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  • 1. Ahacic, Kozma
    et al.
    Kennison, Robert F.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Changes in sobriety in the Swedish population over three decades: age, period or cohort effects?2012In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 107, no 4, p. 748-755Article in journal (Refereed)
    Abstract [en]

    Aims  This study aimed to examine age, cohort and period trends in alcohol abstinence.

    Design  Two surveys, the Level of Living Survey collected in 1968, 1974, 1981, 1990 and 2000, and the Swedish Panel Study of the Oldest Old (SWEOLD) collected in 1992 and 2002, were studied with graphical depictions of cross-sectional and longitudinal data presented over time and over age. Cross-sectional 10-year age group differences, time-lag differences between waves and within-cohort differences between waves for 10-year birth cohorts were examined. Logistic regression models were applied to confirm the observed patterns.

    Setting  The samples were representative of the Swedish population.

    Participants  Participants ranged in age from 18 to 75 (n = 5000 per wave), and 77+ at later waves (n = 500).

    Measurements  Alcohol abstinence was determined by asking ‘Do you ever drink wine, beer, or spirits?’, where a ‘no’ response indicated abstinence.

    Findings  Decreases in abstinence rates were observed from 1968 to 2000/02. While cross-sectional analysis indicated increased abstinence with advancing age, the longitudinal analysis suggested otherwise. Inspection of cohort differences revealed little change within cohorts and large differences between cohorts; abstinence rates declined in later-born cohorts up to the 1940s birth cohorts; stability was observed in cohorts born since the 1940s. Logistic regression models indicated that neither age nor period were significant (P > 0.05) predictors of abstinence when cohort (P < 0.001) was included.

    Conclusion  Decreasing proportions of total alcohol abstainers in Sweden from 1968 to 2000 appear to be attributable primarily to decreases in successive cohorts rather than drinkers becoming abstainers.

  • 2.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social relationships and subsequent health-related behaviours: linkages between adolescent peer status and levels of adult smoking in a Stockholm cohort2012In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 108, no 3, p. 629-637Article in journal (Refereed)
    Abstract [en]

    Aims: Peer status reflects the extent to which an individual is accepted by the group. Some studies have reported that low peer status in adolescence is associated with a higher risk of smoking, while others found the reverse. No studies have investigated peer status influences on adult smoking. The aim of the study was therefore to examine the relationship between adolescents' peer status and the intensity of smoking in adulthood.

    Design: Prospective cohort study.

    Setting: Stockholm, Sweden.

    Participants: A subsample (n = 2329) of the cohort with information about adult smoking.

    Measurements: Peer status was assessed sociometrically at age 13 and information on smoking was gathered through a questionnaire at age 32. Relative risks (RR) for self-reported level of smoking were calculated using multinomial logistic regression. Several family-related and individual variables were included as control variables.

    Findings: Lower peer status in adolescence was associated with smoking of any intensity in adulthood. For example, the risk of heavy smoking was more than threefold (RR = 3.67) among individuals in the lowest status positions. The association with occasional smoking was abolished by controlling for factors related to adolescents' attitude to school and cognitive ability. For regular and heavy smoking the relationship was attenuated by controlling for these factors.

    Conclusions: Low peer status in adolescence appears to be a risk factor for smoking in adulthood. Part of this association may be explained by adolescents' feelings towards school and cognitive ability. However, being unpopular in adolescence remains a strong risk factor for regular and heavy smoking in adulthood.

  • 3. Atkinson, Jo-An
    et al.
    Prodan, Ante
    Livingston, Michael
    Knowles, Dylan
    O'Donnell, Eloise
    Room, Robin
    La Trobe University, Australia.
    Indig, Devon
    Page, Andrew
    McDonnell, Geoff
    Wiggers, John
    Impacts of licensed premises trading hour policies on alcohol-related harms2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 7, p. 1244-1251Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM: Evaluations of alcohol policy changes demonstrate that restriction of trading hours of both 'on'- and 'off'-licence venues can be an effective means of reducing rates of alcohol-related harm. Despite this, the effects of different trading hour policy options over time, accounting for different contexts and demographic characteristics, and the common co-occurrence of other harm reduction strategies in trading hour policy initiatives, are difficult to estimate. The aim of this study was to use dynamic simulation modelling to compare estimated impacts over time of a range of trading hour policy options on various indicators of acute alcohol-related harm.

    METHODS: An agent-based model of alcohol consumption in New South Wales, Australia was developed using existing research evidence, analysis of available data and a structured approach to incorporating expert opinion. Five policy scenarios were simulated, including restrictions to trading hours of on-licence venues and extensions to trading hours of bottle shops. The impact of the scenarios on four measures of alcohol-related harm were considered: total acute harms, alcohol-related violence, emergency department (ED) presentations and hospitalizations.

    RESULTS: Simulation of a 3 a.m. (rather than 5 a.m.) closing time resulted in an estimated 12.3 ± 2.4% reduction in total acute alcohol-related harms, a 7.9 ± 0.8% reduction in violence, an 11.9 ± 2.1% reduction in ED presentations and a 9.5 ± 1.8% reduction in hospitalizations. Further reductions were achieved simulating a 1 a.m. closing time, including a 17.5 ± 1.1% reduction in alcohol-related violence. Simulated extensions to bottle shop trading hours resulted in increases in rates of all four measures of harm, although most of the effects came from increasing operating hours from 10 p.m. to 11 p.m.

    CONCLUSIONS: An agent-based simulation model suggests that restricting trading hours of licensed venues reduces rates of alcohol-related harm and extending trading hours of bottle shops increases rates of alcohol-related harm. The model can estimate the effects of a range of policy options.

  • 4. Babor, T.
    et al.
    Caetano, R.
    Casswell, S.
    Edwards, G.
    Giesbrecht, N.
    Graham, K.
    Grube, J.
    Hill, L.
    Holder, H.
    Homel, R.
    Livingston, M.
    Rehm, J.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Rossow, I.
    Österberg, E.
    Alcohol: No Ordinary Commodity – a summary of the second edition2010In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 105, no 5, p. 769-779Article in journal (Refereed)
    Abstract [en]

    This article summarizes the contents of Alcohol: No Ordinary Commodity (2nd edn). The first part of the book describes why alcohol is not an ordinary commodity, and reviews epidemiological data that establish alcohol as a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. This section also documents how international beer and spirits production has been consolidated recently by a small number of global corporations that are expanding their operations in Eastern Europe, Asia, Africa and Latin America. In the second part of the book, the scientific evidence for strategies and interventions that can prevent or minimize alcohol-related harm is reviewed critically in seven key areas: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drink-driving countermeasures, restrictions on marketing, education and persuasion strategies, and treatment and early intervention services. Finally, the book addresses the policy-making process at the local, national and international levels and provides ratings of the effectiveness of strategies and interventions from a public health perspective. Overall, the strongest, most cost-effective strategies include taxation that increases prices, restrictions on the physical availability of alcohol, drink-driving countermeasures, brief interventions with at risk drinkers and treatment of drinkers with alcohol dependence.

