| 1. |
- Källmén, Håkan, et al.
(author)
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The psychometric properties of the AUDIT : a survey from a random sample of elderly Swedish adults
- 2014
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14, s. 672-
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Journal article (peer-reviewed)abstract
- Background: Increasing alcohol consumption and related harms have been reported among the elderly population of Europe. Consequently, it is important to monitor patterns of alcohol use, and to use a valid and reliable tool when screening for risky consumption in this age group. The aim was to evaluate the internal consistency reliability and construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in elderly Swedish adults, and to compare the results with the general Swedish population. Another aim was to calculate the level of alcohol consumption (AUDIT-C) to be used for comparison in future studies. Methods: The questionnaire was sent to 1459 Swedish adults aged 79-80 years with a response rate of 73.3%. Internal consistency reliability, were assessed using Cronbach alpha, and confirmatory factor analysis assessed construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in elderly population as compared to a Swedish general population sample. Results: The results showed that AUDIT was more reliable and valid among the Swedish general population sample than among the elderly and that Item 1 and 4 in AUDIT was less reliable and valid among the elderly. Conclusions: While the AUDIT showed acceptable psychometric properties in the general population sample, it's performance was of less quality among the elderly respondents. Further psychometric assessments of the AUDIT in elderly populations are required before it is implemented more widely.
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| 2. |
- Agardh, Emilie E., et al.
(author)
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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
- 2021
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In: Drug and Alcohol Review. - : Wiley. - 0959-5236 .- 1465-3362. ; 40:3, s. 431-442
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Journal article (peer-reviewed)abstract
- 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.
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| 3. |
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| 4. |
- Andersson, Filip, et al.
(author)
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Prevalence of cannabis use among young adults in Sweden comparing randomized response technique with a traditional survey
- 2023
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In: Addiction. - 0965-2140 .- 1360-0443. ; 118:9, s. 1801-1810
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Journal article (peer-reviewed)abstract
- Background and Aims: The prevalence of cannabis use based on self-reports is likely to be underestimated in population surveys, especially in contexts where its use is a criminal offence. Indirect survey methods ask sensitive questions ensuring that answers cannot be identified with an individual respondent, therefore potentially resulting in more reliable estimates. We aimed to measure whether the indirect survey method ‘randomized response technique’ (RRT) increased response rate and/or increased disclosure of cannabis use among young adults compared with a traditional survey.Design: We conducted two parallel nation-wide surveys during the spring and the summer of 2021. The first survey was a traditional questionnaire-based one (focusing on substance use and gambling). The second survey applied an indirect survey method known as ‘the cross-wise model’ to questions related to cannabis use. The two surveys employed identical procedures (e.g. invitations, reminders and wording of the questions)Setting and Participants: The participants were young adults (aged 18–29 years) living in Sweden. The traditional survey had 1200 respondents (56.9% women) and the indirect survey had 2951 respondents (53.6% women).Measurements: In both surveys, cannabis use was assessed according to three time-frames: life-time use; use during the past year; and use during the past 30 days.Findings: The estimated prevalence of cannabis use was two- to threefold higher on all measures when estimated using the indirect survey method compared with the traditional survey: use during life-time (43.2 versus 27.3%); during the past year (19.2 versus 10.4%); and during the past 30 days (13.2 versus 3.7%). The discrepancy was larger among males and individuals with an education shorter than 10 years, who were unemployed, and who were born in non-European countries.Conclusions: Indirect survey methods may provide more accurate estimates than traditional surveys on prevalence of self-reported cannabis use.
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| 5. |
- Axelsson Sohlberg, Tove, et al.
(author)
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Tal om tobak 2008 : Tobakskonsumtionen i Sverige 2008
- 2009
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Reports (pop. science, debate, etc.)abstract
- Under år 2008 fördes cirka 424 miljoner cigaretter in i Sverige från utlandet i samband med svenskars utlandsresor. I jämförelse med år 2007 har ingen förändring skett. Antalet köpta smuggelcigaretter har däremot ökat mellan 2007 och 2008 från 144 miljoner till 440 miljoner dvs. med cirka 205 procent. Köp av privatimporterade cigaretter, det vill säga köp av cigaretter som privatpersoner lagligt fört in i landet och sålt vidare utan kommersiellt syfte, uppgick år 2008 till cirka 134 miljoner vilket i jämförelse med år 2007 är en ökning med cirka 6 procent. Sammantaget så ökade därmed den oregistrerade cigarettkonsumtionen under 2008 med cirka 44 procent i jämförelse med 2007 (998 miljoner mot 694 miljoner). Den registrerade (i Sverige beskattade) cigarettförsäljningen minskade under 2008 samtidigt som den oregistrerade cigarettkonsumtionens andel av den totala cigarettkonsumtionen (det vill säga den registrerade och den oregistrerade sammantaget), ökade från 9,5 procent under 2007 till 14 procent för 2008. Den totala cigarettkonsumtionen fortsätter dock att minska under 2008 och var ca 2,7 procent lägre än 2007 och 7,7 procent lägre än 2006. Denna utveckling får stöd i andra uppgifter som visar att andelen dagligrökare minskat under samma period. I denna rapport skattades också den oregistrerade snuskonsumtionen för år 2008 vilken uppgick till cirka 30,8 miljoner dosor varav 17 miljoner var resandeinförda (främst från Finland) och cirka 9,7 miljoner hade beställts via Internet. Köp av smuggelsnus uppgick till cirka 4 miljoner dosor. Detta är i jämförelse med år 2007 en total ökning med cirka 320 procent (30,8 miljoner mot 7,3 miljoner).
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| 6. |
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| 7. |
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| 8. |
- Engdahl, Barbro, et al.
