Non-Drinkers' Experiences of Drinking Occasions: A Population-Based Study of Social Consequences of Abstaining from Alcohol.

BACKGROUND: People should be able to quit or moderate their drinking without negative social consequences, but studies have shown how nondrinkers often face pressure and negative reactions. As previous research has mostly focused on youth, we conducted a population-level study of the ways adult nondrinkers encounter their drinking companions on drinking occasions and what kinds of reactions they perceive from their social environments. METHOD: The data were based on the Finnish Drinking Habits Survey (FDHS), a general population survey of Finns aged 15-79 collected in 2016 (N = 2,285; 330 nondrinkers; response rate 60%). Characteristics of drinking occasions where nondrinkers participate ("non-drinking occasions") were measured through self-reports of frequency, time, purpose, and social companion on those occasions. Nondrinkers' experiences of non-drinking occasions and reactions from the social environment were measured by question batteries on social consequences. RESULTS: Compared with drinking occasions, non-drinking occasions occurred more often at family events at home than on late-night drinking occasions. Accordingly, nondrinkers reported relatively low levels of negative consequences, and the reported consequences were least frequent in the oldest age group. Nondrinkers reported mostly positive feedback from people around them, more often from family members than from peers. However, negative consequences were reported in all studied groups, most commonly among youth and former drinkers. CONCLUSIONS: The study indicates that nondrinkers' social environments may be more supportive than what has been suggested previously, yet coping mechanisms are required especially from youth and former drinkers. The positive social experiences of being a nondrinker should guide the promotion of moderate and non-drinking.

Adjusting for non-response in the Finnish Drinking Habits Survey.

AIM: We aim to compare four different weighting methods to adjust for non-response in a survey on drinking habits and to examine whether the problem of under-coverage of survey estimates of alcohol use could be remedied by these methods in comparison to sales statistics. METHOD: The data from a general population survey of Finns aged 15-79 years in 2016 ( n=2285, response rate 60%) were used. Outcome measures were the annual volume of drinking and prevalence of hazardous drinking. A wide range of sociodemographic and regional variables from registers were available to model the non-response. Response propensities were modelled using logistic regression and random forest models to derive two sets of refined weights in addition to design weights and basic post-stratification weights. RESULTS: Estimated annual consumption changed from 2.43 litres of 100% alcohol using design weights to 2.36-2.44 when using the other three weights and the estimated prevalence of hazardous drinkers changed from 11.4% to 11.4-11.8%, correspondingly. The use of weights derived by the random forest method generally provided smaller estimates than use of the logistic regression-based weights. CONCLUSIONS: The use of complex non-response weights derived from the logistic regression model or random forest are not likely to provide much added value over more simple weights in surveys on alcohol use. Surveys may not catch heavy drinkers and therefore are prone for under-reporting of alcohol use at the population level. Also, factors other than sociodemographic characteristics are likely to influence participation decisions.

Follow-Up Data Improve the Estimation of the Prevalence of Heavy Alcohol Consumption.

AIMS: We aim to adjust for potential non-participation bias in the prevalence of heavy alcohol consumption. METHODS: Population survey data from Finnish health examination surveys conducted in 1987-2007 were linked to the administrative registers for mortality and morbidity follow-up until end of 2014. Utilising these data, available for both participants and non-participants, we model the association between heavy alcohol consumption and alcohol-related disease diagnoses. RESULTS: Our results show that the estimated prevalence of heavy alcohol consumption is on average of 1.5 times higher for men and 1.8 times higher for women than what was obtained from participants only (complete case analysis). The magnitude of the difference in the mean estimates by year varies from 0 to 9 percentage points for men and from 0 to 2 percentage points for women. CONCLUSION: The proposed approach improves the prevalence estimation but requires follow-up data on non-participants and Bayesian modelling.

Estimating the public health impact of disbanding a government alcohol monopoly: application of new methods to the case of Sweden.

