Risk and Protective Factors for Gambling Among Youth by origin: Findings from the three waves of cross-sectional Finnish School Health Promotion Study among 238,939 Students.

Gambling is a public health problem that can cause many kinds of harm. The aim of this study was to examine youth gambling by origin, and the risk and protective factors associated with it. The data was drawn from the School Health Promotion Study (n = 238,939) conducted in Finland, representative of the 14 to 16-year-old Finnish schoolchildren. Cross-tabulations and multivariate logistic regression were used in assessing the association between origin and weekly gambling. Interaction terms of origin and background variables related to substance use, peer and family relations and leisure time were then calculated to assess inter-group differences. The study showed that foreign-born, migrant origin and youth from mixed families were more likely to gamble weekly compared to youth with Finnish-born parents. The likelihood of gambling was particularly high among foreign-born and migrant-origin youth. Weekly gambling was significantly more common among boys than girls in all studied youth groups, and it was particularly common among foreign-born boys compared to other groups. Substance use was associated with weekly gambling and even more so among foreign-born youth. There were also differences by origin in the strength of association between other background factors and weekly gambling. Foreign-born boys appear to be especially vulnerable to multiple health and social risks including gambling, making them a particularly important group for targeted preventive programs. Preventive efforts are needed to enhance public awareness, boost parental supervision, and limit gambling-related risks. Special attention is needed to prevent migrant-origin boys from developing problems with gambling.

Exclusive and dual use of electronic cigarettes among European youth in 32 countries with different regulatory landscapes.

BACKGROUND: The Tobacco Products Directive (2014/40/EU) partially harmonised the regulation of electronic cigarettes (e-cigarettes) in Europe, but individual countries maintain jurisdiction over bans on use in public places, domestic advertising, taxation and flavour regulations. Their association with youth e-cigarette use has not been examined. METHODS: We used the cross-sectional 2019 European School Survey Project on Alcohol and Other Drugs data from 32 countries with 98 758 students aged 15-16 years and the 2020 WHO's assessment of the e-cigarette regulations. Multilevel logistic regression models on ever (vs never) and current (vs non-current) exclusive e-cigarette use, exclusive cigarette use and dual use by e-cigarette regulations' composite score were adjusted for age, gender, parental education, perceived family's financial well-being, perceived difficulty of obtaining cigarettes, country income level and general progress in tobacco control. RESULTS: Of the respondents, 13.3% had ever used cigarettes, 10.6% e-cigarettes and 27.3% both; 13.0% currently used cigarettes, 6.0% e-cigarettes and 6.4% both. Higher composite country score in the e-cigarette regulations was associated with lower current exclusive e-cigarette use (OR=0.78; 95% CI 0.65 to 0.94) and current dual use (OR=0.80; 95% CI 0.67 to 0.95). Youth perceiving more difficulties in obtaining cigarettes were less likely to use cigarettes, e-cigarettes and both ever and currently (OR from 0.80 (95% CI 0.76 to 0.85) to 0.94 (95% CI 0.92 to 0.96)). CONCLUSIONS: More comprehensive e-cigarette regulations and enforcement of age-of-sale laws may be protective of e-cigarette and dual use among adolescents.

Abstainers and Drinkers - Two Sides of the Same Coin?

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

The effect of the severity of parental alcohol abuse on mental and behavioural disorders in children.

