The Relationship Between Pain Severity and Alcohol Use Among School-Aged Children and Adolescents: The Moderating Role of Drinking Motives.

Objective: Evidence from adult samples suggests a co-occurrence between pain and alcohol abuse. However, studies in adolescents are scarce and results are inconsistent, with some studies observing heightened and others observing reduced alcohol consumption in adolescents suffering from pain. We hypothesized that in adolescents the association between pain and alcohol use will be moderated by drinking motives. Methods: Data from a large representative sample of Flemish school children and adolescents (N = 10,650, 50.8% boys, age range = 10-21 years, Mage = 14.33 years) were collected as part of the World Health Organization collaborative Health Behaviour in School-Aged Children (HBSC) survey. Pain severity was graded based on a pediatric pain classification system that accounts for both pain intensity and disability. Alcohol consumption was operationalized using two variables: frequency of drinking and drunkenness. The Drinking Motives Questionnaire-Revised was used to capture drinking motives; it assesses four motive categories (enhancement, coping, social, and conformity). Results: Findings indicated that higher pain severity was associated with greater frequency of alcohol use and drunkenness. However, drinking motives moderated this association. The positive association between pain severity and drinking frequency was stronger in case of high conformity motives. Likewise, the association between pain severity and drunkenness frequency was stronger at high levels of conformity motives and reached significance only at high levels of coping motives. Conclusions: Our findings suggest that specific drinking motives are linked to problematic alcohol use in adolescents with pain. Future studies using a longitudinal design are needed to draw conclusions about direction of effects.

Trends in Tobacco Smoking among Czech School-aged Children from 1994 to 2014.

OBJECTIVE: The aim of the article is to examine trends in tobacco consumption among the Czech school-age population. METHODS: For the analysis, data from the Czech Health Behaviour in School-aged Children project, conducted between 1994 and 2014 were used. Trends in tobacco smoking were determined separately for boys and girls, applying the binary logistic regression with survey period as an independent variable for the smoking status. RESULTS: The analysis showed that there have been significant changes in adolescent tobacco smoking for the recent 20 years. While the share of current school-aged smokers was continuously increasing since the mid-1990s, the trend reached its peak in the mid-2000s. CONCLUSION: In recent years, the prevalence of adolescent smokers has significantly declined in the Czech Republic. Despite this recent decline, adolescent smoking remains a major challenge for the national health policy.

The role of community social capital in the relationship between socioeconomic status and adolescent life satisfaction: mediating or moderating? Evidence from Czech data.

BACKGROUND: The concept of social capital has been extensively used to explain the relationship between socioeconomic status (SES) and adolescent health and well-being. Much less is known about the specific mechanism through which social capital impacts the relationship. This paper investigates whether an individual's perception of community social capital moderates or mediates the association between SES and life satisfaction. METHODS: This study employs cross-sectional data from the 2009-2010 Czech Health Behaviour in School-Aged Children survey: a WHO Collaborative Cross-National Study (HBSC). A sample of 4425 adolescents from the 5th, 7th and 9th grade (94.5% school response rate, 87% student response) was used to perform multilevel analysis. RESULTS: We found that pupils' life satisfaction was positively related to both family affluence and perceived wealth. Moreover, we found the cognitive component of social capital to be positively associated with life satisfaction. Additionally, a significant interaction was found, such that the social gradient in life satisfaction was flattened when pupils reported high levels of perceived community social capital. CONCLUSIONS: The present findings suggest that community social capital acts as an unequal health resource for adolescents, but could potentially represent opportunities for public health policy to close the gap in socioeconomic disparities.

Health promotion interventions in social economy companies in Flanders (Belgium).

BACKGROUND: Disadvantaged groups are often not reached by mainstream health promotion interventions. Implementing health promotion (HP) interventions in social economy companies, can be an opportunity to reach those people. The implementation of these interventions in social economy companies was studied. Factors that could be related to the implementation of HP and being supportive towards implementation in the future, were investigated. METHODS: An online, quantitative survey was sent to all 148 sheltered and social workshops in Flanders. In the questionnaire, the status of HP interventions and characteristics of the workshop were explored. Personal factors (such as attitudes towards HP, behavioural control, social norms and moral responsibility) were asked to the person responsible for implementation of HP interventions. Univariate and multivariate logistic regressions were performed. RESULTS: Respondents of 88 workshops completed the questionnaire. Almost 60% of the workshops implemented environmental or policy interventions. Having a positive attitude towards HP, being more morally responsible, and having the subjective norm that employees are positive towards health promotion at work, were related to being more supportive towards the implementation of HP in the univariate analyses. Only attitude stayed significantly related to being more supportive towards the implementation of HP in the multivariate analyses. CONCLUSIONS: Sheltered and social workshops are open to HP interventions, but more can be done to optimize the implementation. To persuade persons responsible for the implementation of HP to invest more in HP, changing attitudes concerning the benefits of health promotion for the employee and the company, is an important strategy.

