Johan Svensson

The declining trend in Swedish youth drinking: collectivity or polarization?

AIMS Alcohol consumption among youth in Sweden has declined markedly during the last decade. This study aims to tackle the following research questions: (i) how is the decrease in drinking distributed across consumption categories; and (ii) is the pattern of change in consumption consistent with Skogs theory of the collectivity of drinking behaviour? DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS We analysed data from the nationally representative annual school survey of alcohol and drug habits among Swedish 9th-grade students (aged 15-16 years) covering the period 2000-12 (n ≈ 5000/year). Respondents were divided into seven drinking groups based on their relative ranking on consumption, which was measured by beverage-specific quantity and frequency items summarized into a measure of overall drinking in litres of 100% alcohol per year. In addition, the mean number of heavy episodic drinking occasions (HED) was computed for each drinking group. FINDINGS The decline in consumption among Swedish youth was mirrored in all seven drinking groups, although the relative decrease was smaller for heavy drinkers (top 5%) than for light drinkers (below the median). Among the top 5%, the average annual decrease was 2% (P = 0.027), while the corresponding figure for light drinkers was 28.9% (P < 0.001). The reverse pattern was true when looking at the absolute decrease. The decrease among the top 5% accounted for 26.1% of the decrease in mean consumption during the study period, whereas the light drinkers accounted for 2.9%. There was a marked relation between overall consumption, on one hand, and mean consumption and HED, on the other hand, in each of the seven drinking groups. CONCLUSION The marked decrease in youth drinking in Sweden that occurred during the period 2000-12 was manifest at all consumption levels. The findings are consistent with Skogs theory of the collectivity of drinking behaviour.

Is Youth Violence Temporally Related to Alcohol? A Time-Series Analysis of Binge Drinking, Youth Violence and Total Alcohol Consumption in Sweden

AIMS The purpose of this study is to investigate the temporal association between violence and binge drinking among Swedish youth. Two time periods are analysed, the first one representing the full observation period 1971-2009 and the second one representing a confined period 1971-2000. Furthermore, the association between population drinking and binge drinking among youths is also investigated with regards to the two time periods. METHODS ARIMA modelling was applied in order to estimate these associations. RESULTS Based on the confined time period (1971-2000), analyses revealed that four out of six estimates (two where borderline) of the association between binge drinking and violence (self-reported as well as convictions for assaults) were positive and statistically significant. However, most estimates became non-significant when the full study period (1971-2009) was analysed. The analyses of the relationship between total consumption and youth binge drinking revealed that binge drinking among military conscripts and boys was affected by changes in total consumption during the shorter confined study period. These associations became non-significant when the full study period was included in the models. CONCLUSIONS (a) there was a positive relationship between violence and binge drinking among Swedish youth at the aggregated level, but mainly with regards to the shorter study period, (b) changes in per capita alcohol consumption were associated with binge drinking among young men and this was more evident for the shorter study period and (c) there was empirical evidence for the idea that these associations became weaker or non-existent after the year 2000.

What Role Do Changes in the Demographic Composition Play in the Declining Trends in Alcohol Consumption and the Increase of Non-drinkers Among Swedish Youth? A Time-series Analysis of Trends in Non-drinking and Region of Origin 1971–2012

Aim Non-drinkers among youth in Sweden have increased markedly during the last 15 years. The aim of this study is to investigate the temporal association between region of origin among Swedish youth and rates of non-drinking. Data and method Data on non-drinkers were obtained from The Swedish Council on Information and Other drugs (CAN) yearly school surveys among Swedish ninth-grade students over the period 1971–2013. Annual data of region of origin for 1968–2012 has been compiled from Statistics Sweden (SCB) and consists of all 15-year-olds in Sweden and their region of birth; Sweden, The Nordic Countries, Europe, The Middle East and the rest of the world. Autoregressive Integrated Moving Average (ARIMA) modelling was applied in order to estimate these associations. Results Descriptive results revealed a change in the demography of Swedish 15- to 16-year-olds. In the early 1990s 1% of Swedish 15- to 16–year-olds were born in a Middle East country, this proportion increased to 6% in 2012. Furthermore, those born in the rest of the world (non-European or non-Nordic countries) increased from 1% to almost 4%. Similarly, the trend of non-drinkers increased from about 20% to more than 40% among Swedish 15- to 16-year-olds during the same period. However, a more thorough analysis using ARIMA modelling revealed no significant association between rates of region of origin and non-drinking. Conclusion The marked increase in non-drinkers during the last 15 years is not associated to changes in the demographic composition, in terms of region of origin, among Swedish youth.