  • 5. Babor, Thomas F.
    et al.
    Caulkins, Jonathan
    Fischer, Benedikt
    Foxcroft, David
    Medina-Mora, María Elena
    Obot, Isidore
    Rehm, Jürgen
    Reuter, Peter
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Rossow, Ingeborg
    Strang, John
    Drug Policy and the Public Good: a summary of the second edition2019In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443Article in journal (Refereed)
    Abstract [en]

    The second edition of Drug Policy and the Public Good presents up-to-date evidence relating to the development of drug policy at local, national and international levels. The book explores both illicit drug use and non-medical use of prescription medications from a public health perspective. The core of the book is a critical review of the scientific evidence in five areas of drug policy: (1) primary prevention programs in schools and other settings; (2) treatment interventions and harm reduction approaches; (3) attempts to control the supply of illicit drugs, including drug interdiction and law enforcement; (4) penal approaches, decriminalization and other alternatives; and (5) control of the legal market through prescription drug regimens. It also discusses the trend towards legalization of some psychoactive substances in some countries and the need for a new approach to drug policy that is evidence-based, realistic and coordinated. The accumulated evidence provides important information about effective and ineffective policies. Shifting the emphasis towards a public health approach should reduce the extent of illicit drug use, prevent the escalation of new epidemics and avoid the unintended consequences arising from the marginalization of drug users through severe criminal penalties.

  • 6. Babor, Thomas F.
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Strang, John
    Drug Policy and the Public Good: a summary of the book2010In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 105, no 7, p. 1137-1145Article in journal (Refereed)
    Abstract [en]

    Drug Policy and the Public Good was written by an international group of scientists from the fields of addiction, public health, criminology and policy studies to improve the linkages between drug research and drug policy. The book provides a conceptual basis for evidence-informed drug policy and describes epidemiological data on the global dimensions of drug misuse. The core of the book is a critical review of the cumulative scientific evidence in five general areas of drug policy: primary prevention programmes in schools and other settings; health and social services for drug users; attempts to control the supply of drugs, including the international treaty system; law enforcement and ventures into decriminalization; and control of the psychotropic substance market through prescription drug regimes. The final chapters discuss the current state of drug policies in different parts of the world and describe the need for future approaches to drug policy that are coordinated and informed by evidence.

  • 7.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bäck, Karin
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental alcohol-related disorders and school performance in 16 year olds - a national cohort study2016In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 111, no 10, p. 1795-1803Article in journal (Refereed)
    Abstract [en]

    To study the links between parental alcohol-related disorders and offspring school performance and, specifically, whether associations vary by gender of parent or child and whether associations are mediated by other adverse psychosocial circumstances commonly appearing together with parental alcohol problems, such as parental mental health problems or criminal behaviour.

    Register study in a national cohort.

    Setting

    Sweden.

    740 618 individuals born in Sweden in 1990-1996.

    Parental hospital admissions for alcohol-related disorders and school performance in their offspring, in the final year of compulsory school at age 15-16, was analysed in relation to sociodemographic confounders and psychosocial covariates, using linear and logistic regressions.

    Both mothers’ and fathers’ alcohol-related hospital admissions were associated with lower z-scores of grades and national mathematic tests scores. After adjustment for parental education and sociodemographic confounders, beta-coefficients of z-scores of grades were -0.42 (95% CI -0.45, -0.39) and -0.42 (95 % CI -0.43,-0.40), and beta-coefficients of mathematic tests scores were -0.36 (95% CI -0.39, -0.33) and -0.31 (95% CI -0.33, -0.29), for mothers’ and fathers’ alcohol-related disorders, respectively. Adjusted ORs for not being eligible for secondary school were 1.99 (95% CI 1.84-2.15) and 2.04 (95% CI 1.95-2.15) for mothers’ and fathers’ alcohol-related disorders, respectively. Adjusting the analyses for psychosocial factors in the family almost eradicated the statistical effects of parental alcohol-related disorders on offspring school performance to beta-coefficients of 0.03 to -0.10 and ORs of 0.89 to 1.15. The effect of a mother's alcohol-related hospital admission on school performance was stronger in girls than in boys, whereas no gender differences were seen for a father's alcohol-related hospital admission.

    Conclusions

    In Sweden, alcohol-related disorders in both mothers and fathers are associated with lower school performance in their children at age 15-16, with most of the statistical effects being attributed to psychosocial circumstances of the family, such as parental psychiatric disorders, drug use, and criminality and receipt of social or child welfare interventions.

  • 8.
    Bergmark, Anders
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Drug misuse - psychosocial interventions2009In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, ISSN 0965-2140, Vol. 104, no 4, p. 676-677Article in journal (Refereed)
  • 9.
    Bergmark, Anders
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Mindfulness training: specific intervention or psychological panacea?2010In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 105, no 10, p. 1708-1709Article in journal (Refereed)
  • 10.
    Bergmark, Anders
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    The role of psychopathology as motivator for drug dependency—some moderating remarks2013In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 108, no 4, p. 673-674Article in journal (Refereed)
  • 11. Billieux, Joël
    et al.
    van Rooij, Antonius J.
    Heeren, Alexandre
    Schimmenti, Adriano
    Maurage, Pierre
    Edman, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Blaszczynski, Alexander
    Khazaal, Yasser
    Kardefelt‐Winther, Daniel
    Behavioural Addiction Open Definition 2.0—using the Open Science Framework for collaborative and transparent theoretical development2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 10, p. 1723-1724Article in journal (Other academic)
  • 12.
    Blomqvist, Jan
    Research and Development Unit (FoU) Social Services Administration, Stockholm, Sweden.
    Striking the balance between science and common sense2002In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 91, no 2, p. 136-137Article in journal (Refereed)
  • 13. Danielsson, Anna-Karin
    et al.
    Falkstedt, Daniel
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Allebeck, Peter
    Agardh, Emilie
    Cannabis use among Swedish men in adolescence and the risk of adverse life course outcomes: results from a 20 year-follow-up study2015In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 11, p. 1794-1802Article in journal (Refereed)
    Abstract [en]

    AimsTo examine associations between cannabis use in adolescence (at age 18) and unemployment and social welfare assistance in adulthood (at age 40) among Swedish men. DesignLongitudinal cohort study. Setting and ParticipantsA total of 49321 Swedish men born in 1949-51, who were conscripted to compulsory military service at 18-20 years of age. MeasurementsAll men answered two detailed questionnaires at conscription and were subject to examinations of physical aptitude psychological functioning and medical status. By follow-up in national databases, information on unemployment and social welfare assistance was obtained. FindingsIndividuals who used cannabis at high levels in adolescence had increased risk of future unemployment and of receiving social welfare assistance. Adjusted for all confounders (social background, psychological functioning, health behaviours, educational level, psychiatric diagnoses), an increased relative risk (RR) of unemployment remained in the group reporting cannabis use >50 times [RR=1.26, 95% confidence interval (CI)=1.04-1.53] only. For social welfare assistance, RR in the group reporting cannabis use 1-10 times was 1.15 (95% CI=1.06-1.26), RR for 11-50 times was 1.21 (95% CI=1.04-1.42) and RR for >50 times was 1.38 (95% CI=1.19-1.62). ConclusionsHeavy cannabis use among Swedish men in late adolescence appears to be associated with unemployment and being in need of social welfare assistance in adulthood. These associations are not explained fully by other health-related, social or behavioural problems.

  • 14. Danielsson, Anna-Karin
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Hibell, Björn
    Romelsjö, Anders
    Alcohol use, heavy episodic drinking, and subsequent problems among adolescents in 23 European countries: does the prevention paradox apply?2012In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 107, no 1, p. 71-80Article in journal (Refereed)
    Abstract [en]

    Aims  According to the prevention paradox, a majority of alcohol-related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems among adolescents in 23 European countries.

    Design and setting  Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16-year-old students were analysed.

    Participants  A total of 38 370 alcohol-consuming adolescents (19 936 boys and 18 434 girls) from 23 European countries were included.

