Psychosocial correlates of drinking transitions: A longitudinal study among adolescents in Sweden

INTRODUCTION

Non-drinkers have been shown in older studies to have poorer mental health and social life compared to their alcohol-using counterparts. Given the profound decline in adolescent drinking observed in most high-income countries, this pattern may have changed. This study explores drinking transitions and examines psychosocial factors among adolescents by longitudinal drinking status.

METHODS

Data were based on two waves of a prospective longitudinal nationwide study (n = 4018). The first wave (T1) of data was collected in 2017 (age 15/16) and the second wave (T2) was in 2019 (age 17/18). Respondents were asked about their past year drinking status, general health, psychosomatic problems, psychiatric medication, school enjoyment, emotional symptoms, peer relationship problems, prosocial ability, friendships satisfaction and satisfaction with relation to mother/father. Comparisons by mean values were assessed and multinomial logistic regressions were used to examine associations.

RESULTS

Abstainers and later drinkers differed significantly from early drinkers on 9/10 factors respectively at T1. Fewer psychosomatic problems, less psychiatric medication, higher school enjoyment, more emotional symptoms, higher parental relationship satisfaction, more peer problems and lower friendships satisfaction at T1 were associated with abstaining and/or later drinking. All factors were more strongly associated with abstaining. School enjoyment predicted abstaining but not later drinking.

DISCUSSION AND CONCLUSIONS

Longitudinal drinking status relates to small to moderate systematic psychosocial differences. Adolescents with better mental health, more content relationships with parents and lower friendships satisfaction are more often abstainers. Those generally worse off are more likely early drinkers but they also have better friendships.

Adolescent Drinking and Alcohol Policy

Policy approaches to prevention have considerable promise for addressing underage drinking and its associated problems. Based on the available evidence, the most effective policies appear to be (a) taxation or price increases, (b) increases in the minimum drinking age, and (c) graduated licensing or zero tolerance. Random breath testing and sobriety checkpoints also appear promising, although there is little evidence for their effectiveness specifically with young people. Major changes in the conditions of sale (e.g., privatization) may also affect the availability of alcohol to young people and thus underage drinking. The evidence is less convincing, however, for the effects of more modest license restrictions (e.g., limiting outlet density, hours of sale), responsible beverage service, advertising restrictions, warning labels, keg registration, and school policies. It is clear from the available research that no policy can be effective unless it is accompanied by enforcement and by awareness on the part of the intended targets of both the policy and the enforcement efforts.

The collectivity of drinking cultures: is the theory applicable to African settings?

AIMS

Skog's theory of collective drinking behaviour implies that countries with a strict informal social control of drinking alcohol would not exhibit 'collective displacement' of consumption (a linear association between population mean consumption and percentile values across the full range of the distribution), as do countries with less informal social control. This paper aimed to test this hypothesis by examining the alcohol consumption distributions in African countries with a strong informal control of alcohol.

DESIGN SETTING, PARTICIPANTS AND MEASUREMENTS

Data on alcohol consumption from the World Health Organization's general population surveys in 15 African countries were aggregated and analysed with respect to skewedness and collective displacement of the distribution.

FINDINGS

The distribution of consumption was strongly positively skewed, with 10-15% of the drinkers consuming more than twice the mean consumption. There was also clear evidence of a collective displacement of the consumption distribution, and the consumption mean was a strong predictor of the distribution percentile values across the full range of the distribution. Correspondingly, consumption mean predicted the prevalence of heavy drinkers.

CONCLUSION

The distribution patterns of alcohol consumption in African countries are consistent with those observed previously in industrialized countries. These findings seem to counter Skog's theory of collective drinking behaviour and support the universality of the observation that the prevalence of problem drinking is linked closely to mean consumption.

Low level of alcohol drinking among two generations of non-Western immigrants in Oslo: a multi-ethnic comparison

Background

Alcohol drinking is a risk factor for harm and disease. A low level of drinking among non-Western immigrants may lead to less alcohol-related harm and disease. The first aim of this study was to describe frequency of drinking in two generations of immigrants in Oslo, contrasting the result to drinking frequency among ethnic Norwegians. The second aim was to study how frequency of drinking among adult immigrants was associated with social interaction with their own countrymen and ethnic Norwegians, acculturation, age, gender, socioeconomic factors and the Muslim faith.

