Similar countries, similar factors? Studying the decline of heavy episodic drinking in adolescents in Finland, Norway and Sweden

How well do DSM-5 criteria measure alcohol use disorder in the general population of older Swedish adolescents? An item response theory analysis

BACKGROUND

This study assesses the psychometric properties of DSM-5 criteria of AUD in older Swedish adolescents using item response theory models, focusing specifically on the precision of the scale at the cut-offs for mild, moderate, and severe AUD.

METHODS

Data from the second wave of Futura01 was used. Futura01 is a nationally representative cohort study of Swedish people born 2001 and data for the second wave was collected when participants were 17/18 years old. This study included only participants who had consumed alcohol during the past 12 months (n = 2648). AUD was measured with 11 binary items. A 2-parameter logistic item response theory model (2PL) estimated the items' difficulty and discrimination parameters.

RESULTS

31.8% of the participants met criteria for AUD. Among these, 75.6% had mild AUD, 18.3% had moderate, and 6.1% had severe AUD. A unidimensional AUD model had a good fit and 2PL models showed that the scale measured AUD over all three cut-offs for AUD severity. Although discrimination parameters ranged from moderate (1.24) to very high (2.38), the more commonly endorsed items discriminated less well than the more difficult items, as also reflected in less precision of the estimates at lower levels of AUD severity. The diagnostic uncertainty was pronounced at the cut-off for mild AUD.

CONCLUSION

DSM-5 criteria measure AUD with better precision at higher levels of AUD severity than at lower levels. As most older adolescents who fulfil an AUD diagnosis are in the mild category, notable uncertainties are involved when an AUD diagnosis is set in this group.

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.

Changes in co-use of alcohol and cannabis among Nordic adolescents in the 21st century: Results from the European School Survey Project on Alcohol and Other Drugs study

INTRODUCTION

In the 21st century, there has been a decline in alcohol use among adolescents in most Nordic countries, while trends of cannabis use have diverged. We explore how alcohol and cannabis use, respectively, and co-use of the two substances, have changed among Nordic adolescents. Three hypotheses are used to frame the study: (i) cannabis use has substituted alcohol use; (ii) there has been a parallel decline in both substances; and/or (iii) there has been a 'hardening' of users, implying that alcohol users increasingly use cannabis.

METHODS

Data from the European School Survey Project on Alcohol and Other Drugs, conducted among 15- to 16-year-olds in Denmark, Finland, Iceland, Norway and Sweden (N = 74,700, 49% boys), were used to explore trends of past-year alcohol and cannabis use in the period 2003-2019.

RESULTS

The proportion of adolescents reporting alcohol use decreased significantly in all Nordic countries except Denmark. The proportion of those using cannabis only was low (0.0%-0.7%) and stable in all countries. The total number of substance use occasions declined among all adolescents in all countries but Denmark. Among alcohol users, cannabis use became increasingly prevalent in all countries but Denmark.

DISCUSSION AND CONCLUSIONS

We found no support for the 'parallel decline hypothesis' in alcohol and cannabis use among Nordic adolescents. Partially in line with the 'substitution hypothesis', cannabis use accounted for an increasing proportion of all substance use occasions. Our results suggests that the co-use of alcohol and cannabis has become more common, thus also providing support to the 'hardening' hypothesis.

Understanding youth drinking decline: Similarity and change in the function and social meaning of alcohol use (and non-use) in adolescent cohorts 20 years apart

INTRODUCTION

Qualitative research aimed at understanding the decline in youth drinking has so far been hampered by a lack of baseline data for comparison. This New Zealand study overcomes this limitation by comparing archival qualitative data collected at the height of youth drinking (1999-2001) with contemporary data collected for this study (June-October 2022). The aim is to explore changes in the function and social meaning of alcohol use (and non-use) for two cohorts about 20 years apart.

METHODS

Both archival and contemporary data were collected from 14 to 17 year old secondary school students (years 10-12) through individual and small-group/pair interviews in matched suburban co-ed schools. Interviews explored friendships, lifestyles, romantic relationships and experiences and perceptions of substance use and non-use.

RESULTS AND DISCUSSION

Comparative analysis highlighted changes that may help to explain the decline in youth drinking, including an increased value placed on personal choice and acceptance of diversity; decreased face-to-face socialising and the emergence of social media as a central feature of adolescent social life, perhaps displacing key functions of drinking and partying; increased pervasiveness of risk discourses and increased awareness of health and social risks of alcohol; and increased framing of alcohol use as a coping mechanism by both drinkers and non-drinkers.

CONCLUSIONS

Collectively, these changes appear to have shifted the social position of drinking from an almost compulsory component of adolescent social life in 1999-2001, to an optional activity that many contemporary adolescents perceive to have high risks and few benefits.

