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- Danielsson, Anna-Karin, et al.
(författare)
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Alcohol use, heavy episodic drinking and subsequent problems among adolescents in 23 European countries : does the prevention paradox apply?
- 2012
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 107:1, s. 71-80
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Tidskriftsartikel (refereegranskat)abstract
- Aims According to the prevention paradox, a majority of alcohol-related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems among adolescents in 23 European countries.Design and setting Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16-year-old students were analysed.Participants A total of 38 370 alcohol-consuming adolescents (19 936 boys and 18 434 girls) from 23 European countries were included.Measurements The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol-related problems.Findings Although the mean levels of consumption and alcohol-related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol-related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems.Conclusions The prevention paradox, based on measures of annual consumption and heavy episodic drinking, seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large proportion of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives combined with targeted interventions.
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| 2. |
- Romelsjö, Anders, et al.
(författare)
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Abstention, alcohol use and risk of myocardial infarction in men and women considering social anchorage and working conditions : the SHEEP case control study
- 2003
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 98:10, s. 1453-1462
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Tidskriftsartikel (refereegranskat)abstract
- Aims Very few studies indicating that low–moderate alcohol consumption protects from myocardial infarction (MI) controlled for social support and working conditions, which could confound the findings. Therefore, a first aim was to study the risk of non-fatal and total MI in relation to volume of alcohol consumption and measures of social support and working conditions. A second aim was to analyse the impact of the volume of earlier alcohol use in abstainers.Design Data came from a case–control study, the Stockholm Heart Epidemiology Program (SHEEP), including first MI among Swedish citizens 45–70 years old.Setting Stockholm County 1992–94.Participants There were 1095 cases of MI in men and 471 in women (928 and 372 were non-fatal), and 2339 living controls from the general population.Measurement Information about alcohol use at different periods in life and job strain, social anchorage and life control besides pre-existing health problems, smoking, physical activity, socio-economic status and marital status was obtained by a questionnaire from the cases and the controls.Findings In multivariate logistic regression analyses, the relative risk for MI (especially non-fatal) was reduced among alcohol consumers. RR for non-fatal MI was 0.52 (95% confidence intervals 0.32, 0.85) in men with a consumption of 50–69.9 g 100% ethanol/day and 0.21 (95% confidence interval 0.06, 0.77) in women with a consumption of 30 g or more per day (reference category 0.1–5 g 100% ethanol/day). Men who were abstainers during the previous 1–10 years and with an earlier average consumption of 5–30 g 100% ethanol/day had a significantly lower relative risk compared to such abstainers with an earlier higher consumption. Earlier consumption among abstainers may also have an impact on gender differences in MI. Analyses showed positive interaction between abstention and low life-control in women, but only 4% of the female cases were due to this interaction. There were no other interactions between measures of alcohol use and social anchorage, life control and working situations.Conclusion Alcohol use had a protective impact on MI, with little impact of job strain, social anchorage and life control, giving increased support for a protective impact of low-moderate alcohol use. The level of previous alcohol consumption among male 1–10-year-long abstainers influenced the risk of MI.
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| 4. |
- Romelsjö, Anders, et al.
(författare)
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Were the changes to Sweden's maintenance treatment policy 2000-06 related to changes in opiate-related mortality and morbidity?
- 2010
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 105:9, s. 1625-1632
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Tidskriftsartikel (refereegranskat)abstract
- Aims To analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006. Design We collected data from surveys of methadone maintenance treatment units, of buprenorphine and methadone sales, and of mortality and inpatient care in Sweden. Setting Sweden. Participants Patients in maintenance treatment. Measurements Survey data of treatment policy to all units in 2003 and 2005. Trend tests and correlation analyses of data on sales, mortality, inpatient care and forensic investigations. Findings The surveys showed a marked change to a less restrictive policy, with increased use of 'take-away doses' and a reduction of discharges due to side misuse. The one-year retention rate stayed high. Sales of buprenorphine and methadone and the number of patients in treatment increased more than threefold from 2000 to 2006, with the greatest increase for buprenoprphine, introduced in year 2000. There was a significant 20-30% reduction in opiate-related mortality and inpatient care between 2000-2002 and 2004-2006 but not of other drug-related mortality and inpatient care. This decline was larger in Stockholm County, which had a less restricted treatment policy. However, a significant increase in buprenorphine- and methadone-related mortality occurred. For the study period 1998-2006, statistically significant declines occurred only in Stockholm County. Conclusions The liberalization of Sweden's drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.
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| 5. |
- Rossow, I., et al.
(författare)
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The extent of the "prevention paradox" in alcohol problems as a function of population drinking patterns
- 2006
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 10:1, s. 84-90
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To assess to what extent use of various criteria for high-risk groups and analyses from subpopulations with different drinking patterns may affect the extent of the prevention paradox (that most alcohol-related harm in populations arises within the drinkers at low risk). Data sets Two national surveys of Norwegian adult samples (n = 4321 current drinkers) and one register linkage of Swedish armed forces conscripts (n = 45 839 current drinkers) with in-patient hospital data. MEASURES: High-risk groups were categorized as the upper 10% of drinkers by annual alcohol intake or by intoxication frequency. Acute alcohol-related harms comprised number of quarrels and fights in the Norwegian surveys and number of hospital admissions for attempted suicide and violent injuries over a follow-up period (3 and 25 years) in the Swedish conscript study. RESULTS: The majority of acute alcohol problems were found among the majority of drinkers with low or moderate risk (the lower 90%) by drinking volume, suggesting empirical support for the prevention paradox. By applying frequency of intoxication rather than annual volume of consumption to determine the high-risk group, a somewhat larger proportion of acute alcohol-related harms was found within the high-risk group, and the number of alcohol-related harms tended to be distributed more evenly between high-risk drinkers and other drinkers. The proportion of alcohol-related harms within the risk groups was significantly lower in the younger age group, where the majority drinks to intoxication compared with other drinkers. CONCLUSION: The extent of the prevention paradox with respect to acute alcohol problems may be more prominent in drinking in subpopulations where intoxication is a common part of the drinking pattern compared with those where intoxication occurs less frequently and among a smaller fraction of the drinkers.
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