Trends in the co-occurrence of tobacco and cannabis use in 15-year-olds from 2002 to 2010 in 28 countries of Europe and North America.

BACKGROUND: Cannabis and tobacco use frequently co-occur. Adolescents who consume both substances experience more respiratory distress and psychosocial problems and are less likely to stop compared with those who use either tobacco or cannabis alone. This study examined time trends in tobacco and cannabis use among 15-year-olds in Europe and North America between 2002 and 2010. METHODS: Twenty-eight countries were included and merged into six regions based on their welfare systems. Adolescents (n = 142 796) were divided in four 'user groups': 'no-users', 'tobacco and cannabis users', 'tobacco-only users' and 'cannabis-only users'. Prevalence rates are reported by study-wave and region. Logistic regressions with study wave as independent variable were used to study trends in the user groups and regions. Interaction effects between time and gender were considered. RESULTS: Overall, tobacco use, and concurrent tobacco and cannabis use decreased by 3 and 3.7%, respectively, but prevalence rates varied by region. Only in North America, an interaction effect between time and gender was found in tobacco and cannabis users. CONCLUSIONS: Although this study demonstrates a decrease in tobacco and cannabis use in most regions, it also shows that the use of both substances is related. Therefore, studying the co-occurring use of tobacco and cannabis is necessary.

Traditional and cyberbullying victimization as correlates of psychosocial distress and barriers to a healthy lifestyle among severely obese adolescents--a matched case-control study on prevalence and results from a cross-sectional study.

BACKGROUND: Obese youth are at increased risk for peer victimization, which may heighten their risk of psychosocial problems and physical activity avoidance, and lower the effectiveness of professional and lifestyle weight-loss initiatives. Little is known about obese adolescents' risk for victimization from cyber-bullying and how this relates to psychosocial functioning and healthy lifestyle barriers. The purpose of the study was to assess traditional and cyber-victimization among adolescents with severe obesity and its relation to psychosocial distress and barriers to healthy lifestyles. METHODS: A sample of 102 obese adolescents (mean age=15.32±1.71) in residential treatment was matched with 102 normal-weight youngsters from the Health Behavior in School-aged Children (HBSC) study (mean age=15.30±1.73). RESULTS: Adolescents with obesity were significantly more often cyber-victimized than normal-weight peers. Obese youth victimized by traditional bullying experienced lower quality of life, lower motivation for physical activity and higher avoidance and emotional coping towards healthy lifestyles than those non-victimized. Obese cyber-victims experienced significantly higher suicidal ideation. CONCLUSIONS: Traditional and cyber-victimization may hinder treatment effectiveness and healthy lifestyle change in adolescents with obesity. Health professionals should pro-actively address peer victimization and psychosocial functioning during multidisciplinary obesity treatment. Schools could contribute to a better physical and psychosocial health of obese youth by implementing multi-behavioral health-promotion programs.

Trends in educational differences in adolescent daily smoking across Europe, 2002-10.

BACKGROUND: Across Europe, tobacco use is more prevalent among secondary school students attending vocational tracks compared with students attending academic tracks. The purpose of the present study is to describe trends in social inequality in daily smoking among adolescents between 2002 and 2010 by addressing both absolute social inequality (prevalence difference between vocational and academic tracks) and relative social inequality (prevalence ratio) in seven European countries. METHODS: Analyses were based on data from 15-year-olds who participated in the Health Behaviour in School-aged Children study in 2002, 2006 and 2010 in Belgium, Croatia, France, Germany, Hungary, Italy and The Netherlands (total N = 32 867). RESULTS: Overall, daily smoking decreased between 2002 and 2010 in Belgium, France, Germany and The Netherlands, increased in Croatia and remained stable in Hungary and Italy. Considerable differences in daily smoking according to educational track existed in all countries. Absolute educational inequalities increased dramatically in Croatia and Italy, while relative inequalities showed a tendency to increase in all countries (significant in Belgium and The Netherlands). CONCLUSIONS: Conclusions on social inequality in adolescent smoking may appear differently when described by absolute and relative measures. Especially the large increase in absolute educational inequalities in daily smoking in Croatia and Italy are worrisome and warrant attention from the public health domain. The findings underline the need for appropriate smoking policies and interventions in vocational schools across Europe.