Increases in Sleep Difficulties and Psychological Symptoms are Associated With the Increase of Chronic Back Pain in Adolescents: The HBSC Study 2002 to 2018

Cross-national research using data from the Health Behavior in School-aged Children (HBSC) survey showed an increase in the prevalence of chronic back pain from 2002 to 2014. However, it is unknown if this trend has persisted beyond 2014. The aims of this study were to 1) determine if the prevalence of chronic back pain in girls and boys aged 11, 13, and 15 continued to increase from 2014 to 2018 and if this was the case, 2) examine whether this increase in the prevalence of chronic back pain between 2002 and 2018 was explained indirectly by increases in sleep difficulties and psychological symptoms. Data from 7,89,596 adolescents retrieved from 5 waves of the HBSC survey conducted in 2002, 2006, 2010, 2014, and 2018 in 32 countries/regions were used. Logistic regressions and path analyses were conducted. Results showed an overall increase of .5% in the prevalence of chronic back pain between 2014 and 2018, ranging from .4% for 15-year-old girls to 1.3% for 11-year-old boys, indicating a continued overall increase in chronic back pain in adolescents beyond 2014. For 13-year-old girls and for 15-year-old girls and boys, the increase in the prevalence of chronic back pain between 2002 and 2018 was partially mediated by increases in sleep difficulties, which in turn were associated with increases in psychological symptoms. The findings provide important information that may aid stakeholders in enhancing public health initiatives to prevent or reduce the increasing trend in the prevalence of chronic back pain in adolescents. PERSPECTIVE: This study shows that chronic back pain prevalence continues to increase among adolescents, with sleep difficulties and psychological symptoms contributing significantly to this trend. The findings provide insights that may inform strategies to prevent or reduce the increasing trend of chronic back pain in adolescents.

Does the decline in Swedish adolescent drinking persist into early adulthood?

BACKGROUND AND AIMS

Sweden has experienced a substantial decrease in adolescent drinking over the past decades. Whether the reduction persists into early adulthood remains unclear. Using survey data, the present study aimed to determine whether reductions in indicators of alcohol use observed among adolescents remain in early adulthood and whether changes in alcohol intake are consistent among light/moderate and heavy drinkers.

DESIGN

Data from the Swedish monthly Alcohol Monitoring Survey (2001-20) were used to construct five 5-year birth cohorts (1978-82, 1983-87, 1988-92, 1993-97 and 1998-2002).

SETTING

Sweden.

PARTICIPANTS

A total of n = 52 847 respondents (48% females) aged 16 and 30 years were included in this study.

MEASUREMENTS

For both males and females, temporal changes in the prevalence of any drinking, the prevalence of heavy episodic drinking (HED) and total alcohol intake in the past 30 days in centilitres were analysed.

FINDINGS

The prevalence of any drinking in more recent cohorts remained low until young people came into their early (females) and mid- (males) 20s. Male cohorts differed in the prevalence of HED across age, with the later cohorts showing lower odds than earlier cohorts (odds ratios between 0.54 and 0.66). Among females, no systematic differences between cohorts across age could be observed. Later male birth cohorts in light/moderate drinkers had lower alcohol intake than earlier cohorts (correlation coefficients between -0.09 and -0.54). No statistically significant cohort effects were found for male heavy drinkers. Although differences in alcohol intake among females diminished as age increased, the cohorts did not differ systematically in their level of alcohol intake.

CONCLUSIONS

In Sweden, the reduced uptake of drinking in adolescents appears to fade as people move into adulthood. Observed reductions in alcohol intake among light and moderate drinkers appear to persist into adulthood. More recent male cohorts show a lower prevalence rate of heavy episodic drinking.

Socioeconomic Inequalities in Alcohol and Tobacco Consumption: A National Ecological Study in Mexican Adolescents

Alcohol and cigarettes are the psychoactive substances that adolescents use most frequently. When both addictions are combined, they carry the worst burden of disease globally. The objective of this study was to identify whether socioeconomic factors correlate with alcohol and tobacco consumption in Mexican adolescents aged 10 years or more and to establish the relationship in the consumption between the two substances. This ecological study utilized data describing alcohol and tobacco consumption among adolescents aged 10-16 years (n = 48,837 ≈ N = 11,621,100). Having ever consumed any alcohol-containing beverage constituted alcohol consumption. Smoking a cigarette within 30 days constituted cigarette consumption. For both variables, the state-level percentages reported in the survey were used. Diverse socioeconomic variables were collected from official sources. Data on the prevalence of tobacco use and alcohol consumption were entered into an Excel database estimated for each of the states of the Mexican Republic, as well as the socioeconomic variables. We performed the analysis using Stata 14. Consumption prevalence was 15.0% for alcohol and 4.2% for tobacco. Alcohol consumption was not correlated with any studied socioeconomic variable (p > 0.05). The prevalence of tobacco consumption among elementary school students correlated (p < 0.05) with the portion of the population living in private dwellings without sewage, drainage, or sanitation (r = 0.3853). The prevalence of tobacco consumption among middle-school adolescents correlated with the portion of the employed population that earned up to two minimum wages (r = 0.3960), the percentage in poverty by income 2008 (r = 0.4754) and 2010 (r = 0.4531), and the percentage in extreme poverty by income 2008 (r = 0.4612) and 2010 (r = 0.4291). Positive correlations were found between tobacco consumption and alcohol consumption among both elementary (r = 0.5762, p=0.0006) and middle-school children (r = 0.7016, p=0.0000). These results suggest that certain socioeconomic factors correlate with tobacco consumption but not alcohol consumption. A correlation between alcohol consumption and tobacco consumption was observed. The results can be used for developing interventions in adolescents.

