Sandra Kuntsche

Cultural and Gender Convergence in Adolescent Drunkenness: Evidence From 23 European and North American Countries

OBJECTIVE To investigate time-trend changes in the frequency of drunkenness among European and North American adolescents. DESIGN Cross-sectional surveys in the 1997/1998 and 2005/2006 Health Behaviour in School-Aged Children Study (HBSC). SETTING High schools in 23 countries. PARTICIPANTS A sample of 77 586 adolescents aged 15 years was analyzed by means of hierarchical linear modeling. MAIN OUTCOME MEASURE The frequency of drunkenness. RESULTS We observed a significant increase of about 40% in the mean frequency of drunkenness in all 7 participating Eastern European countries. This increase was evident among both genders, but most consistently among girls. Meanwhile, it declined in 13 of 16 Western countries, about 25% on average. Declines in Western countries were particularly notable among boys and in North America, Scandinavia, the United Kingdom, and Ireland. Despite this gender convergence, with few exceptions (Greenland, Norway, United Kingdom) boys continued to have a higher frequency of drunkenness in 2005/2006 than girls. CONCLUSIONS The confirmed cultural convergence implies that adoption and implementation of evidence-based measures to mitigate the frequency of adolescent drunkenness such as tax increases and restricting alcohol access and advertisement should get the same priority in Eastern European countries as in Western countries. Policy measures that might facilitate decreases in drunkenness such as server training and the promotion of alcohol-free leisure-time activities should be reinforced in Western countries. The gender convergence implies that prevention policy should be less exclusively focused on male adolescents.

Development and Validation of the Drinking Motive Questionnaire Revised Short Form (DMQ-R SF).

A short form of the Drinking Motive Questionnaire Revised (DMQ–R; Cooper, 1994) was developed, using different item selection strategies based on a national representative sample of 5,617 12- to 18-year-old students in Switzerland. To confirm the concurrent validity of the short-form questionnaire, or DMQ–R SF, data from a second national sample of 2,398 12- to 17-year-old students were analyzed by means of structural equation modeling. The results confirmed the four-dimensional factor structure of the DMQ–R SF both in general and among subpopulations. The mean values as well as the links with alcohol use and related problems were similar to those obtained with the original DMQ–R. These results support the potential use of the DMQ–R SF in a wide range of international studies that measure drinking motives.

Alcohol-related negative consequences among drinkers around the world

AIMS This paper examines (i) gender and country differences in negative consequences related to drinking; (ii) relative rates of different consequences; and (iii) country-level predictors of consequences. DESIGN SETTING AND PARTICIPANTS Multi-level analyses used survey data from the Gender, Alcohol, and Culture: An International Study (GENACIS) collaboration. MEASUREMENTS Measures included 17 negative consequences grouped into (i) high endorsement acute, (ii) personal and (iii) social. Country-level measures included average frequency and quantity of drinking, percentage who were current drinkers, gross domestic product (GDP) and Human Development Index (HDI). FINDINGS Overall, the three groupings of consequences were reported by 44%, 12% and 7% of men and by 31%, 6% and 3% of women, respectively. More men than women endorsed all consequences, but gender differences were greatest for consequences associated with chronic drinking and social consequences related to male roles. The highest prevalence of consequences was in Uganda and lowest in Uruguay. Personal and social consequences were more likely in countries with higher usual quantity, fewer current drinkers and lower scores on GDP and HDI. However, significant interactions with individual-level quantity indicated a stronger relationship between consequences and usual quantity among drinkers in countries with lower quantity, more current drinkers and higher scores on GDP and HDI. CONCLUSIONS Both gender and country need to be taken into consideration when assessing adverse drinking consequences. Individual measures of alcohol consumption and country-level variables are associated with experiencing such consequences. Additionally, country-level variables affect the strength of the relationship between usual quantity consumed by individuals and adverse consequences.