BACKGROUND: Government alcohol monopolies were created in North America and Scandinavia to limit health and social problems. The Swedish monopoly, Systembolaget, reports to a health ministry and controls the sale of all alcoholic beverages with > 3.5% alcohol/volume for off-premise consumption, within a public health mandate. Elsewhere, alcohol monopolies are being dismantled with evidence of increased consumption and harms. We describe innovative modelling techniques to estimate health outcomes in scenarios involving Systembolaget being replaced by 1) privately owned liquor stores, or 2) alcohol sales in grocery stores. The methods employed can be applied in other jurisdictions and for other policy changes. METHODS: Impacts of the privatisation scenarios on pricing, outlet density, trading hours, advertising and marketing were estimated based on Swedish expert opinion and published evidence. Systematic reviews were conducted to estimate impacts on alcohol consumption in each scenario. Two methods were applied to estimate harm impacts: (i) alcohol attributable morbidity and mortality were estimated utilising the International Model of Alcohol Harms and Policies (InterMAHP); (ii) ARIMA methods to estimate the relationship between per capita alcohol consumption and specific types of alcohol-related mortality and crime. RESULTS: Replacing government stores with private liquor stores (Scenario 1) led to a 20.0% (95% CI, 15.3-24.7) increase in per capita consumption. Replacement with grocery stores (Scenario 2) led to a 31.2% (25.1-37.3%) increase. With InterMAHP there were 763 or + 47% (35-59%) and 1234 or + 76% (60-92%) more deaths per year, for Scenarios 1 and 2 respectively. With ARIMA, there were 850 (334-1444) more deaths per year in Scenario 1 and 1418 more in Scenario 2 (543-2505). InterMAHP also estimated 10,859 or + 29% (22-34%) and 16,118 or + 42% (35-49%) additional hospital stays per year respectively. CONCLUSIONS: There would be substantial adverse consequences for public health and safety were Systembolaget to be privatised. We demonstrate a new combined approach for estimating the impact of alcohol policies on consumption and, using two alternative methods, alcohol-attributable harm. This approach could be readily adapted to other policies and settings. We note the limitation that some significant sources of uncertainty in the estimates of harm impacts were not modelled.

Changes in prevalence and correlates of alcohol-use disorders in Finland in an 11-year follow-up.

AIMS: This study aimed to examine changes in prevalence and correlates of alcohol-use disorders (AUD) between 2000 and 2011. We also explored the impact of using multiple imputation on prevalence estimates, to address survey nonresponse. METHODS: The study used a Finnish nationally representative survey of adults aged 30 years and older in 2000 and in 2011. The Munich Composite International Diagnostic Interview (M-CIDI) was used to diagnose AUD in 6005 persons in 2000 (response rate 75%) and 4381 in 2011 (response rate 55%). Multiple imputation using sociodemographic, health, and registry-linked data on mental health hospitalizations was compared with weights to account for nonresponse. RESULTS: Prevalence of 12-month AUD in Finland decreased from 4.6% (95% CI 4.0-5.1) in 2000 to 2.0% in 2011 (95% CI 1.6-2.4). Lifetime AUD prevalence decreased from 10.8% (95% CI 9.9-11.6) to 7.5% (CI 95% 6.8-8.3) from 2000 to 2011. The reduction was observed for people aged 30-64 years. At both time points, AUD prevalence was higher among individuals aged 30-64, men and those unmarried, widowed or divorced. The observed prevalence changes can be partly attributed to reporting and selection bias. The latter was addressed by multiple imputation. CONCLUSIONS: Alcohol use disorders appear to have decreased in Finland from 2000 to 2011, especially for the 30-64 years age group. Males, younger adults and those unmarried, widowed or divorced had a higher risk of AUD.

Predictors of Persistence of Risky Drinking in Adults: An 11-Year Follow-Up Study.

AIM: To examine the long-term predictors of persistence of risky drinking in a baseline group of risky drinkers in whom alcohol use disorder had not been diagnosed. METHODS: The data was derived from a representative sample of the Finnish adult population aged 30 years or more, surveyed at 2 time points in the years 2000 (n = 5,726) and 2011 (n = 3,848, 67.2% of the baseline sample). Risky drinking was defined using BSQF-measurement (for men, 21 standard UK drinks or more per week; for women 14+ drinks) and not having alcohol abuse or alcohol dependence. The sample of risky drinkers in baseline comprised 642 persons, of whom 380 (59.2%) people provided follow-up data. Multivariable logistic regression models were estimated to identify determinants of persistence of risky drinking. RESULTS: The rate for persistence of risky drinking was 48.7%. Persistence was predicted by daily smoking, low physical activity, and male gender, whereas higher age and later onset of drinking predicted cessation of risky drinking. Daily smoking remained an independent predictor after adjusting for other risk factors. CONCLUSIONS: Health behaviour predicts the persistence of risky drinking in a study population of adults aged 30 and over. These factors should be taken into account when assessing the long-term prognosis on risky drinking.