Trends in and factors associated with parental provision of alcohol to minors in Western Australia, 2013-2019

INTRODUCTION

Some parents provide alcohol to their underage children, despite a range of negative outcomes being associated with this practice. The present study aimed to assess factors associated with and changes in parental provision behaviours from 2013 to 2019 in Western Australia.

METHODS

Annual cross-sectional online surveys were conducted (total n = 2635). Assessed variables included parents' demographic characteristics, alcohol use, awareness of the relevant Australian alcohol guideline, attitudes to parental provision of alcohol and provision behaviours. A binary logistic generalised linear model was used to identify factors associated with parental provision of alcohol.

RESULTS

Parental provision of alcohol prevalence decreased from 40% in 2013 to 27% in 2019. The following variables were significantly associated with parental provision: permissive attitudes to provision (β = 2.82); older parental age (β = 1.28); a lack of knowledge of the relevant guideline (β = 0.78); survey year (β = 0.083); and greater alcohol use (β = 1.12). Socioeconomic position was not associated with parental provision. Female parents were more likely to report that an adult in the household provided children with alcohol (β = 1.3) DISCUSSION AND CONCLUSIONS: The findings suggest that (i) although still commonplace, parental provision of alcohol to minors in Western Australia has declined over time; and (ii) the effectiveness of campaigns aiming to reduce this behaviour may be enhanced by targeting households with parents who are older and heavier drinkers and by including content that challenges permissive views on alcohol provision to minors.

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.

Abstainers and Drinkers - Two Sides of the Same Coin?

This commentary discusses a recently published literature review focussing on the growing trend of young people abstaining from drinking alcohol. Despite the recent increase in research on the decline in youth drinking, the review only identified 10 papers that explicitly examined abstainers. The inclusion criteria used thus excluded and overlooked the vast literature available on the decline in youth drinking. This commentary discusses the implications of this and raises the issue of how the adolescent abstainer should be viewed in research; is it a distinct social phenomenon with unique determinants or are abstainers merely the flip side of drinkers?

Generational shifts in attitudes and beliefs about alcohol: An age-period-cohort approach

INTRODUCTION AND AIMS

Population level alcohol consumption has declined markedly in Australia in the past two decades, with distinct generational patterns. The underlying reason for this shift remains unclear and there has been little work assessing how attitudes and beliefs about alcohol have shifted in population sub-groups.

DESIGN AND METHODS

Using seven waves of survey data spanning 19 years (2001-2019, n = 166,093 respondents aged 14 +), we assess age, time-period and birth cohort effects on trends in four measures of alcohol attitudes (disapproval of regular alcohol use, perceptions of safe drinking levels for men and women and perception that alcohol causes the most deaths of any drug in Australia).

RESULTS

There were steady increases in period effects for perceived safe drinking levels (especially for men) and belief that alcohol causes the most deaths. Disapproval of regular use has been stable at the population level, but there are marked cohort differences, with early and recent cohorts more likely than others to disapprove of regular alcohol use.

DISCUSSIONS AND CONCLUSIONS

These findings point to a broad lowering of perceived safe levels of drinking across the population alongside a sharp increase in disapproval of drinking for recent cohorts, potentially contributing to the reductions in drinking that have been reported in these cohorts.

Hazardous alcohol use among Danish adolescents during the second wave of COVID-19: Link between alcohol use and social life

Background: Adolescent drinking has historically been closely linked to social events, and across many countries, students typically increase drinking rates when they transition to upper secondary school. COVID-19-related restrictions offered a unique possibility to examine how changes in social life impact adolescent drinking in the transition to upper secondary school. Aim: The current study investigated changes in hazardous alcohol use, social life and well-being among Danish first-year students (mean age = 16.8 years) during the second wave of the COVID-19 pandemic when restrictions gradually became more intensified. Methods: Data were collected at two time points among 352 Danish students in the first months of upper secondary school (August and November 2020). Multilevel regression models tested changes across time on past 30 days hazardous alcohol use (dependent variables). Separate models tested whether changes in alcohol use were related to gender, social interaction, loneliness and mental health. Results: During increased COVID-19-related restrictions in the second wave, students decreased the frequency and quantity of drinking (number of drinking days and binge drinking), which was associated with attending fewer parties. Students also reported less high-intensity drinking and fewer alcohol-related consequences. Students reported better mental health, but more students were affected by loneliness. Changes in mental health or loneliness were not related to reduced hazardous alcohol use. Conclusion: Our results provide evidence that alcohol use decreased among Danish students transitioning to upper secondary school during the COVID-19 pandemic when restrictions increased, thereby providing support for a close link between adolescent alcohol use and social life; this is an important frame that is relevant when designing interventions to promote healthier and less risky choices throughout the next phase(s) of the pandemic and in general.

