexts reflected an overall shifting of drinking into the private sphere, with a major increase in the proportion of evenings at home and sauna drinking.

The reward structure of drinking among younger and older male drinkers.

In discussions of addictive processes, the arguments presented often imply that the reward structure of drinking changes over time: most benefits are immediate, but many adverse effects are delayed (Skog, 1996). That people continue to drink at a certain level despite increasing adverse consequences is best explained by saying that they become, in various degrees, addicted to alcohol. Seen from this perspective, age can be used as an indirect measure of the length of the drinking career, and the overall reward structure should be more positive among young drinkers than among old. A recurrent finding in drinking surveys is, however, that young drinkers report more adverse consequences than older drinkers even when overall intake of alcohol is held constant (Bondy, 1995; Bongers et al., 1995; Casswell et al., 1993; Makela & Simpura, 1985; Midanik, 1995; Midanik & Clark, 1995; Room et al., 1995). There are good common-sense explanations for this phenomenon: the drunken comportment of young people may be more reckless, they may still be learning to hold their liquor, they may be under stricter social control, and smaller economic and social resources may aggravate the negative consequences of their drinking. One important question remains, however: Why do young people continue to drink? That is, what outbalances the fact that they experience more negative consequences than older drinkers? In discussing the reward structure of drinking, it is obviously not enough to study negative consequences. The perceived benefits of drinking have also to be taken into account. In this report, our aim is to analyze the overall reward structure of drinking at various levels of intake in two different age groups. We pay particular attention to how the reward structure changes as a function of increasing intake. Our data come from a Finnish general population survey. We focus on male drinkers 20-29 years old and 40-49 years old. The choice of the age groups is based on the following considerations: The older respondents have consumed alcohol, on the average, 20 years longer than the younger respondents. Men 20-29 years old have, on the average, passed the experimental phase but are still in the early stages of their drinking career. Those in the older age group have had time to experience some of the delayed adverse consequences of drinking, but relatively few have died or turned abstinent because of them. Survey data provide information on the probability of occurrence of each consequence of drinking at different levels of consumption, but we have no yardstick for the utility or disutility of each consequence. There is no way of relating the utility of receiving a small reward with a high probability to the disutility of suffering a serious loss with a low probability. Moreover, our survey questions cover only a small and rather trivial selection of the possible benefits and disadvantages of drinking. To interpret our results, we have to apply indirect reasoning. Earlier analyses (Makela & Mustonen, 1988) show that the incidence of negative effects of drinking increases more rapidly than that of beneficial effects as a function of annual intake of alcohol. Perceived benefits of drinking continue to increase even among those with the highest consumption levels, but the differences in growth rates can be interpreted as indicating that the cost-benefit balance is more favorable at lower levels of consumption. Applying the same reasoning, we may also compare the reward structure in different groups of respondents as a function of overall intake of alcohol. Material and methods In September-October 1992, interviews were performed with a representative sample of the population between 15 and 69 years of age in Finland (for sampling operations and data collection, see Makela, 1971; Simpura, 1987; Simpura et al., 1995). The overall response rate was 87% and the number of completed interviews was 3,446. …

The beverage alcohol concentration at intake and estimated blood alcohol concentrations

Belief in differential health risks for different alcoholic beverages continues despite a relative lack of supporting evidence, and continues to influence alcohol policy debate both in Finland and elsewhere. The present data from a survey of Finnish drinking habits conducted in 1992 suggest that the central issue is not the actual strength of the beverage itself but rather the solution at intake and the amount of alcohol imbibed. The results are based on a one week survey of all occasions on which alcohol was consumed from a general population survey of drinking habits. Spirits are diluted almost two times out of three when spirits are taken. The data indicate that the median alcohol content of spirits at intake was about 13 percent of volume: i.e. on half of the occasions when spirits were imbibed, the actual alcohol content was not higher than that of unfortified wines. Beer and wine were rarely diluted, white spirits and rum were almost always diluted, whereas cognac and liqueurs were taken unmixed. The data also provide a basis for estimating the blood alcohol concentration (BAC) reached on each drinking occasion. There was hardly any correlation between the BAC and the actual alcohol concentration of the beverages imbibed. More detailed analyses showed mixed results. Drinking to intoxication (estimated BAC < 20 mM) was more likely with those spirits that are typically diluted than those drunk straight, but a higher percentage of the spirit intake in general occurred on such intoxicating occasions than was reported for other beverages. Older respondents reported that the primary beverage used when drinking to intoxication was spirits, but younger ones said beer. The results are only for Finland, but show little basis here for the traditional tripartite (beer, wine, spirits) division of beverages in prevention of alcohol-related harm.