The effects of missing data when surveying alcohol habits

AIMS This study aimed at describing the effects of missing data when surveying alcohol consumption using a Random Digit Dialling procedure. Methods Data was part of the Monitor project including repeated monthly data on the alcohol habits in the general Swedish population. Non-respondents during four months were followed up a year later and asked to do a shortened telephone interview and were compared to a concurrent sample of respondents (n=2552 versus n=6005). Further, using a second approach, the monthly levels of non-response was related to the level of measured alcohol use in a time series analysis (n=67500). Results The results indicated no differences in the level of reported alcohol or tobacco use with except for a slightly higher proportion of alcohol abstainers in the sample of initial non-response. The time series showed no pattern of co-variation between the obtained non-response levels and the assessed levels of alcohol or tobacco use. Conclusions On the basis of the results it was meaningful to make a distinction between “soft” non-respondents (responding after extensive contacting effort) and “hard” non-respondents (not responding albeit extensive effort) and the results suggest that inclusion of the “soft” non-respondents does not by necessity lead to higher levels of assessed alcohol use.

Travellers' Alcohol Imports to Sweden at the Beginning of the 21st Century: Do those who privately import alcohol drink more than or have different patterns of drinking to those who do not?

Background Privately imported alcohol has increased during the last decade in Sweden. Estimates suggest an increase from 1.1 liter (pure alcohol) per inhabitant in 1996 to 2.7 liters in 2004, and a decrease to 1.8 liters by 2007. Privately imported alcohol represented approximately 20% of total consumption in Sweden during the period 2001–2007 and thus represents a large amount of all alcohol consumed. However, the drinking habits of importers have been rarely studied. Aim The main aim of this paper is to examine drinking patterns and experiences of alcohol-related problems among Swedes who bring alcohol in from abroad and to investigate whether these differ according to the levels of importing. In addition those who bring alcohol in from abroad are compared with those who do not. Data & Methods Data on private import of alcohol, alcohol consumption, adverse consequences of alcohol and socio-demographics were obtained from a monthly telephone survey for the period January 2002 until December 2007 and were aggregated into annual data. For each month a randomised population of 1,500 individuals where asked whether they had returned to Sweden from abroad. If they responded affirmatively they where then asked questions on how many times abroad, during the last 30 days, and if they had brought any alcohol to Sweden the last and or the second-to-the-last time. Irrespective of the respondent had been abroad or not questions on alcohol consumption, drinking patterns, adverse consequences and socio-demographics were asked. On average the telephone interviews lasted for approximately ten minutes. Logistic regressions was used to estimate the association between drinking habits (and problems) and different amounts of alcohol imports. Results The findings of this study indicate that those who import alcohol drink more and engage in binge drinking more frequently than those who do not. However, adverse consequences of alcohol consumption were not reported to the same degree as among the non-importers.

No polarization in youth drinking in Stockholm county: response to Hallgren

1. Norstrom T., Svensson J. The declining trend in Swedish youth drinking: collectivity or polarization? Addiction 2014; doi: 10.1111/add.12510 [Epub 2014/02/14] 2. Skog O. J. The collectivity of drinking cultures: a theory of the distribution of alcohol consumption. Br J Addict 1985; 80: 83–99. 3. Hallgren M., Leifman H., Andreasson S. Drinking less but greater harm: could polarized drinking habits explain the divergence between alcohol consumption and harms among youth? Alcohol Alcohol 2012; 47: 581–90. 4. Branstrom R., Andreasson S. Regional differences in alcohol consumption, alcohol addiction and drug use among Swedish adults. Scand J Public Health 2008; 36: 493–503. 5. Ramstedt M., Lindell A., Raninen J. Tal om alkohol 2012—en statistisk årsrapport från Monitorprojektet [Speaking about alcohol in 2012—a statistical report from the Monitor Project]. Stockholm: Center for Social Research on Alcohol and Drugs (SoRAD), 2013 67. 6. Livingston M. Alcohol outlet density and assault: a spatial analysis. Addiction 2008; 103: 619–28.

