The collectivity of British alcohol consumption trends across different temporal processes: a quantile age-period-cohort analysis

Expanding our understanding of long-term trends in alcohol abstention and consumption in England (2001-19) using two age-period-cohort approaches

BACKGROUND AND AIMS

Alcohol consumption has decreased in England in recent decades, while alcohol-specific death rates have remained relatively stable. Age-period-cohort (APC) models offer the potential for understanding these paradoxical trends. This study aimed to use an APC model approach to measure long-term trends in alcohol abstention and consumption in England from 2001 to 2019.

DESIGN, SETTING AND PARTICIPANTS

The study used grouped and proxy-variable APC models of repeat cross-sectional survey data, set in England (2001-19). Participants were residents in England aged 13 years or over who took part in the Health Survey for England.

MEASUREMENTS

Outcome variables were alcohol abstention and consumption in units. We created nine age groups (13-15, 16-17, 18-24, 25-34, until 65-74 and 75+, reference 45-54 years), four periods (2001-04, 2005-09, 2010-14 to 2015-19, reference 2005-09) and 18 5-year birth cohorts (1915-19 to 2000-04, reference 1960-64). We proxied age effects (systolic and diastolic blood pressure), period effects (alcohol affordability, internet usage and household alcohol expenditure) and birth cohort effects (prevalence of smoking and prevalence of overweight).

FINDINGS

The odds of abstaining were considerably larger at young ages, 13-15 years [odds ratio (OR) = 5.38; 95% confidence interval (CI) = 4.50-6.43], were lowest during the first period, 2001-04 (OR = 0.83; 95% CI = 0.79-0.86) and had a U-shaped pattern by birth cohort. For units of alcohol, the incidence rate ratio (IRR) increased until age 18-24 years (IRR = 1.41, 95% CI = 1.34-1.48) and decreased afterwards, were highest during the first period, 2001-04 (IRR = 1.07; 95% CI = 1.05-1.08) and showed an inverted J-shape by birth cohort. Our proxy variable approach revealed that using blood pressure measures, alcohol affordability and prevalence of overweight as proxies resulted in APC effects that differed from our base-case model. However, internet usage, household expenditure on alcohol and smoking prevalence resulted in APC effects similar to our base-case model.

CONCLUSIONS

The discrepancy between decreasing alcohol consumption and increasing alcohol-related deaths observed in England from 2001 to 2019 may, in part, be explained by the halt in abstention trends since 2010 and a slight consumption decline since 2001.

Population-Based Study of Alcohol-Related Liver Disease in England in 2001-2018: Influence of Socioeconomic Position

INTRODUCTION

England has seen an increase in deaths due to alcohol-related liver disease (ALD) since 2001. We studied the influence of socioeconomic position on the incidence of ALD and the mortality after ALD diagnosis in England in 2001-2018.

METHODS

This was an observational cohort study based on health records contained within the UK Clinical Practice Research Datalink covering primary care, secondary care, cause of death registration, and deprivation of neighborhood areas in 18.8 million residents. We estimated incidence rate and incidence rate ratios of ALD and hazard ratios of mortality.

RESULTS

ALD was diagnosed in 57,784 individuals with a median age of 54 years and of whom 43% had cirrhosis. The ALD incidence rate increased by 65% between 2001 and 2018 in England to reach 56.1 per 100,000 person-years in 2018. The ALD incidence was 3-fold higher in those from the most deprived quintile vs those from the least deprived quintile (incidence rate ratio 3.30, 95% confidence interval 3.21-3.38), with reducing inequality at older than at younger ages. For 55- to 74-year-olds, there was a notable increase in the incidence rate between 2001 and 2018, from 96.1 to 158 per 100,000 person-years in the most deprived quintile and from 32.5 to 70.0 in the least deprived quintile. After ALD diagnosis, the mortality risk was higher for patients from the most deprived quintile vs those from the least deprived quintile (hazard ratio 1.22, 95% confidence interval 1.18-1.27), and this ratio did not change during 2001-2018.

DISCUSSION

The increasing ALD incidence in England is a greater burden on individuals of low economic position compared with that on those of high socioeconomic position. This finding highlights ALD as a contributor to inequality in health.

