Is there a link between per capita alcohol consumption and youth drinking? A time-series analysis for Sweden in 1972-2012

Mind the gap! Gender differences in alcohol consumption among Swedish ninth graders 1989-2021

INTRODUCTION

To examine gender differences in drinking habits among Swedish ninth graders over the period 1989-2021.

METHODS

Annual school surveys with nationally representative samples of ninth-grade students in Sweden covering the period 1989-2021, total sample of 180,538 students. Drinking habits were measured with self-reports of frequency and quantity of use and frequency of heavy episodic drinking. Differences between genders were compared annually and differences were tested using logistic and ordinary least square regression models with cluster robust standard errors.

RESULTS

Small gender differences in the prevalence of alcohol use during the first part of the study period were followed by an increasing gap over the past decade with girls being more likely to drink alcohol than boys. Boys consumed larger amounts of alcohol than girls during the first three decades of the studied period but no gender differences were found in later years. Binge drinking was more prevalent among boys during 1989 to 2000 but no systematic gender difference was found during the past 15 years.

DISCUSSION AND CONCLUSIONS

There used to be clear gender differences in drinking habits among ninth graders in Sweden with boys drinking more than girls. This gap has narrowed over the past three decades and among contemporary adolescents, no gender differences are found neither in binge drinking nor volume of drinking and the prevalence of drinking is even higher among girls.

Trends in alcohol-related harm among Swedish youth: Do in-patient care registry data match drinking trends?

INTRODUCTION

Youth drinking has been declining in Sweden since the year 2000. There is a paucity of studies examining trends in alcohol-related harm during this period. The overall aim of the present study is to examine how trends in alcohol-related harm match trends in drinking among Swedish youths during 2000-2021.

METHODS

Measures of alcohol use were obtained from national school surveys. Prevalence rates of any alcohol use and heavy episodic drinking were used. Alcohol-related harm indicators were obtained from registry information from the National Board of Health and Welfare. Annual trends in harm indicators were tested with linear regression models and correlations between alcohol use and alcohol-related harm indicators were assessed using Pearson's correlation on annual data.

RESULTS

Statistically significant negative trends were observed for all alcohol-related harm indicators for the period 2000-2021. Significant correlations were found for both measures of alcohol use and all alcohol-related harm indicators.

DISCUSSION AND CONCLUSIONS

The levels of alcohol-related harm have declined among youths in Sweden during the period 2000-2021. The trends in harm seem to reflect the decline in youth drinking that has occurred during the same period.

Trends in Tobacco Use among 9th Graders in Sweden, 1991-2020

Tobacco use was measured with self-reports of lifetime use of cigarettes and snus to examine trends in tobacco use among Swedish 9th graders over the period 1991-2020. Annual school surveys with nationally representative samples of 9th-grade students in Sweden covering the period 1991-2020 with a total sample of 163,617 students. We distinguished between the use of cigarettes only, use of snus only, dual use (use of both cigarettes and snus), and total tobacco use (use of any of these tobacco products). In addition to a graphical description of trends in the various measures of tobacco use, the correlation between these trends was calculated with the Pearson correlation coefficient (Rxy). The prevalence of total tobacco use declined from 72% in 1991 to 36% in 2020. The declining trend in total tobacco use was positively correlated with the trend in dual use (Rxy = 0.98) and the trend in cigarette use only (Rxy = 0.87). The trend in total tobacco use was, on the other hand, negatively correlated with snus use only (Rxy = -0.41), and snus use only was negatively correlated with cigarette use only (Rxy = -0.71). The situation became different after 2017 when total tobacco use increased as a result of an increasing prevalence of snus use. The sharp decline in tobacco use among 9th graders in Sweden over the past three decades is driven by declining cigarette use. The correlations between the various forms of tobacco use suggest that snus use may have contributed to the decline in cigarette use and, by that, overall tobacco use. The situation changed after 2017 when a sharp rise in snus use seems to have increased total tobacco use among adolescents in Sweden. A possible explanation behind this development is the introduction of a new form of snus called "All white snus", which was introduced in Sweden in 2014.

17 Is the New 15: Changing Alcohol Consumption among Swedish Youth

To examine and compare trends in drinking prevalence in nationally representative samples of Swedish 9th and 11th grade students between 2000 and 2018. A further aim is to compare drinking behaviours in the two age groups during years with similar drinking prevalence. Data were drawn from annual surveys of a nationally representative sample of students in year 9 (15-16 years old) and year 11 (17-18 years old). The data covered 19 years for year 9 and 16 years for year 11. Two reference years where the prevalence of drinking was similar were extracted for further comparison, 2018 for year 11 (n = 4878) and 2005 for year 9 (n = 5423). The reference years were compared with regard to the volume of drinking, heavy episodic drinking, having had an accident and quarrelling while drunk. The prevalence of drinking declined in both age groups during the study period. The rate of decline was somewhat higher among year 9 students. In 2018, the prevalence of drinking was the same for year 11 students as it was for year 9 students in 2005. The volume of drinking was lower among year 11 students in 2018 than year 9 students in 2005. No differences were observed for heavy episodic drinking. The decline in drinking has caused a displacement of consumption so that today's 17-18-year-olds have a similar drinking behaviour to what 15-16-year-olds had in 2005.

