Alcohol consumption and closed borders - how COVID-19 restrictions have impacted alcohol sales and consumption in Europe.

BACKGROUND: The closing of bars, restaurants and international borders during the COVID-19 pandemic led to significant changes in alcohol availability. This study provides a first systematic overview of the monthly development of alcohol sales in Europe during the pandemic in order to determine the effect of closed borders on the sales and consumption of alcohol. METHODS: The study covers 72 months from January 2015 to December 2020 in 14 countries from northern, central and western Europe with excise revenue data for beer, spirits, wine separately and summed, converted into litres of pure alcohol per capita 15+ as a proxy for alcohol sales. March-December 2020 is seen as the pandemic period. The analyses consist of (1) descriptive trends of sales before and during the pandemic, (2) assessment of the pandemic impact on sales by time-series analyses and (3) case studies of countries and a region with substantial cross-border inflow or outflow of alcohol. RESULTS: The result shows an overall reduction in alcohol sales with 3.6% during the pandemic. Nevertheless, the results differ based on the level of cross-border purchasing flows pre-pandemic, as countries with high cross-border inflow saw an increase in domestic sales as the pandemic hit. Norway, for example, saw a 23% increase in domestic sales during the pandemic period March-December 2020 compared to the same period in 2019. CONCLUSION: The closing of intra-European borders had a significant redistributing effect on alcohol sales. While noting sales increases, cross-border inflow countries generally saw a decrease in total amount of alcohol consumed per capita as not all cross-border purchases were replaced by domestic sales. This has important policy implications as large volumes of cross-border inflow of alcohol can negatively affect excise revenue as well as public health outcomes. The methodology can be used to further explore the reliance of different purchasing streams in a domestic alcohol market.

Effects of Local Alcohol Prevention Initiatives in Swedish Municipalities, 2006-2014.

Background: Several components of the Swedish alcohol policy, e.g., pricing and availability, weakened when Sweden joined the EU in 1995. To counteract the possible negative effects of this, emphasis was placed on the local level as an important arena of alcohol prevention. Thus, considerable efforts were made to strengthen alcohol prevention in Swedish municipalities. Objectives: The aim of this study was to examine whether local alcohol prevention reduced consumption and alcohol-related harm in Swedish municipalities. Methods: Alcohol prevention was monitored using a composite measure called the Alcohol Prevention Magnitude Measure (APMM), with subcategories of staff and budget, inspections and licenses, policy, activities, and cooperation. APMM and its categories were analysed in relation to alcohol consumption and harm over time, 2006-2014. A fixed effects model was used with 63% (N=182, consumption) and 71% (N=207, harm) of 290 Swedish municipalities, respectively, included in the analyses. Results: The main results suggest that when APMM increases with 1 percent, the alcohol-related mortality decreases with 0.26 percent, controlled for changes in population size, median income, unemployment, and post-secondary education. In light of this result, the estimated effect of APMM on alcohol consumption (sales) is small (0.02 percent decrease); possible explanations for this are discussed in the article. Conclusion: The overall results indicate that local alcohol prevention initiatives in Sweden have reduced some forms of alcohol-related harm, not least alcohol-related mortality, during the period 2006-2014. Further studies are needed to assess the generalizability of the present study.

'Are The Times A-Changin'? Trends in adolescent substance use in Europe.

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

The increased trend of non-drinking in adolescence: The role of parental monitoring and attitudes toward offspring drinking.

INTRODUCTIONS AND AIMS: The proportion of adolescents who do not drink alcohol has increased during the last decade in many European countries, the USA and Australia. Few studies have addressed why this positive trend has occurred. The aim of the present study is to examine associations between parenting factors, peers' alcohol use and non-drinking among 15- to 16-year-old adolescents over time, from 2003 to 2015, and to evaluate potential gender differences. DESIGN AND METHODS: Data from the Swedish subsample of European School Survey Project on Alcohol and Other Drugs were used. Data were available for 2003, 2007, 2011 and 2015 in nation-based samples with responses from 11 531 adolescents in total. RESULTS: The proportion of non-drinkers increased from 23.2% in 2003 to 48.7% in 2015. For each year, indicators of especially restrictive attitudes toward offspring drinking were robustly associated with an increased probability of non-drinking. However, neither indicators of parental monitoring nor parental attitudes toward offspring drinking were associated with the increase in the proportion of non-drinkers that occurred from 2003 to 2015. Two indicators of parental monitoring were more strongly associated with non-drinking among girls than among boys, while paternal restrictive attitudes toward offspring drinking were more strongly associated with non-drinking among boys than girls. DISCUSSION AND CONCLUSIONS: Parenting characteristics are important for adolescents who do not use alcohol, which has implications for prevention strategies. However, the increased trend of non-drinkers could not be attributed to parental factors.