Situational drinking in private and public locations: A multilevel analysis of blood alcohol level in Finnish drinking occasions

INTRODUCTION AND AIMS The first aim was to estimate the extent to which the variation in alcohol use across specific drinking occasions arises from variation at the occasion level and from variation at the drinker level. The second aim was to identify characteristics of drinking situations that moderate or increase situational alcohol use beyond the influence of drinker-level characteristics. DESIGN AND METHODS The general population aged 15-69 years in Finland was sampled randomly in 2008. The multilevel analysis was based on data from 1511 drinkers and 2933 drinking occasions that occurred in the 7 days before the interview. Alcohol use was operationalised as estimated blood alcohol level (BAL). Characteristics of drinking occasions included location, circumstance, company and timing. Drinker-level data included demographic and drinking pattern variables. RESULTS Fifty-three percent of the variance in BAL was between occasions and 47% between respondents, for both women and men. With drinking patterns and demographic characteristics controlled for, the dominant characteristics of drinking occasions predisposing to greater intoxication were late-night drinking, across locations and for both genders. For private locations, predisposing characteristics included drinking on weekends for both genders and drinking with friends for men. DISCUSSION AND CONCLUSIONS Situational and drinker levels are equally important in determining the BAL in drinking occasions; therefore, prevention efforts should be targeted at both risky individuals and risky drinking occasions. Occasions occurring late at night, often at home and with friends, are a central challenge for targeting preventive efforts related to situational drinking.[Mustonen H, Mäkelä P, Lintonen T. Situational drinking in private and public locations: A multilevel analysis of blood alcohol level in Finnish drinking occasions. Drug Alcohol Rev 2016;35:772-784].

Situational drinking in private and public locations: a multilevel analysis of blood alcohol level in Finnish drinking occasions

INTRODUCTION AND AIMS The first aim was to estimate the extent to which the variation in alcohol use across specific drinking occasions arises from variation at the occasion level and from variation at the drinker level. The second aim was to identify characteristics of drinking situations that moderate or increase situational alcohol use beyond the influence of drinker-level characteristics. DESIGN AND METHODS The general population aged 15-69 years in Finland was sampled randomly in 2008. The multilevel analysis was based on data from 1511 drinkers and 2933 drinking occasions that occurred in the 7 days before the interview. Alcohol use was operationalised as estimated blood alcohol level (BAL). Characteristics of drinking occasions included location, circumstance, company and timing. Drinker-level data included demographic and drinking pattern variables. RESULTS Fifty-three percent of the variance in BAL was between occasions and 47% between respondents, for both women and men. With drinking patterns and demographic characteristics controlled for, the dominant characteristics of drinking occasions predisposing to greater intoxication were late-night drinking, across locations and for both genders. For private locations, predisposing characteristics included drinking on weekends for both genders and drinking with friends for men. DISCUSSION AND CONCLUSIONS Situational and drinker levels are equally important in determining the BAL in drinking occasions; therefore, prevention efforts should be targeted at both risky individuals and risky drinking occasions. Occasions occurring late at night, often at home and with friends, are a central challenge for targeting preventive efforts related to situational drinking.[Mustonen H, Mäkelä P, Lintonen T. Situational drinking in private and public locations: A multilevel analysis of blood alcohol level in Finnish drinking occasions. Drug Alcohol Rev 2016;35:772-784].

Effects of telephone versus face-to-face survey modes on reports of alcohol-related attitudes, harms and alcohol consumption

Abstract Aims: To assess the effect of telephone vs. face-to-face interview modes on reports of alcohol-related attitudes, harms and alcohol consumption. Methods: Two simple random samples of persons aged 15–69 were drawn for the Finnish Drinking Habits Survey with sample sizes of 800 for the telephone interviews and 3750 for the face-to-face interviews. Results: There was an estimated mode effect for the whole population in 4 out of 28 descriptive measures. They did not show a consistent pattern, but some support was found for a lower level of reported alcohol-related harm in telephone interviews than in face-to-face interviews. In the subgroup analysis, our results showed differences in 9 out of 68 comparisons. The most consistent ones of these differences were between the age groups. Conclusion: The results of the alcohol-related measures in the telephone interviews were reasonably well in line with the results of the face-to-face interviews.