Many studies have shown that children of alcohol abusing parents have a higher risk for mental and behavioural disorders compared to other children. Using a retrospective population-based cohort study, based on health care and social welfare registers that include children born in Finland in 1997 and their biological parents, we evaluated whether the severity of parental alcohol abuse is related to these disorders in children. We examined (1) differences in the incidence of mental and behavioural disorders over time among the children of parents with no alcohol problems, parents with less severe alcohol problems and parents with severe alcohol problems, and (2) associations between mother's and father's alcohol abuse and children's risk of disorders. Children were followed up until the age of 15. A diagnosis of mental or behavioural disorders during the follow-up was received by 15.4% of the boys and 9.0% of the girls. Both less severe alcohol abuse (HR = 1.36, 95% CI 1.14-1.61) and severe alcohol abuse (HR = 1.29, 95% CI 1.11-1.49) in mothers increased the risk of these disorders in their offspring. The corresponding figures among fathers were HR = 1.19, 95% CI 0.92-1.54 and HR = 1.16, 95% CI 1.02-1.32. Our results indicate that both maternal alcohol abuse and paternal alcohol abuse, regardless of severity, are associated with an increased risk of mental and behavioural disorders in children. It is crucial for professionals working with children to pay attention to all children whose parents have any alcohol abuse problems.

Decreasing adolescent drinking: Is there evidence of a continuation into future adult cohorts? APC analysis of adolescent drinking in Finland, 1983-2013.

AIMS: Unlike adults, abstaining has increased and regular use of alcohol has decreased among 12-16-year-olds over the past two decades. The paper studies whether these developments will be continued as the adolescent cohorts come of age. METHODS: The Adolescent Health and Lifestyle Survey is a nationally representative monitoring system of the health habits of 12-, 14-, 16-, and 18-year-old Finns, conducted biannually between 1981 and 2013. The prevalence of alcohol use and drunkenness were measured for each 5-year cohort born in 1967-1995. Age-by-cohort trajectories and hierarchical age-period-cohort (APC) modeling were used to assess effects of age, period, and birth cohort. RESULTS: Cohorts differentiate for underage drinking, but not at the age of 18. The younger cohorts postpone their drinking debut compared with older cohorts and thus age profiles are steeper than before. The most recent cohorts born in the 1990s, and the oldest cohorts born in 1967-71, have the highest prevalence in abstinence but drinking has been more prevalent for cohorts born in 1973-1989. APC modeling confirms significant cohort effects, but no significant decrease in drinking or drunkenness at the age of 18 years. Some of the changes can also be attributed to period effects. CONCLUSIONS: Despite the decrease in underage drinking in Finland, 18-year-olds continue to drink similarly from cohort to another. Postponing the onset of drinking has a preventive effect on alcohol-related harms, but a reduction in drinking among adult cohorts is not evident in the future.

Mental health and alcohol use: a cross-sectional study of the Finnish general population.

BACKGROUND: The connections between alcohol use, mental health problems and mental well-being have been under-researched. We examined the links between different aspects of alcohol use and positive and negative aspects of mental health, and the effect of protective social factors on these links. METHODS: A cross-sectional general population survey of Finns aged 15-69 years was carried out in 2008 (n = 2725, response rate 74%). The included aspects of alcohol use were the frequency and volume of drinking, binge drinking and hazardous drinking using Alcohol Use Disorders Identification Test (AUDIT). The included aspects of mental health were subjective well-being (life satisfaction), self-efficacy (sense of mastery) and psychological distress using the General Health Questionnaire. The protective social factors examined were social support (loneliness, having a confidant) and socioeconomic status. RESULTS: Binge drinking and, particularly, hazardous drinking were associated with different aspects of mental health. The proportion of respondents with poor mental well-being increased when binge drinking was more frequent than monthly, and when respondents scored ≥6 on the AUDIT scale. Abstainers reported poor sense of mastery and former drinkers additionally reported poor satisfaction with life. Frequency and volume of drinking did not have a consistent connection with mental health. These associations between alcohol use and mental health did not depend on the protective social factors. CONCLUSIONS: Frequent binge drinking and alcohol problems are associated with poor mental health, especially with a lack of life satisfaction and psychological distress. This result applies equally to lower and higher social status groups.

Have there been changes in daily smoking and cigarette consumption among adolescents? Investigation between 1999 and 2019 among Finnish adolescents.