One explanation to rule them all? Identifying sub-groups of non-drinking Swedish ninth graders.

INTRODUCTION AND AIMS: Researchers in a number of countries have recently identified major changes in adolescent alcohol consumption since the early 2000s, with the prevalence of teenage drinking more than halving in some countries. The major aims of the current study are to examine if there are sub-groups among non-drinking Swedish ninth graders and to describe how the prevalence of these groups has changed during the period 1999 to 2015. DESIGN AND METHODS: Data from five waves of the Swedish European School Survey Project on Alcohol and other Drugs study was used. The data covered 16 years and the total sample comprised 14 976 students. Latent class analysis was used to identify sub-groups of non-drinkers (n = 4267) based on parental approval towards drinking, parental monitoring, leisure time activities, school performance and use of other substances. RESULTS: Five latent classes were found: computer gamers (8.3%), strict parents (36.5%), liberal parents (27.0%), controlling but liberal parents (16.6%) and sports (11.6%). In the non-drinking sub-group the strict parents group increased most between 1999 and 2015. DISCUSSION AND CONCLUSIONS: The results imply that there is notable within-group diversity in non-drinking youth. Several mechanisms and explanations are thus likely to be behind the decline in drinking participation among Swedish adolescents.

Effects on Alcohol Consumption and Alcohol Related Harm of a Community-Based Prevention Intervention With National Support in Sweden.

BACKGROUND: In order to strengthen local alcohol prevention work in Sweden the Swedish government has for the past almost 15 years commissioned the Public Health Agency of Sweden to initiate a series of community-based alcohol prevention projects. The latest of these, labeled local development with ambitions (LUMA), included 25 municipalities in Sweden. OBJECTIVES: Aim of this study is to examine if LUMA municipalities that received financial support, with requirements, increased local alcohol prevention and if alcohol consumption and harm declined. METHODS: Twenty-five Swedish municipalities that received financial support aiming to strengthen local alcohol preventing activities (intervention group) were compared to municipalities that did not receive such support (control group, N = 224), before, during, and after the intervention period. Two composite measures of policy and activity were created and used. The composite activity measure includes seven activity indicators and the composite policy measure includes six policy indicators. Harm measures have been selected based on several recommended indicators for monitoring alcohol, tobacco, and other drugs in Sweden. A fixed effects model was used to analyze data. RESULTS: The results reveal that prevention activities increased and several alcohol-related harm indicators were reduced in intervention municipalities (LUMA) compared with in control municipalities. CONCLUSIONS: It seems as if financial support, combined with specific requirements and support from the regional and national level, can stimulate local alcohol prevention activities and have a significant effect on alcohol consumption and alcohol-related harm. Similar evaluations in other countries would be of great value for assessing the generalizability of findings.

Declining trends in alcohol consumption among Swedish youth-does the theory of collectivity of drinking cultures apply?

AIMS: To analyse trends in alcohol consumption among young people in Sweden between 2004 and 2012, to test whether the theory of collectivity of drinking cultures is valid for a population of young people and to investigate the impact of an increasing proportion of abstainers on the overall per capita trends. METHODS: Data were drawn from an annual survey of a nationally representative sample of students in year 11 (17-18 years old). The data covered 9 years and the total sample comprised 36,141 students. Changes in the overall per capita consumption were tested using linear regression on log-transformed data, and changes in abstention rates were tested using logistic regression. The analyses were then continued by calculating average consumption in deciles. RESULTS: Alcohol consumption among year 11 students declined significantly among both boys and girls between 2004 and 2012. These changes were reflected at all levels of consumption, and the same results were found when abstainers were excluded from the analyses. The increasing proportion of abstainers had a minimal effect on the overall decline in consumption; rather, this was driven by a decline in consumption among the heaviest drinkers. CONCLUSION: The theory of collectivity of drinking cultures seems valid for understanding changes in alcohol consumption among Swedish year 11 students. No support was found for a polarization of alcohol consumption in this nationally representative sample.