Alcohol - a scoping review for Nordic Nutrition Recommendations 2023

The objective of this scoping review is to evaluate the updated evidence on the consumption of alcohol and health outcomes regarded as relevant for the Nordic and Baltic countries, including cardiovascular disease, cancer, and all-cause mortality. It is based on the previous Nordic Nutrition Recommendations of 2012 and relevant papers published until 31 May 2021. Current evidence from mainly observational epidemiological studies suggests that regular, moderate alcohol consumption may confer protective effects against myocardial infarction (MI) and type 2 diabetes. Mendelian randomization analyses do not fully support these findings, possibly because these analyses may fail to identify low alcohol intake. For several cancers, it is not possible to set any safe limit. All-cause mortality is not increased with light to moderate alcohol intake in middle-aged and older adults who do not engage in binge drinking. Total abstinence is associated with the lowest risk of mortality in young adults. Observational studies on alcohol consumption are hampered by a number of inherent methodological issues such as ascertainment of alcohol intake, selection of appropriate exposure groups, and insufficient control of confounding variables, colliders, and mediators. It should also be emphasized that there is a socio-economic contribution to the alcohol-health axis with a stronger detrimental effect of alcohol in the lower social classes. The above issues contribute to the complexity of unravelling the causal web between alcohol, mediators, confounders, and health outcome.

Older men and loneliness: a cross-sectional study of sex differences in the English Longitudinal Study of Ageing

BACKGROUND

Research into men and masculinities suggests men may be more reluctant than women to state they are lonely, more reliant on partners/spouses and/or alcohol to tackle it, and that this may be a result of poorer social relationships. Ageing is often associated with loneliness, and research has indicated gendered results in older people, but existing evidence lacks generalisability and cultural context. This study tests hypotheses on sex differences in loneliness in older England-based men and women.

METHODS

We conducted a cross-sectional study using a sample of 6936 respondents aged 50 + from the English Longitudinal Study of Ageing (wave 8). Multiple imputation with chained equations was conducted to handle missing data. Multivariate regression was used to investigate the impact of sex on a direct question on loneliness whilst controlling for the University of California loneliness (UCLA) scale. Multivariate regression with interaction terms were used to examine sex differences in loneliness and alcohol consumption, partner status, and social relationships.

RESULTS

Older men were less likely than older women to state they are lonely even when controlling for UCLA score. Older men showed a greater association between loneliness and alcohol consumption, but only when measuring the number of units consumed in the last week, and not using a less precise measure of the past year. Older men who cohabited with a partner were less lonely than cohabiting older women, whereas previously married but not cohabiting older men were lonelier than their female counterparts. However, never married older men were less lonely than never married older women. Evidence was found to suggests older men's worse friendships mediated this association, but social isolation and number of close relationships did not. Severe isolation predicted greater loneliness in older women, but not older men.

CONCLUSIONS

Cultural ideals of masculinity and older men's poorer quality friendships may explain their reluctance to directly state loneliness, greater dependency on partners/spouses, and use of alcohol. Severely isolated older men may under-report loneliness on the UCLA scale as well as a direct question.

Does the decline in Swedish adolescent drinking persist into early adulthood?

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.

Understanding changes in the locations of drinking occasions in Great Britain: An age-period-cohort analysis of repeat cross-sectional market research data, 2001-2019

INTRODUCTION

The 21st century has seen wide-ranging changes in drinking locations in Great Britain, with on-trade alcohol sales decreasing and off-trade sales increasing. To better understand the underlying time-trends in consumer behaviour, we examine age-period-cohort (APC) effects related to changes in the share of individuals' drinking occasions taking place in: (i) on-trade versus off-trade locations; and (ii) specific on-trade or off-trade locations, that is traditional/community pubs, modern pubs/bars/café bars, nightclubs/late-night venues, restaurants/pub restaurants, social/working men's clubs, golf/other sports clubs/venues, at home (social setting) and at home (non-social setting).

METHODS

Repeat cross-sectional 1-week drinking diary data, collected 2001-2019. APC analysis via negative binomial regression models for each gender (N = 162,296 men, 138,452 women).

RESULTS

A smaller/declining proportion of occasions took place in on-trade compared to off-trade locations. Recent cohorts tended to have a larger share of on-trade occasions than previous cohorts, driven by their larger share of occasions in modern pubs/bars/café bars and nightclubs/late-night venues. Meanwhile, occasions in social/working men's clubs, golf/other sports clubs/venues and traditional/community pubs tended to be popular among older men, but have declined. Finally, the growth of off-trade drinking appears to be driven by a growth of off-trade drinking in non-social settings, in particular by older people/cohorts.