BACKGROUND AND AIMS: It is postulated that due to decreased smoking rates and increased denormalisation of smoking, those who start and maintain smoking have more socially disadvantaged characteristics and are more dependent on nicotine than those who do not (the so-called 'hardening' hypothesis). The aim of this study was to measure changes in daily smoking and cigarette consumption among Finnish adolescents according to background factors. DESIGN AND SETTING: A repeated cross-sectional study using data from European School Survey Project on Alcohol and other Drugs (ESPAD) on six representative cross-sections of 15- to 16-year-old students between 1999 and 2019 in Finland. PARTICIPANTS: A total of 11 377 males and 12 247 females. MEASUREMENTS: The outcome measures included the proportion of daily smokers among current smokers, daily smoking and the estimated mean number of smoked cigarettes per day (CPD). Substance use, parental monitoring and school performance were used as independent variables. All measures were self-reported. FINDINGS: Daily smoking decreased over time and daily smokers constituted a smaller part of current smokers in 2019 compared with 1999 (the ratio among boys 0.68 and 0.43, respectively; among girls 0.59 and 0.43). Boys using cannabis (interaction between cannabis*survey year: P = 0.020; in 2019 odds ratio [OR]: 3.68, 95% confidence interval [CI] 2.23-6.08) and girls with heavy episodic drinking (interaction between heavy episodic drinking*survey year: P = 0.006, in 2019 OR: 9.00, 95% CI 5.61-14.42) had elevated adjusted odds for daily smoking over time. The estimated mean number of CPD decreased among daily smokers from 9.0 in 1999 to 7.2 in 2019 (P = 0.0002) and the differences diminished between groups based on gender, snus/alcohol use and parental monitoring. The between-group differences remained with regard to cannabis use (P = 0.0233 in 2019) and school performance (P = 0.0111 in 2019). CONCLUSIONS: Among currently smoking Finnish adolescents, the proportion of daily smokers decreased between 1999 and 2019, as did the number of cigarettes smoked per day (CPD) among daily smokers, suggesting an absence of 'hardening' in this group. However, differences were observed related to the odds of daily smoking and the mean number of CPD, indicating the change has been less favorable among some adolescent groups than others.

Children's out-of-home placements: Associations with parental substance use and neighbourhood sociodemographics.

Background: Studies have shown an association between parental problematic substance use (PSU) and children's out-of-home care (OHC). But there is little researech on the kind of urban neighbourhoods in which such associations typically show up. This study aims to shed light on the associations between neighbourhood characteristics, parental PSU and children's OHC. Using register data, we explore the spatial concentration of parental PSU and children's OHC in urban areas. Methods: Register data of all children born in Finland in 2002 and their biological parents living in 14 Finnish cities were used to follow the children from birth until their 18th birthday or first OHC episode. The study looks at parental PSU andother individual-level indicators as well-as the sociodemographic neighbourhood characteristics. Cox proportional hazards modelling was used as the analysis method. Results: Parental PSU increased the probability of children's OHC regardless of neighbourhood type. The probabilty was highest if both parents had PSU (hazard ratio [HR] = 8.05, 95% confidence interval [Cl] 6.38-10.16), but this outcome did not look the same for all neighbourhoods. The risk of children's OHC placements was higher in suburbs compared to city centres (HR = 1.76, 95% Cl 1.38-2.25). Conclusion: As parental substance use is a complex problem that is often intertwined with other life challenges, such as financial difficulties and mental health problems, it is insufficient to treat caregiver conditions, such as problematic substance use in isolation. Services that increase positive, pro-social connections may be lacking in the neighbourhoods with the most challenges.

