Pia Mäkelä

Introduction: This study explores changes in Finnish adults' attitudes towards alcohol use and getting drunk in the presence of small children and the changes in these attitudes in a period of declining alcohol consumption in Finland. It also examines whether these attitudes differ by respondents' parental status and by their own risky drinking. Methods: Data were drawn from nationally representative cross‐sectional surveys conducted in 2008 ( N = 2500), 2016 ( N = 1857) and 2023 ( N = 2133) in mainland Finland. Poisson regression assessed the effects of time, parenthood and AUDIT scores on two attitude statements. Interactions with survey year were tested to explore changes over time. Results: The proportion of respondents who agreed that drinking in the presence of small children is unacceptable increased from 73% in 2008 to 78% in 2023. Acceptance of getting drunk around children declined from 37% to 27% (RR = 0.89, 95% CI 0.86–0.92). Parents were more likely to accept any alcohol use (RR = 1.09, 95% CI 1.06–1.13) and less likely to accept getting drunk (RR = 0.96, 95% CI 0.93–0.99). Higher AUDIT scores were linked to more permissive attitudes towards both drinking and getting drunk in the presence of children; these associations remained stable over time. Discussion and Conclusions: Parents were more permissive towards any alcohol use but less accepting of getting drunk in the presence of small children, whereas respondents with riskier drinking consistently expressed more permissive attitudes. Finnish adults' growing disapproval of drunkenness around small children over 2008–2023 likely reflects broader shifts in social norms that have accompanied declining alcohol use.

Background and aims: Originally developed for clinical screening for hazardous alcohol use, the Alcohol Use Disorder Identification Test – Consumption (AUDIT‐C) is also widely used in epidemiological research and monitoring. However, its cutoff values may not suit all purposes, and evidence on its predictive validity is limited. We examined how AUDIT‐C scores relate to subsequent register‐based alcohol‐attributable events across age and sex and identified optimal thresholds for predicting these outcomes. Design: Five general population surveys conducted in 2011–2017, linked to nationwide registers with follow‐up until the end of 2023 (total follow‐up 879 964 person‐years). Setting: Nationwide, Finland. Participants: Adults aged ≥20 years ( n = 103 567). Measurements: AUDIT‐C to assess exposure. Outcome: incident alcohol‐attributable events in any of the registers capturing care, deaths and prescription medicines ( n = 1444). Findings: The hazard of register‐based alcohol‐attributable events increased approximately exponentially with increasing AUDIT‐C score. It rose more strongly among women than men [hazard ratio (HR) = 1.61, 95% confidence interval (CI) = 1.55–1.67 for women; HR = 1.45, 95% CI = 1.40–1.49 for men; P < 0.001 for the sex × AUDIT‐C interaction]. The risk of alcohol‐attributable events was statistically significantly raised at 2 points among women and 3 points among men with 1 point as a reference level. The suggested optimal cutoff values were 2 points for women aged ≥80, 3 points for women aged 65–79 and men aged ≥80, 5 points for women aged 20–64 and men aged 65–79 and 6 points for men aged 20–64. Conclusions: Using Alcohol Use Disorder Identification Test – Consumption (AUDIT‐C) scores, optimal cutoff values for predicting alcohol‐attributable harm may differ by age and sex, with lower cutoffs for older individuals and women. The ≥65 age group appears to be heterogeneous with regard to vulnerability to alcohol‐attributable harm, which should be considered when establishing cutoffs or guidelines for alcohol use.

Alcohol consumption is a major public health challenge, linked to substantial morbidity and mortality worldwide. Despite known genetic influences on alcohol use, relatively little is known about the genetic determinants of specific alcohol-related disease endpoints. In this study, we leveraged the extensive FinnGen study, comprising over 500,000 individuals with up to 56 years of follow-up, to investigate the genetic architecture of 19 alcohol-attributable disease endpoints and 41 disease endpoints in which alcohol is a known risk factor. We identified 93 fine-mapped genetic loci associated with 13 alcohol-attributable disease endpoints, including 37 loci not previously linked to alcohol use or alcohol-attributable disease endpoints. Genetic correlations were strong between mental and behavioural disorders due to alcohol, while alcohol-attributable organ injuries exhibited more distinct genetic profiles. Using a polygenic risk score (PRS) for alcohol use, we demonstrated significant risk stratification for several alcohol-related diseases. For example, individuals in the highest PRS decile showed markedly elevated risks not only for numerous alcohol-attributable diseases (HR = 1.50; 95% CI: [1.46–1.55], compared to the 10th–90th PRS percentiles), but also for opioid use (HR = 1.59; 95% CI: [1.38–1.83]), and to a lesser extent, for several other endpoints. These findings elucidate the complex genetic landscape of alcohol-related diseases, highlighting the potential utility of genetic risk profiling in clinical settings to identify individuals at heightened risk for alcohol-related health complications.

