Co-Occurring Alcohol Misuse and Criminal Offending in Adolescence: Is It a Matter of Similarity, Severity, or Accumulation of Risk Factors?

OBJECTIVE: Alcohol misuse and criminal offending often co-occur, and although previous studies indicate an overlap in risk factors, this evidence originates from studies focusing on either alcohol misuse or criminal offending. Co-occurrence might also stem from the severity or accumulation of risk factors. The aim of the following study was to examine whether risk factors for developing co-occurring alcohol misuse and criminal offending in adolescence are similar or unique, and to examine whether risk factors are more severe or accumulative compared with alcohol misuse only and criminal offending only. METHOD: Data were used from the prospective longitudinal project Futura01, consisting of 4,013 randomly selected adolescents in Sweden (males: n = 1,798). Outcomes and a wide variety of risk factors were measured by self-report at two time points. Logistic regression analysis was carried out on groups of (a) no behavior (reference), (b) alcohol misuse only, (c) criminal offending only, and (d) co-occurring behaviors. RESULTS: The findings indicated that similar factors predicted co-occurring behaviors for alcohol misuse only and criminal offending only. Regarding severity, only more severe sensation seeking was associated with co-occurring behaviors compared with alcohol misuse and criminal offending only. Instead, an accumulation of risks (i.e., more risk factors present) increased the probability of co-occurring behaviors compared with alcohol misuse only and criminal offending only. CONCLUSIONS: The results indicated that the risk factors for developing co-occurring alcohol misuse and criminal offending in adolescence are similar rather than unique and that it is the accumulation of the risk factors, as opposed to their severity, that is associated with co-occurring behaviors when comparing with alcohol misuse and criminal offending only.

Predictors of One-Year Persistence of Harm From a Known Person's Drinking: Findings From a Longitudinal Population-Based Study in Sweden.

OBJECTIVE: Few studies have investigated the persistence over time of experiences of harm from a known person's drinking. The aim of this study was to describe 1-year persistence and investigate its predictors at baseline. Potential predictors included the harmed person's sociodemographic factors, their own drinking habits, their relationship to the person causing harm, and the type of negative experience. METHOD: The sample included respondents who reported experiencing harm from a known person's drinking in a general population survey in 2013 and participated in a follow-up survey in 2014 (n = 1,203). One-year persistence of experienced harm was defined as reporting any harm in both surveys. We investigated potential baseline predictors of persistence by estimating relative risks and 95% confidence intervals through modified binary Poisson regression analyses with robust error variance. RESULTS: One-year persistence of experiencing any type of harm from a known person's drinking was seen in 52.5% of those reporting harm at baseline and was higher among women (56.7%) than men (43.3%). Reporting harm from a partner, parent, or other household member significantly predicted 1-year persistence, as did severity of overall perceived harm at baseline. CONCLUSIONS: In Sweden, 1-year persistence of experienced harm from a known person's drinking is common in most individuals. The risk of experiencing such harm is higher among women, when harm occurs within close relationships, and when it is experienced as severe at baseline. Support to individuals in these situations is crucial.

Using repeated measures to study the contribution of alcohol consumption and smoking to the social gradient in all-cause mortality: Results from the Stockholm Public Health Cohort.

INTRODUCTION: The social gradient in consumption behaviours has been suggested to partly explain health inequalities. The majority of previous studies have only included baseline measurements and not considered potential changes in behaviours over time. The study aimed to investigate the contribution of alcohol consumption and smoking to the social gradient in mortality and to assess whether the use of repeated measurements results in larger attenuations of the main association compared to using single baseline assessments. METHODS: Longitudinal survey data from the population-based Stockholm Public Health Cohort from 2006 to 2014 was linked to register data on mortality until 2018 for 13,688 individuals and analysed through Cox regression. RESULTS: Low socioeconomic position (SEP) was associated with increased mortality compared with high SEP; hazard ratios 1.56 (95% CI 1.30-1.88) for occupational status and 1.77 (95% CI 1.49-2.11) for education, after adjustment for demographic characteristics. Using repeated measurements, alcohol consumption and smoking explained 44% of the association between occupational status and all-cause mortality. Comparing repeated and baseline measures, the percentage attenuation due to alcohol consumption increased from 11% to 18%, whereas it remained similar for smoking (25-23%). DISCUSSION AND CONCLUSIONS: Smoking and alcohol consumption explained a large part of the association between SEP and mortality. Comparing results from time-fixed and time-varying models, there was an increase in overall percentage attenuation that was mainly due to the increased proportion explained by alcohol consumption. Repeated measurements provide a better estimation of the contribution of alcohol consumption, but not smoking, for the association between SEP and mortality.