(author)
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Is the population level link between drinking and harm similar for women and men? : a time series analysis with focus on gender-specific drinking and alcohol-related hospitalizations in Sweden
- 2011
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In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 21:4, s. 432-437
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Journal article (peer-reviewed)abstract
- Background: A question that has not been addressed in the literature is whether the population level association between alcohol and harm differs between men and women. The main aim of this article is to fill this gap by analysing recently collected time series data of male and female self-reported drinking in relation to gender-specific harm indicators in Sweden. Methods: Male and female per capita and risk consumption was estimated on the basis of self-reported data from monthly alcohol surveys for the period 2002-07. Overall per capita consumption including recorded sales and estimates of unrecorded consumption were also collected for the same period. Alcohol-related hospitalizations were used as indicators of alcohol-related harm. Data were aggregated into quarterly observations and analysed by means of time series analyses (ARIMA-modelling). Results: Overall per capita consumption was significantly related to both male and female alcohol-related hospitalizations. Male per capita consumption and risk consumption were also significantly related to alcohol-related hospitalizations among men. Female per capita consumption and risk consumption had also a positive association with alcohol-related hospitalizations but statistical significance was only reached for alcohol poisonings where the association was even stronger than for men. Conclusions: Changes in alcohol consumption in Sweden was associated with changes in male and female alcohol-related hospitalizations also in analyses based on gender-specific consumption measures. There was no clear evidence that the population level association between alcohol and harm differed between men and women.
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| 9. |
- Fugelstad, Anna, et al.
(author)
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Drug-related deaths : Statistics based on death certificates miss one-third of cases
- 2020
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In: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 48:1, s. 29-37
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Journal article (peer-reviewed)abstract
- AIMS: Statistics on drug-related deaths (DRD) provide crucial information on the drug situation. The European Monitoring Centre for Drug and Drug Addiction (EMCDDA) has published a specification for extracting DRD from national mortality registers to be used in international comparisons. However, surprisingly little is known of the accuracy of DRD statistics derived from national mortality registers. This study assesses the accuracy of Swedish data derived from national mortality registers by comparing it with other sources of data.METHODS: We compared five Swedish datasets. Three were derived from national mortality registers, two according to a Swedish specification and one according to the EMCDDA specification. A fourth dataset was based on toxicological analyses. We used a fifth dataset, an inventory of DRD in Stockholm, to assess the completeness and coverage of the Swedish datasets.RESULTS: All datasets were extracted from high-quality registers, but still did not capture all DRD, and both the numbers and demographic characteristics varied considerably. However, the time trends were consistent between the selections. In international comparisons, data completeness and investigation procedures may impact even more on stated numbers.CONCLUSIONS: Basing international comparisons on numbers or rates of DRDs gives misleading results, but comparing trends is still meaningful.
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| 10. |
- Fugelstad, Anna, et al.
(author)
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Oxycodone-related deaths in Sweden 2006-2018
- 2022
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In: Drug And Alcohol Dependence. - : Elsevier BV. - 0376-8716 .- 1879-0046. ; 234
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Journal article (peer-reviewed)abstract
- Aim: To identify and characterize oxycodone related deaths in Sweden from 2006 to 2018 and to compare them to other opioid-related deaths.Methods: To assess the factors contributing to the deaths, we used multinomial logistic regression to compare oxycodone-related deaths extracted from all forensic autopsy examinations and toxicology cases in the age groups 15-34 (reference group), 35-54 and 55-74 with regard to sex, presence of benzodiazepines and alcohol at the time of death, prescription of oxycodone, benzodiazepines and antidepressants, previous substance use related (SUD) treatment, and manner of death. The oxycodone related deaths were compared with deaths with presence of other opioids.Result: We identified 575 oxycodone-related deaths, and the rate increased during the study period from 0.10 to 1.12 per 100,000 in parallel with an increase of oxycodone prescriptions from 3.17 to 30.33 per 1000. Oxycodone-related deaths amounted to 10.0% of all opioid-related deaths. The deaths occurred mainly in older patients previously being prescribed oxycodone. Benzodiazepines were present at the time of death in 403 (70%) and alcohol in 259 (45%). Prescriptions of any opioid for pain (61%), oxycodone (50%), benzodiazepines (67%) and antidepressants (55%) were common. Only 15% had received treatment for SUD during the last year.Conclusion: Oxycodone-related deaths increased in Sweden between 2006 and 2018 in parallel to an increase in oxycodone prescriptions. The increase occurred mainly in older patients being prescribed oxycodone for pain. There might be specific interventions needed to avoid oxycodone-related deaths compared to other opioidrelated deaths associated with illicit opioid use.
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| 11. |
- Gripe, Isabella, et al.
(author)
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Are the well‐off youth in Sweden more likely to use cannabis?
- 2021
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In: Drug and Alcohol Review. - : Wiley. - 0959-5236 .- 1465-3362. ; 40:1, s. 126-134
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Journal article (peer-reviewed)abstract
- Introduction and Aims. Results from previous research are inconsistent regarding the association between socioeconomic status (SES) and cannabis use among adolescents. Since there are risks associated with cannabis use, a social gradient in cannabis use may contribute to reproducing socioeconomic differences in life opportunities. The aim of this study was to assess the association between childhood SES and cannabis use among youth in Sweden. Design and Methods. We used repeated cross‐sectional data from three waves (2014–2016) of the Swedish national school survey among 11th graders. The analysis encompassed 9497 individuals in 668 school classes. Childhood SES was measured through parents' highest education, as reported by the students. Cannabis use was measured in terms of lifetime use and frequency of use. Data were analysed using multi‐level mixed‐effects Poisson regression. Results. Adolescents with at least 1 parent with university/college education had 17% (incidence rate ratio 1.17, confidence interval 1.05, 1.30) higher risk of lifetime use of cannabis compared with those whose parents had no university/college education, adjusting for sex, SES of the school environment, academic orientation, truancy, risk assessment and parental permissiveness. Among life‐time users of cannabis, risk for frequent cannabis use was 28% (incidence rate ratio 0.72, confidence interval 0.53, 0.97) lower for those with at least 1 parent with university or college education. Discussion and Conclusions. Childhood SES, in terms of parental education, was associated with cannabis use among Swedish adolescents. Adolescents from families with lower SES were less likely to ever try cannabis, but at higher risk for frequent use.
