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.

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.

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.

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.

How Are All Drinking Occasions, Intoxication Occasions, and All Alcohol Consumed Distributed Across Different Drinking Occasion Types? A Typology of Drinking Occasions in Finland.

OBJECTIVE: To understand the contexts and characteristics of drinking occasions, we typologized drinking occasions and examined how different aspects of drinking vary in them and what part of population-level drinking and intoxication occasions each covers. METHOD: A Finnish general population survey in 2016 (n = 2,285) with event-level data on drinking occasions (n = 6,697) was used. Occasion types were identified by latent class analysis. The characteristics of the drinking occasions were location, purpose, company, timing, duration, the amounts and beverages drunk, and estimated blood alcohol concentration (eBAC). RESULTS: Eight drinking occasion classes were identified. The three most common ones were all light drinking occasions at home, with the company varying. Five of the eight types were about socializing with people beyond the family. The heaviest drinking occasion type, "big party nights," had an average eBAC of .12%, which seemed to be connected to the long duration of these occasions. The most important contributors to total population-level intoxication occasions were "big party nights" and "at home with the family" occasions (accounting for 30% and 20%, respectively). In terms of contributions to the population's total alcohol consumption, the order of these classes was reversed (19% and 26%, respectively). Drinking at home with no visitors covered 40% of all the alcohol drunk in Finland. Different types of occasions varied little in beverage type composition. CONCLUSIONS: For acute harm, "big party nights" are important to consider because of the prevalence of intoxication, whereas for chronic harm, drinking at home without visitors is even more important to consider.

Changes in Alcohol Consumption during the COVID-19 Pandemic Are Dependent on Initial Consumption Level: Findings from Eight European Countries.

Evidence suggests that changes in alcohol consumption during the first months of the COVID-19 pandemic were unevenly distributed over consumer groups. We investigated possible inter-country differences in how changes in alcohol consumption are contingent on initial consumption (before or at the start of the pandemic), and how changes in consumption translate into possible changes in the prevalence of heavy drinking. We used data from the European Survey on Alcohol use and COVID-19 (ESAC) conducted in Czechia, Denmark, Finland, Germany, Norway, Poland, Spain, and the UK (N = 31921). Past-year alcohol consumption and changes in consumption were measured by AUDIT-C. Drinking habits were compared according to percentiles of pre-pandemic consumption levels, below versus above the 90th percentile. Across countries, drinkers in the highest 10% for pre-pandemic consumption increased their drinking during the pandemic, whereas absolute changes among those initially drinking below this level were modest. The percentage of people reporting >28 alcohol units/week increased significantly in seven of eight countries. During the first months of the COVID-19 pandemic, alcohol consumption in the upper decile of the drinkers increased as did the prevalence of heavy drinkers, in contrast with a declining consumption in other groups in the sample.

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

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

Public Health Thinking Around Alcohol-Related Harm: Why Does Per Capita Consumption Matter?

OBJECTIVE: Alcohol per capita consumption (APC) is used for monitoring harmful alcohol exposure in populations and assessing progress with goals set internationally and nationally. Recently, the alcohol industry challenged the use of this indicator. Here, we assessed the validity of APC as an indicator for reducing alcohol-related harm. METHOD: We conducted a narrative review of association between population-level drinking and harm rates, and the underlying mechanisms of this association. RESULTS: A substantial literature demonstrates quite consistently close associations between APC and population harm levels for various types of health and social harms. Across populations with different total consumption, the distribution of consumption displays a fairly fixed shape, with no clear distinction between heavy drinkers and other drinkers. The mean consumption in a population is closely associated with the prevalence of heavy drinking; an increase in APC arises from a change in the whole distribution, heavy drinkers included. Although risk of harms from drinking increases with consumption, it seems that for many harm types the majority of drinkers, who do not drink heavily, account for a large proportion of harms from alcohol. CONCLUSIONS: By reducing APC, decreases in drinking among heavy drinkers as well as among ordinary drinkers will lead to fewer alcohol-related harms. The evidence strongly suggests public health gains from universal policies targeting APC. Reducing APC is furthermore an investment in future public health, as it is likely an efficient way of preventing people from becoming very heavy drinkers, who may cause themselves and others severe health and social problems.