DISCUSSION AND CONCLUSION

Our findings highlight the declining prominence of certain on-trade locations, and increasing prominence of home drinking in non-social settings, within British drinking practices. While rising non-social home drinking is concerning, it is positive from a public health perspective that it does not appear to be shared by recent cohorts.

Differential impact of minimum unit pricing on alcohol consumption between Scottish men and women: controlled interrupted time series analysis

OBJECTIVE

To assess the immediate impact of the introduction of minimum unit pricing (MUP) in Scotland on alcohol consumption and whether the impact differed by sex, level of alcohol consumption, age, social grade and level of residential deprivation of respondents.

DESIGN

Primary controlled interrupted time series analysis and secondary before-and-after analysis of the impact of introducing MUP in Scotland using alcohol consumption data for England as control.

SETTING

Data from Kantar Worldpanel's Alcovision survey, a continuous retrospective online timeline follow-back diary survey of the previous week's alcohol consumption.

PARTICIPANTS

53 347 women and 53 143 men.

INTERVENTIONS

Introduction of a minimum price of 50 pence per UK unit (6.25 pence/g) for the sale of alcohol in Scotland on 1 May 2018.

MAIN OUTCOME MEASURES

Number of grams of alcohol consumed per week, in total, in off-trade (eg, at home) and in on-trade (eg, in pubs, restaurants).

RESULTS

Primary interrupted time series analyses found that the introduction of MUP was associated with a drop in reported weekly total alcohol consumption of 5.94 g (95% CI 1.29 to 10.60), a drop in off-trade consumption of 3.27 g (95% CI -0.01 to 6.56) and a drop in on-trade consumption of 2.67 g (95% CI -1.48 to 6.82). Associated reductions were larger for women than for men and were greater among heavier drinkers than for lighter drinkers, except for the 5% of heaviest drinking men for whom an associated increase in consumption was found. Secondary before-and-after analyses found that reductions in consumption were greater among older respondents and those living in less deprived areas. The introduction of MUP was not associated with a reduction in consumption among younger men and men living in more deprived areas.

CONCLUSIONS

Greater policy attention needs to be addressed to the heaviest drinking men, to younger men and to men who live in more deprived areas.

Alcohol consumption trajectories over the Australian life course

BACKGROUND AND AIMS

Alcohol consumption changes markedly over the life course, with important implications for health and social development. Assessment of these patterns often relies on cross-sectional data, which cannot fully capture how individuals' drinking changes as they age. This study used data from 18 waves of a general population panel survey to measure drinking trajectories over the life course in Australia.

DESIGN AND SETTING

Longitudinal survey data from the Household, Income and Labour Dynamics in Australia (HILDA) survey between 2001 and 2018.

PARTICIPANTS

A total of 20 593 individuals ages 15 or above in two samples assessing quantity-frequency (n = 20 569, 52.0% female) and risky single occasion drinking (RSOD), respectively, (n = 17 340, 52.5% female), interviewed as part of HILDA.

MEASUREMENTS

Usual quantity of alcohol consumed per drinking occasion; frequency of drinking occasions per week; average daily consumption, calculated by combining reported usual quantity and frequency; and average reported frequency of RSOD per week.

FINDINGS

Multilevel, mixed effects models run with fractional polynomial terms found similar male and female alcohol consumption trajectories for quantity-frequency and RSOD measures. Usual quantity of alcohol consumed per drinking occasion (5.4 drinks for men, 3.8 for women) and RSOD frequency (0.56 occasions/week for men, 0.38 for women) peaked in young adulthood, whereas frequency of drinking occasions (2.5 occasions/week for men, 1.7 for women) peaked in middle age. Middle-age drinkers had the highest average daily consumption of alcohol (1.4 drinks/day for 54-year-old men, 0.6 drinks for 57-year-old women) and engaged in RSOD slightly less than young adults.

CONCLUSIONS

Alcohol consumption in Australia appears to vary substantially over the life course, with usual quantity per drinking occasion and frequency of risky single occasion drinking peaking during early adulthood and average daily consumption and frequency of consumption peaking in middle age.

Declines in alcohol consumption in Australia: some challenges to the theory of collectivity

BACKGROUND AND AIMS

There is significant debate about whether or not changes in per-capita alcohol consumption occur collectively across the entire distribution of drinking. This study used data from a decade of declining drinking in Australia to test the collectivity of drinking trends.