Hospital Admissions Before an Alcohol-Related Death Among Middle-Aged Employed Men and Women: A Cohort Study Using Routine Data.

BACKGROUND: Due to lack of appropriate longitudinal data, relatively little is known about how and when persons who ultimately die due to alcohol-related causes interact with hospitals during the years before death. Using routinely collected nationwide data, we aimed to establish the timing and causes of all hospitalizations during a 10-year period before an alcohol-related death. METHODS: We traced back the timing and causes of all hospitalizations occurring during a 10-year period before death among men and women (n = 2,981) who were aged 35 and in employment at study entry, and who died from alcohol-related causes at ages 45 to 54 in 1997 to 2007. The study data consisted of 80% of all persons living in Finland who died during the study period. Those who died at ages 45 to 54 without alcohol involvement were used as a reference group. RESULTS: Persons who ultimately died from alcohol-related causes had on average 7 (mean 7.4, SD 9.9) hospital admissions, and they spent on average 56 days (mean 56.2, SD 105.1) in hospital during the study period. By the fifth year before death (from the year -10 to year -5), about three-fifths of these persons had been hospitalized due to any cause at least once, but less than one-third had a hospital admission with an alcohol-related diagnosis. Those who died without alcohol involvement had an average 9 hospital admissions (mean 9.3, SD 11.2), and they spent on average 81 days (mean 81.2, SD 163.9) in hospital during the study period. CONCLUSIONS: The majority of employed middle-aged persons who ultimately died due to alcohol-related causes interacted with hospitals frequently and already several years before death. Additional research is warranted to evaluate whether enhanced patient management at hospitals targeted to this population could potentially reduce alcohol-related harms.

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.

Alcohol-induced morbidity and mortality by occupation: a population-based follow-up study of working Finns.

BACKGROUND: To justify alcohol-related health promotion programs and target them at the correct workplaces, it is important to identify occupations with increased risk of severe health outcomes caused by alcohol. METHODS: Data on hospital admissions (854,555 men and 801,653 women) from the Finnish health care register and data on deaths from Statistics Finland from 1 January 2001 to 31 December 2004 were merged with information from the 2000 population census. We assessed the age- and education-adjusted relationship between occupation and the sum of hospitalizations and death primarily caused by alcohol, using Cox proportional hazards regression. We also estimated the fraction of incidence of severe alcohol-induced health outcomes that are attributable to factors related to one's occupation (population attributable fraction). RESULTS: Most of the cases were men (80%), middle-aged and usually had no more than a secondary level of education. When the reference was professionals, who were at the lowest risk, those at increased risk were mostly manual workers in craft work, construction and service. However, we also found several non-manual occupations at a high risk. According to population attributable fraction, the proportion of severe alcohol-induced health outcomes would have been 31% lower among men and 20% lower among women if all occupational groups had been at the same risk as professionals. CONCLUSIONS: We detected considerable occupational differences in alcohol-induced morbidity and mortality among a nationally representative working population. This indicates a need for alcohol-focused health promotion programs in these high-risk occupations.

Inequalities in Alcohol-Related Mortality in 17 European Countries: A Retrospective Analysis of Mortality Registers.

BACKGROUND: Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time. METHODS AND FINDINGS: We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated. Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3.6 (95% CI 3.3-4.0) and the slope index of inequality is 112.5 (95% CI 106.2-118.8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality. Because our study relies on routinely collected underlying causes of death, it is likely that our results underestimate the true extent of the problem. CONCLUSIONS: Alcohol-related conditions play an important role in generating inequalities in total mortality in many European countries. Countering increases in alcohol-related mortality in lower socioeconomic groups is essential for reducing inequalities in mortality. Studies of why such increases have not occurred in countries like France, Switzerland, Spain, and Italy can help in developing evidence-based policies in other European countries.

Minimum prices for alcohol and educational disparities in alcohol-related mortality.