A new perspective on European drinking cultures: a model-based approach to determine variations in drinking practices among 19 European countries.

BACKGROUND AND AIMS: In recent decades, alcohol drinking in the European Union has been characterized by increasing homogenization of levels of drinking coupled with an overall decrease. This study examined whether we can still distinguish distinct practices of drinking by addressing two research questions: (1) are drinking practices still characterized by the choice of a certain alcoholic beverage; and (2) how do drinking practices vary across countries? DESIGN: Cross-sectional study: latent-class analyses of drinking variables and fractional response regression analyses of individual characteristics for individual-level class endorsement probabilities, respectively. SETTING: Nineteen European countries and one autonomous community. PARTICIPANTS: A total of 27 170 past-year drinkers aged 18-65 years in 2015. MEASUREMENTS: Data were collected through the Standardized European Alcohol Survey included frequency of past-year drinking, pure alcohol intake per drink day, occurrence of monthly risky single-occasion drinking and preferred beverage, together with socio-demographic data. FINDINGS: Three latent classes were identified: (1) light to moderate drinking without risky single-occasion drinking [prevalence: 68.0%, 95% confidence interval (CI) = 66.7-69.3], (2) infrequent heavy drinking (prevalence: 12.6%, 95% CI = 11.5-13.7) and (3) regular drinking with at least monthly risky single-occasion drinking (prevalence: 19.4%, 95% CI = 18.1-20.9). Drinking classes differed considerably in beverage preference, with women reporting a generally higher share of wine and men of beer drinking. Light to moderate drinking without risky single-occasion drinking was the predominant drinking practice in all locations except for Lithuania, where infrequent heavy drinking (class 2) was equally popular. Socio-demographic factors and individual alcohol harm experiences (rapid alcohol on-line screen) explained up to 20.5% of the variability in class endorsement. CONCLUSIONS: Beverage preference appears to remain a decisive indicator for distinguishing Europeans' drinking practices. In most European countries, multiple drinking practices appear to be present.

Joint effects of alcohol use, smoking and body mass index as an explanation for the alcohol harm paradox: causal mediation analysis of eight cohort studies.

BACKGROUND AND AIMS: Lower socio-economic status (SES) is associated with higher alcohol-related harm despite lower levels of alcohol use. Differential vulnerability due to joint effects of behavioural risk factors is one potential explanation for this 'alcohol harm paradox'. We analysed to what extent socio-economic inequalities in alcohol-mortality are mediated by alcohol, smoking and body mass index (BMI), and their joint effects with each other and with SES. DESIGN: Cohort study of eight health examination surveys (1978-2007) linked to mortality data. SETTING: Finland. PARTICIPANTS: A total of 53 632 Finnish residents aged 25+ years. MEASUREMENTS: The primary outcome was alcohol-attributable mortality. We used income as an indicator of SES. We assessed the joint effects between income and mediators (alcohol use, smoking and BMI) and between the mediators, adjusting for socio-demographic indicators. We used causal mediation analysis to calculate the total, direct, indirect and mediated interactive effects using Aalen's additive hazards models. FINDINGS: During 1 085 839 person-years of follow-up, we identified 865 alcohol-attributable deaths. We found joint effects for income and alcohol use and income and smoking, resulting in 46.8 and 11.4 extra deaths due to the interaction per 10 000 person-years. No interactions were observed for income and BMI or between alcohol and other mediators. The lowest compared with the highest income quintile was associated with 5.5 additional alcohol deaths per 10 000 person-years (95% confidence interval = 3.7, 7.3) after adjusting for confounders. The proportion mediated by alcohol use was negative (-69.3%), consistent with the alcohol harm paradox. The proportion mediated by smoking and BMI and their additive interactions with income explained 18.1% of the total effect of income on alcohol-attributable mortality. CONCLUSIONS: People of lower socio-economic status appear to be more vulnerable to the effects of alcohol use and smoking on alcohol-attributable mortality. Behavioural risk factors and their joint effects with income may explain part of the alcohol harm paradox.

Comparison of data sources on alcohol problems: An exploratory exercise using surveys vs. national healthcare registers.