Do early life factors explain the educational differences in early labour market exit? A register-based cohort study.

BACKGROUND: Socioeconomic inequalities in labour market participation are well established. However, we do not fully know what causes these inequalities. The present study aims to examine to what extent factors in childhood and late adolescence can explain educational differences in early labour market exit among older workers. METHODS: All men born in 1951-1953 who underwent conscription examination for the Swedish military in 1969-1973 (n = 145 551) were followed from 50 to 64 years of age regarding early labour market exit (disability pension, long-term sickness absence, long-term unemployment and early old-age retirement with and without income). Early life factors, such as cognitive ability, stress resilience, and parental socioeconomic position, were included. Cox proportional-hazards regressions were used to estimate the association between the level of education and each early labour market exit pathway, including adjustment for early life factors. RESULTS: The lowest educated men had a higher risk of exit through disability pension (HR: 2.72), long-term sickness absence (HR: 2.29), long-term unemployment (HR: 1.45), and early old-age retirement with (HR: 1.29) and without income (HR: 1.55) compared to the highest educated men. Factors from early life explained a large part of the educational differences in disability pension, long-term sickness absence and long-term unemployment but not for early old-age retirement. Important explanatory factors were cognitive ability and stress resilience, whilst cardiorespiratory fitness had negligible impact. CONCLUSIONS: The association between education and early exit due to disability pension, long-term sickness absence and long-term unemployment was to a large part explained by factors from early life. However, this was not seen for early old-age retirement. These results indicate the importance of taking a life-course perspective when examining labour market participation in later working life.

Is the association between alcohol use and sickness absence modified by socioeconomic position? findings from the Stockholm public health cohort.

BACKGROUND: The distribution of sickness absence tends to be socially patterned less is however known about the underlying mechanisms and pathways of the social gradient found in sickness absence. The present study aims to investigate (i) if the risk function between average volume of alcohol consumption and sickness absence is modified by socio-economic position (SEP), and (ii) whether such an effect modification can be attributed to differences in drinking patterns and other risk factors including other lifestyle behaviours, health status, and working conditions. METHODS: The study was based on data from the Stockholm public health cohort 2006, with an analytical sample of 13 855 respondents aged 18-64 years. Self-reported information on occupational class (a measure of SEP), alcohol consumption, other lifestyle behaviour, health and working conditions was collected from the survey. The outcome of long-term (> 14 days) sickness absence between 2006 and 2008 was obtained from national registers. Negative binomial regression was used to estimate the Incidence Rate Ratios (IRR) with 95% confidence intervals (CI). RESULTS: In the initial analyses, heavy drinking manual workers had a 5-fold increased risk of long-term sickness absence compared to non-manual employees who were moderate drinkers, and approximately 60% of the excess risk among heavy drinking manual workers was attributable to an interaction between alcohol use and SEP. Adjusting for working conditions was associated with the largest attenuation of the risk estimate, compared to other lifestyle behaviors and health. In the fully adjusted model, the IRR was further attenuated for the manual workers and the joint effect of SEP and heavy drinking remained in the final model with an attributable proportion of 49%. CONCLUSIONS: Individuals in Sweden with lower levels of SEP appear to be more vulnerable to alcohol consumption in relation to sickness absence, where differences in working conditions explained a large part but not all of the differential vulnerability.

The association between population drinking and ischemic heart disease mortality in educational groups.