    Measurements  The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol-related problems.

    Findings  Although the mean levels of consumption and alcohol-related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol-related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems.

    Conclusions  The prevention paradox, based on measures of annual consumption and heavy episodic drinking, seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large proportion of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives combined with targeted interventions.

  • 15. Demers, A.
    et al.
    Gerretsen, H.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Rossow, I.
    Ugland, T.
    The Kettil Bruun Society for Social and Epidemiological Research on Alcohol2004In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 99, no 2, p. 161-164Article in journal (Refereed)
    Abstract [en]

    The Kettil Bruun Society for Social and Epidemiological Research on Alcohol (KBS) was established in 1987 and is an independent organization open to all scientists working on problems related to social and epidemiological research on alcohol. The aim of the Society is to promote social and epidemiological research which fosters a comparative understanding of the social aspects of alcohol use and alcohol problems. In line with this the Society also aims at promoting a spirit of international collaboration. The Kettil Bruun Society is based on individual membership and, by 2003, has 197 fully paid-up members, representing 34 different countries over five continents. The main activities include an annual meeting as well as thematic meetings. In these meetings, discussions are emphasized by having precirculated papers and assigned discussants. The KBS also serves as a basis for organizing international collaborative projects. Project meetings or work-shops are often organized around the annual meetings, and the projects tend to run over several years. The Society's primary influence is through the mutual influence of its members on each others' thinking, the work of the projects that KBS sponsors and the influence its members have collectively on the development of the field.

  • 16. Dietze, Paul
    et al.
    Agius, Paul A.
    Livingston, Michael
    Callinan, Sarah
    Jenkinson, Rebecca
    Lim, Megan S. C.
    Wright, Cassandra J. C.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Correlates of alcohol consumption on heavy drinking occasions of young risky drinkers: event versus personal characteristics2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 8, p. 1369-1377Article in journal (Refereed)
    Abstract [en]

    Aims Risky single-occasion drinking (RSOD) by young people is a serious public health issue, yet little is known about the specific circumstances of risky drinking occasions. This study examined the independent effects of event- and individual-specific variables on RSOD. Design Longitudinal cohort study measuring self-reported RSOD and event- and individual-specific variables across two drinking occasions approximately 1 year apart. Setting Metropolitan Melbourne, Australia. Participants A sample of 710 young risky drinkers aged between 18 and 25years and defined as engaging in risky drinking practices (males: consumed alcohol in excess of 10 Australian Standard Drinks (ASD: 10g ethanol) in a single occasion in the previous year; females: consumed alcohol in excess of seven ASD for females in a single occasion in the previous year). Measurements Random digit-dial telephone landline survey of the most recent heavy drinking occasion and socio-demographic variables. The primary outcome was the log of the total drinks consumed in the most recent heavy drinking occasion. Event-specific (e.g. number of drinking locations) and time-varying (e.g. weekly income) and time-invariant (e.g. sex) individual-specific variables were examined as correlates of total drinks consumed. Findings Changes in event-specific characteristics including the length of the drinking occasion (Likelihood Ratio (2)(2)=24.4, P<0.001), the number of drinking locations (Wald (2)((1))=7.6, P=0.006) and the number of different drink types (Wald (2)((1))=13.6, P<0.001) were associated with increases in total drinks consumed, after adjustment for time-invariant and time-variant individual-specific variables such as gender, income level and weekly consumption. Few other effects were noted. Conclusions Event-specific characteristics are important predictors of the number of drinks consumed during risky single occasion drinking (RSOD) and illustrate the importance of event contexts when considering interventions targeting RSOD. The total number of drinks consumed in a RSOD session appears to rise independently with the duration of the drinking event, the number of drinking locations and the number of different types of beverage consumed.

  • 17.
    Enefalk, Hanna
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Swedish alcohol consumption on the threshold of modernity: Legislation, attitudes, and national economy ca 1775-18552013In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 108, no 2, p. 265-274Article in journal (Refereed)
    Abstract [en]

    Aims: We aimed to map the context of the large increase in vodka consumption in Sweden during the transition from early modern to modern times (ca 1775-1855). What were the attitudes to alcohol among the groups that dominated society, and how did these attitudes relate to contemporary legislation and socio-economic change?

    Methods: Qualitative analysis of diaries and memoirs. Information was also collected from legislation, writings of the temperance movement, and previous research.

    Findings: During the period studied, attitudes to alcohol among the socio-economic elite were positive if the drinker was a person of standing, wereas drinking among the working population was scorned and, from the 1830s on, a cause for concern. Legislation was characterized by frequent and radical changes. Consumption levels are difficult to estimate: in the 1820s, agricultural overproduction, liberal legislation and improved distilling methods probably resulted in a major consumption increase. In 1846-53, permissive licensing laws and the industrialization of distilling similarly led to very high consumption levels.

    Conclusions: In Sweden in the late 18th and early 19th centuries the social elite appears to have used alcohol as a tool in their negotiations with the working population; but later, as the spread of wage labour and cheap vodka coincided with Sweden's largest ever population growth, the view that popular drinking must be checked gained support in leading circles.

  • 18.
    Gauffin, Karl
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work. National Board of Health and Welfare, Sweden.
    Fridell, Mats
    Hesse, Morten
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Childhood socio-economic status, school failure and drug abuse: a Swedish national cohort study2013In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 108, no 8, p. 1441-1449Article in journal (Refereed)
    Abstract [en]

    Aim To investigate whether socio-economic status (SES) in childhood and school failure at 15 years of age predict illicit drug abuse in youth and young adulthood. Design setting and participantsRegister study in a Swedish national cohort born 1973-88 (n=1405763), followed from age 16 to 20-35 years. Cox regression analyses were used to calculate hazard ratios (HR) for any indication of drug abuse. Measurements Our outcomes were hospital admissions, death and criminality associated with illicit drug abuse. Data on socio-demographics, school grades and parental psychosocial problems were collected from censuses (1985 and 1990) and national registers. School failure was defined as having mean school grades from the final year in primary school lower than -1standard deviation and/or no grades in core subjects. Findings School failure was a strong predictor of illicit drug abuse with an HR of 5.87 (95% CI: 5.76-5.99) after adjustment for age and sex. Childhood SES was associated with illicit drug abuse later in life in a stepwise manner. The lowest stratum had a HR of 2.28 (95% CI: 2.20-2.37) compared with the highest stratum as the reference, when adjusted for other socio-demographic variables. In the fully adjusted model, the effect of SES was greatly attenuated to an HR of 1.23 (95% CI: 1.19-1.28) in the lowest SES category, while the effect of school failure remained high with an HR of 4.22 (95% CI: 4.13-4.31). Conclusions School failure and childhood socio-economic status predict illicit drug abuse independently in youth and young adults in Sweden.