Reducing youth violence related to student parties: Findings from a community intervention project in Stockholm.

BACKGROUND: During the spring of 2007, the police reported a marked increase in violence and binge drinking related to high school student graduation parties on weekday nights at restaurants in Stockholm city. This spurred a multi-component community intervention project to reduce these problems. AIMS: This study aims to evaluate the impact of the intervention on youth-related violence on weekday nights in 2008-2010. DESIGN AND METHOD: The outcome measure entailed the number of violence-related emergency room visits on weekday nights (10:00 pm-6:00 am) by adolescents aged 18-20 years. The study period was 1 April-31 May, which is when most student graduation parties took place. The data covered the years 2005-2010, with three data points before the intervention, and three after the intervention was introduced. Because the intervention was expected to apply to weekdays only, the control series involved a corresponding indicator pertaining to weekend nights (10:00 pm-6:00 am). The intervention effect was assessed by means of difference-in-differences estimation. RESULTS: The estimated intervention effect according to the difference-in-differences estimation models was a statistically significant 23% reduction of violence among young people. DISCUSSION AND CONCLUSION: This type of intervention is a promising measure of preventing youth violence and deserves to be continued. Such continuation would also provide additional data required for a more conclusive assessment.

Who is not drinking less in Sweden? An analysis of the decline in consumption for the period 2004-2011.

AIMS: This study aimed to analyse if changes in drinking in Sweden have been similar in different population subgroups between 2004 and 2011, a period when per capita consumption declined significantly. METHOD: The analysis starts out from monthly alcohol survey data including 1500 telephone interviews every month. The population is divided into 20 equally large consumption groups separately for men and women and two broad age groups. Both absolute and relative changes in drinking are studied. RESULTS: Most findings confirmed a collectivity of change in drinking: a decline was found at all consumption levels overall, among men and women, and among those under 50 years of age. The decline was smaller in groups with the highest consumption, and among those over 50 years consumption rather increased among the heaviest drinkers. CONCLUSION: Support was obtained for the conception of a social component in recent consumption changes in Sweden. This finding has an important policy message in line with the total consumption model, namely that measures that reduce per capita consumption are likely to imply fewer heavy drinkers. Some exceptions from the collectivity theory that deserves attention in future studies were also noted, e.g. the development among heavier drinkers above 50 years of age.

Prevalence of adolescents who perceive their parents to have alcohol problems: a Swedish national survey using a web panel.

AIMS: The primary aim is to estimate the prevalence of Swedish adolescents who perceive their parent(s) to have alcohol problems. Additional research questions pertain to the prevalence of adolescents who think someone close to them drinks too much alcohol and if this has hurt them or caused them problems. METHODS: A cross-sectional design was employed using a web-based survey targeted to 1000 Swedish 16-19-year-olds randomly selected from a web panel. The questionnaire included the CAST-6 scale, used to assess whether or not participants perceived their parents' alcohol consumption as problematic, and questions relating to whether or not they think someone close to them drinks too much and if this has caused them problems. Data was weighted using a post-stratification procedure. RESULTS: The proportion of adolescents classified as having parents with alcohol problems was 20.1%. Further, 44.0% reported that they think someone close to them drinks too much alcohol and 9.6% that this has hurt them or caused them problems. CONCLUSIONS: These results indicate that the problem is widespread. Our findings are similar to previous research where a more indirect methodology has been adopted, using either psychiatric interviews or self-reported alcohol consumption of adults, to estimate the magnitude of the problem.

Effects of a multi-component responsible beverage service programme on violent assaults in Sweden.

AIM: A multi-component Responsible Beverage Service (RBS) programme has been disseminated in Swedish municipalities. The aim of the programme is to reduce violence associated with consumption of alcohol at on-licensed premises. This study aimed to analyse the effect of the programme on police-recorded assaults after the dissemination of the programme in Swedish municipalities, 1996-2009. DESIGN: This study is a natural experiment that uses variation in the level of implementation of the RBS programme to predict change in the rate of police-recorded assaults. SETTING: Swedish municipalities. PARTICIPANTS: The municipalities included in the study initiated the RBS programme no later than 2008. On-licensed premises open during the evenings must exist. Of 290 municipalities, 237 fulfilled these requirements. MEASUREMENT: Programme fidelity was studied by means of several surveys. Yearly data on police-recorded assaults, per 100,000 inhabitants aged 15 and above, committed on weekend nights, were used as dependent variable. A fixed-effects panel data regression model was used to examine the effect of the programme. FINDINGS: Each extension of the programme, by one component, was associated with a significant 3.1% reduction in assaults. However, this effect was seen mainly in smaller municipalities. Of the different components of the programme, the presence of a community coalition steering group had a significant effect on assaults. No significant effect was found regarding RBS training or supervision of on-licensed premises. CONCLUSION: Multi-component Responsible Beverage Service programmes can have a significant effect on police-recorded assaults even when implemented on a large scale in many communities.