The Declining Trend in Adolescent Drinking: Do Volume and Drinking Pattern Go Hand in Hand?

Traditionally, adolescent drinking cultures differed between Nordic and Mediterranean countries; the former being characterised by low volume and relatively frequent heavy episodic drinking (HED). Across these drinking cultures, we examined the associations between alcohol volume and HED with respect to (i) secular trends at the country level and (ii) individual-level associations over time. The data stem from the European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted among 15–16-year-olds in Finland, Iceland, Norway, Sweden, France and Italy, employing six cross-sectional surveys from 1999 to 2019 (n = 126,126). Both consumption volume and HED frequency decreased in all Nordic countries and displayed a curvilinear trend in France and Italy. In all countries, consumption volume and HED correlated highly over time at the country level. At the individual level, the correlation was positive but with a varying magnitude over time and between countries. In 1999/2003, the alcohol volume–HED correlation was significantly higher in the Nordic compared to the Mediterranean countries but became significantly weaker in Finland, Norway and Sweden and remained stable in France, Iceland and Italy during the period. In conclusion, while trends in consumption volume and drinking patterns went hand in hand at the aggregate level, the association at the individual level weakened over time in several Nordic countries, along with the substantial decline in adolescent drinking since 2000.

Declining Trend in Adolescent Alcohol Use: Does It Have Any Significance for Drinking Behaviour in Young Adulthood?

Since 2000, adolescent alcohol use has declined substantially in many high-income countries, particularly in Northern Europe. This study examined whether birth cohorts in Norway who experienced different levels of alcohol consumption in mid-adolescence differed in drinking behaviour when they reached young adulthood. We analysed data from annual population surveys in Norway (2012–2021). The analytic sample comprised data from respondents aged 20–29 years (N = 5266), and we applied four birth cohorts (i.e., 1983–1987, 1988–1992, 1993–1996 and 1997–2001). We applied age categories with two- and five-year intervals and tested whether drinking frequency, heavy episodic drinking (HED) and usual number of drinks per drinking occasion during the past 12 months differed by birth cohort in age-specific strata. Possible cohort differences within age groups were tested using Pearson’s Chi square. There were no statistically significant differences between cohorts with respect to drinking frequency or HED frequency. However, the youngest cohort had fewer drinks per occasion when in their early 20s compared to older cohorts. This study showed that birth cohorts who differed substantially in levels of alcohol consumption in mid-adolescence, only to a little extent differed in drinking behaviour in young adulthood.

The Explanatory Role of Sedentary Screen Time and Obesity in the Increase of Chronic Back Pain among European Adolescents: The HBSC Study 2002-2014

Background

Previous research has shown that chronic back pain amongst European adolescents is increasing. Determining the factors associated with this increasing trend is crucial for developing prevention strategies. In this study, we used data from the Health Behaviour in School‐aged Children (HBSC) survey to examine whether increases in screen time and/or obesity between 2002 and 2014 were associated with the increase in the prevalence of chronic back pain amongst European adolescents during the 12‐year period.

Methods

Data from 423,092 adolescents from 27 European countries/regions were drawn from the HBSC questionnaire‐based surveys conducted in 2002, 2006, 2010 and 2014. The Karlson–Holm–Breen method was used to examine the explanatory role of increases in screen time and obesity on the increase in the prevalence of chronic back pain whilst controlling for sex and age.

Results

Increases in both screen time and obesity between 2002 and 2014 were associated with increases in the prevalence of chronic back pain (p < 0.001). The percent of chronic back pain prevalence increase accounted for by screen time and obesity was 3.98% and 1.65%, respectively.

Conclusions

The increase in the prevalence of chronic back pain amongst European adolescents may be explained, in part, by the rising trends in both sedentary screen time and obesity. The fact that screen time and obesity only accounted for a small part of the increase in the prevalence of chronic back pain indicates that other unmeasured factors also play a role.

Significance

More screen time and obesity are slightly associated with more chronic back pain (CBP) prevalence in adolescents across the WHO European Region. The findings may be used to identify ways to prevent or reduce the rising trend of CBP in adolescents.

Declining drinking among adolescents: Are we seeing a denormalisation of drinking and a normalisation of non-drinking?

BACKGROUND

In the early 2000s, alcohol use among young people began to decline in many western countries, especially among adolescents (ages between 12-17 years old). These declines have continued steadily over the past two decades, against the backdrop of much smaller declines among the general population.

ARGUMENT

Hypotheses examining individual factors fail adequately to provide the necessary 'big picture' thinking needed to understand declines in adolescent drinking. We use the normalisation thesis to argue that there is strong international evidence for both processes of denormalisation of drinking and normalisation of non-drinking occurring for adolescents in many western countries.