  • 19. Hall, W.
    et al.
    Fischer, B.
    Lenton, S.
    Reuter, P.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Making space for cannabis policy experiments2011In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 106, no 6, p. 1192-1193Article in journal (Refereed)
  • 20.
    Härkönen, Juho
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. European University Institute, Italy; University of Turku, Finland.
    Lindberg, Matti
    Karlsson, Linnea
    Karlsson, Hasse
    Scheinin, Noora M.
    Education is the strongest socio-economic predictor of smoking in pregnancy2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 6, p. 1117-1126Article in journal (Refereed)
    Abstract [en]

    Aims To investigate socio-economic disparities in smoking in pregnancy (SIP) by the mother's education, occupational class and current economic conditions. Design Cross-sectional analysis with linked survey and register data. Setting South-western Finland. Participants A total of 2667 pregnant women [70% of the original sample (n=3808)] from FinnBrain, a prospective pregnancy cohort study. Measurements The outcome was smoking during the first pregnancy trimester, measured from the Finnish Medical Birth Register. Education and occupational class were linked from population registers. Income support recipiency and subjective economic wellbeing were questionnaire-based measures of current economic conditions. These were adjusted for age, partnership status, residential area type, parental separation, parity, childhood socio-economic background, childhood adversities (the Trauma and Distressing Events During Childhood scale) and antenatal stress (Edinburgh Postnatal Depression Scale). Logistic regressions and attributable fractions (AF) were estimated. Findings Mother's education was the strongest socio-economic predictor of SIP. Compared with university education, adjusted odds ratios (aORs) of SIP were: 2.2 [95% confidence interval (CI)=1.2-3.9; P=0.011] for tertiary vocational education, 4.4 (95% CI=2.1-9.0; P<0.001) for combined general and vocational secondary education, 2.9 (95% CI=1.4-6.1; P=0.006) for general secondary education, 9.5 (95% CI 5.0-18.2; P<0.001) for vocational secondary education and 14.4 (95% CI=6.3-33.0; P<0.001) for compulsory schooling. The total AF of education was 0.5. Adjusted for the other variables, occupational class and subjective economic wellbeing did not predict SIP. Income support recipiency was associated positively with SIP (aOR=1.8; 95% CI=1.1-3.1; P=0.022). Antenatal stress predicted SIP (aOR=2.0; 95% CI=1.4-2.8; P<0.001), but did not attenuate its socio-economic disparities. Conclusions In Finland, socio-economic disparities in smoking in pregnancy are attributable primarily to differences in the mother's educational level (low versus high) and orientation (vocational versus general).

  • 21.
    Jernigan, David
    et al.
    Institute for the Prevention of Alcohol and Other Drug Problems, San Rafael CA, USA.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The ambiguous role of alcohol in economic and social development2000In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 95, no 12, Suppl. 4, p. 523-535Article in journal (Refereed)
    Abstract [en]

    An increased and industrialized alcohol supply in a developing society is usually assumed to have positive effects on economic development, although it may be recognized that the effects on public health and order will be negative. There has been little attention to the potential for negative effects on the economic side. This paper directs attention to such factors as unemployment for cottage producers (often female heads of household) and reduced industrial employment as highly-automated "turnkey" brewers are installed. On the other hand, changes in the mode of production of alcoholic beverages may have little impact on the much larger work-force involved in serving or selling alcohol in retail trade. The net contribution of an increased and industrialized alcohol supply in terms of economic development is unclear, but industrialization and development bring with them increased demands for attention and sobriety, e.g. in motorized traffic and on the production line, which increased drinking may undercut. Decisions by international development agencies on investment in alcohol production and distribution should take account of both the positive and negative impacts on economic development as well as on public health. In line with this, the World Bank has recently decided to invest in alcohol industry projects only when there is a strong positive development impact and the project is "consistent with public health issues and social policy concerns".

  • 22.
    Jessica, Storbjörk
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Commentary on Witkiewitz et al (2017): Abstinence or moderation – a choice for whom and why?2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 12, p. 2122-2123Article in journal (Other academic)
    Abstract [en]

    Analyses of low-risk drinking add legitimacy to moderation as an alcohol treatment goal, so increasing choice for some patient groups. Moderation also parallels a dominant model of opioid treatment, opioid maintenance treatment. 

  • 23. Jiang, Heng
    et al.
    Xiang, Xiaojun
    Waleewong, Orratai
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia; University of Melbourne, Australia.
    ALCOHOL MARKETING AND YOUTH DRINKING IN ASIA2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 8, p. 1508-1509Article in journal (Refereed)
  • 24. Kardefelt-Winther, Daniel
    et al.
    Heeren, Alexandre
    Schimmenti, Adriano
    van Rooij, Antonius J.
    Maurage, Pierre
    Carras, Michelle
    Edman, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Blaszczynski, Alexander
    Khazaal, Yasser
    Billieux, Joel
    How can we conceptualize behavioural addiction without pathologizing common behaviours?2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 10, p. 1709-1715Article in journal (Refereed)
    Abstract [en]

    Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework.

  • 25.
    Karlsson, Patrik
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Bergmark, Anders
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Compared with what? An analysis of control group typies in Cochrane and Campbell reviews of psychosocial treatment efficacy with substance use disorders2015In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 3, p. 420-428Article in journal (Refereed)
    Abstract [en]

    Background and Aims

    A crucial, but under-appreciated, aspect in experimental research on psychosocial treatments of substance use disorders concerns what kinds of control groups are used. This paper examines how the distinction between different control group designs has been handled by the Cochrane and the Campbell Collaborations in their systematic reviews of psychosocial treatments of substance abuse disorders.

    Methods

    We assessed Cochrane and Campbell reviews (n = 8) that were devoted to psychosocial treatments of substance use disorders. We noted what control groups were considered and analysed the extent to which the reviews provided a rationale for chosen comparison conditions. We also analysed whether type of control group in the primary studies influenced how the reviews framed the effects discussed and whether this was related to conclusions drawn.

    Results

    The reviews covered studies involving widely different control conditions. Overall, little attention was paid to the use of different control groups (e.g. head-to-head comparisons vs. untreated controls) and what this implies when interpreting effect sizes. Seven of eight reviews did not provide a rationale for the choice of comparison conditions.

    Conclusions

    Cochrane- and Campbell reviews of the efficacy of psychosocial interventions with substance use disorders seem to underappreciate that use of different control group types yields different effect estimates. Most reviews have not distinguished between different control group designs and therefore have provided a confused picture regarding absolute and relative treatment efficacy. A systematic approach to treating different control group designs in research reviews is necessary for meaningful estimates of treatment efficacy.

  • 26.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary .
    Seitz, Nicki-Nils
    Piontek, Daniela
    Molinaro, Sabrina
    Siciliano, Valeria
    Guttormsson, Ulf
    Arpa, Sharon
    Monshouwer, Karin
    Leifman, Hakan
    Vicente, Julian
    Griffiths, Paul
    Clancy, Luke
    Feijao, Fernanda
    Florescu, Silvia
    Lambrecht, Patrick
    Nociar, Alojz
    Raitasalo, Kirsimarja
    Spilka, Stanislas
    Vyshinskiy, Konstantin
    Hibell, Bjorn
    'Are The Times A-Changin'? Trends in adolescent substance use in Europe2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 7, p. 1317-1332Article in journal (Refereed)
    Abstract [en]

    Aims To estimate temporal trends in adolescents' current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence. Design and Setting Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]. Participants A total of 223 814 male and 211 712 female 15-16-year-old students. Measurements Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi-level mixed-effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion. Findings Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time. Conclusions Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence.

  • 27.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Östhus, Ståle
    Amundsen, Ellen J.
    Piontek, Daniela
    Harkonen, Janne
    Legleye, Stephane
    Bloomfield, Kim
    Makela, Pia
    Landberg, Jonas
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Changes in mortality due to major alcohol-related diseases in four Nordic countries, France and Germany between 1980 and 2009: a comparative age-period-cohort analysis2015In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 9, p. 1443-1452Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate age, period and cohort effects on time trends of alcohol-related mortality in countries with different drinking habits and alcohol policies.