Cross-sectional study on the characteristics of unrecorded alcohol consumption in nine newly independent states between 2013 and 2017

OBJECTIVES

As unrecorded alcohol use contributes to a substantial burden of disease, this study characterises this phenomenon in newly independent states (NIS) of the former Soviet Union with regard to the sources of unrecorded alcohol, and the proportion of unrecorded of total alcohol consumption. We also investigate associated sociodemographic characteristics and drinking patterns.

DESIGN

Cross-sectional data on overall and unrecorded alcohol use in the past 7 days from WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) surveys. Descriptive statistics were calculated at the country level, hierarchical logistic and linear regression models were used to investigate sociodemographic characteristics and drinking patterns associated with using unrecorded alcohol.

SETTING

Nine NIS (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkmenistan and Uzbekistan) in the years 2013-2017.

PARTICIPANTS

Nationally representative samples including a total of 36 259 participants.

RESULTS

A total of 6251 participants (19.7%; 95% CI 7.9% to 31.5%) reported alcohol consumption in the past 7 days, 2185 of which (35.1%; 95% CI 8.2% to 62.0%) reported unrecorded alcohol consumption with pronounced differences between countries. The population-weighted average proportion of unrecorded consumption in nine NIS was 8.7% (95% CI 5.9% to 12.4%). The most common type of unrecorded alcohol was home-made spirits, followed by home-made beer and wine. Older (45-69 vs 25-44 years) and unemployed (vs employed) participants had higher odds of using unrecorded alcohol. More nuanced sociodemographic differences were observed for specific types of unrecorded alcohol.

CONCLUSIONS

This contribution is the first to highlight both, prevalence and composition of unrecorded alcohol consumption in nine NIS. The observed proportions and sources of unrecorded alcohol are discussed in light of local challenges in policy implementation, especially in regard to the newly formed Eurasian Economic Union (EAEU), as some but not all NIS are in the EAEU.

Declining youth drinking: A matter of faith?

Youth drinking has declined in many high-income countries for two decades. This development is still largely unexplained. Developing evidence and extending our understanding as to the mechanisms behind these changes is imperative for advising governments and policy makers on how to support and maintain the trends. Given the international scope of the trends, comparative studies have been suggested for improving our understanding of the development. In this commentary, we explore the patterns observed across several waves of the European School Survey Project on Alcohol and Other Drugs between 1999 and 2019, and how these match-up with the World Values Survey. We found that the declines in youth drinking are limited to a smaller number of countries and that in Europe these are all found in two groups from the World Values Survey, protestant Europe and English-speaking countries. If the declines in youth drinking are systematic and limited to a smaller number of countries, this challenges some of the hypothesised drivers of this development, but can also help guide future research.

Normalization of Non-Drinking? Health, School Situation and Social Relations among Swedish Ninth Graders That Drink and Do Not Drink Alcohol

Alcohol consumption is a major contributor to the disease burden among adolescents. The adolescent alcohol abstainer is still often depicted as problematic in the research literature and in prominent theoretical frameworks. However, over the past two decades, there has been a marked trend of declining youth drinking in Sweden. The declining trend has led to a shift in the majority behaviour of youth, from drinking to non-drinking. It is plausible that this trend has also shifted the position of non-drinkers. This paper examines the position of non-drinkers in a nationally representative sample of Swedish adolescents. A survey was carried out in 2017 in 500 randomly selected schools. A total of 5549 respondents (15-16-year-olds) agreed to participate and answered the questionnaire. A minority (42.8%) had consumed alcohol during their lifetime. The results show that non-drinkers had better health and school performance when compared to drinkers. The results also showed that there were no differences in the social position between non-drinkers and drinkers. These findings are new and indicate a changed position of non-drinkers among Swedish adolescents. With non-drinking being the majority behaviour among Swedish adolescents this seems to have shifted the position of non-drinkers. There is a need for research on the long-term importance of not drinking during adolescence.

Trends in alcohol intoxication among native and immigrant youth in Sweden, 1999-2017: A comparison across family structure and parental employment status

BACKGROUND

Developing a better understanding of drinking patterns across immigrant generations and how these change over time is important for the development of effective alcohol polices. This study investigates the direction and rate of change in youth alcohol intoxication over time, based on immigrant status, and by family structure and parental employment status.

METHOD

The study is based on eight nationally representative school surveys conducted by the Swedish National Council for Crime Prevention between 1999 and 2017, with a combined sample of 50,657 adolescents. Group by time interactions were examined to compare rates of change of alcohol intoxication over time across immigrant generations.