A large number of observational studies have found a J-shaped relationship between alcohol intake and ischemic heart disease (IHD) risk. However, some studies suggest that the alleged cardio-protective effect may be an artifact in the way that the elevated risk for abstainers is due to self-selection on risk factors for IHD. The aim of this paper is to estimate the association between alcohol and IHD-mortality on the basis of aggregate time-series data, where the problem with selection effects is not present. In addition, we will analyze SES-specific mortality to investigate whether there is any socio-economic gradient in the relationship at issue. SES was measured by educational level. We used IHD-mortality in three educational groups as outcome. Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres of alcohol 100% per capita 15+). Swedish quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2020Q4. We applied SARIMA time-series analysis. Survey data were used to construct an indicator of heavy SES-specific episodic drinking. The estimated association between per capita consumption and IHD-mortality was positive and statistically significant in the two groups with primary and secondary education, but not in the group with postsecondary education. The association was significantly stronger the lower the educational group. Although the associations were generally stronger for males than for females, these differences were not statistically significant (P > 0.05). Our findings suggest that the detrimental impact of per capita consumption on IHD-mortality was stronger the lower the educational group.

To drink or not to drink: A study of the association between rates of non-drinkers and per drinker mean alcohol consumption in the Swedish general population.

INTRODUCTION: Understanding how the mean consumption per drinker and rates of non-drinking interplay to form overall per capita alcohol consumption is imperative for our understanding of population drinking. The aim of the present study is to examine the association between rates of non-drinkers and per drinker mean alcohol consumption in the Swedish adult population and for different percentiles of drinkers. METHODS: Data came from a monthly telephone survey of drinking habits in the Swedish adult population between 2002 and 2013. Alcohol consumption and non-drinking during the last 30 days were measured by beverage-specific quantity-frequency questions. Regression models estimated the association between the rate of non-drinkers and per drinker volume on annual data. Auto-regressive integrated moving average time-series models estimated the association on monthly data. RESULTS: A significant (P < 0.01) negative association (-0.849) was found between the rate of non-drinkers and per drinker mean volume on annual data. A unit increase in non-drinking was associated with a decline of 0.85 cl of pure alcohol among drinkers. This finding was mirrored across all percentiles of consumption. The semi-log models found that a 1% unit increase in the rate of non-drinkers was followed by a 2% reduction in per drinker mean consumption. Auto-regressive integrated moving average time-series models verified these results. DISCUSSION AND CONCLUSIONS: There is a significant association between the proportion of non-drinkers and the amount of drinking among drinkers. The theory of collectivity of drinking cultures should also include the non-drinking part of the population.

Educational qualification differences and early labor market exit among men: the contribution of labor market marginalization measured across the working life.

BACKGROUND: The present study aims to investigate the association between educational qualification and early labor market exit among men and to examine the contribution of labor market marginalization measured across the working life on this association. METHOD: A register-linked cohort study was conducted including men who completed military service in 1969/70 (born between 1949 and 1951) and were alive at age 55 and not disability pension beneficiaries (n = 40 761). Information on the highest level of educational qualification and the outcome of early exit (disability pension, sickness absence, unemployment, and early old-age pension) was obtained from Swedish nationwide registers between the ages of 55 and 64 years. Labor market marginalization was defined as periods of long-term unemployment and sickness absence over the working life and up to follow-up. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: Low-educated men were more likely to leave the labor force early due to disability pension or sickness absence (HR: 2.48), unemployment (HR: 2.09), and early old-age pension with- (HR:1.25) and without -income (HR: 1.58). Labor market marginalization across the working life explained a large part of the association for the more involuntary early exit routes (disability pensions, sickness absence, unemployment) and explained very little with regards to the more voluntary early exit routes (early old-age pension with and without income). CONCLUSION: Exposure to labor market marginalization across the working life was important in explaining educational differences in early labor market exit due to disability pension or sickness absence and unemployment. This study underscores the importance of identifying and implementing preventive measures in the workplace (e.g. adaptions) to prevent new spells of sickness absence and unemployment, especially among low educated individuals.

Fathers' alcohol consumption and risk of substance-related disorders in offspring.