    Design and setting: Age-period-cohort (APC) analyses on alcohol-related mortality were conducted in Denmark, Finland, Norway, Sweden, France and Germany.

    Participants: Cases included alcohol-related deaths in the age range 20-84 years between 1980 and 2009.

    Measurements: Mortality data were taken from national causes of death registries and covered the ICD codes alcoholic psychosis, alcohol use disorders, alcoholic liver disease and toxic effect of alcohol.

    Findings: In all countries changes across age, period and cohort were found to be significant for both genders [effect value with confidence interval (CI) shown in Supporting information, Table S1]. Period effects pointed to an increase in alcohol-related mortality in Denmark, Finland and Germany and a slightly decreasing trend in Sweden, while in Norway an inverse U-shaped curve and in France a U-shaped curve was found. Compared with the cohorts born before 1960, the risk of alcohol-related mortality declined substantially in cohorts born in the 1960s and later. Pairwise between-country comparisons revealed more statistically significant differences for period (P<0.001 for all 15 comparisons by gender) than for age [P<0.001 in seven (men) and four (women) of 15 comparisons] or cohort [P<0.01 in two (men) and three (women) of 15 comparisons].

    Conclusions: Strong period effects suggest that temporal changes in alcohol-related mortality in Denmark, Finland, Norway, Sweden, France and Germany between 1980 and 2009 were related to secular differences affecting the whole population and that these effects differed across countries.

  • 28. Laslett, A.-M.
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Ferris, J.
    Wilkinson, C.
    Livingston, M.
    Mugavin, J.
    Surveying the range and magnitude of alcohol's harm to others in Australia2011In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 106, no 9, p. 1603-1611Article in journal (Refereed)
    Abstract [en]

    Aims  This study aims to document the adverse effects of drinkers in Australia on people other than the drinker.

    Design  Cross-sectional survey.

    Setting  In a national survey of Australia, respondents described the harmful effects they experienced from drinkers in their households, family and friendship networks, as well as work-place and community settings.

    Participants  A randomly selected sample of 2649 adult Australians.

    Measurements  Problems experienced because of others' drinking were ascertained via computer-assisted telephone interviews. Respondent and drinker socio-demographic and drinking pattern data were recorded.

    Findings  A total of 70% of respondents were affected by strangers' drinking and experienced nuisance, fear or abuse, and 30% reported that the drinking of someone close to them had negative effects, although only 11% were affected by such a person ‘a lot’. Women were more affected by someone they knew in the household or family, while men were more affected by strangers, friends and co-workers. Young adults were consistently the most negatively affected across the majority of types of harm.

    Conclusions  Substantial proportions of Australians are affected by other people's drinking, including that of their families, friends, co-workers and strangers. These harms range in magnitude from noise and fear to physical abuse, sexual coercion and social isolation.

  • 29. Livingston, Michael
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University of Melbourne, Australia.
    Commentary on Norstrom & Svensson (2014) and Rossow et al. (2014): Understanding how population-level alcohol consumption changes2014In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 109, no 9, p. 1456-1458Article in journal (Refereed)
  • 30. Ludwig, Monika
    et al.
    Kraeplin, Anja
    Braun, Barbara
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Gambling experiences, problems, research and policy: gambling in Germany2013In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 108, no 9, p. 1554-1561Article in journal (Refereed)
    Abstract [en]

    Aims The objective of this paper is to present an overview of gambling in Germany, including historical development, legislative and economic changes as well as treatment options and their effectiveness. Methods The available scientific literature and research reports on gambling in Germany were reviewed to obtain relevant information on history, commercialization, legislation, treatment and research agenda. Results Gambling in Germany is characterized by compromises between protective and economic efforts. At present, gambling is illegal in Germany, and provision is subject to the state monopoly. Mere gaming machines (specific slot machines) are not classified as gambling activity, permitting commercial providers. In recent years, implementing regulations for state gambling and gaming machines have been changed. Concerning the treatment of pathological gambling, various options exist; treatment costs have been covered by health and pension insurance since 2001. Information on the effectiveness of treatment in Germany is limited. Similarly, the number of peer-reviewed publications on gambling is small. Conclusions German gambling legislation was subject to major changes in the past years. Based on the available body of research (longitudinal), studies on risk and protective factors and the aetiology of pathological gambling are needed. The effectiveness of pathological gambling treatment in Germany and the impact of gambling regulations on gambling behaviour also need to be investigated.

  • 31. Molinaro, Sabrina
    et al.
    Benedetti, Elisa
    Scalese, Marco
    Bastiani, Luca
    Fortunato, Loredana
    Cerrai, Sonia
    Canale, Natale
    Chomynova, Pavla
    Elekes, Zsuzsanna
    Feijao, Fernanda
    Fotiou, Anastasios
    Kokkevi, Anna
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Rupsiene, Liudmila
    Monshouwer, Karin
    Nociar, Alojz
    Strizek, Julian
    Lazar, Tanja Urdih
    Prevalence of youth gambling and potential influence of substance use and other risk factors throughout 33 European countries: first results from the 2015 ESPAD study2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 10, p. 1862-1873Article in journal (Refereed)
    Abstract [en]

    Background and aims

    Although generally prohibited by national regulations, underage gambling has become popular in Europe, with relevant cross‐country prevalence variability. This study aimed to estimate the prevalence of underage gambling in Europe stratified by type of game and on‐/off‐line mode and to examine the association with individual and family characteristics and substance use.

    Design

    Our study used data from the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross‐sectional study, a survey using self‐administered anonymous questionnaires.

    Setting

    Thirty‐three European countries.

    Participants

    Sixteen‐year‐old‐year‐old students (n = 93 875; F = 50.8%).

    Measurements

    The primary outcome measure was prevalence of past‐year gambling activity. Key predictors comprised individual behaviours, substance use and parenting (regulation, monitoring and caring).

    Findings

    A total of 22.6% of 16‐year‐old students in Europe gambled in the past year: 16.2% on‐line, 18.5% off‐line. High prevalence variability was observed throughout countries both for mode and types of game. With the exception of cannabis, substance use shows a higher association with gambling, particularly binge drinking [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.39–1.53), life‐time use of inhalants (OR = 1.57, 95% CI = 1.47–1.68) and other substances (OR = 1.78, 95% CI = 1.65–1.92)]. Among life habits, the following showed a positive association: truancy at school (OR = 1.26, 95% CI = 1.18–1.35), going out at night (OR = 1.32, 95% CI = 1.26–1.38), participating in sports (OR = 1.30, 95% CI = 1.24–1.37). A negative association was found with reading books for leisure (OR = 0.82%, 95% CI = 0.79–0.86), parents’ monitoring of Saturday night activities (OR = 0.81, 95% CI = 0.77–0.86) and restrictions on money provided by parents as a gift (OR = 0.89, 95% CI = 0.84–0.94).

    Conclusions

    Underage gambling in Europe appears to be associated positively with alcohol, tobacco and other substance use (but not cannabis), as well as with other individual behaviours such as truancy, going out at night and active participation in sports, and is associated negatively with reading for pleasure, parental monitoring of evening activities and parental restriction of money.