CONCLUSIONS

Research on declining adolescent drinking provides evidence of both denormalisation of alcohol consumption and normalisation of non-drinking. This has implications for enabling policy environments more amenable to regulation and increasing the acceptability of non-drinking in social contexts. Normalisation theory (and its various interpretations) provides a useful multi-dimensional tool for understanding declines in adolescent drinking.

Declines in alcohol consumption in Australia: some challenges to the theory of collectivity

BACKGROUND AND AIMS

There is significant debate about whether or not changes in per-capita alcohol consumption occur collectively across the entire distribution of drinking. This study used data from a decade of declining drinking in Australia to test the collectivity of drinking trends.

DESIGN

Repeated cross-sectional surveys (2010, 2013, 2016, 2019), analysed with quantile regression techniques assessing trends in drinking for 20 quantile groups.

SETTING

Australia.

PARTICIPANTS

A general population sample (total n = 85 891; males = 39 182, females = 46 709) aged 14 years and over.

MEASUREMENTS

Past-year volume of alcohol consumed was measured using standard graduated frequency survey questions. Models were stratified by sex and age group.

FINDINGS

Throughout the whole population, alcohol consumption had declined in all percentile groups, with the largest proportional declines evident for light and moderate drinkers [e.g. drinkers in the 25th percentile declined by 32.7%; 95% confidence interval (CI) = -41.6, -22.3% per wave]. Broadly collective declines were also found for younger men and women with significant declines in every percentile group, but older groups showed some evidence of polarization. For example, women aged 45-64 years significantly increased their consumption (2.9% per wave, 95% CI = 0.3-5.5%), while consumption for those in the 25th percentile fell significantly (-16.7%, 95% CI = -27.6, -4.2%).

CONCLUSIONS

The declines in Australian drinking since 2010 have included important deviations from the collectivity predicted by Skog's influential theory of collectivity of drinking, with markedly different patterns evident among different demographic groups.

Tracking the decline in Australian adolescent drinking into adulthood

BACKGROUND AND AIMS

Adolescent drinking in Australia (and many other countries) has declined substantially since the early 2000s. This study aimed to test whether these declines have been maintained into adulthood and whether they are consistent across sub-groups defined by sex and socio-economic status.

DESIGN

Quasi-cohorts were constructed from seven repeated waves of cross-sectional household survey data (2001-2019).

SETTING

Australia.

PARTICIPANTS

A total of 20 733 respondents age between 14 and 24 (male: 9492; female: 11 241).

MEASUREMENTS

Participants were grouped into five cohorts based on their birth year (from 1979-1983 to 1999-2003). Three measures of drinking were assessed: any past-year consumption (yes/no), past-year regular risky drinking (12 or more drinking episodes of >40 g of pure alcohol, yes/no) and total volume of alcohol consumed in the past year (in Australian standard drinks, 10 g of alcohol). Socio-economic status was measured based on neighbourhood of residence.

FINDINGS

Drinking declines were consistent across socio-economic groups on all measures and trends were broadly similar for women and men. More recent birth cohorts had significantly lower levels of drinking across all three measures (odds ratios between 0.31 and 0.70 for drinking and risky drinking, coefficients between -0.28 and -0.80 for drinking volume). There were significant interactions between birth cohort and age for past-year drinking and past-year regular risky drinking, with cohort differences diminishing as age increased.

CONCLUSIONS

Lighter drinking adolescent cohorts appear to partly 'catch up' to previous cohorts by early adulthood, but maintain lower levels of drinking and risky drinking up to the age of 24. These ongoing reductions in drinking are spread evenly across socio-economic groups.

Are changes in attitudes towards school associated with declining youth drinking? A multi-level analysis of 37 countries

BACKGROUND

Changes in adolescents' attitudes towards school are a potential explanation for recent declines in young people's alcohol consumption. However, this has not been tested using multi-national survey data, which would permit stronger causal inferences by ruling out other country-specific explanations. This study, therefore, uses an international survey of schoolchildren to examine the associations between changing attitudes towards school and adolescent alcohol consumption.

METHODS

We used data from 247 325 15-year-olds across 37 countries participating in four waves of the Health Behaviour in School-aged Children study (2001/02-2013/14). Attitudes towards school were assessed using two measures-self-reported pressure from schoolwork and whether respondents like school. Outcome measures were weekly alcohol consumption and having been drunk twice in one's lifetime. We used whole population and gender-specific hierarchical linear probability models to assess the relationship between attitudes and alcohol outcomes within countries over time.

RESULTS

Country-level changes over time in liking school were not associated with changes in alcohol consumption. However, a 10% increase in feeling pressured by schoolwork was associated with a 1.8% decline in drunkenness [95% confidence interval (CI): -3.2% to -0.3%] and weakly associated with a 1.7% decline in weekly drinking (95% CI: -3.6% to 0.2%). Among girls only, increases in feeling pressured by schoolwork were associated with a 2.1% decline in weekly drinking (95% CI: -3.7% to -0.6%) and a 2.4% decline in drunkenness (95% CI: -3.8% to -1.1%).