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| 12. |
- Gustafsson, Nina-Katri, 1976-
(author)
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Bridging the world : Alcohol Policy in Transition and Diverging Alcohol Patterns in Sweden
- 2010
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Doctoral thesis (other academic/artistic)abstract
- The present dissertation aims at analysing the effects of recent alcohol policy changes. The traditional strict policy in Sweden had focused on high pricing and limited availability to control levels of alcohol consumed and thus alcohol-related harms. However, increased travellers’ allowances meant larger availability of cheaper alcohol when importing from Denmark and Germany, which are the countries from which Swedes obtain most of their private imports; the tax decrease in Denmark further decreased the price. As the economic literature links demand to price of a commodity and the early (smaller) quota changes had resulted in higher consumption in southern Sweden, it was expected that these latest changes would mean higher consumption and more alcohol-related problems in this area in particular. Some groups were additionally expected to be more affected than others.The present compilation thesis comprises four related articles and an introductory chapter that ties them together. Article I focuses on private imports in relation to quota changes 2002 – 2004 and relate this to purchase at the alcohol monopoly stores. Self-reported consumption and alcohol-related problems are studied in Article II and IV. In Article III, register data on alcohol-related harms, i.e. hospitalizations and police-recorded crimes, are analysed.The results of the dissertation were puzzling, since there was no large increase in consumption or alcohol-related problems in the south, but increases in the north during the period. However, private imports and cases of hospitalization due to alcohol poisoning were found to have increased in the south. Thus, the results imply that these policy changes had an effect on private imports, but that this effect was not large enough to increase total consumption as well. Additionally, increased alcohol poisoning cases implied that there had been an impact among high consumers. The increases found in consumption and problems in the north may instead have other explanations.
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Gustafsson, Nina-Katri J., et al.
(author)
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Changes in alcohol-related harm in Sweden after increasing alcohol import quotas and a Danish tax decrease-an interrupted time-series analysis for 2000-2007
- 2011
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In: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 40:2, s. 432-440
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Journal article (peer-reviewed)abstract
- Background Denmark decreased its tax on spirits by 45% on 1 October 2003. Shortly thereafter, on 1 January 2004, Sweden increased its import quotas of privately imported alcohol, allowing travellers to bring in much larger amounts of alcohol from other European Union countries. Although these changes were assumed to increase alcohol-related harm in Sweden, particularly among people living close to Denmark, analyses based on survey data collected before and after these changes have not supported this assumption. The present article tests whether alcohol-related harm in southern Sweden was affected by these changes by analysing other indicators of alcohol-related harm, e. g. harm recorded in different kinds of registers. Methods Interrupted time-series analysis was performed with monthly data on cases of hospitalization due to acute alcohol poisoning, number of reported violent assaults and drunk driving for the years 2000-07 in southern Sweden using the northern parts of Sweden as a control and additionally controlling for two earlier major changes in quotas. Results The findings were not consistent with respect to whether alcohol-related harm increased in southern Sweden after the decrease in Danish spirits tax and the increase in Swedish alcohol import quotas. On the one hand, an increase in acute alcohol poisonings was found, particularly in the 50-69 years age group, on the other hand, no increase was found in violent assaults and drunk driving. Conclusions The present results raise important questions about the association between changes in availability and alcohol-related harms. More research using other methodological approaches and data is needed to obtain a comprehensive picture of what actually happened in southern Sweden.
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| 17. |
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| 18. |
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| 19. |
- Jarl, Johan, et al.
(author)
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The societal cost of alcohol consumption: an estimation of the economic and human cost including health effects in Sweden, 2002
- 2008
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In: European Journal of Health Economics. - : Springer Science and Business Media LLC. - 1618-7601 .- 1618-7598. ; 9:4, s. 351-360
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Journal article (peer-reviewed)abstract
- This article estimates the societal cost of alcohol consumption in Sweden in 2002, as well as the effects on health and quality of life. The estimation includes direct costs, indirect costs and intangible costs. Relevant cost-of-illness methods are applied using the human capital method and prevalence-based estimates, as suggested in existing international guidelines, allowing cautious comparison with prior studies. The results show that the net cost (i.e. including protective effects of alcohol consumption) is 20.3 billion Swedish kronor (SEK) and the gross cost (counting only detrimental effects) is 29.4 billon (0.9 and 1.3% of GDP). Alcohol consumption is estimated to cause a net loss of 121,800 QALYs. The results are within the range found in prior studies, although at the low end. A large number of sensitivity analyses are performed, indicating a sensitivity range of 50%.
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| 20. |
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| 21. |
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| 22. |
- Kraus, Ludwig, 1955-, et al.
(author)
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Does the decline in Swedish adolescent drinking persist into early adulthood?