BACKGROUND: Few studies have assessed how children are affected by parental alcohol consumption without clinically diagnosed alcohol problems, especially in relation to more long-term and severe consequences. The aim is to investigate how fathers' alcohol use is related to the risk for substance-related disorders in offspring. METHOD: A prospective cohort study of 64 710 Swedish citizens whose fathers were conscripted for compulsory military training at ages 18-20 in 1969/70. Information on fathers' alcohol consumption, frequency of intoxication and apprehended for drunkenness, was collected during conscription. Offspring was followed for substance-related disorders from age 12 to end of follow up in 2009. RESULTS: All measures of fathers' alcohol use were significantly and positively associated with risk for substance-related disorders in offspring. The associations were to a large extent explained by other risk factors in childhood. In the fully adjusted model, those with fathers in the highest alcohol consumption quintile still had a 63% higher risk (HR=1.63 CI 1.26-2.12) of substance-related disorders compared to those whose fathers' reported abstinence. The highest risk was found among offspring to fathers with alcohol-related disorders or that had been apprehended for drunkenness, with a more than two-fold increased risk for substance-related disorders. CONCLUSIONS: Despite the lower risk found among offspring to fathers with sub-clinical drinking when compared to those with alcohol-related disorders, the former group accounts for a much larger proportion of all cases of substance-related disorders in the population, prompting universal prevention efforts targeting the level of total alcohol consumption in society.

Country-Level Heavy Episodic Drinking and Individual-Level Experiences of Harm from Others' Drinking-Related Aggression in 19 European Countries.

INTRODUCTION: There is limited knowledge about how individual experiences of harm from others' drinking are influenced by heavy episodic drinking (HED) at the country level. The present study aimed to assess (1) the association between the country-level prevalence of HED and the risk of experiencing harm from others' drinking-related aggression and (2) if HED at the country level modifies the association between consumption of alcohol per capita (APC) and such harm. METHODS: Outcome data from 32,576 participants from 19 European countries stem from the RARHA SEAS study. Self-reported harm from others' drinking included having been verbally abused, harmed physically, or having serious arguments. Data on country-level drinking patterns were derived from the World Health Organization. Associations between country-level prevalence of monthly HED and experiences of aggression (at least 1 of 3 studied harms) were derived through multilevel models - adjusted for country-level age structure and by including the respondent's own HED patterns as a mediator. RESULTS: A 1% increase in the prevalence of monthly HED was associated with 5% higher odds (odds ratio [OR] 1.05) of experiencing others' alcohol-related aggression among men, and 6% (OR 1.06) among women. The results suggest that the association between APC and harm was stronger in countries with high prevalences of HED, but the modifying effect could not be confirmed. DISCUSSION/CONCLUSION: Harm from others' drinking-related aggression depends not only on individual factors but is also influenced by the drinking patterns of the population. However, the country-level prevalence of HED only explains a small part of the variance of this type of harm.

Drinking and acquisition of unrecorded alcohol across educational groups in Sweden.

INTRODUCTION: It is estimated that 18.5% of total alcohol consumption in Sweden in 2018 was unrecorded. However, little is known about the socio-economic profile of consumers of unrecorded alcohol. The aim of this study was to elucidate this issue by analysing data from a unique Swedish national repeated cross-sectional alcohol use survey. METHODS: Individual-level information on alcohol consumption and socio-economic status (SES) for the years 2013-2018 was retrieved from the Monitoring Project; a nationally representative monthly alcohol use survey. The analytical sample comprised 64 375 respondents aged 25-74 years. SES was measured by educational level. We used three educational groups: (i) low (<10 years); (ii) intermediate (10-12 years); and (iii) high (13+ years). We included indicators of the following sources of unrecorded alcohol consumption: travellers' import, smuggled alcohol, home production, internet and illicit home-distilling. We estimated adjusted SES-specific means of the various forms of unrecorded consumption. The means were adjusted for the effects of age, sex and region. RESULTS: There were no significant educational differences in the total of unrecorded alcohol consumption; the same holds true for home-production and internet. However, with respect to smuggled and home-distilling, a statistically significant educational gradient was observed with the lowest educational group scoring approximately four times higher than the highest. DISCUSSION AND CONCLUSIONS: Our findings suggest that there are no differences across educational groups in the consumption of unrecorded alcohol as a whole. However, consumption of smuggled alcohol and illicitly distilled spirits is elevated in the low educational group.

Is the theory of collectivity of drinking cultures valid across educational groups?