BACKGROUND: Minimum price of alcohol is one of the proposed set of alcohol policies in many high-income countries. However, the extent to which alcohol-related harm is associated with minimum prices across socioeconomic groups is not known. METHODS: Using Finnish national registers in 1988-2007, we investigated, by means of time-series analysis, the association between minimum prices for alcohol overall, as well as for various types of alcoholic beverages, and alcohol-related mortality, among men and women ages 30-79 years across three educational groups. We defined quarterly aggregations of alcohol-related deaths, based on a sample including 80% of all deaths, in accordance with information on both underlying and contributory causes of death. RESULTS: About 62,500 persons died from alcohol-related causes during the 20-year follow-up. The alcohol-related mortality rate was more than threefold higher among those with a basic education than among those with a tertiary education. Among men with a basic education, an increase of 1% in the minimum price of alcohol was associated with a decrease of 0.03% (95% confidence interval = 0.01, 0.04%) in deaths per 100,000 person-years. Changes in the minimum prices of distilled spirits, intermediate products, and strong beer were also associated with changes in the opposite direction among men with a basic education and among women with a secondary education, whereas among the most highly educated there were no associations between the minimum prices of any beverages and mortality. Moreover, we found no evidence of an association between lower minimum prices for wine and higher rates of alcohol-related mortality in any of the population sub-groups. CONCLUSIONS: The results reveal associations between higher minimum prices and lower alcohol-related mortality among men with a basic education and women with a secondary education for all beverage types except wine.

The Socioeconomic Differences in Alcohol-Related Harm and the Effects of Alcohol Prices on Them: A Summary of Evidence from Finland.

AIMS: We make a case study of Finland to study the connections between socioeconomic status, alcohol use, related harm and possibilities for intervention by means of alcohol pricing. METHODS: A review of Finnish studies on the topic. RESULTS: The socioeconomic differences in severe alcohol-related harm were great, and in the past two decades, these differences have widened. Alcohol-related mortality has also strongly contributed to both the level and widening of socioeconomic differences in life expectancy. Both in 2004, when alcohol prices were abruptly cut, and in the longer term with more gradual changes in lowest prices of alcohol, the lowest socioeconomic groups were most affected in absolute-but not so clearly in relative-terms, particularly among men. However, these effects are sometimes weak, not fully consistent by gender and across different measures of harm. CONCLUSIONS: The large and increasing socioeconomic differences in alcohol-related harm in Finland underline the importance of reducing these differences. The finding that particularly among men the impact of reduced alcohol prices on health has often in absolute terms been the greatest in the lower socioeconomic groups suggests that policies aimed at keeping the price of alcoholic beverages high may help to both minimize the overall level of alcohol-related health problems and to reduce absolute inequalities.

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.

Can the accuracy of health behaviour surveys be improved by non-response follow-ups?

BACKGROUND: Prevalence estimates may be biased if the characteristics of respondents differ from those of non-respondents in surveys. In this study, we used a follow-up telephone interview of initial non-respondents to examine the differences--in terms of self-rated health and health behaviours--to initial postal respondents and to assess improvements in prevalence estimates. METHODS: Following a postal questionnaire survey using a random sample (n = 5000) of the Finnish working-age population with a response rate of 57% (n = 2826), a follow-up telephone survey was performed based on 1261 non-respondents (response rate 56%, n = 708) in 2010. Prevalence of smoking, alcohol use, body mass index, physical activity, self-rated fitness, dietary habits and self-rated health were calculated for the survey population with and without a telephone interview. Logistic regression models were used to examine differences in health behaviours and health between the initial postal questionnaire respondents and follow-up telephone interview respondents. RESULTS: The total response rate increased from 57% to 71% when the telephone respondents were included. The telephone survey indicated that both male and female telephone respondents were more often smokers, and female telephone respondents were more often heavy episodic drinkers and less often reported poor self-rated fitness than postal respondents. Nonetheless, the prevalence rates of outcome variables did not change significantly when telephone respondents were included. CONCLUSION: The response rate of surveys can be increased by using a telephone survey in follow-up contacts with non-respondents. As non-respondents differ from respondents, this contributes to an improvement--although small--in internal validity.

The extent and distribution of gambling harm in Finland as assessed by the Problem Gambling Severity Index.