CONCLUSION

Changes in attitudes towards school may have played a minor role in the decline in alcohol consumption among adolescent girls only.

Becoming Safe, Legal, Mature, Moderate, and Self-Reflexive: Trajectories of Drinking and Abstinence among Young People

In recent years, a vast body of research has investigated trends of declining alcohol consumption among youths. However, the extent to which restrictive-youth approaches towards drinking are maintained into adulthood is unclear. The aim of this study is to explore how young people's relation to alcohol changes over time. Our data are based on longitudinal qualitative in-depth interviews with 28 participants aged 15 to 23 conducted over the course of three years (2017-2019). The study draws on assemblage thinking by analysing to what kinds of heterogeneous elements young people's drinking and abstinence are related and what kinds of transformations they undergo when they get older. Five trajectories were identified as influential. Alcohol was transformed from unsafe to safe assemblages, from illegal to legal drinking assemblages, from performance-orientated to enjoyment-orientated assemblages, and from immature to mature assemblages. These trajectories moved alcohol consumption towards moderate drinking. Moreover, abstinence was transformed from authoritarian assemblages into self-reflexive assemblages. Self-control, responsibility, and performance orientation were important mediators in all five trajectories. As the sober generation grows older, they will likely start to drink at more moderate levels than previous generations.

An examination of the role of changes in country-level leisure time internet use and computer gaming on adolescent drinking in 33 European countries

INTRODUCTION

Adolescent alcohol consumption has been declining in many high-income countries since the turn of this century. Research investigating the plausible explanations for these declines has been mostly based on individual-level studies, which are largely inconclusive. Changes in leisure time internet use and computer gaming (referred to in this article as 'computer activities') have been hypothesised to play a role in declining adolescent alcohol consumption at a country-level. The aim of this study was to examine the association between country-level changes over time in computer activities and adolescent drinking in 33 European countries.

METHODS

This is a multi-level repeated cross-national study examining the role of changes over time in country-level and individual-level computer activities on regular drinking. We utilised four waves of the European School Survey Project on Alcohol and Drugs (ESPAD) from 2003, 2007, 2011 and 2015. At an individual-level the primary exposure of interest was daily engagement in computer activities and aggregated means were used to measure country-level daily computer activities in each included country. Data were analysed using three-level hierarchical linear probability methods.

RESULTS

In the fully adjusted model, for between individual effects, we found significant positive association between daily computer activities and regular drinking (β = 0.043, p-value <0.001 and 95% CI = 0.033-0.054). However, at a country-level, we did not find any association between within-country changes in daily computer activities and regular drinking (β = 0.031, p-value = 0.652 and 95% CI = -0.103-0.164.

CONCLUSION

Findings from this study suggest that broad cultural shifts towards increased computer-based activities among adolescents has played a little or no role in declining adolescent drinking. Future research should be directed towards examining other high-level cultural changes which may have influenced cross-national reductions in adolescent drinking.

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.

Are changes in parenting related to the decline in youth drinking? Evidence from a comparison of Sweden and Denmark

Introduction: The aim of this study was to replicate earlier studies suggesting that changes in parenting have contributed to the recent decline in youth drinking by comparing parenting in a country experiencing a sharp decline in youth drinking (Sweden) with a country with only a small decline (Denmark). Data and analysis: Data stem from self-reported information from 15–16-year-old children in the Swedish and Danish subsamples of ESPAD. Youth drinking was measured by prevalence and frequency of drinking over the past year. Parenting was measured in terms of the extent the child reported that: (1) parents’ attitudes towards offspring drinking are restrictive, (2) parents set up general rules for what their children are allowed to do, and (3) parents have high level of knowledge about where and with whom their children spend time. The association between these indicators of parenting and youth drinking was first estimated with logistic regressions. Second, changes in parenting between 1999 and 2015 were compared between Denmark and Sweden across the study period. Results: Restrictive parental attitudes were associated with a lower likelihood of past-year drinking and frequent drinking in both Sweden and Denmark. This attitude was more common in Sweden, where it also became more prevalent between 2003 and 2015 in contrast to in Denmark. The association between strict parental rule-setting and youth drinking was weak in both countries. A high parental knowledge of the child's whereabouts was linked to a lower likelihood of past-year drinking in Sweden and a lower frequency of drinking in both countries. Parental knowledge of offspring's whereabouts did not develop differently in Sweden and Denmark, with a high and stable proportion in both countries. Conclusion: More restrictive parental attitudes towards youth drinking may have contributed to the decline in youth drinking, whereas the importance of general parental rule-setting and parental knowledge of offspring's whereabouts was not supported.

The Role of Parental Control and Support in Declining Adolescent Drinking: A Multi-Level Study Across 30 European Countries

BACKGROUND

Adolescent drinking has declined in many high-income countries since the early 2000s. It has been suggested that changing parenting practices may have contributed to the decline. However, previous studies investigating parenting have focused on single countries and have provided conflicting evidence. This study tested the association between changes in individual- and population-level parental control and parental support and changes in past month adolescent drinking.