- 2024
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In: Addiction. - 0965-2140 .- 1360-0443. ; 119:2, s. 259-267
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Journal article (peer-reviewed)abstract
- Background and aims: Sweden has experienced a substantial decrease in adolescent drinking over the past decades. Whether the reduction persists into early adulthood remains unclear. Using survey data, the present study aimed to determine whether reductions in indicators of alcohol use observed among adolescents remain in early adulthood and whether changes in alcohol intake are consistent among light/moderate and heavy drinkers.Design: Data from the Swedish monthly Alcohol Monitoring Survey (2001–20) were used to construct five 5-year birth cohorts (1978–82, 1983–87, 1988–92, 1993–97 and 1998–2002).Setting: Sweden.Participants: A total of n = 52 847 respondents (48% females) aged 16 and 30 years were included in this study.Measurements: For both males and females, temporal changes in the prevalence of any drinking, the prevalence of heavy episodic drinking (HED) and total alcohol intake in the past 30 days in centilitres were analysed.Findings: The prevalence of any drinking in more recent cohorts remained low until young people came into their early (females) and mid- (males) 20s. Male cohorts differed in the prevalence of HED across age, with the later cohorts showing lower odds than earlier cohorts (odds ratios between 0.54 and 0.66). Among females, no systematic differences between cohorts across age could be observed. Later male birth cohorts in light/moderate drinkers had lower alcohol intake than earlier cohorts (correlation coefficients between −0.09 and −0.54). No statistically significant cohort effects were found for male heavy drinkers. Although differences in alcohol intake among females diminished as age increased, the cohorts did not differ systematically in their level of alcohol intake.Conclusions: In Sweden, the reduced uptake of drinking in adolescents appears to fade as people move into adulthood. Observed reductions in alcohol intake among light and moderate drinkers appear to persist into adulthood. More recent male cohorts show a lower prevalence rate of heavy episodic drinking.
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| 23. |
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| 24. |
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| 25. |
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| 26. |
- Landberg, Jonas, 1974-
(author)
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Alcohol-Related Problems in Eastern Europe : A Comparative Perspective
- 2010
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Doctoral thesis (other academic/artistic)abstract
- This thesis investigates the association between alcohol consumption and alcohol-related harm in Eastern Europe. The main aim was to estimate to what extent changes in per capita alcohol consumption have an impact on different forms of alcohol-related mortality, and to put the results in an international comparative perspective. The thesis includes four papers; the first two papers use aggregate time-series analysis to assess how changes in per capita consumption affect rates in suicide mortality and fatal non-intentional injuries in several Eastern European countries, respectively. The third paper applies the same methodological approach to analyse the population-level relationship between alcohol and homicide in Russia and the U.S.. The fourth paper employs survey data to assess how the risk of experiencing alcohol-related problems in relation to volume of consumption in the Baltic countries compares to Sweden and Italy. The results of the first three papers suggests: (i) that changes in per capita consumption are significantly related to changes in mortality rates of suicide, non-intentional injuries and homicide in the countries under study; (ii) that the relationship is stronger for men than for women, and (iii) that the relationship tends to be stronger in the countries with more detrimental drinking patterns, e.g. Russia. The results of the fourth paper suggest that the risk of experiencing alcohol-related problems in relation to level of drinking in the Baltic countries is similar to the corresponding risk in Sweden, but considerably stronger than in Italy. In conclusion, the findings support the significance of a public health approach to alcohol-related problems in Eastern Europe, i.e., policy measures directed towards total alcohol consumption. In addition, strategies aimed at reducing the occurrence of binge drinking seem to have great potential for reducing alcohol-related harm and mortality in Eastern European countries.
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| 27. |
- Landberg, Jonas, 1974-, et al.
(author)
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Distribution of sickness absence risk across different levels and patterns of drinking : findings from the Stockholm Public Health Cohort
- 2021
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In: Nordic Studies on Alcohol and Drugs. - : SAGE Publications. - 1455-0725 .- 1458-6126. ; 38:3, s. 305-318
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Journal article (peer-reviewed)abstract
- Aim: This study estimated (i) the risk function between different indicators of alcohol use and long-term sickness absence, adjusting for possible confounding factors, (ii) whether the risk function between average volume of consumption and sickness absence is modified by heavy episodic drinking (HED), and (iii) to what extent the risk for sickness absence among abstainers is due to health selection bias. Data and methods: The study was based on data from the Stockholm Public Health Cohort 2006, with an analytical sample of 16,477 respondents aged 18–64 years. The outcome included register-based long-term (> 14 days) sickness absence. Negative binominal regression was used to estimate the association between sickness absence and average weekly volume of consumption, frequency of HED, and both in interaction. Results: Abstainers, chronic heavy drinkers and respondents with the highest frequency of HED had approximately two-fold higher rates of sickness absence relative to the reference groups, i.e., moderate drinkers and those with HED one to 6 times per year. Adjustment for confounding factors did not materially affect the shape of the risk function. After exclusion of abstainers with alcohol-related problems, or poor health, the estimates for abstainers became non-significant. Moderate drinkers with HED did not have significantly higher rates of sickness absence than moderate drinkers without HED. Conclusions: Our results suggest a significant association between alcohol use and sickness absence. There were indications that the U-shaped risk function may largely be due to health selection bias among abstainers. We found no indication of effect modification of HED on moderate drinking.
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| 28. |
- Landberg, Jonas, et al.
