Nina-Katri Gustafsson

Changes in Alcohol Availability, Price and Alcohol-related Problems and the Collectivity of Drinking Cultures: What Happened in Southern and Northern Sweden?

Aims: The aims of this study were to study whether alcohol-related self-reported problems follow the same pattern of changes in alcohol consumption in southern Sweden, assumed to be affected by a decrease in Danish spirits tax and by an increase in Swedish travellers’ import quotas, and to study whether the results obtained for southern and northern Sweden follow the predictions of Skogs theory of collectivity of drinking cultures. Methods: Analysis was carried out on a sample from the Swedish general population from southern and northern Sweden separately. Two indices such as impaired self-control/dependent behaviour and extrinsic problems for alcohol-related problems were computed and analysed in terms of sex, age, income and alcohol consumption level. Results: Although there were no huge changes in the number of persons reporting alcohol-related problems, the general trend in data for various subpopulations was a decrease in the southern site and an increase in the northern site. In the northern site, the increase in alcohol consumption among men also showed an increase in alcohol-related problems. However, various population subgroups changed in different directions and did not move in concert over the population distribution. Conclusions: Analysis confirmed that alcohol-related problems, according to the two indices used, followed a similar pattern to alcohol consumption, but less divergent. A version of Skogs theory applied on alcohol-related problems could not confirm that alcohol-related problems did not change collectively within the population.

Changes in alcohol-related harm in Sweden after increasing alcohol import quotas and a Danish tax decrease—an interrupted time-series analysis for 2000–2007

Background Denmark decreased its tax on spirits by 45% on 1 October 2003. Shortly thereafter, on 1 January 2004, Sweden increased its import quotas of privately imported alcohol, allowing travellers to bring in much larger amounts of alcohol from other European Union countries. Although these changes were assumed to increase alcohol-related harm in Sweden, particularly among people living close to Denmark, analyses based on survey data collected before and after these changes have not supported this assumption. The present article tests whether alcohol-related harm in southern Sweden was affected by these changes by analysing other indicators of alcohol-related harm, e.g. harm recorded in different kinds of registers. Methods Interrupted time-series analysis was performed with monthly data on cases of hospitalization due to acute alcohol poisoning, number of reported violent assaults and drunk driving for the years 2000–07 in southern Sweden using the northern parts of Sweden as a control and additionally controlling for two earlier major changes in quotas. Results The findings were not consistent with respect to whether alcohol-related harm increased in southern Sweden after the decrease in Danish spirits tax and the increase in Swedish alcohol import quotas. On the one hand, an increase in acute alcohol poisonings was found, particularly in the 50–69 years age group, on the other hand, no increase was found in violent assaults and drunk driving. Conclusions The present results raise important questions about the association between changes in availability and alcohol-related harms. More research using other methodological approaches and data is needed to obtain a comprehensive picture of what actually happened in southern Sweden.

Changes in Alcohol Consumption in Denmark after the Tax Reduction on Spirits

Aims: This paper examines changes in alcohol consumption in Denmark between 2003 and 2006 after the excise tax on spirits in Denmark was lowered by 45% on October 1, 2003 and travelers’ allowances for the import of alcohol were increased on January 1, 2004. Methods: Cross-sectional and panel data from Denmark from 2003 to 2006 were analyzed. Samples were collected by telephone interviews using random digit dialing. Results: Panel data for Denmark revealed that alcohol consumption remained relatively stable. Similar results were found in the Danish cross-sectional data. It appears that ‘substitution’ rather than increased importation occurred. Conclusion: We found no evidence to support earlier research stating that decreased prices and increased availability is related to higher alcohol consumption. This could be partly because (1) Denmark has reached a ‘saturation’ level of consumption over the past 30 years and (2) the survey mode of data collection did not capture specific subpopulations who might have increased their consumption. It may be necessary to examine other indicators of alcohol use or alcohol-related harm in order to fully assess the consequences of such changes in alcohol availability.

Alcohol consumption in southern Sweden after major decreases in Danish spirits taxes and increases in Swedish travellers' quotas.

Background: In 2003, Denmark lowered its tax on spirits, and in 2004, Sweden increased its traveller import quotas. Aim: The aim of the study was to determine whether these two changes increased self-reported alcohol consumption in southern Sweden, which is located near Denmark. Method: Data were collected through telephone interviews with the general population between 2003 and 2006. Individuals aged 16–80 years were interviewed. Some lived in southern Sweden, others in the northern region, which was assumed to be unaffected by the policy changes and was thus used as a control site. Analyses were performed for the total population as well as by sex, age, socio-economic group and consumption pattern. Results: The expected results were not found: alcohol consumption in southern Sweden had not changed. The few statistically significant changes found in southern Sweden indicated decreases. In the north, however, consumption seemed to have increased. Conclusion: In addition to the two policy changes mentioned above, other changes seem to have affected alcohol consumption in Sweden. It is possible, however, that the policy changes have affected population groups not reached by the survey, and thus other types of data need to be analysed before drawing any far-reaching conclusions.

Dimensionality of drinking consequences – cross-cultural comparability and stability over time

Despite the long tradition for asking about the negative social and health consequences of alcohol consumption in surveys, little is known about the dimensionality of these consequences. Analysing cross-sectional and longitudinal data from the Nordic Taxation Study collected for Sweden, Finland, and Denmark in two waves in 2003 and 2004 by means of an explorative principal component analysis for categorical data (CATPCA), it is tested whether consequences have a single underlying dimension across cultures. It further tests the reliability, replicability, concurrent and predictive validity of the consequence scales. A one-dimensional solution was commonly preferable. Whereas the two-dimensional solution was unable to distinguish clearly between different concepts of consequences, the one-dimensional solution resulted in interpretable, generally very stable scales within countries across different samples and time.

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.

The frequency of drinking in different sites in different Nordic areas, and the effects on it of changes in alcohol availability

The site of drinking, as reported in population surveys in 2003 and 2004, was studied in Denmark, Finland and two areas of Sweden, in the north and the south. The aim of the study is to see whether there were differences in main sites of drinking between the four sites; to examine the effect of changes in price and availability due to major reductions in alcohol taxes in Finland and Denmark as well as increased traveler’s quotas on frequency of drinking in different sites; to see whether this effect varied for heavier drinkers; and to measure the stability of frequency of drinking in particular sites. The changes in availability affected Finland, Denmark and the southern area of Sweden. The north of Sweden is used as a control, as it was relatively unaffected by these changes. Probability samples aged 16-69 years were collected from all four sites through telephone interviews and postal questionnaires. The context questions concerned the frequency of drinking in restaurants or taverns, in the respondent’s own home, and in another person’s home. The most frequent location of drinking was usually one’s own home, particularly for those aged 30 and over. For younger Danes and Swedes, drinking in restaurants and other’s homes were also relatively frequent contexts for drinking. There were thus some differences between different Nordic areas in frequencies of drinking in different sites. However, there were few signs of substantial change between 2003 and 2004 in rates of drinking regularly in any of the contexts. Despite the changes in price and availability, the pre-existing differences in contexts of drinking thus stayed largely intact. This was true also among heavier drinkers. While there was substantial stability in all geographic areas between 2003 and 2004 in each respondent’s reported frequency of drinking in his or her own home, there was considerable variability from one year to the other in the frequencies of drinking in restaurants and on another’s house.