Aims: Both survey and healthcare register data struggle as data sources to capture the phenomenon of alcohol problems. We study a large group of people for whom survey data and two types of register data are available, and examine the overlaps of similar or related measures in the different data sources to learn about potential weaknesses in each. We also examine how register-based data on the prevalence of alcohol problems change depending on which register data are used. Design: We use data from the Regional Health and Wellbeing Study (ATH) of the adult Finnish population collected in 2013 and 2014 (n = 69,441), individually linked with data on two national healthcare registers (Care Register for Health Care; Register of Primary Health Care visits) for the survey year and previous year. Results: The prevalence of substance-abuse-related healthcare was almost two-fold if data on outpatient primary care visits were included in addition to hospitalisations. Forty-six per cent of the survey respondents self-reporting substance-abuse-related healthcare service use were identified in the registers, and 22% of all respondents with such service use according to registers reported this in the survey. Records of substance-abuse-related healthcare service use, controlled for self-reported alcohol use and self-reported substance-abuse-related service use, were found more often for men, the middle-aged, people with basic education only, and the non-employed. Conclusions: The results are suggestive of underreporting in both data sources. There is an evident need to develop recording practices in the healthcare registers regarding substance use disorders.

The future of alcohol surveys: Between the devil and the deep blue sea.

The future of survey research in the alcohol field, as elsewhere, does look gloomy. Even if there is a need to better confront this reality, abandoning traditional survey methods does not guarantee better outcomes and is not an equally burning issue in all countries or surveys and for all objectives. Correcting biases is easier when the aim is to estimate the parameters of a consumption distribution than when the aim is to measure drinking patterns, their changes and subgroup differences. Combining data from various sources requires making assumptions that affect the results but that may be hard to base on evidence. Despite these challenges, alcohol researchers need to take steps in this direction to find out more about the situations and ways in which such new methods would best serve the field.

Measurement error as an explanation for the alcohol harm paradox: analysis of eight cohort studies.

BACKGROUND: Despite reporting lower levels of alcohol consumption, people with lower socio-economic status (SES) experience greater alcohol-related harm. Whether differential biases in the measurement of alcohol use could explain this apparent paradox is unknown. Using alcohol biomarkers to account for measurement error, we examined whether differential exposure to alcohol could explain the socio-economic differences in alcohol mortality. METHODS: Participants from eight representative health surveys (n = 52 164, mean age 47.7 years) were linked to mortality data and followed up until December 2016. The primary outcome was alcohol-attributable mortality. We used income and education as proxies for SES. Exposures include self-reported alcohol use and four alcohol biomarkers [serum gamma-glutamyl transferase (available in all surveys), carbohydrate-deficient transferrin, alanine aminotransferase and aspartate aminotransferase (available in subsamples)]. We used shared frailty Cox proportional hazards to account for survey heterogeneity. RESULTS: During a mean follow-up of 20.3 years, totalling 1 056 844 person-years, there were 828 alcohol-attributable deaths. Lower SES was associated with higher alcohol mortality despite reporting lower alcohol use. Alcohol biomarkers were associated with alcohol mortality and improved the predictive ability when used in conjunction with self-reported alcohol use. Alcohol biomarkers explained a very small fraction of the socio-economic differences in alcohol mortality, since hazard ratios either slightly attenuated (percent attenuation range 1.0-12.1%) or increased. CONCLUSIONS: Using alcohol biomarkers in addition to self-reported alcohol use did not explain the socio-economic differences in alcohol mortality. Differential bias in the measurement of alcohol use is not a likely explanation for the alcohol-harm paradox.

Alcohol-attributed disease burden in four Nordic countries between 2000 and 2017: Are the gender gaps narrowing? A comparison using the Global Burden of Disease, Injury and Risk Factor 2017 study.