(author)
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The Contribution of Alcohol Use, Other Lifestyle Factors and Working Conditions to Socioeconomic Differences in Sickness Absence
- 2020
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In: European Addiction Research. - : S. Karger AG. - 1022-6877 .- 1421-9891. ; 26:1, s. 40-51
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Journal article (peer-reviewed)abstract
- Introduction: This study investigates how alcohol use contributes to the social gradient in sickness absence. Other factors assessed include lifestyle factors (smoking, physical activity and body mass index), physical and psychosocial working conditions. Methods: The study used baseline data from the Stockholm public health cohort 2006, with an analytical sample of 17,008 respondents aged 25-64 years. Outcome variables included self-reported short-term (<14 days) and register-based long-term (>14 days) sickness absence. Socioeconomic position (SEP) was measured by occupational class. Alcohol use was measured by average weekly volume and frequency of heavy episodic drinking. Negative binominal regression was used to estimate sex-specific SEP differences in sickness absence, before and after adjusting for alcohol use and the additional explanatory factors. Results: Adjusting for alcohol use attenuated the SEP differences in long-term sickness absence by 20% for men and 14% for women. Alcohol use explained a smaller proportion of the differences in short-term sickness absence. Alcohol use in combination with other lifestyle factors attenuated the SEP differences (20-35%) for both outcomes. Physical working conditions explained more than half of the gradient in long-term sickness absence, whereas psychosocial conditions had greater impact on short-term sickness absence among men. Discussion/Conclusion: Alcohol use explains a substantial proportion of the SEP disparities in long-term sickness absence among men. The effect is smaller among women and for short-term sickness absence. Our findings support the notion that physical working conditions constitute the key explanatory variable for SEP differences in long-term sickness absence, but add that psychosocial working conditions have greater impact on the gradient in short-term sickness absence among men.
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| 29. |
- Leimar, Per, et al.
(author)
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Public opinion and alcohol policy in Sweden, 1990-2012
- 2013
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In: Nordic Studies on Alcohol and Drugs. - : SAGE Publications. - 1455-0725 .- 1458-6126. ; 30:6 2013, s. 473-490
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Journal article (peer-reviewed)abstract
- We analyse the association between public opinions and political decisions on alcohol policy in Sweden during the last decades. Methods Reviews of existing Swedish surveys on public opinion and recent data on the opinion of decision-makers. Results Restrictive alcohol policy measures have much support in Sweden and this support has increased in the last decade. The opinions of the public and their elected representatives correspond fairly well but the relation between these opinions and policy decisions are not always straightforward. Conclusions There is little support for the idea that public opinion has been a major influence on alcohol policy formation in the period of 1990–2012.
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| 30. |
- Nordström, T., et al.
(author)
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Mortality and population drinking : a review of the literature
- 2005
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In: Drug and Alcohol Review. - 0959-5236 .- 1465-3362. ; 24:6, s. 537-547
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Journal article (peer-reviewed)abstract
- The aim of this review was to review research addressing the relationship between population drinking and health, particularly mortality. The review is based primarily on articles published in international journals after 1994 to February 2005, identified via Medline. The method used in most studies is time-series analysis based on autoregressive intergrated moving average (ARIMA) modelling. The outcome measures covered included the following mortality indicators: mortality from liver cirrhosis and other alcohol-related diseases, accident mortality, suicide, homicide, ischaemic heart disease (IHD) mortality and all-cause mortality. The study countries included most of the EU member states as of 1995 (14 countries), Canada and the United States. For Eastern Europe there was only scanty evidence. The study period was in most cases the post-war period. There was a statistically significant relationship between per capita consumption and mortality from liver cirrhosis and other alcohol-related diseases in all countries. In about half the countries, there was a significant relationship between consumption, on one hand, and mortality from accidents and homicide as well as all-cause mortality on the other hand. A link between alcohol and suicide was found in all regions except for mid- and southern Europe. There was no systematic link between consumption and IHD mortality. Overall, a 1-litre increase in per capita consumption was associated with a stronger effect in northern Europe and Canada than in mid- and southern Europe. Research during the past decade has strengthened the notion of a relationship between population drinking and alcohol-related harm. At the same time, the marked regional variation in the magnitude of this relationship suggests the importance of drinking patterns for modifying the impact of alcohol. By and large, there was little evidence for any cardioprotective effect at the population level. It is a challenge for future research to reconcile this outcome with the findings from observational studies, most of which suggest a protective effect of moderate drinking.
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| 31. |
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| 32. |
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| 33. |
- Norström, Thor, et al.
(author)
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Concluding policy implications
- 2002
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In: Alcohol in Postwar Europe. - Stockholm : National Institute of Public Health [Folkhälsoinstitutet] :Almqvist & Wiksell International. - 9122019928 ; , s. 220-225
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Book chapter (other academic/artistic)
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| 34. |
- Norström, Thor, et al.
(author)
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Conclusions
- 2002
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In: Alcohol in Postwar Europe. - Stockholm : National Institute of Public Health and Almqvist & Wiksell International. - 9122019928 ; , s. 185-194
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Book chapter (other academic/artistic)
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| 35. |
- Norström, Thor, et al.
(author)
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Extended opening hours at nightclubs in Visby : An evaluation of a trial in the summer of 2014
- 2018
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In: Nordic Studies on Alcohol and Drugs. - : SAGE Publications. - 1455-0725 .- 1458-6126. ; 35:5, s. 388-396
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Journal article (peer-reviewed)abstract
- Background and aims:During 10 weeks in the summer 2014 opening hours in nightclubs in Visby (Sweden) were extended by 1 hour, postponing the permitted closing time from 2 to 3 a.m. A number of preventive efforts such as Responsible Server Training, and an intensified cooperation between the police and the nightclubs were strengthened in connection with the trial. The aim of this study was to evaluate the impact of this trial on police-reported violence.Data and methods:To estimate the effect of the trial on violence, we compared the violence rate during the intervention period (week 24–week 33, 2014) with the violence rate in the corresponding period in Visby in 2010–2013. The intervention period thus comprised 10 weeks, and the pre-intervention period 40 weeks. As outcome measure we chose police-reported assaults that had occurred at night (midnight–6 a.m.). As control series we used assaults daytime (6 a.m.–midnight). The intervention effect was estimated with the method of “difference in differences” (DiD). Interviews with key informants provided the study with an explanatory context for the trial outcomes.Results:The intervention effect was strongly statistically significant with a reduction of 3.336 reported assaults at night per week compared to the pre-intervention period. This represents a decrease of 71%.Conclusion:The trial with an extension of opening hours at nightclubs in Visby was followed by a reduction in police-reported violence. This unexpected outcome is likely to be the result of (i) the simultaneous strengthening of efficient preventive measures, and (ii) a decreased congestion in the streets resulting from increased spread in closing hours.