BACKGROUND: Preventing gambling harm has become a policy priority in many European countries. Adverse consequences related to problem gambling are well known, but few studies have analyzed gambling-related harm in detail in general population samples. We determined the extent and distribution of gambling harm in Finland, as assessed by the Problem Gambling Severity Index (PGSI), and analyzed gambling involvement, demographics and their association with various types of harm. METHODS: A nationwide telephone survey was conducted among 4484 Finns aged 15-74 years in 2011-12. Gambling-related harms were based on the nine-item PGSI. Gambling involvement was measured by gambling frequency and weekly average gambling expenditure. Associations among harms, demographics and gambling involvement were examined in logistic regression. RESULTS: During the previous year, 13% of respondents experienced at least one gambling-related harm (males 18.1%, females 7.2%). The four commonest harms were 'chasing losses' (8.6%), 'escalating gambling to maintain excitement' (3.1%), 'betting more than could afford to lose' (2.8%), and 'feeling guilty' (2.6%). The harm profile in descending order was the same for both genders but differed in prevalence. Young age (<25 years) was associated with increased likelihood of reporting harms. Both monthly and weekly gambling and spending over €21 per week on gambling were related to the harms. CONCLUSIONS: Our results provide support for the public health approach to gambling: harms were reported even at low gambling frequency-expenditure levels. In addition to the high-risk approach, adopting a population-level approach to preventing gambling harm could shift the population distribution of harm in a lower direction.

Income differences in life expectancy: the changing contribution of harmful consumption of alcohol and smoking.

BACKGROUND: Social differences in mortality have increased in high-income countries, but the causes of these changes remain unclear. We quantify the contribution of alcohol and smoking to trends in income differences in life expectancy from 1988 through 2007 in Finland. METHODS: An 11% sample from the population registration data of Finns 25 years and older was linked with an 80% oversample of death records. Alcohol-attributable mortality was based on underlying and contributory causes of death on individual death certificates and smoking-attributable mortality on an indirect method that used lung cancer mortality as an indicator for the impact of smoking on mortality. RESULTS: Alcohol- and smoking-attributable deaths reduced life expectancy by about 4.5 years among men. Alcohol-attributable mortality increased and smoking-attributable mortality decreased over the period 1988-2007, leaving the joint contribution stable. Among women, the contribution of these risk factors to life expectancy over the same period increased from 0.7 to 1.2 years. In 2003-2007, life expectancy differentials between the lowest and highest income quintile were 11.4 years (men) and 6.3 years (women). In the absence of alcohol and smoking, these differences would have been 60% less for men and 36% less for women. Life expectancy differentials increased rapidly over the study period; without alcohol and smoking, the increase would have been 69% less among men and 85% less among women. CONCLUSIONS: Alcohol and smoking have a major influence on income differences in mortality and, with the exception of smoking among men, their contribution is increasing. Without alcohol and smoking, there would have been little change in life expectancy differentials.

Drinking in the home: What does it entail for younger and older Finns?

INTRODUCTION: Studies about drinking in homes are scarce despite the growing importance of the phenomenon. We examined how often different age groups in Finland drink-overall or to intoxication-in their own homes without company beyond the family and in their own or other people's homes with other company, compared to other settings, and on what days and hours of the week this occurs. METHODS: A general population survey carried out in 2016 with event-level data (n = 7124 occasions by 1955 respondents). Key measurements included location, drinking company, amount of alcohol drunk and time of the week. RESULTS: Drinking occasions in which alcohol was drunk at home without visitors made up 74% of all occasions and 73% of all intoxication occasions among people aged 60-79 years and 25% and 5% among 15- to 29-year-olds, respectively. The share of 'with company' occasions in somebody's home varied less by age. Occasions with pre/post drinking in homes and drinking occasions lasting until late at night were seen most often among 15- to 29-year-olds. DISCUSSION AND CONCLUSIONS: The important aspects of home drinking vary greatly by age group and depending on what risk or type of consequence is considered. For older people and for chronic harm, the key aspect is drinking at home without company beyond the family. The more important aspect for younger people and acute harm is pre- and post-drinking in homes before or after going to bars or nightclubs, which results in long evenings with large amounts of alcohol consumed.

Access to Alcohol Outlets From Home and Work in Sweden: Longitudinal Associations With Problem Drinking.