Dance is the new metal: adolescent music preferences and substance use across Europe.

This study examined relationships between music preferences and substance use (tobacco, alcohol, cannabis) among 18,103 fifteen-year-olds from 10 European countries. In 2005-2006, across Europe, preferences for mainstream Pop (pop chart music) and Highbrow (classical music and jazz) were negatively associated with substance use, while preferences for Dance (house/trance and techno/hardhouse) were associated positively with substance use. In three countries, links were identified between liking Rock (rock, heavy metal punk/hardcore, and gothic) and substance use; associations between Urban (hip-hop and R&B) and substance use were mixed. No substantial gender differences emerged in these patterns, and controlling for relevant covariates did not attenuate the predictive value of substance use. The findings are consistent with the conclusion that music is a robust marker of adolescent substance use.

Evaluation of a Brief Intervention for Promoting Mental Health among Employees in Social Enterprises: A Cluster Randomized Controlled Trial.

Evidence on the effectiveness of workplace mental health promotion for people with disabilities is limited. This study aimed to evaluate the effectiveness of a brief mental health promotion intervention in social enterprises. It had a non-blinded cluster randomized controlled trial design with follow-up one and four months after the intervention. In total 196 employees agreed to participate (86 intervention and 110 control). Empowerment was the main outcome; secondary outcomes were resilience, palliative behavior, determinants of four coping strategies of mental health, quality of life, and life satisfaction. A brief participant satisfaction survey was conducted after the intervention. No significant intervention effect on empowerment was found. However, at one month follow-up, significant favorable effects were found on perceived social support for coping strategies for mental health and on palliative behavior. At four months follow-up, favorable intervention effects were found on quality of life, but unfavorable effects were found on unjustified worrying. In addition, the intervention was well received by the employees. This brief intervention might be a promising first step to improve mental health in people with disabilities working in social enterprises. Nevertheless, additional monitoring by professionals and managers working in the organizations might be needed to maintain these effects.

Who does not cut down? Comparing characteristics and drinking motives of drinkers and abstainers during the exam periods.

OBJECTIVE: Drinking alcohol during the exams can affect academic performance and future career options, but is rarely investigated. Drinking motives, sociodemographics and personality characteristics are investigated in nonabstainers and weekly drinkers during the exams. PARTICIPANTS: 7,181 Belgian university students who anonymously responded to an email invitation to an online survey. METHODS: Logistic regressions and mixed design analysis of variance on cross-sectional data. RESULTS: One-third of the students continued drinking during the exams, with 40% drinking weekly. Nonabstainers were mainly men, elder, internally motivated when drinking, and housed with parents or independently. Weekly drinkers were similar, except mainly housed in student apartments or independently. Personality characteristics were nonsignificant. All drinking motives were less pronounced during the exams, with smaller differences for internal motives. CONCLUSIONS: Mainly linked to internal drinking motives, drinking during the exams in higher education is underestimated. The characteristics and motives of students doing so can be used in future interventions.

Smoking trends among adolescents from 1990 to 2002 in ten European countries and Canada.

BACKGROUND: Daily smoking adolescents are a public health problem as they are more likely to become adult smokers and to develop smoking-related health problems later on in their lives. METHODS: The study is part of the four-yearly, cross-national Health Behaviour in School-aged Children study, a school-based survey on a nationally representative sample using a standardised methodology. Data of 4 survey periods are available (1990-2002). Gender-specific daily smoking trends among 14-15 year olds are examined using logistic regressions. Sex ratios are calculated for each survey period and country. Interaction effects between period and gender are examined. RESULTS: Daily smoking prevalence in boys in 2002 ranges from 5.5% in Sweden to 20.0% in Latvia. Among girls, the daily smoking prevalence in 2002 ranges from 8.9% in Poland to 24.7% in Austria. Three daily smoking trend groups are identified: countries with a declining or stagnating trend, countries with an increasing trend followed by a decreasing trend, and countries with an increasing trend. These trend groups show a geographical pattern, but are not linked to smoking prevalence. Over the 4 surveys, the sex ratio has changed in Belgium, Switzerland, and Latvia. CONCLUSION: Among adolescents in Europe, three groups of countries in a different stage of the smoking epidemic curve can be identified, with girls being in an earlier stage than boys. In 2002, large differences in smoking prevalence between the countries have been observed. This predicts a high mortality due to smoking over 20-30 years for some countries, if no policy interventions are taken.