Method

The Oslo Health Study (HUBRO) was conducted during the period 2000 to 2002 and consisted of three separate surveys: a youth study (15-16-year-olds, a total of 7343 respondents, response rate 88.3%); adult cohorts from 30 to 75 years old (18,770 respondents, response rate 46%); the five largest immigrant groups in Oslo (aged 20–60 years, a total of 3019 respondents, response rate 39.7%). Based on these three surveys, studies of frequency of drinking in the previous year (four categories) were conducted among 15-16-year-olds and their parents’ generation, 30-60-year-old Iranians, Pakistanis, Turks and ethnic Norwegians. A structural equation model with drinking frequency as outcome was established for the adult immigrants.

Results

Adults and youth of ethnic Norwegian background reported more frequent alcohol use than immigrants with backgrounds from Iran, Turkey and Pakistan. Iranians reported a higher drinking frequency than Turks and Pakistanis. In the structural equation model high drinking frequency was associated with high host culture competence and social interaction, while high own culture competence was associated with low drinking frequency. Adult first-generation immigrants with a longer stay in Norway, those of a higher age, and females drank alcohol less frequently, while those with a higher level of education and work participation drank more frequently. Muslim immigrants reported a significantly lower drinking frequency than non-Muslims, although this did not apply to Iranians.

Conclusions

The existence and growth in Western societies of immigrant groups with low-level alcohol consumption contributed to a lower level of consumption at the population level. This may imply reduced drinking and alcohol-related harm and disease even among ethnic Norwegians.

Correlates of heavy alcohol consumption at Rhodes University

OBJECTIVE

To establish the extent to which students typically overestimate normative drinking and to determine whether these estimates are uniquely implicated in alcohol consumption over and above the role of the various demographic and family variables.

METHOD

An online survey was used to obtain a sample of 2 177 students who completed the AUDIT questionnaire along with other items, including three adapted from the AUDIT asking respondents to estimate the descriptive drinking norms of their typical same-sex student. A hierarchical regression analysis was performed to determine the relative contributions of these variables towards individual student's own consumption scores. Three blocks of variables were entered in temporal sequence, starting with demographic variables, then family variables, followed by the normative estimates.

RESULTS

Most students overestimate how frequently their same-sex peers go drinking and how much alcohol they consume on these drinking occasions and how often they consume six or more drinks on one occasion. These normative estimates account for a significant portion of the variance over and above that accounted for by the demographic and family variables.

CONCLUSIONS

The university should attempt to correct inflated normative estimates of how many drinks a typical same-sex peer has on a typical day when drinking.

The empirical testability of Skog's theory of collective drinking behaviour

The objects of this study we (1) to review systematically Skog's theory of collective drinking behaviour and its interpretations by alcohol researchers, and (2) to give examples of how Skog's theory and these different interpretations have been empirically tested and to indicate how they might be tested. Based on a computer-aided search of the literature, a reconstruction of the theory and possible alternative interpretations is provided. Different interpretations of Skog's theory are possible and can be found in the literature. Surprisingly, there is little empirical evidence, especially recent evidence, to support Skog's key assumptions. Suggestions for further research are given.

Economic and other views of addiction: implications for the choice of alcohol, tobacco and drug policies

It is the aim of this paper to provide an overview of developments in implicit and explicit economic views of addiction, to contrast these perceptions with the views of other disciplines and discuss the implications for policy. Addictive behaviours have received considerable attention from disciplines other than economics. The nature of addiction and the contribution of psychological, physiological and social factors have been strongly debated within the addictions field for many years. The views of economists are becoming increasingly important because economic studies of consumption, and tax revenue in the case of licit drugs, are one factor when framing policy. It is therefore crucial to know how economists have treated addiction. Have they neglected it and what are the implication if they have? This paper attempts to answer this question by reviewing and discussing the literature in depth and drawing out the implications for policy.