METHODS

A total of 271,823 adolescents aged 15-16 years, from 30 European countries between 2003 and 2015 were included in this study. Our key independent variables were adolescent reports of parental control and parental support. Our outcome measure was a dichotomous measure of any alcohol use in the 30 days before the survey, referred as past month drinking. Aggregated measures of parenting variables were used to estimate between-country and within-country effects of parenting on adolescent drinking. Data were analysed using three-level hierarchical linear probability methods.

RESULTS

At the individual-level, we found a negative association between the two parental measures, i.e. parental control (β = -0.003 and 95% CI = -0.021 to 0.017) and parental support (β = -0.008 and 95% CI = -0.010 to 0.006) and past month drinking. This suggests adolescents whose parents exert higher control and provide more support tend to drink less. At a population level, we did not find any evidence of association on between-country and within-country parenting changes and past month drinking.

CONCLUSIONS

It is unlikely that changes in parental control or support at the population-level have contributed to the decline in drinking among adolescents in 30 European countries.

Reasons Not to Drink Alcohol among 9th Graders in Sweden

AIM

Alcohol is one of the leading contributors to the disease burden among young people. Drinking motives are one of the strongest factors influencing drinking behaviors among youth, yet we know little about reasons for why young people do not drink. The aim of the present study is to examine reasons for not drinking in a nationally representative sample of Swedish youth.

DATA AND METHODS

Data from a survey of a nationally representative sample of students in year 9 (15-16 years old) was used. Data was collected in 2017 and the total sample comprise 5549 respondents. Ten items measured reasons not to drink alcohol. Comparisons were made between drinkers and nondrinkers in endorsement of the reasons for not drinking. A multivariable logistic regression model was fitted to examine the relative importance of the different reasons.

RESULTS

That alcohol is bad for health and parents disapproval of drinking was the most commonly endorsed reasons both among drinkers and nondrinkers. The multivariable analysis showed that the strongest association with being a nondrinker was found for "Alcohol tastes horrible" (OR 2.995), "I have religious reasons for not drinking" (OR 2.775), "People who drink lose control in an unpleasant way" (OR 2.460) and "Drinking is too likely to lead to serious accidents" (OR 2.458).

DISCUSSION AND CONCLUSIONS

Harm avoidance and religious reasons are the most important reasons not to drink among Swedish youth. Future research should examine how different reasons predict abstinence.

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 the co-use of alcohol and tobacco among Japanese adolescents: periodical nationwide cross-sectional surveys 1996-2017

OBJECTIVES

This study aimed to assess trends in the prevalence of alcohol use depending on smoking behaviours and that of smoking depending on drinking behaviours among Japanese adolescents.

DESIGN

This was a retrospective study using Japanese school-based nationwide surveys conducted between 1996 and 2017.

SETTING

Surveyed schools, both junior and senior high schools, considered representative of the entire Japanese population, were sampled randomly.

PARTICIPANTS

We enrolled 11 584-64 152 students from 179 to 103 schools yearly. They completed a self-reported and anonymous questionnaire on smoking and drinking behaviour.

RESULTS

Since 1996, the prevalence of alcohol use and smoking among adolescents decreased in each survey (p<0.01). The prevalence of alcohol use in the non-smokers group was 29.0% in 1996 and 4.0% in 2017, and in the smokers group, it was 73.3% in 1996 and 57.4% in 2017. The reduction rate (the difference in prevalence between 1996 and 2017 divided by the prevalence in 1996) was 0.86 in the non-smokers group and 0.22 in the smokers group. The prevalence of smoking in the non-drinkers group was 6.7% in 1996 and 0.7% in 2017, while that in the drinkers group was 32.5% in 1996 and 18.9% in 2017. The reduction rate was 0.90 in the non-drinkers group and 0.42 in the drinkers group. Therefore, downward trends differed among the groups. In a subanalysis of senior high school students, we divided students into three groups according to their intention to pursue further education. Between 1996 and 2017, there was a consistent difference in the prevalence of alcohol use and smoking among these groups.

CONCLUSIONS

Alcohol use and smoking among Japanese adolescents seem to have reduced. However, certain groups showed poor improvements, and health risk behaviour disparity exists, which may widen further. We need to focus on high-risk groups and implement appropriate measures or interventions accordingly.

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.

Associations between trust and drinking among adolescents

INTRODUCTION

Trust is closely linked with health, but previous research on its association with alcohol use has yielded mixed findings. The aim of this study is to examine: (i) how two different dimensions of trust (general/institutional) are associated with alcohol use among adolescents; (ii) how these dimensions interact with alcohol use; and (iii) whether the associations are moderated by sex, parenting, health, school satisfaction or economic disadvantage.

METHODS

A nationwide sample of 5549 adolescents (aged 15-16 years) in Sweden answered a questionnaire in school. General and institutional trust were measured with five items each. Logistic regressions were used to examine associations between drinking and the trust dimensions, and the cross-combinations of these. Moderation by sex, parenting, health, school satisfaction and economic disadvantage was tested.