INTRODUCTION: To explore whether Skog's theory of collectivity of drinking cultures is valid across groups with different socioeconomic position (SEP). METHODS: Individual-level information on alcohol consumption and SEP for the years 2004-2014 were retrieved from the Monitoring Project; a nationally representative monthly alcohol use survey. The analytical sample consisted of 162 369 respondents aged 25-79 years. SEP was measured by education level. Alcohol use was measured by yearly volume of consumption and frequency of heavy episodic drinking (HED). Respondents were divided into six SEP-groups based on their education level and sex. Mean yearly volume consumption and prevalence of monthly HED was calculated for each group and graphically plotted against the overall mean volume of consumption. RESULTS: The yearly changes in overall mean consumption during the study period reflected a collective shift in drinking across groups with basic, intermediate and high education. There were also indications that changes in overall mean consumption reflected collective shifts in the prevalence of HED across the SEP-groups. Moreover, while the magnitude of the associations for both average volume and HED differed somewhat in strength across the SEP-groups, they were clearly in the same, positive, direction. DISCUSSION AND CONCLUSIONS: Our findings add support for including a socioeconomic dimension to Skog's theory of collectivity of drinking cultures. Future studies should replicate our analyses on cases and periods with more tangible changes in the price and availability of alcohol.

Understanding the differential effect of alcohol consumption on the relation between socio-economic position and alcohol-related health problems: results from the Stockholm Public Health Cohort.

AIM: To test (i) whether the harmful effects of average volume of alcohol consumption (AC) and heavy episodic drinking (HED) differ by socio-economic position (SEP), and (ii) if so, to what extent such differential effects can be attributed to an unequal distribution of harmful levels and patterns of drinking, health, life-style and social factors. DESIGN: A longitudinal cohort study with baseline in 2002 or 2006, with record-linkage to national registers. SETTING: Stockholm County, Sweden. PARTICIPANTS: A total of 37 484 individuals, aged 25-70 years, responding to the survey in 2002 or 2006. MEASUREMENTS: The outcome of alcohol-related health problems was obtained from the National Patient Register and Cause of Death Register using the Swedish index diagnoses related to alcohol use. Self-reported information on occupational class (measure of SEP), AC, HED as well as other health-related factors were extracted from the surveys. Average follow-up time was 13.3 years. FINDINGS: During follow-up, a total of 1237 first-time events of alcohol-related health problems occurred. After initial adjustments, heavy drinking appeared to be more harmful to individuals with low SEP compared with high SEP (P = 0.001). Differences in HED frequency explained the largest part of the differential effect of AC. Engaging in weekly HED was more harmful to individuals with low SEP (P = 0.031) than high SEP. Differences in AC, together with other factors, explained a large part of the differential effect of HED. Conclusions The greater adverse impact of alcohol consumption on health in Sweden on people with lower socio-economic position may be largely attributable to higher prevalence of heavy episodic drinking, as well as other behavioral and social risk factors.

Distribution of sickness absence risk across different levels and patterns of drinking: findings from the Stockholm Public Health Cohort.

Aim: This study estimated (i) the risk function between different indicators of alcohol use and long-term sickness absence, adjusting for possible confounding factors, (ii) whether the risk function between average volume of consumption and sickness absence is modified by heavy episodic drinking (HED), and (iii) to what extent the risk for sickness absence among abstainers is due to health selection bias. Data and methods: The study was based on data from the Stockholm Public Health Cohort 2006, with an analytical sample of 16,477 respondents aged 18-64 years. The outcome included register-based long-term (> 14 days) sickness absence. Negative binominal regression was used to estimate the association between sickness absence and average weekly volume of consumption, frequency of HED, and both in interaction. Results: Abstainers, chronic heavy drinkers and respondents with the highest frequency of HED had approximately two-fold higher rates of sickness absence relative to the reference groups, i.e., moderate drinkers and those with HED one to 6 times per year. Adjustment for confounding factors did not materially affect the shape of the risk function. After exclusion of abstainers with alcohol-related problems, or poor health, the estimates for abstainers became non-significant. Moderate drinkers with HED did not have significantly higher rates of sickness absence than moderate drinkers without HED. Conclusions: Our results suggest a significant association between alcohol use and sickness absence. There were indications that the U-shaped risk function may largely be due to health selection bias among abstainers. We found no indication of effect modification of HED on moderate drinking.