INTRODUCTION AND AIMS: The gender difference in alcohol use seems to have narrowed in the Nordic countries, but it is not clear to what extent this may have affected differences in levels of harm. We compared gender differences in all-cause and cause-specific alcohol-attributed disease burden, as measured by disability-adjusted life-years (DALY), in four Nordic countries in 2000-2017, to find out if gender gaps in DALYs had narrowed. DESIGN AND METHODS: Alcohol-attributed disease burden by DALYs per 100 000 population with 95% uncertainty intervals were extracted from the Global Burden of Disease database. RESULTS: In 2017, all-cause DALYs in males varied between 2531 in Finland and 976 in Norway, and in females between 620 in Denmark and 270 in Norway. Finland had the largest gender differences and Norway the smallest, closely followed by Sweden. During 2000-2017, absolute gender differences in all-cause DALYs declined by 31% in Denmark, 26% in Finland, 19% in Sweden and 18% in Norway. In Finland, this was driven by a larger relative decline in males than females; in Norway, it was due to increased burden in females. In Denmark, the burden in females declined slightly more than in males, in relative terms, while in Sweden the relative decline was similar in males and females. DISCUSSION AND CONCLUSIONS: The gender gaps in harm narrowed to a different extent in the Nordic countries, with the differences driven by different conditions. Findings are informative about how inequality, policy and sociocultural differences affect levels of harm by gender.

Night-time is the right time? Late-night drinking and assaults in Finnish public and private settings.

INTRODUCTION AND AIMS: The risk of alcohol-related injuries and violence increases in late-night settings. We analysed temporal patterns of drinking and assaults and present an event-level analysis of connections between night-time drinking, estimated blood alcohol level, location and drinkers' age and sex. DESIGN AND METHODS: Main data source is a Finnish general population (aged 18-69 years) survey carried out in 2016 (n = 1962), including event-level data on drinking occasions in the previous 7 days (n = 1891). Statistical analyses consisted of tabulations and logistic regression analyses. RESULTS: Finns' drinking peaked around 8-9 pm on most days, with the greatest peaks on Fridays and Saturdays. The main pattern was similar for drinking occasions occurring in home surroundings and in licensed premises, but a larger proportion of the latter occurred in later hours of the day. Assaults had a similar weekday distribution, but the peak occurred several hours later, around 3-5 am. One explanation is that the mean estimated blood alcohol concentration strongly increased as the ending time of the drinking occasion extended later into the night, and the proportion of late-night drinking was higher in licensed premises than home surroundings. DISCUSSION AND CONCLUSIONS: Peaks for assaults in public places temporally coincide with the late closing times of licensed premises and with high estimated blood alcohol concentrations among drinkers. The results underline a need to reduce harm from intoxication, which in public places could include restricted opening hours, increased law enforcement, improved responsible beverage service practices and other interventions to better manage aggression.

Genomic prediction of alcohol-related morbidity and mortality.

While polygenic risk scores (PRS) have been shown to predict many diseases and risk factors, the potential of genomic prediction in harm caused by alcohol use has not yet been extensively studied. Here, we built a novel polygenic risk score of 1.1 million variants for alcohol consumption and studied its predictive capacity in 96,499 participants from the FinnGen study and 39,695 participants from prospective cohorts with detailed baseline data and up to 25 years of follow-up time. A 1 SD increase in the PRS was associated with 11.2 g (=0.93 drinks) higher weekly alcohol consumption (CI = 9.85-12.58 g, p = 2.3 × 10-58). The PRS was associated with alcohol-related morbidity (4785 incident events) and the risk estimate between the highest and lowest quintiles of the PRS was 1.83 (95% CI = 1.66-2.01, p = 1.6 × 10-36). When adjusted for self-reported alcohol consumption, education, marital status, and gamma-glutamyl transferase blood levels in 28,639 participants with comprehensive baseline data from prospective cohorts, the risk estimate between the highest and lowest quintiles of the PRS was 1.58 (CI = 1.26-1.99, p = 8.2 × 10-5). The PRS was also associated with all-cause mortality with a risk estimate of 1.33 between the highest and lowest quintiles (CI = 1.20-1.47, p = 4.5 × 10-8) in the adjusted model. In conclusion, the PRS for alcohol consumption independently associates for both alcohol-related morbidity and all-cause mortality. Together, these findings underline the importance of heritable factors in alcohol-related health burden while highlighting how measured genetic risk for an important behavioral risk factor can be used to predict related health outcomes.

Change and continuity in Finnish drinking in the 21st century.