The interplay of drinking patterns and other determinants of health

The health effects of alcohol are determined not only by level of intake but also by patterns of alcohol use and many other health determinants. This study seeks to identify groups of individuals who share various features in terms of drinking styles and other health indicators. Data used are a subset of the 1990 Ontario Health Survey, corresponding to men and women aged 20-64 with complete data in four substantive areas: alcohol use; demographic characteristics; current health status; and various behavioural risk factors for chronic disease. Cluster analysis was used to groups of male and female respondents who were similar in terms of their style of alcohol use, along with other constructs relevant to health risk and health status. For both sexes, clusters were identified which matched expectation in terms of drinking patterns and other relevant variables. For both sexes, clusters were found with generally higher social class indicators, generally positive health behaviours and health status and drinking patterns which did not include drinking to excess. Clusters were also found for which high-volume drinking occasions corresponded with poor health status and high levels of risk factors for chronic disease. Other unanticipated patterns were also identified. This information may assist in identifying confounding effects in epidemiological studies as well as identifying the characteristics of unique sub-populations which are likely to be the focus of primary prevention efforts.

The population mean and the proportion of frequent gamblers: is the theory of total consumption valid for gambling?

The study looks at three representative samples of Norwegians in different age groups with the aim of finding evidence for the validity of the total consumption model for the area of gambling. The results show that gambling was distributed in the population in a way consistent with the predictions of the total consumption theory. Populations with a low mean gambling frequency had a lower proportion of frequent gamblers than populations with a high mean gambling frequency. It was also shown that in a population with a low mean gambling frequency, consumers along the whole consumption continuum gambled less frequently, than in a population with a high mean gambling frequency. It is concluded that the total consumption model seems to be valid for gambling, and that gambling consequently needs to be understood as a public health issue. The actions and behaviours of the normal majority can then not be regarded as irrelevant for the development in problem gambling prevalences.

Flux and stability: individual fluctuations, regression towards the mean and collective changes in alcohol consumption

AIM

First, to extend the predictions of the collectivity theory of drinking cultures to contexts of ordinary panel data, thereby integrating collective change and individual fluctuations in consumption. Secondly, to develop a technique for controlling the regression towards the mean effect, in order to estimate the pattern of individual change, net of this effect.

DESIGN

The task is, first and foremost, to develop a theoretical model, guided by earlier contributions and empirical results. The applicability of the model is illustrated through re-analyses of panel data on annual intake of alcoholic beverages from the Finnish alcohol reform in 1968-69, and Norwegian panel data from 1975 to 1976.

FINDINGS

The model offers a reasonable fit to the data. It is demonstrated that a previous attempt at controlling the regression effect has overlooked a methodological complication, and therefore underestimates the real change.

CONCLUSION

Analysis of the Finnish data demonstrates that the large increase in average consumption was due to approximately the same percentage-wise increase in the consumption level of drinkers at all levels, when the regression effect was controlled for. Thus, in absolute terms the increase was largest among the heavier drinkers.

Having the wrong friends? Peer effects in adolescent substance use

Swedish cross-sectional survey data on young individuals aged 12-18-year-old was used to analyse school-class based peer effects in binge drinking, smoking and illicit-drug use. Significant and positive peer effects were found for all three activities. By introducing school/grade fixed effects, the estimated peer effects were identified by variation in peer behaviour across school-classes within schools and grades, implying that estimates were not biased due to endogenous sorting of students across schools. Further, endogeneity bias due to bi-directionality of peer effects was found for binge drinking and smoking. Controlling for this source of endogeneity resulted in even stronger peer effects.

An Improved Method for Predicting Which Heavy Drinkers Become Intoxicated

Not all heavy drinkers become intoxicated. We sought to improve predictability of intoxication of heavy drinkers. Based on criteria for heavy drinking in the National Household Survey on Drug Abuse (NHSDA), we identified characteristics related to heavy drinking. We then created a dichotomous heavy drinker typology variable (yes/no) and determined how well we were able to identify drinkers who became intoxicated at least twice a month. Of those who fit this heavy drinking profile, 54% drank regularly to the point of intoxication, the same percent as those who become intoxicated in the self-reported heavy drinking group. However, 77% of those who fit both the profile and were self-described heavy drinkers, drank regularly to intoxication. We concluded that a demographic typology combined with self-reported drinking improves predictability of intoxication in heavy drinkers, and is a promising direction for research.