Social roles and alcohol consumption: A study of 10 industrialised countries

The empirical evidence as regards the precise associations between alcohol use and social roles, and these associations across genders and cultures is heterogeneous. The literature tends to focus on two central but conflicting theories. The first - classic role theory - assumes that a higher number of social roles is associated with a more structured life and thus fewer opportunities to drink heavily. The second - the multiple burden hypothesis - posits that the increasing complexity of multiple social roles leads to higher stress levels, and thus to increased alcohol use. Survey data on 25-54-year olds in 10 western industrialised countries which participate in the Gender, Alcohol and Culture: An International Study (GenACIS) project were used to test whether holding the three main social roles - partnership, parenthood, and paid labour - had a more protective or a more detrimental association with problematic alcohol use than holding fewer roles. Age and education were included as possible confounders, while the outcome variables were risky single occasion drinking (RSOD) and heavy-volume drinking. For both men and women and in almost all countries, the study found that those who had all three roles were least likely to drink heavily or engage in RSOD, thus supporting the assumptions of classic role theory. It also found that the protective effect of multiple roles was more consistent for RSOD. There were a few countries where a two-role model gave a better fit. Results for Germany (RSOD), Switzerland, and the Unites States (heavy-volume drinking) indicate that the role of paid labour appears to be particularly relevant for risky alcohol use among women. Despite some variability in the association between paid labour and heavy drinking or RSOD among women, in almost all countries the greater the number of roles a person held, the lower their risk of this type of alcohol use was.

The Social Consequences of Binge Drinking: A Comparison of Young Adults in Six European Countries

ABSTRACT A considerable amount of survey information was available from general population surveys carried out in six countries between 2000 and 2005. These studies were conducted under the auspices of Gender, Alcohol and Culture: An International Study (GENACIS). A total of 1,446 adults between 18 and 23 years of age and 2,482 adults between 24 and 32 years of age from the Czech Republic, Denmark, the Isle of Man, Spain, Sweden, and the United Kingdom responded to questions about their drinking habits and the social consequences directly resulting from their drinking. Survey methods varied from quota sampling with face-to-face interviewing in Spain and the United Kingdom to telephone surveys in Denmark and Sweden. Response rates varied from 50% to 72%. “Binge” or “heavy episodic” drinking was defined as a usual amount on one occasion of more than 8 UK “units” for men and more than 6 units for women. Consequences investigated comprised relationship, health and financial problems, being asked to cut down on drinking, and being involved in a fight. In Denmark and Sweden, the group aged 24 to 32 years was less likely to be binge drinkers than the 18 to 23 year olds. In the other countries, there was little difference. There was also little difference between the age groups in frequency of drinking, but there were considerable variations in this respect between countries. People in the United Kingdom, Sweden, the Czech Republic, and Denmark were more likely to suffer at least one consequence than those in Spain and the Isle of Man. In Spain, there was little change between the age groups in this respect. Fights were most common in the United Kingdom. Being asked to cut down ones drinking was less common in Spain and Sweden than it was elsewhere. Findings are discussed in terms of the varied drinking cultures in the different countries.

Is ‘age at first drink’ a useful concept in alcohol research and prevention? We doubt that

AIM To address and discuss the weaknesses of age at first drink (AFD) as a concept in alcohol research and prevention. METHODS Narrative literature review. RESULTS Varying from one sip to the consumption of several full drinks, and sometimes including the specification of particular conditions (e.g. without parental consent), no exact definition and operationalization of AFD was found. Evidence reveals poor test-retest reliability when the same individuals report their AFD two or more times. Theoretical arguments and empirical evidence fail to explain why having one sip or one drink earlier than peers should cause heavier drinking and related problems later in life. Alternative explanations such as self-selection, third variable effects and systematic report bias are not considered in most studies. These shortcomings also make AFD unsuitable as an indicator or marker of underlying problems such as conduct problems and academic failure. Together with unjustified causal inferences, this has led to an over-emphasis on the relevance of postponing AFD as a way to prevent problems later in life. CONCLUSION We argue in favour of shifting the focus of alcohol research and prevention away from AFD towards a better understanding of the progression from infrequent, low-quantity drinking to more detrimental drinking patterns and the prevention of associated acute and short-term harm.

