Changes in alcohol availability, price and alcohol-related problems and the collectivity of drinking cultures: what happened in southern and northern Sweden?

Social network characteristics and alcohol use by ethnic origin: An ego-based network study on peer similarity, social relationships, and co-existing drinking habits among young Swedes

The study explores how social network determinants relate to the prevalence and frequency of alcohol use among peer dyads. It is studied how similar alcohol habits co-exist among persons (egos) and their peers (alters) when socio-demographic similarity (e.g., in ethnic origin), network composition and other socio-cultural aspects were considered. Data was ego-based responses derived from a Swedish national survey with a cohort of 23-year olds. The analytical sample included 7987 ego-alter pairs, which corresponds to 2071 individuals (egos). A so-called dyadic design was applied i.e., all components of the analysis refer to ego-alter pairs (dyads). Multilevel multinomial-models were used to analyse similarity in alcohol habits in relation to ego-alter similarity in ethnic background, religious beliefs, age, sex, risk-taking, educational level, closure in network, duration, and type of relationship, as well as interactions between ethnicity and central network characteristics. Ego-alter similarity in terms of ethnic origin, age and sex was associated with ego-alter similarity in alcohol use. That both ego and alters were non-religious and were members of closed networks also had an impact on similarity in alcohol habits. It was concluded that network similarity might be an explanation for the co-existence of alcohol use among members of peer networks.

Decline in alcohol consumption in Russia: Collectivity or polarisation?

INTRODUCTION

Sales and survey data have shown a decline in alcohol consumption in Russia since 2007. This study examines whether this decline is consistent across lighter and heavier drinkers in line with the theory of the collectivity of drinking cultures.

METHODS

Data were collected through annual nationally representative surveys conducted between 2006 and 2018 of 33 109 individuals aged 18-85 years. We estimated generalised linear regression with Gamma distribution and used log alcohol volume consumed during the previous 30 days as the dependent variable for five percentile groups: heavy drinkers (95th), near heavy drinkers (90th), moderate drinkers (80th), light drinkers (60th for men and 70th for women) and non-drinkers. Dummy variables for years, percentile groups and their interactions were used as independent variables. The controls were age, education, income, body weight, marital status, household demographic structure, residence, ethnicity and regional climate.

RESULTS

Reductions in alcohol consumption were observed in all percentiles, but the scale of change was proportionally smaller among heavier drinkers than among lighter drinkers. However, consumption fell by a smaller amount among lighter drinkers than among heavier drinkers. Results of the regression analysis fit with the descriptive statistics. Interactions between the time period and the percentile groups were significant after 2010. Trends were similar for both sexes.

DISCUSSION AND CONCLUSIONS

Downward trends across percentiles were in the same direction but the magnitude of change varied. Obtained evidence fails to support a polarisation and points towards soft collectivity hypothesis in the reduction in drinking in Russia.

The impact of relaxed traveller allowances: Fixed-effects analyses of the associations between consumer behaviour and alcohol use

Aim:

To analyse to what extent the gradual relaxation of traveller allowances for alcoholic beverages 2001–2004 changed consumer behaviours and subsequent alcohol consumption patterns within a longitudinal panel data population study in Southern Sweden.

Methods:

General population random sample panel data study with repeated measurements were collected in 1999, in 2005, and in 2010 in the county of Scania. The study analyses answers from 9770 individuals, who in 1999 were 18–80 years old. A fixed-effects modelling was applied to assess the association between consumer behaviour and change in alcohol use across the study period.

Results:

Cross-border shopping for alcoholic beverages was associated, on average, with a 3.1% (p < 0.001) increase in alcohol use. Buying imported alcohol from a private person was associated with a mean increase of 2.6% (p < 0.001), with a total additive effect of 5.7%. Furthermore, when stratified for gender, age, and location, significant fixed effects were found. The magnitude was greater among women, younger and older ages, and in particular in the Northeast and Central regions. Both consumer behaviours – cross-border trading (OR 1.6, CI 95% 1.28–1.92) and buying alcohol from a private person (OR 1.4, CI 95% 1.12–1.73) – were significantly associated with heavy alcohol use.