A general causal model to guide alcohol, tobacco, and illicit drug prevention: assessing the research evidence

The problems associated with the use of alcohol, tobacco, and other drugs (ATOD) extract a significant health, social, and economic toll on American society. While the field of substance abuse prevention has made great strides during the past decade, two major challenges remain. First, the field has been disorganized and fragmented with respect to its research and prevention practices; that is, there are often separate ATOD prevention "specialists." Second, both the prevention researchers who test the efficacy of specific prevention strategies and the practitioners who implement prevention efforts often lack an overall perspective to guide strategy selection. To address these limitations, we present an ATOD causal model that seeks to identify those variables (Domains) that are theoretically salient and empirically connected across alcohol, tobacco, and illicit drugs. For the researcher, the model demonstrates important commonalities, as well as gaps, in the literature. For the practitioner, the model is a means to recognize both the complexity of the community system that produces ATOD problems and the multiple intervention points that are possible within this system. Researchers and practitioners are thus challenged to work synergistically to find effective and cost-effective approaches to change or reduce ATOD use and associated problems.

Women's alcohol consumption: emerging patterns, problems and public health implications

There is growing awareness of changes in the levels and patterns of women's use of alcohol. Australian and international data suggest that patterns of consumption among younger women are beginning to echo that of their male counterparts. Similarly, alcohol consumption among older women is also increasing in some developed countries. This paper provides an overview of available data sources that address changing patterns of consumption among women in Australia, and explanatory models which may account for these changes are discussed. Particular attention is directed to drinking among younger women and indigenous women. External social factors are explored, including the erosion of traditional values associated with women's consumption of alcohol. Finally, the paper examines the evidence for a long speculated 'convergence' of female and male alcohol consumption and assesses the public health implications of the emerging patterns of alcohol consumption by women. The inconsistent findings regarding brief interventions when applied to women, compared to men, are also highlighted in terms of appropriate future public health strategies.

Effects of depression and social integration on the relationship between alcohol consumption and all-cause mortality

AIMS

This study was designed to assess the potentially confounding influences of social integration and depression on the form of the relationship between alcohol consumption and all-cause mortality. DESIGN, PARTICIPANTS AND MEASUREMENT: Respondents from the 1984 US National Alcohol Survey (N = 5177) were followed by searching the National Death Index (NDI) through 1995; 540 were identified as deceased. Predictor variables in a Cox proportional hazards model included gender, ethnicity, marital status, income, smoking, age and alcohol consumption (volume and patterns). Two social variables and their interactions with alcohol consumption were added, the Center for Epidemiological Studies Depression (CES-D) scale and an eight-item social isolation scale.

FINDINGS

The J-shaped risk curve for all-cause mortality by volume was approximated for men but not significantly for women. In addition heavy drinking occasions independently contributed to mortality in men. Low social integration (bottom 12%) had no significant effects on mortality or on the relationship between alcohol consumption and mortality curve. Inclusion of the interaction between alcohol consumption and depression proved significant for heavy male drinkers (> six drinks on average per day) and for female former drinkers with heavy drinking occasions. In both cases, the respective subgroup, which additionally was depressed, had about four times the risk of a life-time abstainer.

CONCLUSIONS

The relationship of alcohol consumption to 11-year all-cause mortality in a general population indicated little confounding effect of social isolation, but revealed important interactions with depression for heavy male drinkers and heavy female ex-drinkers.

Public health consequences of the J-curve hypothesis of alcohol problems

This paper addresses some issues related to the hypothesis that the risk for premature death is a J-shaped function of alcohol intake. The first part of the paper contains a discussion of the individual level epidemiological evidence. It is argued that the evidence is not yet good enough to allow precise statements about "safe limits", nor does it allow a precise location of the "optimum" consumption level. Measurement errors and confounding variables not yet controlled for remain substantial problems. In particular, future studies need to control for social integration, as this factor may affect both health status and alcohol consumption. The second part of the paper discusses the population level relationship. It is argued that, typically, what is optimum for an individual is too much for a population. Unintended side effects of major public health importance should be expected in this area. In the last section, a plea is made for aggregate level studies as a way of addressing the public health side of the issue.