Does the familial transmission of drinking patterns persist into young adulthood? A 10-year follow up

BACKGROUND Parental drinking has been shown to be associated with offspring drinking. However, the relationship appears to be more complex than often assumed and few studies have tracked it over longer time periods. AIMS To explore the long-term (10-year) transmission of familial drinking during adolescence to offspring drinking patterns in young adulthood. DESIGN Swedish longitudinal study, assessing the relationship between familial drinking in 2000 and offspring drinking in 2010 using simultaneous quantile regression analysis (n=744). DATA Data on familial drinking was gathered from the Swedish level-of-living surveys (LNU) and from partner LNU in 2000 while data on offspring drinking in young adulthood was gathered from LNU 2010. Drinking among offspring, parents and potential stepparents was measured through identical quantity-frequency indices referring to the past 12 months in 2010 and 2000 respectively. RESULTS Young adults whose families were abstainers in 2000 drank substantially less across quintiles in 2010 than offspring of non-abstaining families. The difference, however, was not statistically significant between quintiles of the conditional distribution. Actual drinking levels in drinking families were not at all or weakly associated with drinking in offspring. Supplementary analyses confirmed these patterns. CONCLUSION The association between familial drinking and offspring drinking in young adulthood exhibits clear non-linear trends. Changes in the lower part of the familial drinking distribution are strongly related to drinking in young adults, but the actual levels of drinking in drinking families appear less important in shaping the drinking patterns of the offspring in young adulthood.

Who are private alcohol importers in the Nordic countries

Aims The high price of alcohol in the Nordic countries has been a long-standing policy to curb consumption, which has led consumers to importing alcohol from countries with lower prices. This paper seeks to develop a profile of alcohol importers in four Nordic countries. Methods Cross-sectional data from general population surveys in Denmark (2003-2006), Norway (2004), Sweden (2003-2006) and Finland (2005-2006) were analysed by multiple logistic and linear regression. Independent variables included region, socio-demographics, drinking indicators and alcohol-related problems. Outcome variables were importer status and amount of imported alcohol. Results People living in regions close to countries with lower alcohol prices were more often importers and imported higher amounts than people living in other regions. Higher educated persons were more likely to be importers, but the amounts imported were smaller than those by people with lower education. Persons with higher incomes were also more likely to be importers and they also imported larger amounts than people with lower incomes. In Sweden and Denmark regional differences of importer rates were more pronounced for persons of lower incomes. Age, risky single-occasion drinking, risky drinking and alcohol problems were positively related to the amounts of imported alcohol. Conclusions Private importers in the Nordic countries are an integrated yet heavy drinking segment of society and do not appear to be located on the fringes of society.

One explanation to rule them all? Identifying sub-groups of non-drinking Swedish ninth graders

INTRODUCTION AND AIMS Researchers in a number of countries have recently identified major changes in adolescent alcohol consumption since the early 2000s, with the prevalence of teenage drinking more than halving in some countries. The major aims of the current study are to examine if there are sub-groups among non-drinking Swedish ninth graders and to describe how the prevalence of these groups has changed during the period 1999 to 2015. DESIGN AND METHODS Data from five waves of the Swedish European School Survey Project on Alcohol and other Drugs study was used. The data covered 16 years and the total sample comprised 14 976 students. Latent class analysis was used to identify sub-groups of non-drinkers (n = 4267) based on parental approval towards drinking, parental monitoring, leisure time activities, school performance and use of other substances. RESULTS Five latent classes were found: computer gamers (8.3%), strict parents (36.5%), liberal parents (27.0%), controlling but liberal parents (16.6%) and sports (11.6%). In the non-drinking sub-group the strict parents group increased most between 1999 and 2015. DISCUSSION AND CONCLUSIONS The results imply that there is notable within-group diversity in non-drinking youth. Several mechanisms and explanations are thus likely to be behind the decline in drinking participation among Swedish adolescents.

Extended opening hours at nightclubs in Visby: An evaluation of a trial in the summer of 2014

Background and aims: During 10 weeks in the summer 2014 opening hours in nightclubs in Visby (Sweden) were extended by 1 hour, postponing the permitted closing time from 2 to 3 a.m. A number of preventive efforts such as Responsible Server Training, and an intensified cooperation between the police and the nightclubs were strengthened in connection with the trial. The aim of this study was to evaluate the impact of this trial on police-reported violence. Data and methods: To estimate the effect of the trial on violence, we compared the violence rate during the intervention period (week 24–week 33, 2014) with the violence rate in the corresponding period in Visby in 2010–2013. The intervention period thus comprised 10 weeks, and the pre-intervention period 40 weeks. As outcome measure we chose police-reported assaults that had occurred at night (midnight–6 a.m.). As control series we used assaults daytime (6 a.m.–midnight). The intervention effect was estimated with the method of “difference in differences” (DiD). Interviews with key informants provided the study with an explanatory context for the trial outcomes. Results: The intervention effect was strongly statistically significant with a reduction of 3.336 reported assaults at night per week compared to the pre-intervention period. This represents a decrease of 71%. Conclusion: The trial with an extension of opening hours at nightclubs in Visby was followed by a reduction in police-reported violence. This unexpected outcome is likely to be the result of (i) the simultaneous strengthening of efficient preventive measures, and (ii) a decreased congestion in the streets resulting from increased spread in closing hours.