Context matters: Student-perceived binge drinking norms at faculty-level relate to binge drinking behavior in higher education.

BACKGROUND: Binge drinking in higher education is an important problem. To target binge drinking in students it is necessary to study the social context of students. Faculties (i.e., colleges or schools in Northern American education) are social contexts in which students behave, but little is known about how the faculty structure relates to monthly binge drinking. This study investigates the relationship with student-perceived binge drinking norms at faculty-level in addition to known personal determinants. METHODS: Data were collected in 7181 students within 22 faculty-level units, using an anonymous online survey. Multilevel analyses were used to investigate the relationship of both individual-level determinants (e.g., perceived norms, social drinking motives) and student-perceived binge drinking norms at faculty-level on monthly binge drinking. RESULTS: Two-third (62.2%) of the sample were female and the mean age was 21.06 (SD=2.85) years. In males, significant faculty-level variance in monthly binge drinking was found. At faculty-level, only same-sex student-perceived binge drinking norms showed a positive relationship (OR=2.581; 95%CI=[1.023,6.509]). At individual level, both opposite- and same-sex perceived binge drinking norms, and social drinking motives positively related to monthly binge drinking. In females, no significant faculty-level variance was found. Only individual-level determinants positively related to monthly binge drinking. No cross-level interactions were found. CONCLUSION: Besides individual determinants, especially in men, faculties are relevant environmental structures and networks to take into account when targeting binge drinking in higher education.

Socioeconomic inequalities in the impact of tobacco control policies on adolescent smoking. A multilevel study in 29 European countries.

INTRODUCTION: There are concerns that tobacco control policies may be less effective in reducing smoking among disadvantaged socioeconomic groups and thus may contribute to inequalities in adolescent smoking. This study examines how the association between tobacco control policies and smoking of 15-year-old boys and girls among 29 European countries varies according to socioeconomic group. METHODS: Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 comprising 50,338 adolescents aged 15 years from 29 European countries. Multilevel logistic regression analyses were conducted to assess the association of weekly smoking with components of the Tobacco Control Scale (TCS), and to assess whether this association varied according to family affluence (FAS). Analyses were carried out per gender and adjusted for national wealth and general smoking rate. RESULTS: For boys, tobacco price was negatively associated with weekly smoking rates. This association did not significantly differ between low and high FAS. Levels of tobacco-dependence treatment were significantly associated with weekly smoking. This association varied between low and high FAS, with higher treatment levels associated with higher probability of smoking only for low FAS boys. For girls, no tobacco policy was significantly associated with weekly smoking, irrespective of the FAS. CONCLUSIONS: Results indicated that most tobacco control policies are not clearly related to adolescent weekly smoking across European countries. Only tobacco price seemed to be adequate decreasing smoking prevalence among boys, irrespective of their socioeconomic status.

The association between family affluence and smoking among 15-year-old adolescents in 33 European countries, Israel and Canada: the role of national wealth.

AIMS: To examine the role of national wealth in the association between family affluence and adolescent weekly smoking, early smoking behaviour and weekly smoking among former experimenters. DESIGN AND PARTICIPANTS: Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 in 35 countries from Europe and North America that comprises 60 490 students aged 15 years. Multi-level logistic regression was conducted using Markov chain Monte Carlo methods (MCMC) to explore whether associations between family affluence and smoking outcomes were dependent upon national wealth. MEASUREMENT: Family Affluence Scale (FAS) as an indicator for the socio-economic position of students. Current weekly smoking behaviour is defined as at least weekly smoking (dichotomous). Early smoking behaviour is measured by smoking more than a first puff before age 13 years (dichotomous). Weekly smoking among former experimenters is restricted to those who had tried a first puff in the past. FINDINGS: The logistic multi-level models indicated an association of family affluence with current weekly smoking [odds ratio (OR) = 1.088; 95% credible interval (CrI) = 1.055-1.121, P < 0.001], early smoking behaviour (OR = 1.066; CrI = 1.028-1.104, P < 0.001) and smoking among former experimenters (OR = 1.100; CrI = 1.071-1.130; P < 0.001). Gross domestic product (GDP) per capita was associated positively and significantly with the relationship between family affluence and current weekly smoking (OR = 1.005; CrI = 1.003-1.007; P < 0.001), early smoking behaviour (OR = 1.003; CrI = 1.000-1.005; P = 0.012) and smoking among former experimenters (OR = 1.004; CrI = 1.002-1.006; P < 0.001). The association of family affluence and smoking outcomes was significantly stronger for girls. CONCLUSIONS: The difference in smoking prevalence between rich and poor is greater in more affluent countries.