Alcohol consumption and suicide mortality by age among Finnish men, 1950-1991

An earlier comparative time series analysis of the connection between per capita alcohol consumption and suicide mortality reported, unexpectedly, a non-significant effect of alcohol on the suicide rate of Finnish men. However, the suicide rate of Finnish men is heterogeneous in regard to age groups. There is also indication that the connection between alcohol and suicides is stronger in younger than in older age groups. Time series data on per capita alcohol consumption and age-specific suicide mortality in 1950-91 were used to scrutinize the relationship. The results indicate that the suicide rate of Finnish men in age groups 15-34 years and 35-49 years is associated with per capita alcohol consumption, while no connection could be established between the suicide rates of men aged 50-69 years and 70+ years and either per capita alcohol consumption or a lagged consumption measure. Real income, divorce rate and unemployment rate were regarded as possible confounding variables.

A grouped data regression approach to estimating economic and social influences on individual drinking behaviour

General Household Survey (GHS) data sets, covering the period 1978-1990, are pooled to investigate the relationship between the riskiness of individuals' self-reported drinking behaviour and a wide range of personal characteristics and economic factors. A grouped data regression approach is used to reduce problems with the inaccuracy of self-reports of alcohol consumption and clustering of observations in the consumption data. Results for males aged 18 to 24 years are presented, and possible methods for interpreting the results of grouped data regression are illustrated. Controlling for other factors, current smokers are estimated to be at a 75% higher risk of drinking over recommended levels than non-smokers. Particular attention is paid to the interactions between the price of alcohol, income and heavy drinking. At average levels of income, a 5% increase in the real price of alcohol is predicted to reduce the probability of 'at-risk' drinking by 1.5%. At lower initial levels of income, drinking patterns are found to be more responsive to both price and income changes. Grouped data regression is proposed as a way of focusing policy analysis on individual risks of alcohol-related health and social problems.

Reduced alcohol use in pregnancy and changed attitudes in the population

The objectives of this study were to investigate (1) changes in consumption of alcohol among pregnant women over a period of 5 years (1984/85-1990), (2) changes of attitudes towards drinking during pregnancy in the general population over the same period of time, and (3) possible connections between (1) and (2). The investigation was designed as a cross-sectional study. Our subjects were two representative samples of pregnant women in Oslo, n = 377 and 425, and two representative samples of the Norwegian population, n = 1004 and 1204. The main outcome measures were a self-completed questionnaire for the pregnant women and a personal interview for the general population sample. There was a significant reduction (50% decrease) in alcohol consumption among the second cohort of pregnant women compared with the first. Furthermore, we found an increase during the 5-year period in the number of persons with a restrictive attitude towards alcohol use during pregnancy. There seems to be a connection between these two phenomena, but with our present state of knowledge it is hard to say anything about the causal relationship between them.

Unemployment and use of drug and alcohol among young people: a longitudinal study in the general population

A prospective study of a representative sample of nearly 2000 young people aged 17-20 years was started in 1985. It was followed up twice, in 1987 and in 1989. The Central Bureau of Statistics in Norway was responsible for the data collection. Sixty-five per cent of the stratified sample (1985) participated in all the three surveys. The aim of this paper has been to explore the relationship between unemployment and the use of drugs and alcohol. The results show that unemployment does not appear to influence the consumption of alcohol. In a high consumption group, unemployment seems to lead to a decrease in alcohol consumption, though there was a clear tendency to increase use of cannabis. The results seem to indicate that there was no increase in use of alcohol or drugs in response to stress as a result of unemployment, though unemployment may lead to a stronger identification with or joining marginalized or deviant subcultures which in turn leads to an increased use of cannabis.