Conclusion:

The fixed-effects analyses identified significant associations between consumer behaviours and alcohol consumption. The uptake of behaviours that developed because of a relaxation of the Swedish alcohol policy has contributed to an overall long-term increase in alcohol use and higher prevalence of heavy alcohol use within this general population study sample.

Trajectories of positive alcohol expectancies and drinking: An examination of young adults in the US and Sweden

Positive alcohol expectancies and alcohol use tend to increase from adolescence to young adulthood, yet little is known about the associations between these constructs across cultures. The current study adds to the extant literature by examining the growth trajectories of positive alcohol expectancies and drinking behavior among United States (US) and Swedish participants during a critical period where significant change in these outcomes may be expected to occur. A total of 870 (US, N=362; Sweden, N=508) high school seniors completed baseline, 6-month, and 12-month assessments of alcohol expectancies and drinking (i.e., drinks per week). Changes in positive alcohol expectancies and drinking behavior were examined using a parallel process latent growth model. In both samples, higher baseline levels of positive alcohol expectancies were associated with a higher number of drinks consumed per week at baseline. In the US sample, lower baseline levels of positive alcohol expectancies were associated with a greater increase in positive alcohol expectancies at 12-month follow-up, and lower baseline levels of drinks per week were associated with a greater increase in drinks consumed per week at 12-month follow-up. In the Swedish sample, an increase in positive alcohol expectancies over time was associated with an increase in drinks consumed per week over the same period of time. Additional research is needed to examine when and for whom expectancy-based alcohol interventions are most efficacious.

What happens to drinking when alcohol policy changes? A review of five natural experiments for alcohol taxes, prices, and availability

Natural experiments are an important alternative to observational and econometric studies. This paper provides a review of results from empirical studies of alcohol policy interventions in five countries: Denmark, Finland, Hong Kong, Sweden, and Switzerland. Major policy changes were removal of quotas on travelers' tax-free imports and reductions in alcohol taxes. A total of 29 primary articles are reviewed, which contain 35 sets of results for alcohol consumption by various subpopulations and time periods. For each country, the review summarizes and examines: (1) history of tax/quota policy interventions and price changes; (2) graphical trends for alcohol consumption and liver disease mortality; and (3) empirical results for policy effects on alcohol consumption and drinking patterns. We also compare cross-country results for three select outcomes-binge drinking, alcohol consumption by youth and young adults, and heavy consumption by older adults. Overall, we find a lack of consistent results for consumption both within- and across-countries, with a general finding that alcohol tax interventions had selective, rather than broad, impacts on subpopulations and drinking patterns. Policy implications of these findings are discussed.

Collectivity of drinking behavior among adolescents: An analysis of the Norwegian ESPAD data 1995-2011

Aims

The aim of the current study was to test empirically two predictions from Skog's theory of collectivity of drinking behavior, using time series data from Norwegian adolescents. The two specific predictions were: 1) A change in mean alcohol consumption is positively associated with a change in the proportion of heavy drinkers, and 2) A change in mean alcohol consumption is positively associated with a change at all consumption levels.

Data & Methods

The present analyses are based on ESPAD data collected from Norwegian adolescents (15-16 years) in 1995, 1999, 2003, 2007 and 2011. The relationship between mean consumption and the proportion of heavy drinkers was analyzed by regressing the proportions of heavy drinkers at each time point on the consumption means at each time point. In order to assess whether adolescents at all consumption levels, from light to heavy drinkers, changed collectively as mean consumption changed, we regressed log-transformed consumption means on the log-transformed percentile values (P25, P50, P75, P90 and P95). The analysis was restricted to adolescents who had consumed alcohol in the last 30 days (total n = 7554).