  • 32.
    Norström, Thor
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Commentary on Pridemore (2014): Drinking and suicide in Russia — strong evidence of a strong link2014In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 109, no 2, p. 189-190Article in journal (Other academic)
  • 33.
    Norström, Thor
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    The role of alcohol in the Russian mortality crisis2011In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 106, no 11, p. 1957-1965Article in journal (Refereed)
    Abstract [en]

    Aims  Alcohol is believed to be an important factor behind the sharp rise in mortality during the period 1990-94 in Russia. However, the rise in the standard alcohol consumption proxy does not seem to be sufficient to explain all the increase in mortality. This study adopts a novel approach to exploring the role of the alcohol factor in the increased mortality by investigating whether the mismatch between trends in mortality and recorded alcohol consumption is due to an underestimation of the consumption increase. Design and measurements  First, the alcohol effect on the male accident rate was estimated using data for the period 1959-89. Next, the estimated alcohol effect and the observed accident mortality rate for the period 1990-98 were used to backcast alcohol consumption during that period. Thirdly, the backcasted alcohol series was used to predict trajectories in alcohol poisoning mortality, the homicide rate and all-cause mortality during the period 1990-98. Findings  There was a markedly stronger increase in the backcasted consumption proxy than in the standard alcohol consumption proxy during the period 1990-98. There was a substantial gap between the observed mortality rates and the rates predicted from the standard alcohol consumption proxy, whereas the predictions from the backcasted alcohol proxy were much closer to the target. Conclusions  Much of the rise in Russian mortality in 1990-94 appears to have been due to the increase in population drinking, but this increase is grossly underestimated by the commonly used consumption proxy combining alcohol sales, estimation of illicit alcohol production and proportion of alcohol-positive violent deaths. 

  • 34.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Miller, Ted
    Services Research Institute Pacific Institute for Research and Evaluation Calverton, MD, USA.
    Holder, Harald
    Prevention Research Center Pacific Institute for Research and Evaluation Berkeley, CA, USA.
    Österberg, Esa
    Alcohol and Drug Research National Institute for Health and Welfare, Helsinki, Finland.
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Rossow, Ingeborg
    Norwegian Institute for Alcohol and Drug Research Oslo, Norway.
    Stockwell, Tim
    Centre for Addictions Research of BC Department of Psychology University of Victoria Victoria, BC, Canada .
    Potential Consequences of Replacing a Retail Alcohol Monopoly with a Private License System: Results from Sweden2010In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 105, no 12, p. 2113-2119Article in journal (Refereed)
    Abstract [en]

    Aim  To examine the potential effects of replacing the Swedish alcohol retail system with a private licensing system on alcohol consumption and alcohol-related harm.

    Design  Two possible scenarios were analysed: (1) replacing the current alcohol retail monopoly with private licensed stores that specialize in alcohol sales or (2) making all alcohol available in grocery stores. We utilized a multiplicative model that projected effects of changes in a set of key factors including hours of sale, retail prices, promotion and advertising and outlet density. Next, we estimated the effect of the projected consumption increase on a set of harm indicators. Values for the model parameters were obtained from the research literature.

    Measurements  Measures of alcohol-related harm included explicitly alcohol-related mortality, accident mortality, suicide, homicide, assaults, drinking driving and sickness absence.

    Findings  According to the projections, scenario 1 yields a consumption increase of 17% (1.4 litres/capita), which in turn would cause an additional 770 deaths, 8500 assaults, 2700 drinking driving offences and 4.5 million sick days per year. The corresponding figures for scenario 2 are a consumption increase of 37.4% (3.1 litres/capita) leading to an additional annual toll of 2000 deaths, 20 000 assaults, 6600 drinking driving offences and 11.1 million days of sick leave.

    Conclusions  Projections based on the research literature suggest that privatization of the Swedish alcohol retail market would significantly increase alcohol consumption and alcohol-related harm.

  • 35.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Pape, H.
    Alcohol, suppressed anger and violence2010In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 105, no 9, p. 1580-1586Article in journal (Refereed)
    Abstract [en]

    Aims Is alcohol related causally to violence, and if so, is the effect of drinking contingent on suppressed anger such that it is strongest among individuals who are highly inclined to withhold angry feelings? We addressed these questions by analysing panel data using a method that diminishes the effects of confounding factors. Design We analysed data on heavy episodic drinking and violent behaviour from the second (1994) and third (1999) waves of the Young in Norway Longitudinal Study ( n = 2697; response rate: 67%). The first difference method was applied to estimate the association between these behaviours, implying that changes in the frequency of violence were regressed on changes in the frequency of drinking. Hence, the effects of time-invariant confounders were eliminated. Analyses were conducted for the whole sample, and for groups scoring low, medium and high on a short version of the STAXI anger suppression scale. Findings Changes in drinking were related positively and significantly to changes in violent behaviour, but the alcohol effect varied with the level of suppressed anger: it was strongest in the high-anger group (elasticity estimate = 0.053, P = 0.011) and weakest (and insignificant) in the low-anger group (elasticity estimate = 0.004, P = 0.806). Conclusions Alcohol use may be related causally to violence, but the effect of drinking is confined to individuals who are inclined to suppress their angry feelings. [ABSTRACT FROM AUTHOR]

  • 36.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Raninen, Jonas
    Is there a link between per capita alcohol consumption and youth drinking? A time–series analysis for Sweden in 1972–20122015In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 6, p. 967-974Article in journal (Refereed)
    Abstract [en]

    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.

  • 37.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Rossow, I
    On the mis-match between population drinking and drink driving :: response to Gjerde et al.2014In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 109, no 2, p. 333-334Article in journal (Refereed)
  • 38.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI). Norwegian Inst Alcohol & Drug Res SIRUS, Oslo.
    Rossow, Ingeborg
    Population drinking and drink driving in Norway and Sweden: an analysis of historical data 1957–892013In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 108, no 6, p. 1051-1058Article in journal (Refereed)
    Abstract [en]

    Aim Research suggests an association between population drinking and a large number of outcomes. However, driving while under the influence of alcohol (DWI) is conspicuously absent from this list of outcomes. The aim of this study was to estimate the relation between DWI and total consumption of alcohol on annual timeseries data for Norway and Sweden. Design, setting, and measurements For Norway, we used data on convictions for DWI per 100000 inhabitants (aged 1569 years). The DWI proxy for Sweden comprised the proportion (%) of all police-reported traffic accidents with personal injuries where the driver was under the influence of alcohol. Data on total alcohol sales in litres of pure alcohol per inhabitant (aged 15 years and older) were used as proxy for total alcohol consumption. We focused on the period 195789, during which the legislation concerning DWI remained unchanged in Norway as well as in Sweden. The statistical analyses were based on co-integrated models. Findings The estimates of the association between DWI and per capita alcohol consumption were strongly significant in Norway as well as in Sweden. For Norway, the estimated elasticity equalled 2 (P<0.001) and for Sweden 1.5 (P<0.001). Conclusions In Norway and Sweden, as total population level of alcohol consumption increases or decreases so does the incidence of driving while intoxicated.

  • 39.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Svensson, Johan
    No polarization in youth drinking in Stockholm county: response to Hallgren2014In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 109, no 8, p. 1385-1386Article in journal (Refereed)
  • 40.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Svensson, Johan
    The declining trend in Swedish youth drinking: collectivity or polarization?2014In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 109, no 9, p. 1437-1446Article in journal (Refereed)
    Abstract [en]

    Aims: Alcohol consumption among youth in Sweden has declined markedly during the last decade. This study aims to tackle the following research questions: (i) how is the decrease in drinking distributed across consumption categories; and (ii) is the pattern of change in consumption consistent with Skog's theory of the collectivity of drinking behaviour?