DESIGN

Repeated cross-sectional surveys (2010, 2013, 2016, 2019), analysed with quantile regression techniques assessing trends in drinking for 20 quantile groups.

SETTING

Australia.

PARTICIPANTS

A general population sample (total n = 85 891; males = 39 182, females = 46 709) aged 14 years and over.

MEASUREMENTS

Past-year volume of alcohol consumed was measured using standard graduated frequency survey questions. Models were stratified by sex and age group.

FINDINGS

Throughout the whole population, alcohol consumption had declined in all percentile groups, with the largest proportional declines evident for light and moderate drinkers [e.g. drinkers in the 25th percentile declined by 32.7%; 95% confidence interval (CI) = -41.6, -22.3% per wave]. Broadly collective declines were also found for younger men and women with significant declines in every percentile group, but older groups showed some evidence of polarization. For example, women aged 45-64 years significantly increased their consumption (2.9% per wave, 95% CI = 0.3-5.5%), while consumption for those in the 25th percentile fell significantly (-16.7%, 95% CI = -27.6, -4.2%).

CONCLUSIONS

The declines in Australian drinking since 2010 have included important deviations from the collectivity predicted by Skog's influential theory of collectivity of drinking, with markedly different patterns evident among different demographic groups.

Youth drinking in decline: What are the implications for public health, public policy and public debate?

Youth drinking has declined across most high-income countries in the last 20 years. Although researchers and commentators have explored the nature and drivers of decline, they have paid less attention to its implications. This matters because of the potential impact on contemporary and future public health, as well as on alcohol policy-making. This commentary therefore considers how youth drinking trends may develop in future, what this would mean for public health, and what it might mean for alcohol policy and debate. We argue that the decline in youth drinking is well-established and unlikely to reverse, despite smaller declines and stabilising trends in recent years. Young people also appear to be carrying their lighter drinking into adulthood in at least some countries. This suggests we should expect large short- and long-term public health benefits. The latter may however be obscured in population-level data by increased harm arising from earlier, heavier drinking generations moving through the highest risk points in the life course. The likely impact of the decline in youth drinking on public and policy debate is less clear. We explore the possibilities using two model scenarios, the reinforcement and withdrawal models. In the reinforcement model, a 'virtuous' circle of falling alcohol consumption, increasing public support for alcohol control policies and apparent policy successes facilitates progressive strengthening of policy, akin to that seen in the tobacco experience. In the withdrawal model, policy-makers turn their attention to other problems, public health advocates struggle to justify proposed interventions and existing policies erode over time as industry actors reassert and strengthen their partnerships with government around alcohol policy. We argue that disconnects between the tobacco experience and the reinforcement model make the withdrawal model a more plausible scenario. We conclude by suggesting some tentative ways forward for public health actors working in this space.

"Drinkers Like Me": A Thematic Analysis of Comments Responding to an Online Article About Moderating Alcohol Consumption

Background

There has been media coverage surrounding the dangers of heavy drinking and benefits of moderation, with TV and radio presenter, Adrian Chiles, documenting his experience of moderating alcohol consumption in an online article for the Guardian. By analysing the comments in response to Chiles' article, this study aimed to explore (i) posters' (someone who has posted a comment in response to the article) attitudes or beliefs toward moderating alcohol and (ii) posters' experiences of moderating or abstaining from alcohol.

Method

A secondary qualitative analysis of online comments in response to an article about moderating alcohol consumption. Main outcome measures: Comments (n = 784) in response to a United Kingdom online news article about moderating alcohol consumption were extracted and inductive thematic analysis was used.

Results

For aim one, two themes were developed; "general attitudes toward drinking" and "general attitudes toward reducing consumption". These themes reflect negative perceptions of alcohol and issues around changing attitudes. For aim two, three themes were developed: "moderation vs. abstention", "reflection on past drinking behaviours", and "current drinking behaviours". These themes represent posters' experiences and implications changing their drinking habits.

Conclusion

Our analysis provides a novel insight into perceptions and experiences of moderating or abstaining from alcohol. Alcohol is embedded within United Kingdom culture, creating difficulties for those who choose to moderate or abstain from alcohol. Our analysis highlights the need for public health to focus on shifting the current drinking culture, through clearer drinking guidelines and a wider availability of alcohol-free alternatives.

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.