Hazardous drinking among restaurant workers.

BACKGROUND/AIMS: We address three research questions pertaining to Swedish restaurant workers: (i) What is the prevalence of hazardous drinking? (ii) How is the consumption of alcohol distributed? (iii) Does the prevention paradox apply? METHODS: Data were collected by administering the Alcohol Use Disorders Identification Test (AUDIT) among restaurant workers who attended a 2-day Responsible Beverage Service training in Stockholm during the period from October 2008 to December 2009. The control group comprised a sample representative of the general Swedish population. We restricted the analyses to the age span 18-59 years, which yielded a sample size of 579 for restaurant workers and 434 for the general population. RESULTS: The prevalence of hazardous drinking as measured by AUDIT (8+ for men and 6+ for women) was markedly higher among restaurant workers than in the general population. The difference was especially pronounced among females below 30 years of age. We found no difference between restaurant workers and the general population in the distribution of alcohol consumption. About 76% of the drinking problems were found in the lower part of the consumption distribution (bottom 88%), which supports the prevention paradox. CONCLUSIONS: Restaurant workers comprise a high-risk group with respect to drinking.

Drinking less but greater harm: could polarized drinking habits explain the divergence between alcohol consumption and harms among youth?

AIMS: This paper describes changes in alcohol consumption among Swedish youth over the past decade with the aim of exploring the polarization hypothesis, which asserts that while a majority of young drinkers have reduced their alcohol consumption, a subgroup have increased their drinking substantially, resulting in greater harm. METHODS: We analysed repeated cross-sectional self-report data from 45,841 15-16-year olds and 40,889 18-19-year-old high-school students living in the Stockholm municipality between 2000 and 2010. The questionnaire assessed alcohol and drug use, and risk factors for alcohol misuse. Changes over time at different levels of consumption are presented by age and gender. RESULTS: We find evidence of a polarization effect in youth drinking, with consumption reducing significantly over the past 10 years among all young people, except the heaviest drinkers, where consumption and binge drinking tended to increase. The dispersion in per capita consumption also increased over time, indicating more heavy drinkers. The total number of risk factors for alcohol misuse decreased among most survey participants from 2000 to 2010, but with variability between years. CONCLUSION: Polarized drinking habits are a likely explanation for the recent divergence between per capita alcohol consumption, which has decreased, and alcohol-related hospitalizations, which have increased sharply among Swedish youth in recent years. We suggest that ongoing social changes could be affecting young people in the form of greater disparities, which are associated with a higher incidence of social problems generally, including heavy drinking.

Design of a Web-based individual coping and alcohol-intervention program (web-ICAIP) for children of parents with alcohol problems: study protocol for a randomized controlled trial.

BACKGROUND: It has been estimated that approximately 20% of all Swedish children grow up with parents having alcohol problems, which may result in negative outcomes among these children. Therefore, most Swedish municipalities provide resources for support, but at the same time figures reveal that not even 2% receive support, mainly due to difficulties in identifying and recruiting these children into support programs. Delivering intervention programs to children and adolescents via the Internet seems a promising strategy, but to date, the number of web-based interventions aimed at this target group is very scarce. We have therefore developed a novel internet-delivered therapist assisted self-management intervention called the web-ICAIP (Individual Coping and Alcohol Intervention Program) for adolescents having parents with alcohol problems. The purpose of the program is to strengthen adolescents' coping behavior, improve their mental health, and postponing the onset or decreasing risky alcohol consumption. This paper describes the web-ICAIP and the design of a randomized controlled trial (RCT) to measure the efficacy of this intervention. METHODS/DESIGN: The RCT will include at least 183 adolescents (15-19 year old) who will be randomly allocated to two conditions where one group has access to the web-ICAIP and the other is a waiting list control group. Participants will be recruited from websites containing information and facts for adolescents about alcohol and other drugs. Possible participants will be screened using the short version of the Children of Alcoholics Screening Test (CAST-6). The assessment consists of a baseline and two follow-up measurements taking place after two and six months, respectively. The primary outcomes include the Center for Epidemiological Studies Depression Scale (CES-DC), a coping behavior scale, and also the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). Additional outcomes include the "Ladder of life" which measures overall life satisfaction and questions concerning program adherence. DISCUSSION: There is an urgent need for developing and evaluating web-based intervention programs which target children having parents with alcohol problems. This study will therefore make an important contribution to this novel field of research. TRIAL REGISTRATION: ISRCTN41545712.