Does the association between different dimension of social capital and adolescent smoking vary by socioeconomic status? a pooled cross-national analysis.

OBJECTIVES: To analyze how dimensions of social capital at the individual level are associated with adolescent smoking and whether associations differ by socioeconomic status. METHODS: Data were from the 'Health Behaviour in School-aged Children' study 2005/2006 including 6511 15-year-old adolescents from Flemish Belgium, Canada, Romania and England. Socioeconomic status was measured using the Family Affluence Scale (FAS). Social capital was indicated by friend-related social capital, participation in school and voluntary organizations, trust and reciprocity in family, neighborhood and school. We conducted pooled logistic regression models with interaction terms and tested for cross-national differences. RESULTS: Almost all dimensions of social capital were associated with a lower likelihood of smoking, except for friend-related social capital and school participation. The association of family-related social capital with smoking was significantly stronger for low FAS adolescents, whereas the association of vertical trust and reciprocity in school with smoking was significantly stronger for high FAS adolescents. CONCLUSIONS: Social capital may act both as a protective and a risk factor for adolescent smoking. Achieving higher levels of family-related social capital might reduce socioeconomic inequalities in adolescent smoking.

Tracking and predictors of screen time from early adolescence to early adulthood: a 10-year follow-up study.

PURPOSE: To examine tracking of weekday and weekend screen time (ST; i.e., television [TV] and computer [PC] time) from early adolescence to early adulthood and to identify social ecological predictors of weekday and weekend ST among boys and girls separately. METHODS: Data were retrieved from elementary schools (n = 59) in Flanders (Belgium). At baseline, 1,957 children (age, 9.9 ± .43 years) and one of the parents filled out a questionnaire on sedentary behavior and individual, social, and environmental variables. After a 10-year follow-up period, six hundred fifty-five 20-year-olds (age, 19.9 ± .43 years) filled out an adapted questionnaire on sedentary behavior, of which 593 contained full data at baseline and follow-up. Multiple regressions were performed to examine predictors (baseline) of ST (follow-up), and logistic regressions were used to analyze tracking of ST. RESULTS: For boys, a consistent positive predictor of weekday and weekend TV and PC time at follow-up was ST at baseline (p < .01). For girls, drinking more soda at baseline predicted more weekday and weekend TV and PC time at follow-up (p ≤ .02). Some other individual variables also predicted ST in both boys and girls. Tracking was only found among boys; those exceeding the ST guideline at baseline were three to five times more likely to exceed this guideline at follow-up (p ≤ .001). Tracking was not present among girls. CONCLUSIONS: To minimize TV and PC time during early adulthood, interventions for adolescent boys should focus on minimizing ST. For girls, focus should be on healthy eating. However, more research is warranted to confirm these conclusions.

The influence of parental drinking on offspring's drinking motives and drinking: a mediation analysis on 9 year follow-up data.

BACKGROUND AND AIMS: The influence of parental drinking on offspring's drinking is well-documented. However, longitudinal evidence on the mediating role of drinking motives in this relationship is lacking. This study longitudinally investigates the mediating role of drinking motives in the relationship between parental and offspring's drinking. METHODS: Using a prospective design, 587 Flemish children (response 30.0%) were followed for 9 years. Parental drinking was documented during the offspring's late childhood (10 and 11 years old) through paper-and-pencil questionnaires distributed by schools. The offspring's drinking habits and -motives were documented in early adulthood (18 and 19 year old) through a web-based questionnaire; invitations were sent by letter. Motives were measured using the Drinking Motives Questionnaire Revised Short-form, and mediation analyses were conducted with the product of coefficient test using bootstrapping. RESULTS: Half the offspring were female (53.8%) and the mean age was 19.35 (SD = 0.52) years. A significant direct effect of maternal drinking during childhood on offspring drinking nine years later was found (ß = 0.091, t = 2.071, p = 0.039). However, the association turned non-significant after stratifying the model for boys and girls. No direct effect was found for paternal drinking on offspring's drinking. Nevertheless, paternal drinking indirectly affected offspring's drinking through offspring's enhancement motives (ß = 0.041, 95%CI[0.004, 0.082]) and maternal drinking indirectly affected male offspring's drinking through offspring's social motives (ß = 0.067, 95%CI[0.007, 0.148]). CONCLUSION: These results show that parental drinking during late childhood relates to a high level of those drinking motives among young adults that are known risk factors for heavy drinking in early adulthood.