Trends in alcohol consumption among adolescents in Europe: Do changes occur in concert?

OBJECTIVE

The present paper extends the scope of testing Skog's theory on the 'collectivity of drinking culture' to adolescent alcohol use in 26 European countries. The aim was to 1) examine whether changes in adolescent alcohol use are consistent across different consumption levels, and 2) explore whether trends in heavy and light drinkers diverged or converged.

METHOD

Data came from six waves of the cross-sectional European School Survey Project on Alcohol and other Drugs (ESPAD) between 1999 and 2019. The sample consisted of n = 452,935 students aged 15-16 years. Trends in alcohol volume across consumption levels including abstainers were estimated by quantile regression models (50th, 80th, 90th and 95th percentile). Countries were classified according to trends showing (soft/hard) collectivity or (soft/hard) polarisation. Trends in heavy drinkers were compared with the population trend.

RESULTS

Trends in alcohol consumption at different levels across 26 European countries in the period 1999-2019 were not homogeneous. Collective changes were found in 15 (14 soft/1 hard), and polarised trends in 11 countries (5 soft/6 hard). Collectivity was generally associated with a declining trend. In 18 countries, trends in heavy and light drinkers diverged.

CONCLUSION

Accepting some variation in the strength of changes across consumption levels, changes in many European countries occurred in the same direction. Yet, diverging trends at different consumption levels in most countries indicate a less beneficial change in heavy compared with light drinkers, implying that in addition to universal population-level strategies, intervention strategies targeting specific risk groups are needed to prevent alcohol-related harm.

Changes in Alcoholic Beverage Choice and Risky Drinking among Adolescents in Europe 1999-2019

This paper explores trends in beverage preference in adolescents, identifies related regional differences, and examines cluster differences in key drinking measures. Data were obtained from the European School Survey Project on Alcohol and Other Drugs (ESPAD), covering 24 European countries between 1999 and 2019. Trends in the distribution of alcoholic beverages on the participants’ most recent drinking occasion were analysed by sex and country using fractional multinomial logit regression. Clusters of countries based on trends and predicted beverage proportions were compared regarding the prevalence of drinkers, mean alcohol volume and prevalence of heavy drinking. Four distinct clusters each among girls and boys emerged. Among girls, there was not one type of beverage that was preferred across clusters, but the proportion of cider/alcopops strongly increased over time in most clusters. Among boys, the proportion of beer decreased, but was dominant across time in all clusters. Only northern European countries formed a geographically defined region with the highest prevalence of heavy drinking and average alcohol volume in both genders. Adolescent beverage preferences are associated with mean alcohol volume and heavy drinking at a country-level. Future approaches to drinking cultures need to take subpopulations such as adolescents into account.

Socioeconomic inequalities in alcohol consumption in Argentina: Comparative analysis from 2009, 2013, and 2018

BACKGROUND

The present study investigates the socioeconomic inequalities in alcohol use and harmful drinking in Argentina, a middle-income beer- and wine-producing country with high levels of alcohol consumption.

METHODS

Data from the last three waves (2009, 2013, and 2018) of the National Risk Factors Survey were used. Each wave comprised samples of 34,732, 32,365, and 29,224 individuals, respectively. Outcome measures included the prevalence of alcohol use and heavy episodic drinking (HED). The Erreygers concentration index was employed to measure the socioeconomic inequalities.

RESULTS

HED prevalence among drinkers increased from 17 % in 2009 to 25 % in 2018. Overall, the results showed significant pro-rich inequality for alcohol use and pro-poor inequality for HED, indicating that while a smaller proportion of the most disadvantaged population consumed alcohol, harmful drinking tended to concentrate among them. Pro-rich inequality for alcohol use was deeper in the population aged 25+, particularly among women. HED among males aged 35+ showed the highest inequality against lower income groups. During the period analyzed, the group aged 18-24 years had the highest HED prevalence as well as the greatest increase in this measure; it tended to be equally distributed across socioeconomic groups, presenting no socioeconomic inequality by 2018.

CONCLUSIONS

These results highlight the importance of the assessment and characterization of the most exposed population to alcohol and harmful drinking. Regardless of their socioeconomic status, the young population was identified as a group for targeted interventions because of its greater alcohol exposure and the potential growth in economic and social burdens.