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

INTRODUCTION: In the 21st century, there has been a decline in alcohol use among adolescents in most Nordic countries, while trends of cannabis use have diverged. We explore how alcohol and cannabis use, respectively, and co-use of the two substances, have changed among Nordic adolescents. Three hypotheses are used to frame the study: (i) cannabis use has substituted alcohol use; (ii) there has been a parallel decline in both substances; and/or (iii) there has been a 'hardening' of users, implying that alcohol users increasingly use cannabis. METHODS: Data from the European School Survey Project on Alcohol and Other Drugs, conducted among 15- to 16-year-olds in Denmark, Finland, Iceland, Norway and Sweden (N = 74,700, 49% boys), were used to explore trends of past-year alcohol and cannabis use in the period 2003-2019. RESULTS: The proportion of adolescents reporting alcohol use decreased significantly in all Nordic countries except Denmark. The proportion of those using cannabis only was low (0.0%-0.7%) and stable in all countries. The total number of substance use occasions declined among all adolescents in all countries but Denmark. Among alcohol users, cannabis use became increasingly prevalent in all countries but Denmark. DISCUSSION AND CONCLUSIONS: We found no support for the 'parallel decline hypothesis' in alcohol and cannabis use among Nordic adolescents. Partially in line with the 'substitution hypothesis', cannabis use accounted for an increasing proportion of all substance use occasions. Our results suggests that the co-use of alcohol and cannabis has become more common, thus also providing support to the 'hardening' hypothesis.

Societal images of Cannabis use: comparing three countries.

BACKGROUND: Differences in beliefs about Cannabis were compared between Canada, Sweden and Finland using nationally representative population surveys containing similar items. FINDINGS: Compared to Finnish and Swedish respondents, Canadians were both more likely to have tried Cannabis and to view Cannabis as a less serious problem for society. CONCLUSIONS: These findings emphasize the extent to which views about Cannabis can vary. It is possible that views about Cannabis are, at least in part, a social construction influenced by media, social policy and exposure to the drug that varies from country to country.

Risk Factors for Excessive Social Media Use Differ from Those of Gambling and Gaming in Finnish Youth.

PURPOSE: Adolescents' excessive social media use has characteristics similar to other addictive behaviours. This study aims to explore whether the same risk factors are associated with excessive social media use as with excessive gaming and gambling among Finnish adolescents. METHODS: Multinomial logistic regression analyses were carried out using the European School Survey Project on Alcohol and Other Drugs data, collected from Finnish adolescents aged 15-16 in 2019 (n = 4595). RESULTS: Excessive use of social media was more common among girls (reported by 46% of respondents) than boys of the same age (28%), whereas boys reported both excessive gaming (23%) and gambling (6%) more often than girls (4% and 1%, respectively). All differences between genders were statistically significant (p < 0.0001). Daily smoking was associated with a high risk of excessive gambling (AOR = 3.23) and low risk of excessive gaming (AOR = 0.27) but had no significant effect on excessive social media use. Cannabis use in the past 12 months was positively associated only with excessive gambling (AOR = 2.39), while past 12 months alcohol consumption increased the risk for excessive social media use (AOR = 1.25). CONCLUSIONS: Adolescent girls are at greater risk of excessive social media use than boys, while boys are at greater risk of excessive gaming and gambling. The associations with known risk factors are somewhat different for excessive use of social media as compared to excessive gambling and gaming and should be acknowledged when developing preventive measures for adolescents.

Single, Dual, and Triple Use of Cigarettes, e-Cigarettes, and Snus among Adolescents in the Nordic Countries.

New tobacco and nicotine products have emerged on the market in recent years. Most research has concerned only one product at a time, usually e-cigarettes, while little is known about the multiple use of tobacco and nicotine products among adolescents. We examined single, dual, and triple use of cigarettes, e-cigarettes, and snus among Nordic adolescents, using data of 15-16-year-olds (n = 16,125) from the European School Survey Project on Alcohol and other Drugs (ESPAD) collected in 2015 and 2019 from Denmark, Finland, Iceland, Norway, Sweden, and the Faroe Islands. Country-specific lifetime use of any of these products ranged between 40% and 50%, and current use between 17% and 31%. Cigarettes were the most common product in all countries except for Iceland, where e-cigarettes were remarkably more common. The proportion of dual and triple users was unexpectedly high among both experimental (24%-49%) and current users (31-42%). Triple use was less common than dual use. The users' patterns varied somewhat between the countries, and Iceland differed substantially from the other countries, with a high proportion of single e-cigarette users. More knowledge on the patterns of multiple use of tobacco and nicotine products and on the potential risk and protective factors is needed for targeted intervention and prevention efforts.