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| 36. |
- Norström, Thor, 1948-, et al.
(author)
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Mortality and population drinking
- 2002
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In: Alcohol in postwar Europe. - Stockholm : National Institute of Public Health [Folkhälsoinstitutet]. - 9122019928 ; , s. 157-176
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Book chapter (other academic/artistic)
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| 37. |
- Norström, Thor, 1948-, et al.
(author)
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Potential Consequences of Replacing a Retail Alcohol Monopoly with a Private License System : Results from Sweden
- 2010
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In: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 105:12, s. 2113-2119
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Journal article (peer-reviewed)abstract
- Aim To examine the potential effects of replacing the Swedish alcohol retail system with a private licensing system on alcohol consumption and alcohol-related harm. Design Two possible scenarios were analysed: (1) replacing the current alcohol retail monopoly with private licensed stores that specialize in alcohol sales or (2) making all alcohol available in grocery stores. We utilized a multiplicative model that projected effects of changes in a set of key factors including hours of sale, retail prices, promotion and advertising and outlet density. Next, we estimated the effect of the projected consumption increase on a set of harm indicators. Values for the model parameters were obtained from the research literature. Measurements Measures of alcohol-related harm included explicitly alcohol-related mortality, accident mortality, suicide, homicide, assaults, drinking driving and sickness absence. Findings According to the projections, scenario 1 yields a consumption increase of 17% (1.4 litres/capita), which in turn would cause an additional 770 deaths, 8500 assaults, 2700 drinking driving offences and 4.5 million sick days per year. The corresponding figures for scenario 2 are a consumption increase of 37.4% (3.1 litres/capita) leading to an additional annual toll of 2000 deaths, 20 000 assaults, 6600 drinking driving offences and 11.1 million days of sick leave. Conclusions Projections based on the research literature suggest that privatization of the Swedish alcohol retail market would significantly increase alcohol consumption and alcohol-related harm.
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| 38. |
- Norström, Thor, et al.
(author)
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The impact of the COVID-19 pandemic on mortality in Sweden—Did it differ across socioeconomic groups?
- 2024
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In: European Journal of Epidemiology. - 0393-2990 .- 1573-7284.
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Journal article (peer-reviewed)abstract
- The characterization of the socioeconomic profle of COVID-19 mortality is limited. Likewise, the mapping of potential indirect adverse outcomes of the pandemic, such as suicide and alcohol abuse, along socioeconomic lines is still meagre. The main aim of this paper is to (i) depict SES-diferences in COVID-19 mortality, and (ii) to assess the impact of the COVID-19 pandemic on suicide and alcohol mortality across socioeconomic groups. We used Swedish monthly data spanning the period January 2016–December 2021. We chose education as indicator of socioeconomic status (SES). The following causes of deaths were included in the analysis: COVID-19, all-cause mortality excluding COVID-19, suicide and a composite index of alcohol-specifc deaths. SARIMA-modelling was used to assess the impact of the pandemic on suicide and alcohol-specifc mortality. Two alternative measures of the pandemic were used: (1) a dummy that was coded 1 during the pandemic (March 2020 and onwards), and 0 otherwise, and (2) the Oxford COVID-19 Government Response Tracker’s Stringency Index. There was a marked SES-gradient in COVID-19 mortality in the working-age population (25–64) which was larger than for other causes of death. A SES-gradient was also found in the old-age population, but this gradient did not difer from the gradient for other causes of death. The outcome from the SARIMA time-series analyses suggested that the pandemic did not have any impact on suicide or alcohol-specifc mortality in any of the educational and gender groups.
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| 39. |
- Norström, Thor, et al.
(author)
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The Link Between Alcohol Sales and Alcohol-Related Harm in Finland, 1995-2016
- 2020
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In: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 81:5, s. 641-646
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Journal article (peer-reviewed)abstract
- Objective:A key assumption in Finnish alcohol policy is that the officially registered alcohol consumption (i.e., alcohol sales) is closely related to alcohol-related harm. During the last two decades, a sizable part of total alcohol consumption, however, comprises unrecorded consumption, which may potentially make alcohol sales less powerful as a predictor of alcohol-related harm. This article thus aims to estimate the relationship between alcohol sales and alcohol-related harm on the basis of more recent Finnish time-series data.Method:Data on alcohol sales (liters of 100% alcohol/capita age 15 years and older) were obtained from the National Institute for Health and Welfare in Finland. As indicators of harm, we used police-reported assaults and three forms of mortality: alcohol-specific mortality, accidents, and suicide. Quarterly data on mortality and alcohol sales spanned the period 1995–2016, and data on police-reported offenses covered the period 1990–2016. Data were analyzed by SARIMA (Seasonal Autoregressive Integrated Moving Average) modeling.Results:A positive and significant association between alcohol sales and all harm indicators was found. A 1-L increase in alcohol sales per capita was associated with a 20% increase in alcohol-specific mortality, a 12% increase in assaults, and a 5%–6% increase in accidents and suicide. These estimates are in line with earlier findings estimated on data for the period when unrecorded alcohol consumption was less common in Finland.Conclusions:The results provide support for a continued strong relationship between alcohol sales and alcohol-related harm in Finland. Policy measures aimed at lowering alcohol sales were supported from these results.
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| 40. |
- Norström, Thor, et al.