    Design, Setting, Participants and Measurements: We analysed data from the nationally representative annual school survey of alcohol and drug habits among Swedish 9th-grade students (aged 15–16 years) covering the period 2000–12 (n ≈ 5000/year). Respondents were divided into seven drinking groups based on their relative ranking on consumption, which was measured by beverage-specific quantity and frequency items summarized into a measure of overall drinking in litres of 100% alcohol per year. In addition, the mean number of heavy episodic drinking occasions (HED) was computed for each drinking group.

    Findings: The decline in consumption among Swedish youth was mirrored in all seven drinking groups, although the relative decrease was smaller for heavy drinkers (top 5%) than for light drinkers (below the median). Among the top 5%, the average annual decrease was 2% (P = 0.027), while the corresponding figure for light drinkers was 28.9% (P < 0.001). The reverse pattern was true when looking at the absolute decrease. The decrease among the top 5% accounted for 26.1% of the decrease in mean consumption during the study period, whereas the light drinkers accounted for 2.9%. There was a marked relation between overall consumption, on one hand, and mean consumption and HED, on the other hand, in each of the seven drinking groups.

    Conclusion: The marked decrease in youth drinking in Sweden that occurred during the period 2000–12 was manifest at all consumption levels. The findings are consistent with Skog's theory of the collectivity of drinking behaviour.

  • 41. Pabst, Alexander
    et al.
    van der Auwera, Sandra
    Piontek, Daniela
    Baumeister, Sebastian E.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Decomposing social inequalities in alcohol consumption in Germany 1995-2015: an age-period-cohort analysis2019In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 114, no 8, p. 1359-1368Article in journal (Refereed)
    Abstract [en]

    Background and aims Previous research indicates that compared with individuals with lower socio-economic status (SES), individuals in higher SES groups are more often drinkers but those who drink report drinking smaller amounts more frequently. We aimed to decompose trends in self-reported alcohol consumption in Germany into age, period and birth cohort effects and examine whether these effects varied by SES. Design Age-period-cohort (APC) analysis using data from eight waves of the cross-sectional German Epidemiological Survey of Substance Abuse (ESA) collected between 1995 and 2015. Setting Germany. Participants The analytical sample included n=65821 individuals aged 18-64years reporting alcohol use within the last 30days. Measurements Alcohol measures included drinking prevalence, alcohol volume and prevalence of episodic heavy drinking (EHD). Educational attainment was used as an indicator of SES. A series of generalized linear and logistic regression models, including both main and interaction effects of age, period and cohort with SES, were estimated. Findings Regression models revealed significant interactions between APC effects and SES on two alcohol consumption measures. Higher SES was consistently associated with drinking prevalence across age (P<0.001), period (P=0.016) and cohort (P=0.016), and with volume of drinking in younger cohorts (P=0.002) and 50+-year-olds (P=0.001). Model results were inconclusive as to whether or not APC effects on EHD prevalence differed by SES. Conclusions In Germany, there are positive associations between socio-economic status and alcohol consumption during the life-course, over time and among birth cohorts. Three groups appear vulnerable to risky drinking: high socio-economic status young birth cohorts who drink high average quantities, low socio-economic status young birth cohorts who show a risky drinking pattern and high socio-economic status adults in their 50s and older who increase their drinking volume beyond that age.

  • 42. Pape, Hilde
    et al.
    Norström, Thor
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI). Norwegian Institute of Public Health, Norway.
    Rossow, Ingeborg
    Adolescent drinking – a touch of social class?2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 5, p. 792-800Article in journal (Refereed)
    Abstract [en]

    Aims

    To estimate whether parental socio-economic status (SES) is associated with adolescent drinking, and the degree to which a possible association may be accounted for by various parental factors.

    Design and setting

    Cross-sectional Norwegian school survey from 2006 (response rate: 86%).

    Participants

    Students aged 13–14 years (n = 5797), 15–16 years (n = 6613) and 17–18 years (n = 5351), of whom 51% were girls.

    Measurements

    Parents' education was our main SES indicator, and we distinguished between low (7%) and middle/high (93%) educational level. The outcomes comprised past-year drinking and intoxication. We also applied measures on general parenting, parents' alcohol-related permissiveness and parental intoxication. The main analyses were conducted using Poisson regression.

    Findings

    Parents' education had no statistically significant impact on alcohol use among the 17–18-year-olds, while 13–16-year-olds with low educated parents had an elevated relative risk (RR) of both drinking [RR = 1.21, 95% confidence interval (CI) = 1.13–1.29] and intoxication (RR = 1.32, 95% CI = 1.21–1.44). The RRs became statistically insignificant when including all the parental factors as covariates in the regression models. Among adolescents who had consumed alcohol, low parental education was related to more frequent drinking (RR = 1.24, 95% CI = 1.11–1.38) and intoxication episodes (RR = 1.42, 95% CI = 1.22–1.66). Again, the RRs became statistically insignificant when we accounted for all the parental factors. This pattern was replicated when we applied an alternative indicator for low parental SES.

    Conclusions

    Adolescent drinking in Norway appears to be related inversely to parents' social standing. The elevated risk of low socio-economic status vanishes when general parenting, alcohol-related parental permissiveness and parents' drinking are accounted for.

  • 43. Parry, C
    et al.
    Rehm, J
    Poznyak, V
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Alcohol and infectious disease: an overlooked casual linkage?2009In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 104, no 3, p. 331-332Article in journal (Refereed)
  • 44. Piontek, Daniela
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. FT Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary.
    Trends in alcohol-related mortality in East and West Germany, 1980-2014: age, period and cohort variations2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 5, p. 836-844Article in journal (Refereed)
    Abstract [en]

    Background and aims Several indicators suggest that the extent and trends of alcohol-related mortality differ between East and West Germany. Regional drinking patterns and differences in health-care systems are assumed to affect the risk of dying from an alcohol-induced disease. The study addresses two questions: (1) what are the unbiased and independent age, period and cohort effects on alcohol-related mortality trends in Germany; and (2) do these trends differ between East and West Germany? Methods Data on alcohol-related mortality for East and West Germany came from the national causes of death register for the years 1980-2014. Analyses included all deaths fully attributable to alcohol based on the International Classification of Diseases (ICD-9 and ICD-10). Gender-stratified age-period-cohort analyses were conducted using the intrinsic estimator model. Results Age effects showed a concave pattern with a peak at ages 55-64years in both regions. Incidence rate ratios (IRR) in East Germany were highest in the years 1990-1994 (men and women: IRR=1.52) and declined thereafter. In West Germany, IRR were lowest in 1980-1984 (men: IRR=0.81, women: IRR=0.75) and stabilized at approximately 1.10 since 1995-1999. Cohort effects showed continuously lower IRR for those born after 1955-1959 in the East and those born after 1945-1949 in the West. Patterns for males and females were comparable. Conclusions The results suggest that alcohol-related mortality showed different trends in East and West Germany, which can be explained partly by different drinking patterns before and changes in the health-care system after the reunification.

  • 45.
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Alcohol and pancreatitis mortality at the population level: experiences from 14 western countries2004In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 99, no 10, p. 1255-1261Article in journal (Refereed)
    Abstract [en]

    Aims  To test if there is relationship between alcohol consumption and pancreatitis mortality at the population level.

    Data and methods  Annual pancreatitis death rates for 1950–95 were converted into age-adjusted mortality rates per 100 000 inhabitants. Per capita alcohol consumption was measured by alcohol sales. The relationship was estimated with time-series analysis on data from 14 western countries. Several models were tested with different assumptions about risk function and lag structure.