Perceptions of addictions as societal problems in Canada, sweden, Finland and st. Petersburg, Russia.

AIMS: This study reports on the relative gravity people attribute to various addictive behaviors with respect to other societal concerns in four northern populations with different history, social policy and treatment alternatives for addicted individuals. METHODS: Random population surveys were conducted in Canada, Sweden, Finland and St. Petersburg, Russia. In Finland and Sweden, the survey was conducted by mail, in Canada and St. Petersburg by phone. As a part of this survey, the respondents were asked to assess the gravity of various societal problems, some of which involved various addictive behaviors. The data were analyzed by descriptive statistical methods, factor analysis, contextual analysis and multiple regression analysis. RESULTS: Hard drugs, criminality and environmental issues belonged to the topmost problems in all data samples. Overall, Finns and Canadians appeared the least worried about various societal problems, Swedes seemed the most worried and St. Petersburgian views were the most polarized. Two factors were extracted from the combined data. Factor 1 covered criminal behavior and various addictions; it was named Threats to Safety factor. Factor 2 comprised social equality issues. The country context explained 12.5% of the variance of the safety factor and 7.9% of the equality factor. CONCLUSIONS: Despite some cultural variation in the gravity assessments, the central core of the social representation of addictive behaviors tends still to be linked with 'badness' since they were mainly grouped with various forms of criminal behavior in all these countries.

Educational attainment by children with parental alcohol problems in Denmark and Finland.

Background: Adverse childhood experiences have negative outcomes for children, yet previous research suggests the independent effect of parental alcohol problems is inconsistent. Objectives: Our aim was (1) to compare educational attainment among Danish and Finnish youth with parental alcohol problems and (2) to study the associations between parental alcohol problems and children's educational attainment in these two Nordic welfare states. Data and methods: Administrative longitudinal data on children born in 1991 in Finland (n = 64,696) and Denmark (n = 64,138) and their biological parents. The children were followed until their 21st birthdays. We applied a mediation analysis to investigate how the association between parental alcohol problems and children's educational attainment is mediated by four indicators for poor socioeconomic family background (low parental education, long-term economic distress, psychiatric disorders, and living in a non-intact family). Results: At age 20 years, Finnish children were more likely to complete their education than their Danish peers. Young adults with parental alcohol problems faced early school leaving more frequently in both countries compared with their peers, but the relative risk was higher in Finland. In both countries, long-term economic distress mediated the highest proportion of the effect of alcohol problems (39% in Denmark and 34% in Finland). Low parental education and psychiatric disorders mediated part of the effect, but not to the same degree as economic distress. Conclusions: Ensuring education for children with parental alcohol problems is a key to improving their long-term outcomes in different life domains. Consequently, healthcare, social work and education sectors should prioritise advancing education among these children in order to prevent their exclusion from education and labour markets, and they should cooperate closely in doing so.

Money used in gaming is associated with problem gambling: Results of the ESPAD 2019 Finland.

BACKGROUND AND AIMS: The convergence of gaming and gambling may pose a risk for adolescents. Thus, it is important to find out how these behaviours are associated with other addictive behaviours in order to develop efficient preventive measures for youth. The aim of this study was to examine 1) whether problematic gaming and money used for gaming activities are risk factors for gambling, and 2) what kind of impact adolescents' substance use along with other factors related to friends and parents have on this association. METHODS: The European School Survey Project on Alcohol and Other Drugs data, 2019 of Finnish adolescents aged 15 to 16 (N = 4595). Cross-tabulations with Rao-Scott's chisquare tests were applied to study the associations of the background factors with gambling in the past 12 months. A multinomial logistic regression model was fitted for the outcome variable (gambling in the past 12 months) adjusted for all independent and background variables. RESULTS: Problematic gaming alone was not associated with gambling participation, whereas using money for digital games increased the risk of gambling. Boys gamble more than girls. The use of alcohol and drugs increased the risk of gambling. Parental monitoring reduced the risk of gambling, whereas hanging around weekly with friends increased the risk. DISCUSSION AND CONCLUSIONS: Using money on gaming sites may put some adolescents at risk of developing problems with either gaming or gambling. The link between using money in digital games and gambling participation calls for preventive measures, intervention and regulatory acts.

