Mats Ramstedt

Aims: Over the past 20–25 years, Sweden has placed growing focus on local alcohol prevention, as reflected in national action plans. However, municipal efforts vary considerably. Identifying the factors that influence stronger local alcohol prevention is important, given its association with reduced alcohol-related harm. The present study aims to examine the characteristics of municipalities with more comprehensive alcohol prevention efforts, focusing on: (i) need, indicated by alcohol consumption and related problems; (ii) financial resources; (iii) political orientation; and (iv) sociodemographic and socioeconomic factors. Methods: Local alcohol prevention is measured using a developed version of the Alcohol Policy Magnitude Measure (APMM), covering 209 municipalities from 2011 to 2021. Linear and logistic regressions examine how APMM scores relate to factors such as alcohol use, harm, resources, politics and demographics. Both crude and adjusted models assess the robustness of these associations. Results: Left-wing governance, larger populations and younger demographics were consistently linked to higher alcohol prevention levels. Of four need indicators, only one showed a consistent association. Financial resources were significant only in adjusted models, while education and foreign background showed mixed results. Unemployment was not associated with alcohol prevention, and income was significant only in crude models. These patterns were largely confirmed in analyses focusing on the top 10% of municipalities in terms of prevention activity. Conclusions: Stronger alcohol prevention was not linked to higher consumption, harm or resources, but rather to left-wing governance, larger populations and younger residents. This highlights the influence of political and sociodemographic factors on local prevention levels.

Aim: The study aimed to assess the extent to which financial and/or mental health problems resulting from the COVID-19 pandemic were associated with an increased risk of alcohol consumption. Methods: Data stemmed from a Swedish cross-sectional population survey ( n = 9122) collected during the second half of 2020. Questions were asked about changes in alcohol consumption during the pandemic and to what extent financial and mental health problems were experienced. Logistic regression analysis was used to estimate whether exposure to these problems was related to increasing consumption and as a complementary analysis to decreased drinking. An additive interaction analysis was conducted to assess whether there was a joint effect of these problems. Results: The proportion of respondents who reported increased alcohol consumption was higher among those who had experienced financial or mental health problems, and it rose with the severity of negative experiences. However, findings from logistic regressions (including both exposure variables and covariates) showed that only experiences of mental health problems significantly elevated the risk (odds ratio) of increased consumption. Experiences of mental health problems were also related to a higher likelihood of decreasing consumption, although the odds ratio was lower. No interaction effects were found. Conclusions: Although alcohol consumption overall declined in Sweden during the pandemic, a group experiencing pandemic-related mental health problems increased their drinking. A parallel decline in drinking in a subgroup of individuals experiencing mental health problems adds nuance to the findings and is suggested to be influenced by specific pandemic-related circumstances.

Introduction: A growing body of evidence has established alcohol consumption as a causative factor in an increasing array of cancer types, thereby positioning it as a leading global risk factor for cancer. Surprisingly, there is a scarcity of studies examining the extent to which shifts in population drinking affect cancer mortality, despite the substantial public health implications. This paper aims to: (i) estimate the impact of changes in per capita alcohol consumption on both overall cancer mortality rates and specific types of alcohol‐related cancer; and (ii) assess whether the association between cancer and population alcohol consumption is influenced by a country's drinking patterns.Methods: We used time‐series data for 19 high‐income countries spanning the period 1960–2018. Cigarette sales and GDP per capita were included as control variables. The data were analysed using first‐difference modelling. The World Health Organization drinking patterns score was used to evaluate a country's drinking pattern.Results: Our findings revealed that a 1 L per capita increase in alcohol consumption was associated with a 0.9% rise in total cancer mortality among women and a 1.1% increase among men. Notably, among men, the association was more pronounced for cancers with strong evidence of alcohol's effect and for prostate cancer. For women, the alcohol effect was statistically significant for breast cancer. Generally, the estimated alcohol effects were elevated in the country group with more harmful drinking patterns.Discussion and Conclusions: Our results indicate that lowering per capita alcohol consumption is likely to reduce cancer mortality.