Cross-country differences in age trends in alcohol consumption among older adults: a cross-sectional study of individuals aged 50 years and older in 22 countries

BACKGROUND AND AIMS

Age-related changes in physiological, metabolic and medication profiles make alcohol consumption likely to be more harmful among older than younger adults. This study aimed to estimate cross-national variation in the quantity and patterns of drinking throughout older age, and to investigate country-level variables explaining cross-national variation in consumption for individuals aged 50 years and older.

DESIGN

Cross-sectional observational study using previously harmonized survey data.

SETTING

Twenty-two countries surveyed in 2010 or the closest available year.

PARTICIPANTS

A total of 106 180 adults aged 50 years and over.

MEASUREMENTS

Cross-national variation in age trends were estimated for two outcomes: weekly number of standard drink units (SDUs) and patterns of alcohol consumption (never, ever, occasional, moderate and heavy drinking). Human Development Index and average prices of vodka were used as country-level variables moderating age-related declines in drinking.

FINDINGS

Alcohol consumption was negatively associated with age (risk ratio = 0.98; 95% confidence interval = 0.97, 0.99; P-value < 0.001), but there was substantial cross-country variation in the age-related differences in alcohol consumption [likelihood ratio (LR) test P-value < 0.001], even after adjusting for the composition of populations. Countries' development level and alcohol prices explained 31% of cross-country variability in SDUs (LR test P-value < 0.001) but did not explain cross-country variability in the prevalence of heavy drinkers.

CONCLUSIONS

Use and harmful use of alcohol among older adults appears to vary widely across age and countries. This variation can be partly explained both by the country-specific composition of populations and country-level contextual factors such as development level and alcohol prices.

[Age-specific trends in risky drinking in Germany: collectivity or polarisation?]

Einleitung

Nach der Collectivity-of-Drinking-Cultures-Theorie von Skog finden Veränderungen des Alkoholkonsums in allen Bevölkerungsgruppen und -schichten als parallele Verschiebungen statt. Ziele des vorliegenden Beitrags sind (1) die Darstellung zeitlicher Trends des riskanten Konsums und des episodischen Rauschtrinkens nach Altersgruppen und Geschlecht und (2) die Prüfung, ob die Trends in allen Altersgruppen parallel verlaufen („Kollektivität“) oder zwischen Altersgruppen divergieren („Polarisierung“).

Methoden

Datengrundlage sind 9 Erhebungen des Epidemiologischen Suchtsurveys (ESA) zwischen 1995 und 2018. Als Schwellenwert für riskanten Alkoholkonsum wurde ein täglicher Konsum von mehr als 12 g Reinalkohol bei Frauen beziehungsweise 24 g bei Männern herangezogen. Episodisches Rauschtrinken wurde als Konsum von 5 oder mehr Gläsern Alkohol (ca. 70 g Reinalkohol) an mindestens einem Tag in den letzten 30 Tagen definiert. Lineare Regressionen wurden für die Vorhersage des zeitlichen Effekts auf riskanten Konsum bzw. Rauschkonsum nach Altersgruppen (18–29, 30–39, 40–49 und 50–59 Jahre) und Geschlecht getrennt berechnet und auf Unterschiede geprüft.

Ergebnisse

Die Entwicklungen riskanten Alkoholkonsums nach Altersgruppen verlaufen bei Männern weitgehend parallel, bei Frauen gegenläufig. Die Trends des episodischen Rauschtrinken weisen bei beiden Geschlechtern keine parallele Entwicklung auf: Während in der jüngsten und ältesten Altersgruppe die Prävalenz im Zeitverlauf anstieg, sank sie in den übrigen Altersgruppen.

Diskussion

Vor dem Hintergrund einer generellen Abnahme spricht die Zunahme in den Trends risikoreichen Alkoholkonsums in bestimmten Gruppen für einen Ausbau verhaltenspräventiver Maßnahmen. Zur Fortsetzung der positiven Entwicklung und der Vermeidung einer Trendumkehr sollten zudem auf die Gesamtbevölkerung ausgerichtete Präventionsanstrengungen intensiviert werden, beispielsweise durch Erhöhung der Alkoholsteuer oder Reduktion der Verfügbarkeit von Alkohol.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03328-7) enthalten.

Decline in alcohol consumption in Russia: Collectivity or polarisation?

INTRODUCTION

Sales and survey data have shown a decline in alcohol consumption in Russia since 2007. This study examines whether this decline is consistent across lighter and heavier drinkers in line with the theory of the collectivity of drinking cultures.