Results

The results showed a strong relationship between mean alcohol consumption and the proportion of heavy drinkers. An increase in mean consumption was also associated with an increase at all consumption levels, from light to heavy drinkers.

Conclusion

The results of the current study are in line with the theory of collectivity of drinking behavior. The findings of this study suggest that by reducing the total consumption of alcohol among adolescents, consumption and risk of harm may be reduced in all consumer groups.

Explaining trends in alcohol-related harms in Scotland 1991-2011 (II): policy, social norms, the alcohol market, clinical changes and a synthesis

OBJECTIVE

To provide a basis for evaluating post-2007 alcohol policy in Scotland, this paper tests the extent to which pre-2007 policy, the alcohol market, culture or clinical changes might explain differences in the magnitude and trends in alcohol-related mortality outcomes in Scotland compared to England & Wales (E&W).

STUDY DESIGN

Rapid literature reviews, descriptive analysis of routine data and narrative synthesis.

METHODS

We assessed the impact of pre-2007 Scottish policy and policy in the comparison areas in relation to the literature on effective alcohol policy. Rapid literature reviews were conducted to assess cultural changes and the potential role of substitution effects between alcohol and illicit drugs. The availability of alcohol was assessed by examining the trends in the number of alcohol outlets over time. The impact of clinical changes was assessed in consultation with key informants. The impact of all the identified factors were then summarised and synthesised narratively.

RESULTS

The companion paper showed that part of the rise and fall in alcohol-related mortality in Scotland, and part of the differing trend to E&W, were predicted by a model linking income trends and alcohol-related mortality. Lagged effects from historical deindustrialisation and socio-economic changes exposures also remain plausible from the available data. This paper shows that policy differences or changes prior to 2007 are unlikely to have been important in explaining the trends. There is some evidence that aspects of alcohol culture in Scotland may be different (more concentrated and home drinking) but it seems unlikely that this has been an important driver of the trends or the differences with E&W other than through interaction with changing incomes and lagged socio-economic effects. Substitution effects with illicit drugs and clinical changes are unlikely to have substantially changed alcohol-related harms: however, the increase in alcohol availability across the UK is likely to partly explain the rise in alcohol-related mortality during the 1990s.

CONCLUSIONS

Future policy should ensure that alcohol affordability and availability, as well as socio-economic inequality, are reduced, in order to maintain downward trends in alcohol-related mortality in Scotland.

Alcohol prices, taxes, and alcohol-related harms: A critical review of natural experiments in alcohol policy for nine countries

OBJECTIVE

Evidence for alcohol-price policy relies heavily on aggregate econometric studies for the United States. Prior reviews of prices and alcohol-related harms include only a few studies based on natural experiments. This study provides a comprehensive review of natural experiments for a wide variety of harms from studies published during 2003 to 2015. We examine policy changes that importantly affected alcohol taxes and prices, and related changes in availability.

METHODS

Forty-five studies met inclusion criteria, covering nine countries: Australia, Denmark, Finland, Hong Kong, Iceland, Russia, Sweden, Switzerland, and United States. Some studies cover more than one harm or country, and there are 69 outcomes for review. Summaries are provided for five outcome groups: alcohol-related mortality and hospitalizations; assaults and other crime; drink-driving; intoxication; and survey-indexes for dependency. The review notes both positive/mixed results and negative/null results.

RESULTS

Findings indicate that changes in taxes and prices have selective effects on harms. Mortality outcomes are positive for liver disease and older persons, especially in Finland and Russia. Mostly null results for assaults and drink-driving are found for five countries. Intoxication results for Nordic countries are mixed for selective subpopulations. Results for survey indexes are mixed, with no strong pattern of outcomes within or across countries.

CONCLUSION

Prior reviews stress taxes as a comprehensive and cost-effective intervention for addressing alcohol-related harms. A review of natural experiments indicates the confidence placed on this measure is too high, and natural experiments in alcohol policy had selective effects on various subpopulations.