Anabolic androgenic steroids--use and correlates among gym users--an assessment study using questionnaires and observations at gyms in the Stockholm region.

The purpose of this study was to estimate the prevalence of anabolic androgenic steroid (AAS) use and offers to use among gym users in Stockholm County (Sweden), and to conduct a comparison of concordance in estimates of AAS and supplements at gyms between two data collection methods. A questionnaire was distributed to members at 36 training facilities and 1,752 gym users participated in the study. An observation study was conducted as covert participant observations at 64 gyms. According to the questionnaire, 3.9% of men reported life time use of AAS, 1.4% use during the past 12 months and 0.4% AAS use during past 30 days. Not only were there similar patterns found in the two methods, i.e., similar age and gender distributions for AAS use, but analyses of concordance showed that gyms with a higher prevalence of self-reported AAS-use and supplement use (questionnaire) showed a significantly higher proportion of observer-assessed AAS users. Analyses of individual predictors showed that AAS users were almost always young men, regular weight trainers and more often users of drugs and nutritional supplements. The higher prevalence of AAS use among gym users than in the general population makes the former an appropriate target group for AAS prevention. The connection between supplements, drugs and AAS use suggests that effective AAS prevention need to focus on several risk factors for AAS use. The clear resemblance in estimates between the observation and questionnaire data strengthen the credibility of the two methods.

Alcohol habits in Sweden during 1997-2009 with particular focus on 2005 and 2009, assessed with the AUDIT: a repeated cross-sectional study.

AIM: This study aimed to survey the changes in alcohol habits during a period with the European Union legal practices. METHODS: Alcohol habits in Sweden were surveyed in the general Swedish population at four timepoints, in 1997, 2001, 2005 and 2009, using the 10-item AUDIT questionnaire. DESIGN: Four separate randomly drawn cross-sectional samples of 1,250 individuals were surveyed at each timepoint. RESULTS: An average of 70% of the sampled individuals responded to the AUDIT questionnaire. Men had higher total AUDIT scores than women in 2005 and 2009, but scores increased among women 61-71 years old and decreased among men 61-71 years old. Younger men and women 17-27 years old decreased their AUDIT-C consumption scores by almost 20% between 2005 and 2009. An analysis of problem drinkers (+8 for men/+6 for women) indicated that a larger proportion of elderly women drank moderately in 2009 compared with 2005, but fewer elderly women drank hazardously. CONCLUSIONS: Earlier increases in drinking levels between 1997 and 2001 may reflect a latent high demand that was restricted by low availability. When availability due to European Union harmonization increased, alcohol consumption followed suit. After a period of adaptation, alcohol consumption appears to have stabilized.

Children of substance abusing parents: a national survey on policy and practice in Swedish schools.

OBJECTIVES: This study aims at examining policy and practice within the Swedish school setting pertaining to children of substance abusing parents/caregivers. METHODS: A cross-sectional survey, involving a representative sample of randomized schools (n=443) throughout Sweden was conducted using a self-completed questionnaire. Descriptive analysis was performed including bivariate analysis combined with logistic regression modeling to examine possible correlates between variables. RESULTS: The response rate was 66%, and participants reported that 37% had been trained in issues related to children of substance abusing parents, 33% of the schools had a policy document, and 73% of the schools had identified students with this complex of problems. Whether or not schools identify these students depends upon the occurrence of schools being "compulsory" or "upper secondary", "public" or "independent", the "school size", and respondents' participation in further training, which in turn is associated with the presence of a policy document. CONCLUSIONS: It appears as if a policy document does not directly predict whether schools identify students having substance abusing parents. However, it does influence whether respondents have participated in further training, which subsequently predicts the identification of students having substance abusing parents. Implications for policy and practice within the school setting are discussed.