Aim: Alcohol consumption and policy in Finland have undergone a variety of changes in the two last decades. In several cases, trends in both consumption and policy have shifted direction when moving from the first decade of the 21st century to the second one. The aim of the overview is to summarise the trends. Data: The overview draws on results primarily from the cross-sectional Finnish Drinking Habits Survey (FDHS) in 2000, 2008 and 2016, and also from the whole series including altogether seven separate data collections carried out every eight years from 1968 to 2016 and mainly covering Finns aged 15-69 years. Response rates show a falling trend (78% in 2000, 74% in 2008 and 60% in 2016). The overview also makes use of data collected within the European School Survey Project on Alcohol and other Drugs (ESPAD) and, for the elderly, the National FinSote study carried out by the Finnish Institute for Health and Welfare (THL). Results: After an all-time high of 12.7 litres of pure alcohol per capita 15 years and over in 2007, total consumption of alcohol had decreased by 21% by the year 2019. Underage drinking has decreased ever since the millennium shift. Older people's drinking has continued increasing or levelled out. Along with reduced total consumption, heavy episodic drinking (HED) has also decreased, but the differences between manual and white-collar workers in HED have continued to grow. Drinking alcoholic beverages with meals has also declined since 2008. Liberal and restrictive alcohol policy measures have alternated. Conclusions: Finnish drinking culture seems to change at a slow pace; several typical drinking habits have remained unchanged.

The Finnish Drinking Habits Survey: Implications for alcohol policy and prevention.

Aims/materials: This reflection piece reviews some of the key results and conclusions from the book Näin Suomi juo (This is how Finns drink, 2018), based on the Finnish Drinking Habits Survey. Our aim was to go through the results taking the perspective of prevention workers and policymakers: how could they benefit from the scientific findings when tackling alcohol-related harm? Results/reflections: The reflections displayed in this article provide some useful arguments and justifications for population-level alcohol policy in the controversial alcohol policy debate. Harms do not only arise among the heaviest drinkers, and efficient methods to prevent harm may be found among the prevention efforts that apply to populations rather than only to the heaviest drinkers. The article also illustrates how the results from a population survey can be used in order to identify specific challenges and solutions for alcohol prevention in a given population. The results help in identifying the population groups and situations with an elevated risk of alcohol-related harm and in characterising the drinking patterns and social situations in which drinking takes place in these vulnerable parts of the population. Conclusions: The review illustrates that a many-sided understanding of alcohol consumption and the related harm, based on survey results, is more far-reaching in terms of prevention and policy than a knowledge base built solely on register data on the development of alcohol consumption and harm. For example, the respondents' drinking patterns are linked not only to their attitudes and risk perceptions but also to what people consider to be appropriate means to reduce alcohol use and the related harm in terms of alcohol policy, informal social control and people's life management.

Comparing older people's drinking habits in four Nordic countries: Summary of the thematic issue.

Aim: The present article summarises status and trends in the 21st century in older people's (60-79 years) drinking behaviour in Denmark, Finland, Norway and Sweden and concludes this thematic issue. Each country provided a detailed report analysing four indicators of alcohol use: the prevalence of alcohol consumers, the prevalence of frequent use, typical amounts of use, and the prevalence of heavy episodic drinking (HED). The specific aim of this article is to compare the results of the country reports. Findings: Older people's drinking became more common first in Denmark in the 1970s and then in the other countries by the 1980s. Since 2000 the picture is mixed. Denmark showed decreases in drinking frequency, typically consumed amounts and HED, while in Sweden upward trends were dominant regarding prevalence of consumers and frequency of drinking as well as HED. Finland and Norway displayed both stable indicators except for drinking frequency and proportion of women consumers where trends increased. In all four countries, the gender gap diminished with regard to prevalence and frequency of drinking, but remained stable in regard to consuming large amounts. In Norway the share of alcohol consumers among women aged 60-69 years exceeded the share among men. During the late 2010s, Denmark had the highest prevalence of alcohol consumers as well as the highest proportion drinking at a higher frequency. Next in ranking was Finland, followed by Sweden and Norway. This overall rank ordering was observed for both men and women. Conclusion: As the populations aged 60 years and older in the Nordic countries continue to grow, explanations for the drivers and consequences of changes in older people's drinking will become an increasingly relevant topic for future research. Importantly, people aged 80 years and older should also be included as an integral part of that research.