A meta-analysis of life course variation in drinking

Meta-analysis combines results from multiple longitudinal studies to describe life course variation by age and sex for quantity of drinking per typical occasion (20 studies) and frequency of drinking during one month (27 studies). There is cross-study heterogeneity for the Time 1 means of the drinking variables blocking for age and sex. Age distributions for the Time 1 means are similar by gender within nations; in the aggregate, males exceed females in the magnitude of drinking. Dramatic shifts in the standardized mean difference (M2-M1) occur among the young; greater homogeneity and moderate change (declines) occur later in life. Implicated in improving cross-study homogeneity for M2-M1 among the young are interval between measurements, nation, Time 1 per capita consumption (PCC), difference in PCC and the Time 1 mean. Lower unstandardized regression coefficients are found for quantity among youth, but are not consistently homogeneous within nations; the association for frequency becomes increasingly stable with increasing age. Nation and interval are implicated in improving homogeneity. Decline in quantity occurs among the old. M2-M1 produces homogeneously higher regressions for groups of the young who increase quantity v. those who do not. Linkage of the group-level and individual-level findings is discussed.

Regularity in alcohol distributions: implications for the collective nature of drinking behaviour

The assumption of a one parameter lognormal distribution in the Ledermann theory is relaxed. Implications of only regularity in distributional form for the collective nature of drinking behaviour are considered. It is shown that there must be a so-called point of attraction over which an increase in mean consumption will result in a decrease of percentile point value. The validity of regularity in distributional form and the practical relevance of the Ledermann model is discussed. An example from Dutch data on alcohol consumption among men obtained in 1970 and 1985 illustrates the relevance of an existing point of attraction.

Comparing distributions of alcohol consumption: empirical probability plots

Parametric approaches to the problem of the distribution of alcohol consumption have not been very successful. In this article, it is shown that regulatory in distribution can be studied without making assumptions about a distribution model underlying the data. For this purpose, a method is used with which distributions are compared graphically in so-called probability plots. It appears that, up to a proper linear transformation on a logarithmic scale, a surprisingly large regularity over time can be observed between distributions taken from Dutch samples in 1970, 1981 and 1985. Equally, distributions from male and female sub-samples do not appear to differ up to a linear shift. The finding of a relative equality in distributional form is in accordance with the Ledermann model. However, the difference with the Ledermann's model is that no assumptions about the exact shape of the distributions are being made.

Drinkers' use of physical availability of alcohol: buying habits and consumption level

On the aggregate level, physical availability of alcohol is related to per capita consumption, prompting the question whether high availability can increase consumption net of social norms which enhance drinking. This issue is investigated using individual-level data in a high-availability urban environment. Effortless, efficient purchase of alcoholic beverages explains a small but significant amount of the variance in consumption when normative factors are statistically controlled. Qualitative factors of availability are discussed, with particular emphasis on food stores, which account for more than half this sample's purchases.

How environments and persons combine to influence problem drinking. Current research issues

In this chapter, a brief review of existing empirical research on environmental correlates of problem drinking is presented. The review shows that environmental factors do relate to the prevalence of drinking problems and also to the way drinking problems are expressed. In the major section of the chapter, however, it is shown that our present knowledge of how environmental and personal factors combine to influence problem drinking is quite limited, perhaps because almost all of the existing empirical research has attempted to account for problem drinking by means of individual variables alone, environmental variables alone, or in terms of linear combinations of individual and environmental variables. It is shown that alternative approaches offer more promise for understanding how individual and environmental factors combine to influence problem drinking; these approaches are aimed at accounting for problem drinking in terms of the mutual interdependence between persons and their environments. Within two hypothetical sets of data, a number of conceptual and methodological issues, problems, and features of these kinds of interactional or transactional approaches are then illustrated. It is shown that although such approaches offer a promise of greater understanding, they also present a set of interrelated problems which run the gamut from measurement, statistical analysis, experimental design, and sampling issues to paradigm issues lying close to the realm of the philosophy of science.

Distribution of self-reported alcohol consumption: comments on Gregson and Stacey

The method used by Gregson and Stacey for estimating individual drinking levels is shown to be strongly biased and unreliable. Their correction for underreporting is based on several unrealistic assumptions.