Changes in the Price of Alcohol and Effect on Youth Drinking and in Different Socio-Economic Groups.

AIMS: Many studies have shown that changes in alcohol prices have a significant effect on total sales. However, few studies have focused on youth, particularly in different socioeconomic groups. This study examined the effect of changes in the price of alcohol on consumption levels and binge drinking among 15 to 16 year old students in Sweden, both overall, among boys and girls, as well as within different socioeconomic groups. METHODS: Data on consumption were retrieved from a representative survey of students aged 15-16, conducted annually between 1989 and 2017. Time series analysis employed an autoregressive integrated moving average model (ARIMA). Two types of price data were used: the official price at the retail stores, and the mean price of the ten cheapest beverages in each category. The mean aggregate annual income per Swedish household was included as a control variable.The variable used to measure the socioeconomic status was the proportion of the ninth-grade students at each school, who had at least one parent with an education higher than upper secondary school. RESULTS: The students' alcohol consumption levels and binge drinking were not significantly affected by price changes during the study period; this was true both for the group as a whole, and among subgroups of boys or girls or of different socioeconomic status. Results were similar regardless of which type of price data variable was used in the analyses. CONCLUSION: Neither average nor minimum price of alcohol had a significant impact on the development of youth drinking in Sweden during the study period.

Severe harm from others' drinking: A population-based study on sex differences and the role of one's own drinking habits.

INTRODUCTION AND AIMS: Despite the fact that many studies have focused on harm from others' drinking, there is a lack of knowledge regarding severe forms of these harms. This study aimed to assess sex differences in the prevalence of severe harm from others' drinking and sex-specific associations with one's own drinking. DESIGN AND METHODS: The data originated from a Swedish cross-sectional population survey (n = 15 576). Adjusted odds ratios of self-reported experiences of severe harm (harmed 'a lot') from others' drinking were calculated using logistic regression models. Additive interactions were used to determine sex-specific associations between own drinking and harm. RESULTS: The past-year prevalence of severe harm from known and unknown drinkers was higher among women (4.9% and 1.8%, respectively) than men (1.9% and 1.2%, respectively). Alcohol dependence predicted such harm for both sexes. No association with severe harm from known drinkers was found for male drinkers and binge drinkers, whereas female drinkers and binge drinkers reported more experiences of such harm. These differences indicated a supper-additive interaction (RERI: 0.92-1.47) and signs of having alcohol dependence among women indicated an even higher interaction (RERI: 5.37). DISCUSSION AND CONCLUSIONS: Women suffer more frequently from severe harm from others' drinking. Men and women report different experiences of severe harm from known people's drinking conditioning on their drinking behaviour. Sex-specific longitudinal studies are warranted to examine the relation between different behaviours and these harms. Whether these findings hold in settings with different drinking cultures and social norms should be explored.

Educational differences in labor market marginalization among mature-aged working men: the contribution of early health behaviors, previous employment histories, and poor mental health.

BACKGROUND: Social inequalities in labor force participation are well established, but the causes of these inequalities are not fully understood. The present study aims to investigate the association between educational qualification and labor market marginalization (LMM) among mature-aged working men and to examine to what extent the association can be explained by risk factors over the life course. METHOD: The study was based on a cohort of men born between 1949 and 1951 who were examined for Swedish military service in 1969/70 and employed in 2000 (n = 41,685). Data on educational qualification was obtained in 2000 and information on the outcome of LMM (unemployment, sickness absence, and disability pension) was obtained between 2001 and 2008. Information on early health behaviors, cognitive ability, previous employment histories, and mental health was collected from conscription examinations and nationwide registers. RESULTS: Evidence of a graded association between years of education and LMM was found. In the crude model, compared to men with the highest level of education men with less than 12 years of schooling had more than a 2.5-fold increased risk of health-related LMM and more than a 1.5-fold increased risk of non-health-related LMM. Risk factors measured across the life course explained a large part of the association between education and health-related LMM (33-61%) and non-health-related LMM (13-58%). CONCLUSIONS: Educational differences remained regarding LMM among mature-aged workers, even after considering several important risk factors measured across the life course. Previous health problems and disrupted employment histories explained the largest part of the associations.