METHODS

Data were collected through annual nationally representative surveys conducted between 2006 and 2018 of 33 109 individuals aged 18-85 years. We estimated generalised linear regression with Gamma distribution and used log alcohol volume consumed during the previous 30 days as the dependent variable for five percentile groups: heavy drinkers (95th), near heavy drinkers (90th), moderate drinkers (80th), light drinkers (60th for men and 70th for women) and non-drinkers. Dummy variables for years, percentile groups and their interactions were used as independent variables. The controls were age, education, income, body weight, marital status, household demographic structure, residence, ethnicity and regional climate.

RESULTS

Reductions in alcohol consumption were observed in all percentiles, but the scale of change was proportionally smaller among heavier drinkers than among lighter drinkers. However, consumption fell by a smaller amount among lighter drinkers than among heavier drinkers. Results of the regression analysis fit with the descriptive statistics. Interactions between the time period and the percentile groups were significant after 2010. Trends were similar for both sexes.

DISCUSSION AND CONCLUSIONS

Downward trends across percentiles were in the same direction but the magnitude of change varied. Obtained evidence fails to support a polarisation and points towards soft collectivity hypothesis in the reduction in drinking in Russia.

Is the theory of collectivity of drinking cultures valid across educational groups?

Introduction

To explore whether Skog's theory of collectivity of drinking cultures is valid across groups with different socioeconomic position (SEP).

Methods

Individual‐level information on alcohol consumption and SEP for the years 2004–2014 were retrieved from the Monitoring Project; a nationally representative monthly alcohol use survey. The analytical sample consisted of 162 369 respondents aged 25–79 years. SEP was measured by education level. Alcohol use was measured by yearly volume of consumption and frequency of heavy episodic drinking (HED). Respondents were divided into six SEP‐groups based on their education level and sex. Mean yearly volume consumption and prevalence of monthly HED was calculated for each group and graphically plotted against the overall mean volume of consumption.

Results

The yearly changes in overall mean consumption during the study period reflected a collective shift in drinking across groups with basic, intermediate and high education. There were also indications that changes in overall mean consumption reflected collective shifts in the prevalence of HED across the SEP‐groups. Moreover, while the magnitude of the associations for both average volume and HED differed somewhat in strength across the SEP‐groups, they were clearly in the same, positive, direction.

Discussion and Conclusions

Our findings add support for including a socioeconomic dimension to Skog's theory of collectivity of drinking cultures. Future studies should replicate our analyses on cases and periods with more tangible changes in the price and availability of alcohol.

The decline in youth drinking in England-is everyone drinking less? A quantile regression analysis

BACKGROUND AND AIMS

Youth alcohol consumption has declined significantly during the past 15 years in many high-income countries, which may have significant public health benefits. However, if the reductions in drinking occur mainly among lighter drinkers who are at lower risk, then rates of alcohol-related harm among young people today and adults in future may not fall in line with consumption. There is conflicting evidence from Swedish school studies, with some suggesting that all young people are drinking less, while others suggest that alcohol consumption among heavier drinkers may be stable or rising while average consumption declines. This paper extends the geographical focus of previous research and examines whether the decline in youth drinking is consistent across the consumption distribution in England.

DESIGN

Quantile regression of 15 waves of repeat cross-sectional survey data.

SETTING

England, 2001-16.

PARTICIPANTS

A total of 31 882 schoolchildren (50.7% male) aged 11-15 who responded to the Smoking Drinking and Drug Use among Young People surveys.

MEASUREMENTS

Past-week alcohol consumption in UK units at each fifth percentile of the consumption distribution.

FINDINGS

Reductions in alcohol consumption occurred at all percentiles of the consumption distribution analysed between 2001 and 2016, but the magnitude of the decline differed across percentiles. The decline in consumption at the 90th percentile [β = -0.21, confidence interval (CI) = -0.24, -0.18] was significantly larger than among either lighter drinkers at the 50th percentile (β = -0.02, CI = -0.02, -0.01) or heavier drinkers at the 95th percentile (β = -0.16, CI = -0.18, -0.13).

CONCLUSIONS

Alcohol consumption among young people in England appears to be declining across the consumption distribution, and peaks among heavy drinkers. The magnitude of this decline differs significantly between percentiles of the consumption distribution, with consumption falling proportionally less among the lightest, moderate and very heaviest youth drinkers.