RESULTS

The results show a decreasing trend in alcohol intoxication among both first and second generation immigrant youth, and also among immigrant youth across different family structures and parental employment statuses. The results also show that the decrease in alcohol intoxication over time is greater for youths born abroad and for youths with two immigrant parents than for native Swedes, and that the decrease over time is greater for youths from intact families than for native Swedish youths from non-intact families and youths with one immigrant parent.

CONCLUSION

Native and first- and second-generation immigrant youth may differ substantially from one another in many ways, and may therefore manifest different patterns of drinking behaviours. From a policy and prevention perspective, the data in this study imply that native youths and youths with one immigrant parent should be a central target group for alcohol prevention policy in Sweden.

Assessing Heavy Episodic Drinking: A Random Survey of 18 to 34-Year-Olds in Four Cities in Four Different Continents

Background: Heavy episodic drinking (HED) can have health and social consequences. This study assesses the associations between HED and demographic, socioeconomic, motivation and effects indicators for people aged 18–34 years old living in four cities in different regions of the world. Method: Multistage random sampling was consistent across the four cities (Ilorin (Nigeria), Wuhan (China), Montevideo (Uruguay) and Moscow (Russia)). The questionnaire was forward/back translated and face-to-face interviewing was undertaken. A total of 6235 interviews were undertaken in 2014. Separate univariable and multivariable modelling was undertaken to determine the best predictors of HED. Results: HED prevalence was 9.0%. The best predictors differed for each city. The higher probability of HED in the final models included beliefs that they have reached adulthood, feeling relaxed as an effect of drinking alcohol, and forgetting problems as an effect of drinking alcohol. Lower probability of HED was associated with not being interested in alcohol as a reason for limiting alcohol, and the belief that drinking alcohol is too expensive or a waste of money. Conclusion: Although some indicators were common across the four cities, the variables included in the final models predominantly differed from city to city. The need for country-specific prevention and early intervention programs are warranted.

Adolescents drink less: How, who and why? A review of the recent research literature

ISSUES

Today's teenagers have been described as a sober generation and we asked: 'What is known about the recent decline in youth drinking?'

APPROACH

A literature review (2005-2017).

KEY FINDINGS

Research from wealthier parts of the world provides solid evidence of less alcohol use by youth since the millennium shift. Some studies show that this is reflected at all levels of consumption, but there are also indications that the heaviest drinkers have not reduced their drinking. The decrease is predominately seen in underage youth, and has been larger for boys than for girls in several countries. Teenagers across social strata drink less, but some disadvantaged subgroups have not followed the downward trend. Underage drinkers have apparently not become a more deviant group as the prevalence of drinking has dropped, indicating no hardening of the group. The major gap in the literature pertains to the issue of underlying driving forces. We found no evidence in support of the widespread assumption that the digital revolution has been of importance. A decline in parenting practices that are conductive to underage drinking has occurred in several countries, but studies examining whether these changes have contributed to less alcohol use by youth are almost non-existent.

IMPLICATIONS

To inform alcohol policy and prevention, it is imperative to find out why teenage drinking has decreased in a fairly consistent way across numerous countries.

CONCLUSION

Future research into the issue of falling prevalence rates of youth drinking should focus on possible explanatory factors at the population level rather than at the individual level.

Is there a link between per capita alcohol consumption and youth drinking? A time-series analysis for Sweden in 1972-2012

AIMS

To estimate the relationship between per capita alcohol consumption and youth drinking in Sweden during the last 40 years and to estimate the relationship between female and male youth drinking during the 40-year study period.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

Per capita alcohol consumption was proxied by official sales data, supplemented by data on unrecorded consumption. Youth consumption was measured by a question on heavy episodic drinking (HED) included in an annual school survey of alcohol and drug habits among Swedish 9th -grade students (15-16 years of age). The annual samples comprise approximately 5000 individuals (with roughly equal numbers of boys and girls) with response rates in the range 80-93%. The study spans the period 1972-2012. Autoregressive integrated moving average (ARIMA) time-series analysis was used to estimate the relation between per-capita alcohol consumption and youth drinking. Ocular inspection of the time-series data suggested a stronger synchronization between the two series in the early period, before the mid-1990s, than in the later period, indicating a structural shift in the relation at issue. We therefore conducted period specific time-series analyses with 1995 as the year of division.

RESULTS

There was a statistically significant relation between per capita alcohol consumption and HED among youth for 1972-94. A 1% increase in per capita alcohol consumption was associated with an increase in HED of 1.52% (P = 0.008). The estimate for 1995-2012 (0.12) was well below statistical significance (P = 0.580). The estimated elasticity of the association between boys' and girls' HED during 1972-94 was close to unity (0.98, P < 0.001), suggesting proportional changes in boys' and girls' drinking. When controlling for per capita consumption, the association was halved (to 0.55) but still significant in table 3 (P = 0.045).

CONCLUSIONS

Adult and youth drinking in Sweden were synchronized closely during the two last decades of the 20th century, but youth drinking developed an independent trajectory shortly before 2000.