Smoke in the air - Associations between experimentation with cannabis and the use of tobacco and nicotine products among 15-16-year-old school students.

BACKGROUND: Cannabis is the most popular illicit drug among adolescents in developed countries, including Finland. The aim of this study was to estimate 1) how cannabis experimentation among Finnish adolescents changed between 2003 and 2019, and 2) whether the associations between cannabis experiments and factors related to it, especially the use of tobacco and nicotine products, changed during the same time period. METHODS: The analyses are based on the European School Survey Project on Alcohol and Other Drugs data, collected from Finnish adolescents aged 15 to 16 in 2003, 2007, 2011, 2015, and 2019 (N = 20,630). RESULTS: Experimentation with cannabis among Finnish adolescents has increased since the beginning of our follow-up. At the same time, alcohol use and smoking have decreased markedly, and attitudes toward cannabis use have become more relaxed. The association between smoking and cannabis experimentation has become weaker over time. However, the use of tobacco and nicotine products, especially polytobacco, is still a strong risk factor for experimentation with cannabis. The higher the number of tobacco or nicotine products used, the higher the probability for cannabis experimentation. CONCLUSIONS: Experimentation with cannabis has previously been concentrated predominantly on adolescents who smoke, but recently non-smokers are increasingly trying cannabis. It is possible that alternative ways of using cannabis may have increased its use. Despite the strict cannabis policy in Finland, its use has increased, which may be an indication that youth cultures and images of different substances play a significant role in adolescents experimenting with cannabis.

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

AIM: To (i) examine several factors associated with trends in heavy episodic drinking (HED) in Finland, Norway and Sweden, (ii) investigate similarities in these associations across the countries and (iii) analyse the contribution of these factors to the trend in HED and the differences across the countries. DESIGN AND SETTING: Observational study using five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from Finland, Norway and Sweden between 1999 and 2015. PARTICIPANTS: A total of 18 128 male and 19 121 female 15- to 16-year-old students. MEASUREMENTS: Monthly HED, perceived access to alcohol, truancy, parental control, leisure time activities and daily smoking. The Cochran-Armitage test was used to examine linear time trends in HED. Logit regression models using the Karlson-Holm-Breen (KHB) method were fitted for each country separately, including all the independent variables together with time and adjusted for family status, parental education and gender. FINDINGS: In Finland, Norway and Sweden, perceived access to alcohol, truancy and daily smoking decreased significantly between 1999 and 2015 whereas risk perceptions, parental control and participation in sports increased in the same period. The confounding percentage of all the independent variables related to the trend in HED was 48.8%, 68.9% and 36.7% for Finland, Norway and Sweden, respectively. Decline in daily smoking (P < 0.001) and perceived access to alcohol (P < 0.001) were positively and increase in parental control (P < 0.001) negatively associated with the decline in HED in all three countries. Changes in truancy, going out with friends, and engaging in sports and other hobbies had little or no impact on the decline in HED or displayed no consistent results across the countries. CONCLUSIONS: The decline in adolescent heavy episodic drinking in Finland, Norway and Sweden between 1999 and 2015 appears to be associated with a decline in adolescent daily smoking and perceived access to alcohol and an increase in parental control.

Measuring changes in alcohol use in Finland and Norway during the COVID-19 pandemic: Comparison between data sources.