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.

The impact of policy changes on consumer behaviour and alcohol consumption in Scania, Sweden 1999-2005

AIMS

To analyse the hypothesis that a gradual deregulation of traveller allowances, starting in 2001 and ending in 2004, on alcoholic beverages changed consumer behaviours that ultimately led to an increase in alcohol consumption in southern Sweden between in 2005 compared with 1999.

METHODS

The data for this general population random sample prospective cohort study with repeated measurements were collected in 1999 (T1) and in 2005 (T2) in the county of Scania, analysing the answers from 8612 individuals, who at T1 were alcohol consumers and 18-80 years old.

RESULTS

Aggregate age-adjusted general mean alcohol consumption did not change significantly between T1 and T2. Significant downward changes were found in a number of demographical and socioeconomic sub-groups. Generalized linear model analyses indicated that the uptake of buying alcohol from a private person was associated with significantly higher consumption (P < 0.001). No longer buying alcohol from a private person, consuming illicitly distilled spirits or buying alcohol abroad were significantly associated with lower consumption at follow-up. Interaction effects between changing consumer behaviours were also identified.

CONCLUSION

The deregulation of the cross-border trade of alcohol into Sweden did not, within our sample, lead to an increase in consumption. There were, however, significant decreases in consumption levels within different socio-demographic sub-groups. In relation to changing consumer behaviours both upward and downward shifts in drinking trends were observed.

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.

Changes in alcohol drinking patterns and their consequences among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples

AIMS

To describe changes in the patterns and consequences of alcohol use among Norwegian doctors from 2000 to 2010.

METHODS

Longitudinal study based on data from nation-wide postal surveys in 2000 and 2010 among a representative sample of 682 doctors in Norway. The Alcohol Use Disorder Identification Test (AUDIT) was used to measure the changes in drinking patterns (frequency of drinking, frequency of heavy drinking and quantity of drinking), symptoms of alcohol dependence and adverse consequences of drinking. A score above 8 was defined as hazardous drinking.

RESULTS

From 2000 to 2010, the proportion of doctors who used alcohol twice a week or more significantly increased from 31.4 (27.9-34.9) % to 48.7 (44.9-48.7) %, and the proportion of those who drank to intoxication weekly or more decreased significantly from 6.6 (4.7-8.6) % to 2.5 (1.3-1.7) %. The proportion who scored above 8 on the AUDIT decreased from 10.7 (8.4-13.0) % in 2000 to 8.2 (6.2-10.3) % in 2010. There was a significant increase in the partial AUDIT-score for drinking patterns (t = 2.4; P = 0.016), and a significant decrease in the partial AUDIT-score for adverse consequences of drinking (t = -3.6; P < 0.001). The partial AUDIT-score for symptoms of alcohol dependence did not change significantly (t = -1.6; P = 0.112). There were gender differences in drinking patterns. Females had less frequent alcohol consumption and fewer episodes of heavy and hazardous drinking in 2000 and 2010.

CONCLUSION

The drinking pattern of Norwegian doctors has changed over the past decade towards more moderate alcohol consumption and less negative alcohol-related consequences. Changes in the attitude towards alcohol consumption may to a certain extent explain these findings.

The use of epidemiology in alcohol research

AIMS

This paper presents examples to illustrate the utility and limitations in the use of epidemiology in alcohol research and discusses some promising new directions.

METHODS

Review of literature, concentrating on epidemiological alcohol research with relevance to public health.

FINDINGS AND CONCLUSION

Epidemiology offers tools for assessment of causes and effects of alcohol consumption as well as the effects of efforts to prevent alcohol consumption and its consequences. Epidemiological studies have made significant contributions to alcohol research with respect to public health and public policy. Fixed-effects modelling, difference-in-differences estimation and integrated qualitative and epidemiological methods are promising but underused methods in epidemiological studies. Many epidemiological studies have limited transferability of knowledge to other cultures and jurisdictions.