The link between per capita alcohol consumption and alcohol-related harm in educational groups.

INTRODUCTION AND AIMS: Research based on individual-level data suggests that the same amount of alcohol yields more harm in low-socioeconomic status (SES) groups than in high-SES groups. Little is known whether the effect of changes in population-level alcohol consumption on harm rates differs by SES-groups. The aim of this study was to elucidate this issue by estimating the association between per capita alcohol consumption and SES-specific rates of alcohol-related mortality. DESIGN AND METHODS: Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres 100% alcohol per capita 15+). Quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2017Q4. We used two outcomes: (i) alcohol-specific mortality (deaths with an explicit alcohol diagnosis); and (ii) violent deaths. SES was measured by education. We used three educational groups: (i) low (<10 years); (ii): intermediate (10-12 years); and (iii) high (13+ years). We applied error correction modelling to estimate the association between alcohol and alcohol-specific mortality, and seasonal autoregressive integrated moving average-modelling to estimate the association between alcohol and violent deaths. RESULTS: The estimated associations between per capita consumption and the two outcomes were positive and statistically significant in the two groups with low and intermediate education, but not in the high education group. There was a significant gradient in the level of association between alcohol consumption and alcohol-related harm by educational group; the association was stronger the lower the educational group. DISCUSSION AND CONCLUSIONS: Our findings suggest that the association between per capita consumption and alcohol-related harm was stronger the lower the educational group.

The new suit of the Centre for Social Research on Alcohol and Drugs (SoRAD): A well-tailored costume for tackling research and challenges ahead.

This overview reviews the establishment and evolution of the Centre for Social Research on Alcohol and Drugs (SoRAD). It outlines its current organisation and updated research direction, and discusses SoRAD's future challenges and opportunities. SoRAD was established at Stockholm University to strengthen and support Swedish social science research on alcohol and drugs. It became active in 1999, and quickly grew in research efforts and reputation, while experiencing setbacks around 2006 and 2017. In 2018 SoRAD merged with the Centre for Health Equity Studies (CHESS), to form a new Department of Public Health Sciences. In its new suit, SoRAD acts as a research centre within the teaching department. The research activities on alcohol and other drugs and gambling behaviour and problems may be categorised into four main areas: social epidemiology; subcultures and social worlds of use and heavy use; policy formation, implementation and societal responses; and societal and other collective definitions of problems and solutions. The new arrangements, with an increased staff pool and close interplay with higher education, provide a more stable and long-term platform for achieving the main mission of promoting and developing social science research on addictive substances and behaviours and related problems.

The Contribution of Alcohol Use, Other Lifestyle Factors and Working Conditions to Socioeconomic Differences in Sickness Absence.

INTRODUCTION: This study investigates how alcohol use contributes to the social gradient in sickness absence. Other factors assessed include lifestyle factors (smoking, physical activity and body mass index), physical and psychosocial working conditions. METHODS: The study used baseline data from the Stockholm public health cohort 2006, with an analytical sample of 17,008 respondents aged 25-64 years. Outcome variables included self-reported short-term (<14 days) and register-based long-term (>14 days) sickness absence. Socioeconomic position (SEP) was measured by occupational class. Alcohol use was measured by average weekly volume and frequency of heavy episodic drinking. Negative binominal regression was used to estimate sex-specific SEP differences in sickness absence, before and after adjusting for alcohol use and the additional explanatory factors. RESULTS: Adjusting for alcohol use attenuated the SEP differences in long-term sickness absence by 20% for men and 14% for women. Alcohol use explained a smaller proportion of the differences in short-term sickness absence. Alcohol use in combination with other lifestyle factors attenuated the SEP differences (20-35%) for both outcomes. Physical working conditions explained more than half of the gradient in long-term sickness absence, whereas psychosocial conditions had greater impact on short-term sickness absence among men. DISCUSSION/CONCLUSION: Alcohol use explains a substantial proportion of the SEP disparities in long-term sickness absence among men. The effect is smaller among women and for short-term sickness absence. Our findings support the notion that physical working conditions constitute the key explanatory variable for SEP differences in long-term sickness absence, but add that psychosocial working conditions have greater impact on the gradient in short-term sickness absence among men.