    Results  According to the assumed most appropriate model, a positive relationship was found in each country, and statistical significance was reached in all countries except from Finland, Italy and Canada. The magnitude of the association was fairly consistent across countries, with the alcohol effect parameters ranging between 0.05 and 0.14. However, Sweden and Norway deviated from this pattern with estimates between 0.30 and 0.40.

    Conclusions  Pancreatitis joins a wide range of causes of death where the mortality rate is influenced by per capita alcohol consumption, and more so in northern Europe. It is suggested that pancreatitis mortality is an important indicator of alcohol-related harm, not least because a large amount of morbidity is likely to be connected to the mortality rate.

  • 46.
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Alcohol and suicide in 14 European Countries2001In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 96, no Supplement 1, p. 59-75Article in journal (Refereed)
    Abstract [en]

    Aims. To test the hypothesis that a positive population-level relationship between alcohol and suicide is more likely to be found in dry drinking cultures (as indicated by consumption level) than in wet drinking cultures. Design. Gender- and age-specific suicide rates in 14 western European countries were analysed in relation to per capita alcohol consumption employing the Box-Jenkins technique for time series analysis. The country-specific estimates were pooled into low-, medium- and high-consumption countries. Measurements. Suicide mortality data for 5-year age groups were converted into gender- and age-specific mortality rates. Alcohol sales expressed as litres of 100% alcohol per year and inhabitants 15 years and older were used as a measure of alcohol consumption. Findings. A positive and significant relationship between per capita consumption and gender- and age-specific suicide rates was revealed most often in northern Europe and found least often in southern Europe. A stronger absolute alcohol effect for men was found only in northern Europe, whereas the relative alcohol effect was somewhat stronger for women in both northern and central Europe. Also, the suicide rate in younger age groups was more often significantly related to per capita consumption than suicide among the elder in northern and central Europe but not in southern Europe. Conclusions. The population-level association between alcohol and suicide is conditioned by cultural factors. In general, the suicide rate tends to be more responsive to changes in alcohol consumption in drinking cultures characterized by a low post-war per capita consumption compared to drinking cultures with higher consumption levels. The findings give support to the hypothesis derived from previous theoretical and empirical work, suggesting that suicide and alcohol is more closely connected in dry cultures than in wet cultures.

  • 47.
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Commentary on Kerr et al. (2011): Good or bad news - and for whom?2011In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 106, no 2, p. 323-323Article in journal (Refereed)
  • 48.
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Consumption and liver cirrhosis mortality with and without mention of alcohol: the case of Canada2003In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 98, no 9, p. 1267-1276Article in journal (Refereed)
    Abstract [en]

    Aims To analyse post-war variations in per capita alcohol consumption in relation to gender-specific liver cirrhosis mortality in Canadian provinces and to assess the extent to which alcohol bears a different relation to cirrhosis deaths with mention of alcohol (alcoholic cirrhosis) compared to cirrhosis deaths without mention of alcohol (non-alcoholic cirrhosis).

    Data and method Annual liver cirrhosis mortality rates by 5-year age groups were converted into gender-specific and age-adjusted mortality rates. Outcome measures included total cirrhosis—the conventional measure of liver cirrhosis—alcoholic cirrhosis and non-alcoholic cirrhosis. Per capita alcohol consumption was measured by alcohol sales and weighted with a 10-year distributed lag model. A graphical analysis was used to examine the regional relationship and the Box–Jenkins technique for time-series analysis was used to estimate the temporal relationship.

    Findings Geographical variations in alcohol consumption corresponded to variations in total liver cirrhosis and particularly alcoholic cirrhosis, whereas non-alcoholic cirrhosis rates were not associated geographically with alcohol consumption. In general, for all provinces, time-series analyses revealed positive and statistically significant effects of changes in alcohol consumption on cirrhosis mortality. In Canada at large, a 1-litre increase in per capita consumption was associated with a 17% increase in male total cirrhosis rates and a 13% increase in female total cirrhosis rates. Alcohol consumption had a stronger impact on alcoholic cirrhosis, which increased by fully 30% per litre increase in alcohol per capita for men and women. Although the effect on the non-alcoholic cirrhosis rate was weaker (12% for men and 7% for women) it was nevertheless statistically significant and suggests that a large proportion of these deaths may actually be alcohol-related.

    Conclusions Some well-established findings in alcohol research were confirmed by the Canadian experience: per capita alcohol consumption is related closely to death rates from liver cirrhosis and alcohol-related deaths tend to be under-reported in mortality statistics.

  • 49.
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    How much alcohol do you buy?: A comparison of self-reported alcohol purchases with actual sales2010In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 105, no 4, p. 649-654Article in journal (Refereed)
    Abstract [en]

    Background Unrecorded alcohol has increased in the Nordic countries during recent years, above all in terms of cross-border trade. This implies that trends and levels of per capita consumption would look different without estimates of this source of alcohol, estimates that in Sweden and other countries are made through surveys. Aim The overall aim is to analyse the validity of Swedish survey estimates of alcohol bought in the cross-border trade and possibly to develop weights that can be applied to such estimates. Data and method The analysis consists of comparing self-reported purchases of spirits, wine, cider/alcopops and beer at retail monopoly (Systembolaget) during 2008 (n = 18 000) with actual sales during the same period overall and monthly. Findings Of the recorded amount of purchases at Systembolaget, 87% was reported in the survey, compared with the 40-60% usually found for self-reported consumption. Significant differences across beverages were revealed, showing a lower coverage rate for beer and spirits and a higher coverage rate for wine and cider. Changes in purchases of all beverages were captured fairly well, at least changes taking place from one month to another. Conclusions Self-reported alcohol purchases achieve a higher coverage rate than found typically in studies based on self-reported use of alcohol. If adjustments are to be made to correct for underreporting in self-reported data on alcohol purchases, different weights should be applied to different beverages. Furthermore, at least major changes in how much alcohol is purchased in the population can be monitored using well-designed population surveys.

  • 50.
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Per capita alcohol consumption and liver cirrhosis mortality in 14 European countries2001In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 96, no Supplement 1, p. 19-33Article in journal (Refereed)
    Abstract [en]

    Aim. To estimate the effects of changes in per capita alcohol consumption on liver cirrhosis mortality rates in various demographic groups across 14 western European countries. Method. Yearly changes in gender- and age-specific mortality rates from 1950 to 1995 were analysed in relation to corresponding yearly changes in per capita alcohol consumption, employing the Box-Jenkins technique for time series analysis. Country-specific estimates were pooled into three regions: northern, central and southern Europe. Measurements. Cirrhosis mortality data for 5-year age groups were converted into gender-specific mortality rates in the age groups 15 +, 15-44, 45-64 and 65 + and expressed as the number of deaths per 100 000 inhabitants. Alcohol sales were used to measure aggregate consumption, which were calculated into consumption (litres 100% alcohol) per year per inhabitant over 14 years of age and weighted with a 10-year distributed lag model. Findings. The country-specific analyses demonstrated a positive and statistically significant effect of changes in per capita consumption on changes in cirrhosis mortality in 13 countries for males and in nine countries for females. The strongest alcohol effect was found in northern Europe, due mainly to a large effect in Sweden. Moreover, when different age groups were analysed significant estimates were obtained in 29 of 42 cases for males and in 20 of 42 cases for females. Most of the non-significant estimates were found in older age groups. Conclusions. The results suggest clearly that a change in the overall level of drinking as a general rule affect cirrhosis mortality in different drinking cultures as well as among different demographic groups. Moreover, the findings correspond with what is expected from the collectivity theory of drinking cultures.

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