(author)
-
The Link Between Per Capita Alcohol Consumption and Alcohol-Related Harm in Sweden, 1987–2015
- 2018
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In: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 79:4, s. 578-584
-
Journal article (peer-reviewed)abstract
- Objective:Recent studies have suggested a weakening of the relationship between population drinking and harm in Sweden. The aim of the present article was to estimate this association on the basis of more recent Swedish time-series data.Method:The Swedish state monopoly’s (Systembolaget) alcohol sales were used as a proxy for population drinking, expressed in liters 100% alcohol per capita ages 15 and older. As indicators of harm we used mortality (cirrhosis mortality, accidents, and suicide), police-reported assaults, and drink driving. Quarterly data on mortality and alcohol consumption spanned the period 1987Q1–2015Q1, and the data on police-reported offenses covered the period 1995Q1–2015Q1. Data were analyzed by applying the technique of seasonal autoregressive integrated moving average (SARIMA) modeling.Results:We found a positive and statistically significant association between population drinking and all harm indicators. A 1 L increase in per capita consumption was associated with a 19% increase in cirrhosis mortality and a 17% increase in drink driving. The effects on the other harm rates were estimated to be between 11% and 13%. These estimates are in line with earlier findings except the estimate for cirrhosis, which was weaker and now similar to findings for other countries.Conclusions:The results provide continuing support for a strong relationship between population drinking and alcohol-related harm in Sweden. Policy measures aimed at lowering the level of drinking gained support from these results.
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| 41. |
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| 42. |
- Norström, Thor, et al.
(author)
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Unregistered alcohol consumption and alcohol-related harm
- 2007
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Conference paper (pop. science, debate, etc.)abstract
- Background: During the last years unregistered alcohol consumption has increased markedly in Sweden. Above all, it is alcohol that is smuggled or legally privately imported which has increased. It can be hypothesised that the intake of unregistered alcohol is associated with a more risky drinking pattern and is more likely to give rise to various forms of alcohol-related harm.Aim: To estimate the relationship between consumption of unregistered alcohol and indicators of alcohol-related harm.Data and method: Data on consumption of various forms of unregistered alcohol consumption were obtained from the monthly surveys that have been conducted since January 2001 by the Centre for Social Research on Alcohol and Drugs, SoRAD, Stockholm University. Registered consumption was indicated by sales data from the Swedish Alcohol Retail Monopoly. The harm indicators included two alcohol-related crime indicators (police-reported assaults and drink driving offences, source: The Swedish National Council for Crime Prevention) and two indicators on admission to treatment for alcohol-related diagnoses. The montly data were aggregated into quarterly observations separately for southern Sweden, mid-Sweden and northern Sweden. The study period was Q1 2001-Q4 2005. The data were analyzed by means of time-series analyses (ARIMA-models) and pooled cross-sectional time-series analyses.Preliminay findings: Generally, there was a significant relationship between on the one hand various forms of unregistered alcohol and alcohol sales, and on the other hand the various harm indicators. The pattern of these relationships and their implications for the hypothesis will be scrutinezed.
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| 43. |
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| 44. |
- Piontek, Daniela, et al.
(author)
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Individual and country-level effects of cannabis-related perceptions on cannabis use : A multilevel study among adolescents in 32 European countries
- 2013
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In: Journal of Adolescent Health. - : Elsevier BV. - 1054-139X .- 1879-1972. ; 52:4, s. 473-479
-
Journal article (peer-reviewed)abstract
- Purpose. The present paper investigated individual and aggregated effects of cannabis-related perceptions and other cannabis-related indicators on 12-months cannabis use prevalence and frequency among 15-16 year olds using multilevel analysis across 32 European countries.Methods. Data on cannabis use, perceptions of availability, risks and friends’ use as well as socio-demographic characteristics were taken from the 2007 European School Survey Project on Alcohol and Other Drugs (ESPAD). On country-level, aggregated measures of the perceptions were used. Moreover, data on cannabis price and 12-months cannabis use prevalence in the total population were taken from the World Drug Report. The analytical sample comprised n = 86,107 students (82.5 % of the overall 2007 international database).Results. Strong and persistent individual-level effects were identified for perceived availability, perceived harm and the number of cannabis using friends. The effects on cannabis use prevalence and frequency were more pronounced than country-level effects. On country-level, aggregated perceived peer consumption and population prevalence were significant predictors, while price was found not related to both outcome variables. The association between perceived friends’ use and cannabis use was moderated by aggregated perceived availability.Conclusions. Proximal influences related to the immediate social situation seem to be more strongly associated with cannabis use than distal influences related to social contexts emphasizing the importance of personal attitudes and perceptions in substance use behaviour. Prevention programs may focus on informing adolescents about the potential risks of cannabis and on correcting misperceptions of social norms. Policy measures may target on reducing visibility of drug use.
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| 45. |
- Ramstedt, Mats
(author)
-
Alcohol and fatal accidents in the United States : - a time series analysis for 1950-2002
- 2008
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In: Accid Anal Prev. ; 40, s. 273-81
-
Journal article (peer-reviewed)abstract
- AIMS: To estimate the association between per capita alcohol consumption and fatal accidents in the United States and to compare the outcome with findings from Europe and Canada. DATA AND METHOD: Yearly data on fatal accidents by gender and age were analysed in relation to per capita alcohol consumption for 1950-2002 using the Box-Jenkins technique for time series analysis. FINDINGS: A 1-L increase in per capita consumption was on average followed by 4.4 male deaths per 100,000 inhabitants, but had no significant effect on female accident mortality. Regarding specific categories of accidents, the effect on fatal motor vehicle accidents accounted for a large part of the overall effect for men and was also significant for women. With respect to fatal falling accidents and other accidents, the only significant effects were found among young males. As concerns women, the association with per capita consumption in the US was weak in comparison with Canada and Europe. The US effect estimate for overall male accidents was however equally strong as in Northern Europe (5.2) or Canada (5.9), and stronger than that found in Central and Southern Europe (2.1 and 1.6, respectively). With respect to alcohol and fatal motor vehicle accidents, the association for men of 3.2 was stronger than in Europe and more similar to the Canadian finding (3.6). CONCLUSIONS: Per capita alcohol consumption has at least partly been an explanation for the development of male fatal accidents and particularly motor vehicle accident rates in the post-war United States. High traffic density and relatively high legal limits for drunken driving blood alcohol concentration (BAC) are suggested to explain the strong association found between alcohol and fatal motor vehicle accidents. The results also suggest that a reduction in per capita consumption would have its most preventive impact on fatal accidents among younger males.