OBJECTIVE: The association of proximity of alcohol outlets to the workplace with problem drinking has not been previously studied. We examined longitudinal associations of living and working in proximity to alcohol outlets with problem drinking. METHOD: The data consisted of 13,306 employed respondents to the Swedish Longitudinal Occupational Survey of Health between 2012 and 2018. Road distances from the respondents' home and workplace to the nearest liquor outlet, beer outlet, and bar were calculated by Statistics Sweden. We used distance variables both as categorized, to indicate changes in distance, and as continuous variables. Self-reported problem drinking was assessed using modified Cut-Annoyed-Guilty-Eye (CAGE) questions. Binomial logistic regression with generalized estimating equation was used to examine the associations. RESULTS: A decrease (vs. remained unchanged) in the distance from home to a liquor outlet was associated with a higher likelihood of problem drinking (odds ratio = 1.21, 95% confidence interval [1.02, 1.45]). A protective association for problem drinking was observed when the distance from home to a beer outlet increased (vs. remained unchanged) (0.65 [0.44, 0.95]). A decrease (vs. remained unchanged) in the distance from work to a bar was also associated with a higher likelihood of problem drinking (1.37 [1.00, 1.88]). The likelihood of problem drinking was increased also per 1-km decrease in distance from home to liquor outlets (1.01 [1.00, 1.02]), risk estimates being higher for women than for men. CONCLUSIONS: Alcohol outlet proximity to the workplace could be an additional determinant of harmful alcohol consumption behavior. Reducing the number of on- and off-premise alcohol outlets could reduce the level of harmful alcohol consumption.

Domestication of drinking: a survey study of changes in types of drinking occasions during periods of increasing and decreasing alcohol consumption in the 2000s in Finland.

BACKGROUND AND AIMS: In Finland, per-capita alcohol consumption increased in the early 2000s and decreased after 2007. Our aim was to determine how these changes originated from changes in drinking practices. DESIGN: Repeated cross-sectional general-population surveys. SETTING: Finland in 2000, 2008 and 2016. PARTICIPANTS: Finnish residents aged 15-69 years (n = 6703, response rate 59-78%). MEASUREMENTS: Event-level data on drinking occasions (n = 21 097). Types of drinking occasions (drinking practices) were identified with latent class analysis using occasion characteristics. The aggregated volume of consumption and intoxication occasions were decomposed into contributions from drinking practice classes and years. FINDINGS: Nine drinking occasion types were identified: three at home without company other than family (51% of occasions in 2016), three socializing occasions in different places and with different company (33%) and three party occasion types (16%). Both the frequency of drinking occasion types and the occasion type-specific amounts of alcohol consumed contributed to aggregate-level changes in alcohol use. Drinking at home without external company (with family only; for men, also alone) contributed most to the increase in alcohol use before 2008. Big parties in homes and bars became less common in the 2000s, contributing most to the decline in drinking after 2008. CONCLUSIONS: The rise in per-capita alcohol consumption in Finland in the early 2000s appears to have been linked mainly to an increase in lighter drinking occasions at home without external company. The fall in per-capita drinking after 2007 was linked mainly to a decrease in big parties in homes and in licensed premises. Changes in drinking frequency and the amounts of alcohol consumed per occasion changed in the same direction as alcohol affordability.

Age, period and cohort analysis of light and binge drinking in Finland, 1968-2008.

AIMS: To analyse the effects of age, period and cohort (APC) on light and binge drinking in the general population of Finland over the past 40 years. METHODS: All analyses were based on six Drinking Habits Surveys between 1968 and 2008 of representative samples of the Finnish population aged between 15 and 69 (n = 16,400). The number of drinking occasions per year involving 1-2 drinks (light) and 4+ or 6+ drinks (binges) was used as a dependent variable in APC modelling. Descriptive cohort profiles and negative binomial models were used to assess the effects of APC. RESULTS: Descriptive cohort profiles differed for light and binge drinking. No substantial differences were found across cohort profiles for light drinking, while APC modelling predicted declining cohort and increasing period effects. Differences between cohorts were found for binge drinking, with predictions of slightly declining or increasing period and increasing cohort effects. CONCLUSIONS: Light drinking has increased over time for each cohort, with no substantial differences between cohort profiles. Binge drinking has increased with more recent cohorts and there are distinct differences between cohort profiles, especially among women.