Housewife or working mum—each to her own? The relevance of societal factors in the association between social roles and alcohol use among mothers in 16 industrialized countries

AIMS To investigate whether differences in gender-income equity at country level explain national differences in the links between alcohol use, and the combination of motherhood and paid labour. DESIGN Cross-sectional data in 16 established market economies participating in the Gender, Alcohol and Culture: An International Study (GenACIS) study. SETTING Population surveys. PARTICIPANTS A total of 12,454 mothers (aged 25-49 years). MEASUREMENTS Alcohol use was assessed as the quantity per drinking day. Paid labour, having a partner, gender-income ratio at country level and the interaction between individual and country characteristics were regressed on alcohol consumed per drinking day using multi-level modelling. FINDINGS Mothers with a partner who were in paid labour reported consuming more alcohol on drinking days than partnered housewives. In countries with high gender-income equity, mothers with a partner who were in paid labour drank less alcohol per occasion, while alcohol use was higher among working partnered mothers living in countries with lower income equity. CONCLUSION In countries which facilitate working mothers, daily alcohol use decreases as female social roles increase; in contrast, in countries where there are fewer incentives for mothers to remain in work, the protective effect of being a working mother (with partner) on alcohol use is weaker. These data suggest that a countrys investment in measures to improve the compatibility of motherhood and paid labour may reduce womens alcohol use.

Binge drinking: Health impact, prevalence, correlates and interventions

Objective: Binge drinking (also called heavy episodic drinking, risky single-occasion drinking etc.) is a major public health problem. This paper provides an overview of recently published evidence concerning the definition and measurement, prevalence rates, health impact, demographic and psychosocial correlates of, and interventions for, binge drinking. Design: Narrative review. Results: Mostly occurring among young people at weekends, binge drinking increases the risk of both acute (e.g. injuries) and long-term negative consequences (e.g. alcohol disorders). Binge drinkers tend to be extrovert, impulsive and sensation-seeking. Stress, anxiety, traumatic events and depression are also related to binge drinking. Both alcohol-related behaviour of parents and general parenting (e.g. parenting styles, monitoring) are also important. Other major risk factors for binge drinking are frequently spending time with friends who drink, and the drinking norms observed in the wider social environment (e.g. school, community, culture). Emergency departments, birthday parties, fraternities and the workplace serve as settings for interventions; these are increasingly delivered via digital and mobile technology. There is evidence of small-sized effects across approaches (brief interventions, personalised normative feedback, protective behavioural strategies etc.) and populations. Conclusion: A more consistent terminology, investigating multi-level influences and identifying the most effective intervention components are challenges for future research.

Detrimental drinking patterns: Empirical validation of the pattern values score of the Global Burden of Disease 2000 study in 13 countries

In addition to volume, patterns of drinking have an effect on disease and injury. Depending on the prevailing way alcohol is coghnsumed (i.e. on drinking patterns), mortality and morbidity should vary across cultures even if per capita consumption is about the same. In a Comparative Risk Analysis (CRA), the WHO estimated for the year 2000 the Global Burden of Disease stemming from alcohol consumption by including both dimensions of intake (volume and patterns). For this purpose, a detrimental drinking pattern scale was developed. This scale used expert ratings of six dimensions of the prevailing drinking patterns in each country. The present study attempts first to replicate the expert ratings based on survey data from 13 countries. Secondly, it compares the scaling of individual level data with the scaling of aggregate level data. For the latter, such survey measures as percentage usually drinking with meals and percentage usually getting drunk when drinking to approximate the pattern scoring system used in CRA were constructed. Aggregate and individual level analyses resulted in similar orderings of countries on a one‐dimensional scale. There was a good correspondence between the orderings and countrys values on the CRA detrimental drinking pattern scale. The ordering of countries varied if men and women were scaled separately. The results indicated a bias of expert ratings towards focusing on male drinking patterns. From analysis of the survey data, the patterns in Nigeria appeared relatively more detrimental than the CRA score based on expert ratings, while the patterns in Finland appeared less detrimental. Future attempts to include drinking patterns in addition to volume should take gender differences into account.

The influence of drinking pattern, at individual and aggregate levels, on alcohol-related negative consequences.

Aim: To determine the extent drinking patterns (at the individual and country level) are associated with alcohol-related consequences over and above the total alcohol the person consumes. Methods: Hierarchical linear models were estimated based on general population surveys conducted in 18 countries participating in the GENACIS project. Results: In general, the positive association between drinking pattern scores and alcohol-related consequences was found at both the individual and country levels, independent of volume of drinking. In addition, a significant interaction effect indicated that the more detrimental the country’s drinking pattern, the less steep the association between the volume of drinking and its consequences. Conclusion: Drinking patterns have an independent impact on consequences over and above the relationship between volume and consequences.