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| 46. |
- Ramstedt, Mats
(author)
-
Alcohol and fatal accidents in the United States - - a time series analysis for 1950-2002
- 2007
-
Conference paper (pop. science, debate, etc.)abstract
- Aims. To estimate the association between per capita alcohol consumption and fatal accidents in the United States and to compare the outcome with findings from Europe and Canada. Data and method. Yearly data on fatal accidents by gender and age were analysed in relation to per capita alcohol consumption for 1950-2002 using the Box-Jenkins technique for time series analysis. Findings. A one-litre increase in per capita consumption was on average followed by 4.4 male deaths per 100,000 inhabitants, but had no significant effect on female accident mortality. Regarding specific categories of accidents, the effect on fatal motor vehicle accidents accounted for a large part of the overall effect for men and was also significant for women. With respect to fatal falling accidents and other accidents, the only significant effects were found among young males. In comparison with Europe, the extent to which changes in per capita consumption cause accidents in the United States is similar to the pattern for Northern Europe, particularly regarding overall accidents, whereas for falls and traffic accidents, the results are similar to those for Southern Europe. In comparison with Canada, a one-litre change in per capita consumption causes about the same amount of change in accidents overall and motor vehicle accidents, but fewer accidental falls and other accidents. Conclusions. Per capita alcohol consumption has at least partly been an explanation for the development of male fatal accidents and particularly motor vehicle accident rates in the post-war United States. A high traffic density and relatively soft BAC laws are suggested to explain the strong association found between alcohol and fatal motor vehicle accidents. The results also suggest that a reduction in per capita consumption would have its most preventive impact on fatal accidents in younger males.
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| 47. |
- Ramstedt, Mats
(author)
-
Alcohol and IHD-mortality in Russia - a bad connection?
- 2007
-
Conference paper (pop. science, debate, etc.)abstract
- Background: Alcohol consumption is not only good for the heart, it can be bad if consumed in irregular binges. At the level of the population it is suggested that in countries with such detrimental drinking patterns, negative effects will outweigh any protective effects. Russia constitutes an example of such a country and the decline in IHD-mortality during the anti-alcohol campaign is often referred to as support of this idea.Objective. To analyse the temporal association between IHD mortality and various indicators of alcohol consumption in Russia. Method. Using ARIMA time-series analysis, age and gender-specific IHD mortality rates from 1950 to 1998 were analysed in relation to alcohol consumption and two indexes of alcohol-related mortality; alcohol poisonings and all alcohol-specific causes. Lung cancer mortality is used as in indicator of smoking. Preliminary findings. A first preliminary model without any control variables, suggested that a one-litre change in per capita alcohol consumption was followed by an increase in IHD mortality among male adults (15+) of 3.5 percent.
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| 48. |
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| 49. |
- Ramstedt, Mats
(author)
-
Alcohol and pancreatitis mortality at the population level : experiences from 14 western countries
- 2004
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In: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 99:10, s. 1255-1261
-
Journal article (peer-reviewed)abstract
- Aims To test if there is relationship between alcohol consumption and pancreatitis mortality at the population level. Data and methods Annual pancreatitis death rates for 1950–95 were converted into age-adjusted mortality rates per 100 000 inhabitants. Per capita alcohol consumption was measured by alcohol sales. The relationship was estimated with time-series analysis on data from 14 western countries. Several models were tested with different assumptions about risk function and lag structure. Results According to the assumed most appropriate model, a positive relationship was found in each country, and statistical significance was reached in all countries except from Finland, Italy and Canada. The magnitude of the association was fairly consistent across countries, with the alcohol effect parameters ranging between 0.05 and 0.14. However, Sweden and Norway deviated from this pattern with estimates between 0.30 and 0.40. Conclusions Pancreatitis joins a wide range of causes of death where the mortality rate is influenced by per capita alcohol consumption, and more so in northern Europe. It is suggested that pancreatitis mortality is an important indicator of alcohol-related harm, not least because a large amount of morbidity is likely to be connected to the mortality rate.
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| 50. |
- Ramstedt, Mats
(author)
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Alcohol and suicide at the population level : the Canadian experience
- 2005
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In: Drug and Alcohol Review. - 0959-5236 .- 1465-3362. ; 24:3, s. 203-208
-
Journal article (peer-reviewed)abstract
- Studies suggest that the population level link between alcohol and suicide differs across countries and between men and women. The aim of this paper was to estimate the relationship between alcohol consumption and suicide in Canada and to put the results in a comparative perspective. The relationship was elucidated for whole Canada, different provinces and also separately for men and women. The total suicide rate in Canada increased significantly by around 4% as alcohol consumption increased by one litre per capita, suggesting that approximately 25 - 30% of Canadian suicides were related to alcohol. The relationship was stronger for women than for men. A significant effect was found in all provinces except from Quebec, but the overall regional variation was not statistically significant. In an international perspective, the relationship for women was somewhat weaker than in Sweden and Norway, but larger than in Finland, the United States and Southern European countries. For men, the association was similar to what is found in the United States and Finland, weaker than in Sweden, Norway and Russia but stronger than in Southern European countries. The results only partly support the idea that intoxication frequency explains national differences in this relationship. Possible explanations for the stronger association among women are also discussed.
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