Introduction: Previous research has shown associations between parental problem drinking and adverse mental health outcomes in children. However, while many studies assess parental alcohol problems based on clinical measures, longitudinal studies that investigate the impact of potentially less severe levels of parental alcohol problems are scarce. The aim of this study was to examine if the existence and severity of child‐reported parental problem drinking in adolescence is associated with symptoms of depression and anxiety in young adult men and women.Methods: Data was obtained from the Swedish national cohort study Futura01, including 3143 participants born in 2001 who were surveyed in 2017 (age 15–16) and 2022 (age 20–21). Parental problem drinking was measured at age 15–16 with the short version of The Children of Alcoholics Screening Test. Depression and anxiety symptoms were measured at age 20–21 with the Patient Health Questionnaire‐4. Registry information on gender, parental education and parental country of birth were included as covariates.Results: The results demonstrated an exposure‐response pattern, with greater severity of parental problem drinking associated with an increased probability of reporting depression and anxiety symptoms 5 years later. The association between parental problem drinking and subsequent depression symptoms was however present only in females.Discussion and Conclusions: Adolescents exposed to parental problem drinking have elevated risks of long‐term adverse mental health. These risks increase with greater severity of parental problem drinking. It is thus crucial with efforts preventing parental problem drinking and efforts promoting health among children and adolescents who are exposed.

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.

Introduction: To examine gender differences in drinking habits among Swedish ninth graders over the period 1989–2021.Methods: Annual school surveys with nationally representative samples of ninth‐grade students in Sweden covering the period 1989–2021, total sample of 180,538 students. Drinking habits were measured with self‐reports of frequency and quantity of use and frequency of heavy episodic drinking. Differences between genders were compared annually and differences were tested using logistic and ordinary least square regression models with cluster robust standard errors.Results: Small gender differences in the prevalence of alcohol use during the first part of the study period were followed by an increasing gap over the past decade with girls being more likely to drink alcohol than boys. Boys consumed larger amounts of alcohol than girls during the first three decades of the studied period but no gender differences were found in later years. Binge drinking was more prevalent among boys during 1989 to 2000 but no systematic gender difference was found during the past 15 years.Discussion and Conclusions: There used to be clear gender differences in drinking habits among ninth graders in Sweden with boys drinking more than girls. This gap has narrowed over the past three decades and among contemporary adolescents, no gender differences are found neither in binge drinking nor volume of drinking and the prevalence of drinking is even higher among girls.

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.

Background: The aim of this paper is to examine the link between severity in exposure to parental problem drinking in a Swedish national population sample of children aged 15–16 years. Specifically, we assessed whether the risk of poor health, poor relationships and a problematic school situation increase with severity in exposure to parental problem drinking.Methods: National population survey from 2017 with a representative sample of 5 576 adolescents born in 2001. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs). A short version of The Children of Alcoholics Screening Test, CAST-6, was used to identify children with problem-drinking parents. Health status, social relations and school situation were assessed by well-established measures.Results: The risk of having poor health, poor school performance and poor social relations increased with severity of parental problem drinking. The risk was lowest among children least severely affected (Crude models ranged from OR: 1.2, 95% CI 1.0–1.4 to OR: 2.2, 95% CI 1.8–2.6) and highest among children most severely affected (Crude models ranges from OR: 1.7, 95% CI 1.3–2.1 to OR: 6.6, 95% CI 5.1–8.6). The risk became lower when adjusting for gender and socioeconomic position but were still higher compared to children without problem-drinking parents.Conclusions: Appropriate screening and intervention programs are necessary for children with problem-drinking parents especially when exposure is severe but also at mild forms of exposure.

Introduction Understanding how the mean consumption per drinker and rates of non-drinking interplay to form overall per capita alcohol consumption is imperative for our understanding of population drinking. The aim of the present study is to examine the association between rates of non-drinkers and per drinker mean alcohol consumption in the Swedish adult population and for different percentiles of drinkers. Methods Data came from a monthly telephone survey of drinking habits in the Swedish adult population between 2002 and 2013. Alcohol consumption and non-drinking during the last 30 days were measured by beverage-specific quantity-frequency questions. Regression models estimated the association between the rate of non-drinkers and per drinker volume on annual data. Auto-regressive integrated moving average time-series models estimated the association on monthly data. Results A significant (P < 0.01) negative association (-0.849) was found between the rate of non-drinkers and per drinker mean volume on annual data. A unit increase in non-drinking was associated with a decline of 0.85 cl of pure alcohol among drinkers. This finding was mirrored across all percentiles of consumption. The semi-log models found that a 1% unit increase in the rate of non-drinkers was followed by a 2% reduction in per drinker mean consumption. Auto-regressive integrated moving average time-series models verified these results. Discussion and Conclusions There is a significant association between the proportion of non-drinkers and the amount of drinking among drinkers. The theory of collectivity of drinking cultures should also include the non-drinking part of the population.