Introduction: Reducing alcohol affordability reduces alcohol‐related harm but its impact on socio‐economic inequalities requires further study. We examine changes in alcohol‐attributable mortality inequalities in Finland during periods of sharply rising (2000–2007) and falling (2008–2017) alcohol affordability.Methods: Linking individual‐level register data on causes of death and socio‐demographics for the Finnish population aged ≥25 in 2000–2017 (68 million person‐years), we analysed age‐standardised monthly alcohol‐attributable mortality rates by sex and income quintile (n = 32,699 alcohol‐attributable deaths). Regression models were used to analyse mortality trends in the two periods, contrasting high‐ and low‐income groups.Results: Inequalities in alcohol‐attributable mortality between low‐ and high‐income groups were large throughout the study period. During the period of rising alcohol affordability, mortality increased among high‐income men with an average monthly increase of 0.17% (p = 0.046). This rate was even higher among low‐income men, increasing by 0.55% per month, that is, +0.38 percentage points more than the rate for high‐income men (p = 0.002). Among women, mortality increased at similar rates in both income groups. During the period of falling alcohol affordability, mortality decreased among high‐income men with an average monthly decrease of −0.21% (p < 0.001), and it decreased even more among low‐income men (−0.40%, i.e., −0.19 percentage points more, p = 0.030). Among women, the decreases were not statistically significant.Discussion and Conclusions: The results indicate that increased alcohol affordability was associated with widening socio‐economic inequalities while reduced affordability was linked with narrowing inequalities among men. Reducing alcohol affordability is thus a recommendable policy for reducing socio‐economic inequality in alcohol‐related harm.

Introduction: Studies about drinking in homes are scarce despite the growing importance of the phenomenon. We examined how often different age groups in Finland drink—overall or to intoxication—in their own homes without company beyond the family and in their own or other people's homes with other company, compared to other settings, and on what days and hours of the week this occurs.Methods: A general population survey carried out in 2016 with event‐level data (n = 7124 occasions by 1955 respondents). Key measurements included location, drinking company, amount of alcohol drunk and time of the week.Results: Drinking occasions in which alcohol was drunk at home without visitors made up 74% of all occasions and 73% of all intoxication occasions among people aged 60–79 years and 25% and 5% among 15‐ to 29‐year‐olds, respectively. The share of ‘with company’ occasions in somebody's home varied less by age. Occasions with pre/post drinking in homes and drinking occasions lasting until late at night were seen most often among 15‐ to 29‐year‐olds.Discussion and Conclusions: The important aspects of home drinking vary greatly by age group and depending on what risk or type of consequence is considered. For older people and for chronic harm, the key aspect is drinking at home without company beyond the family. The more important aspect for younger people and acute harm is pre‐ and post‐drinking in homes before or after going to bars or nightclubs, which results in long evenings with large amounts of alcohol consumed.

Background and Aims: In Finland, per‐capita alcohol consumption increased in the early 2000s and decreased after 2007. Our aim was to determine how these changes originated from changes in drinking practices.Design: Repeated cross‐sectional general‐population surveys.Setting: Finland in 2000, 2008 and 2016.Participants: Finnish residents aged 15–69 years (n = 6703, response rate 59–78%).Measurements: Event‐level data on drinking occasions (n = 21 097). Types of drinking occasions (drinking practices) were identified with latent class analysis using occasion characteristics. The aggregated volume of consumption and intoxication occasions were decomposed into contributions from drinking practice classes and years.Findings: Nine drinking occasion types were identified: three at home without company other than family (51% of occasions in 2016), three socializing occasions in different places and with different company (33%) and three party occasion types (16%). Both the frequency of drinking occasion types and the occasion type‐specific amounts of alcohol consumed contributed to aggregate‐level changes in alcohol use. Drinking at home without external company (with family only; for men, also alone) contributed most to the increase in alcohol use before 2008. Big parties in homes and bars became less common in the 2000s, contributing most to the decline in drinking after 2008.Conclusions: The rise in per‐capita alcohol consumption in Finland in the early 2000s appears to have been linked mainly to an increase in lighter drinking occasions at home without external company. The fall in per‐capita drinking after 2007 was linked mainly to a decrease in big parties in homes and in licensed premises. Changes in drinking frequency and the amounts of alcohol consumed per occasion changed in the same direction as alcohol affordability.

Objective: To understand the contexts and characteristics of drinking occasions, we typologized drinking occasions and examined how different aspects of drinking vary in them and what part of popul...

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 researc...