RESULTS

General and institutional trust were both significantly associated with drinking. High scores on both dimensions simultaneously were associated with the lowest probability of drinking, and low scores on both with the highest. Low institutional trust had a stronger association than low general trust. The combination of high institutional/low general trust was more protective than low institutional/high general trust. The association between general trust and drinking was moderated by school satisfaction, and the relationship between institutional trust and drinking was moderated by parental support and control.

DISCUSSION AND CONCLUSIONS

High trust is associated with a lower probability of past-year drinking among 15-16-year-olds. Parents and schools can be useful in endeavours to prevent low-trusting individuals in this age group from drinking.

Trends in adolescent alcohol and other risky health- and school-related behaviours and outcomes in Australia

INTRODUCTION

Adolescent drinking has been declining in Australia over the past two decades, but this trend may be part of a broader shift towards healthier lifestyles for adolescents. We examined trends in the prevalence of multiple risky health- and school-related behaviours and outcomes to test whether this was the case.

METHODS

Data on multiple behaviours and outcomes were collated from Australian government agencies and other relevant sources for 10-19-year-olds from the year 2000 onward. Trends were examined descriptively.

RESULTS

Rates of substance use, youth offending and injuries due to underage driving declined over the study period. Some health-related behaviours (physical activity and diet) worsened between 2001 and 2017; however, obesity rates remained stable. Risky sexual behaviours increased in terms of early initiation of lifetime sexual intercourse and decreased condom use. However, sexual health outcomes improved with a reduction in teenage pregnancies and there was a recent decline in sexually transmitted infection rates from 2011 onward. Suicide rates and rates of major depressive disorders increased. School attendance and engagement in full-time work or study remained stable.

DISCUSSION AND CONCLUSIONS

The decline in adolescent drinking does not appear to correspond with increased engagement in healthier behaviours; however, it may be related to a more risk-averse way of living. Future work could be directed towards identifying which social, economic, policy and environmental factors have impacted positive changes in risky behaviours. Public health efforts can then be directed towards behaviours or outcomes, which have not yet improved.

Moderators of Friend Selection and Influence in Relation to Adolescent Alcohol Use

Friendships form an important context in which adolescents initiate and establish alcohol use patterns, but not all adolescents may be equally affected by this context. Therefore, this study tests whether parenting practices (i.e., parental discipline, parental knowledge, unsupervised time with peers) and individual beliefs (i.e., alcohol descriptive norms, positive social expectations, moral approval of alcohol use) moderate friend selection and influence around alcohol use. Stochastic actor-based models were used to analyze longitudinal social network and survey data from 12,335 adolescents (aged 11 to 17, 51.3% female) who were participating in the PROSPER project. A separate model was estimated for each moderating variable. Adolescents who reported consistent parental discipline, less unsupervised time with peers, higher descriptive alcohol use norms, and less positive social expectations about alcohol use were less likely to select alcohol-using friends. Those who reported consistent parental discipline, better parental knowledge, lower descriptive alcohol use norms, and less positive social expectations were more influenced by their friends' level of alcohol use. Thus, adolescents with these characteristics whose friends frequently use alcohol are at greater risk whereas those whose friends do not use alcohol are at lower risk of using alcohol. The findings show that, although selection and influence processes are connected, they may function in different ways for different groups of adolescents. For some adolescents, it is particularly important to prevent them from selecting alcohol-using friends, because they are more susceptible to influence from such friends. These peer network dynamics might explain how proximal outcomes targeted by many prevention programs (i.e., parenting practices and individual beliefs) translate into changes in alcohol use.

Are changes in binge drinking among European adolescents driven by changes in computer gaming?

INTRODUCTION

There is currently no good explanation for the decline in adolescent drinking reported for many Western countries in recent years. As modern computer gaming is highly exciting and socially rewarding, it may function as a substitute for adolescent binge drinking. We hypothesized a negative correlation between country-level changes in computer gaming and binge drinking.

METHODS

We analysed within-country changes based on data from 15-16 year-old pupils (n = 517 794) participating in the European School Survey Project on Alcohol and Drugs from 1995 to 2015. Binge drinking in the last 30 days (5+ units on one occasion) was regressed on frequency of computer gaming and three control variables measuring the frequency of engagement in other hobbies, reading books and going out (to a disco, cafe, etc.).

RESULTS

Descriptive data showed no general decline in binge drinking across European countries. In contrast to our prediction, the association between binge drinking and computer gaming was not negative [b = 0.26, one-sided 95% confidence interval (-∞, 0.47), P = 0.98, Bayes Factor = 0.21]. We found the same pattern of result in a secondary analysis on six Nordic countries that have experienced declines in adolescent drinking recent years. In analyses with covariates reflecting engagement in other activities, we only observed statistical evidence for an effect of going out.

DISCUSSION AND CONCLUSIONS

A substantial decline in adolescent binge drinking during the years 1995-2015 is only evident in some European countries, and it is likely not caused by increased computer gaming.