OBJECTIVES: To examine (1) how a rapid data collection using a convenience sample fares in estimating change in alcohol consumption when compared to more conventional data sources, and (2) how alcohol consumption changed in Finland and Norway during the first months of the COVID-19 pandemic. METHODS: Three different types of data sources were used for the 2nd quarter of 2020 and 2019: sales statistics combined with data on unrecorded consumption; the rapid European Alcohol Use and COVID-19 (ESAC) survey (Finland: n = 3800, Norway: n = 17,092); and conventional population surveys (Finland: n = 2345, Norway: n1 = 1328, n2 = 2189, n3 = 25,708). Survey measures of change were retrospective self-reports. RESULTS: The statistics indicate that alcohol consumption decreased in Finland by 9%, while little change was observed in Norway. In all surveys, reporting a decrease in alcohol use was more common than reporting an increase (ratios 2-2.6 in Finland, 1.3-2 in Norway). Compared to conventional surveys, in the ESAC survey fewer respondents reported no change and past-year alcohol consumption was higher. CONCLUSION: The rapid survey using convenience sampling gave similar results on change in drinking as conventional surveys but higher past-year drinking, suggesting self-selection effects. Aspects of the pandemic driving alcohol consumption down were equally strong or stronger than those driving it up.

Trends in alcohol consumption among adolescents in Europe: Do changes occur in concert?

OBJECTIVE: The present paper extends the scope of testing Skog's theory on the 'collectivity of drinking culture' to adolescent alcohol use in 26 European countries. The aim was to 1) examine whether changes in adolescent alcohol use are consistent across different consumption levels, and 2) explore whether trends in heavy and light drinkers diverged or converged. METHOD: Data came from six waves of the cross-sectional European School Survey Project on Alcohol and other Drugs (ESPAD) between 1999 and 2019. The sample consisted of n = 452,935 students aged 15-16 years. Trends in alcohol volume across consumption levels including abstainers were estimated by quantile regression models (50th, 80th, 90th and 95th percentile). Countries were classified according to trends showing (soft/hard) collectivity or (soft/hard) polarisation. Trends in heavy drinkers were compared with the population trend. RESULTS: Trends in alcohol consumption at different levels across 26 European countries in the period 1999-2019 were not homogeneous. Collective changes were found in 15 (14 soft/1 hard), and polarised trends in 11 countries (5 soft/6 hard). Collectivity was generally associated with a declining trend. In 18 countries, trends in heavy and light drinkers diverged. CONCLUSION: Accepting some variation in the strength of changes across consumption levels, changes in many European countries occurred in the same direction. Yet, diverging trends at different consumption levels in most countries indicate a less beneficial change in heavy compared with light drinkers, implying that in addition to universal population-level strategies, intervention strategies targeting specific risk groups are needed to prevent alcohol-related harm.

Changes in Alcoholic Beverage Choice and Risky Drinking among Adolescents in Europe 1999-2019.

This paper explores trends in beverage preference in adolescents, identifies related regional differences, and examines cluster differences in key drinking measures. Data were obtained from the European School Survey Project on Alcohol and Other Drugs (ESPAD), covering 24 European countries between 1999 and 2019. Trends in the distribution of alcoholic beverages on the participants' most recent drinking occasion were analysed by sex and country using fractional multinomial logit regression. Clusters of countries based on trends and predicted beverage proportions were compared regarding the prevalence of drinkers, mean alcohol volume and prevalence of heavy drinking. Four distinct clusters each among girls and boys emerged. Among girls, there was not one type of beverage that was preferred across clusters, but the proportion of cider/alcopops strongly increased over time in most clusters. Among boys, the proportion of beer decreased, but was dominant across time in all clusters. Only northern European countries formed a geographically defined region with the highest prevalence of heavy drinking and average alcohol volume in both genders. Adolescent beverage preferences are associated with mean alcohol volume and heavy drinking at a country-level. Future approaches to drinking cultures need to take subpopulations such as adolescents into account.