Drinking motives mediate cultural differences but not gender differences in adolescent alcohol use.

PURPOSE: To test whether differences in alcohol use between boys and girls and between northern and southern/central Europe are mediated by social, enhancement, coping, and conformity motives. METHODS: Cross-sectional school-based surveys were conducted among 33,813 alcohol-using 11- to 19-year-olds from northern Europe (Denmark, Estonia, Finland, Ireland, Poland, Scotland, and Wales) and southern/central Europe (Belgium, Hungary, Italy, Portugal, Slovakia, and Switzerland). RESULTS: Particularly in late adolescence and early adulthood, boys drank more frequently and were more often drunk than girls. Instead of mediation, gender-specific motive paths were found; 14- to 16-year-old girls drank more because of higher levels of coping motives and lower levels of conformity motives, whereas 14- to 19-year-old boys drank more because of higher levels of social and enhancement motives. Geographical analyses confirmed that adolescents from southern/central European countries drank more frequently, but those from northern Europe reported being drunk more often. The strong indirect effects demonstrate that some of the cultural differences in drinking are because of higher levels of social, enhancement, and coping motives in northern than in southern/central Europe. CONCLUSIONS: The results from the largest drinking motive study conducted to date suggest that gender-specific prevention should take differences in the motivational pathways toward (heavy) drinking into account, that is, positive reinforcement seems to be more important for boys and negative reinforcement for girls. Preventive action targeting social and enhancement motives and taking drinking circumstances into account could contribute to tackling underage drinking in northern Europe.

Predictors of participation in two different smoking cessation interventions at school.

Multinomial logistic regression was used to identify demographic and psychosocial characteristics of Belgian secondary school students (N = 493), aged 16 to 20, to predict which students choose to participate in a group-based smoking cessation program (five 1-hour weekly sessions), requested self-help quitting material, or did neither (comparison group). The participation rate was 29% for requesting self-help material and 21% for participation in the group program. The analysis indicated that students choosing to participate in the smoking cessation program were more likely to be in the 12th grade, technical students, and daily smokers. They were more likely to believe that quitting would be difficult and reported stronger intentions to quit now and to participate in the group program. Students requesting the self-help materials were less likely to be general students but more likely to see the benefits of quitting; they also reported stronger intentions to participate in the group program.

Drunkenness among young people: a cross-national comparison.

OBJECTIVE: International studies show a rise in drunkenness among young people in recent years. In this study the number of drunkenness occasions among 15-year old students in 22 countries is reported. The cross-national association between drunkenness, on the one hand, and the frequency of alcohol intake and the preference for distilled spirits, on the other, is described. Variation between countries is examined on the basis of national characteristics, including national prevention policies. METHOD: Data on alcohol use were taken from the 1998 World Health Organization (WHO) collaborative, cross-national survey on Health Behaviour of School-Aged Children. The multinational representative sample consisted of 10,951 male and 11,451 female (drinking) students. County characteristics were derived from the WHO Global Alcohol Database. Hierarchical Generalized Linear Model was used to analyze the effects of country characteristics on individual drunkenness. RESULTS: The lifetime prevalence of drunkenness was 57.1% for males and 50.4% for females. The number of drunkenness occasions showed a significant variation in the 22 countries. The correlation between drunkenness and preference for distilled spirits was positive in 21 countries and strong (Spearman's p > 0.40) in some eastern countries. Geographic location turned out to be an important country-level association with drunkenness and its predictors. Southern European countries showed moderate associations, whereas strong associations were found in Scandinavia, the Baltic countries and Russia. CONCLUSIONS: Cultural differences in alcohol use exist, and frequency of alcohol intake and use of spirits influence drunkenness. Despite the potential influence of preventive policy measures on drunkenness, no preventive effect of the measures included in this study was found.