-
[show abstract]
[hide abstract]
ABSTRACT: INTRODUCTION AND AIMS.: In the past 40 years, per capita consumption has increased dramatically in Finland. We study the core changes in drinking culture over this period by age and sex. DESIGN AND METHODS.: We used data from the Finnish Drinking Habit Surveys carried out every 8 years in 1968-2008 (n = 16385, response rates 74-97%). Central measures included share of abstainers, frequency of drinking, amounts drunk per occasion and contexts of drinking (location, company, timing). RESULTS.: Weekly drinking and the frequency of moderate drinking increased among both women and men but proportionately more among women and among respondents aged over 30 years. Amounts drunk per occasion and intoxication increased proportionately more among women and younger respondents. Drinking in home surroundings increased more than drinking in licensed premises, and home drinking increasingly occurred in the company of partners only. Drinking was in all periods heavily concentrated on the weekends and evenings. DISCUSSION AND CONCLUSIONS.: Finland has become a wet and permissive drinking culture, and there has been a fundamental cultural shift in women's drinking in particular. Increases in women's drinking have meant that men's drinking has also increasingly been brought to homes, as a part of spouses' shared activities, and pubs have lost their property as masculine strongholds. Intoxication has maintained its important position in the drinking culture, and drinking still takes place primarily in the evenings and weekends. If drinking cultures in present-day low and middle income countries develop similarly, strong increases in alcohol-related harm will follow.
Drug and Alcohol Review 06/2012; · 1.55 Impact Factor
-
Addiction Research and Theory 01/2012; · 1.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the performance of subjectively defined intoxications, hangovers and alcohol-induced pass-outs in identifying drinkers at risk for adverse health outcomes.
Prospective population-based cohort study.
Working-aged Finnish general population.
A total of 21,204 alcohol-drinking men and women aged 20-24, 30-34, 40-44 and 50-54 years at baseline who participated in the Health and Social Support (HeSSup) postal survey in 1998.
Binge drinking was measured by subjectively defined intoxications/drunkenness, hangovers and alcohol-induced pass-outs. Hazardous drinking was defined according to Finnish guidelines as weekly total intake of >287 g of ethanol for men, and for women > 191 g of ethanol (≥24 and ≥16 standard drinks, respectively). Study participants were followed-up for 7 years for alcohol-specific hospitalizations and deaths. Proportional hazard models and areas under the receiver operating characteristics curves (AUC) were used to analyse the data.
Of the drinkers, 6.5% exceeded the weekly limit for hazardous drinking, and 1.5% experienced the alcohol-specific end-point during the follow-up. Subjective intoxications, hangovers and alcohol-induced pass-outs all predicted future alcohol-specific diagnoses independently of average intake and of several other potential confounders. In identifying baseline hazardous drinking, subjective intoxications had a superior performance in relation to other subjective measures of binge drinking. In identifying future alcohol-specific hospitalizations or death, subjective intoxications had also the best performance, but this was not significantly different from the other binge drinking measures, or average intake.
Subjectively defined intoxications, hangovers and alcohol-induced pass-outs are population-level proxy measures of at-risk drinking patterns.
Addiction 07/2011; 107(2):323-30. · 4.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of the study was to examine the association between social background and drunken driving.
A Finnish register on suspected drunken driving was combined with data on social background. There were 81,125 drivers arrested for drunken driving and 86,279 references from 1993 to 2007.
A low level of education, unemployment, living alone and divorce were strongly associated with drunken driving. In addition, for persons aged 15-24 years, low parental education and income, high own income and possession of a car correlated with higher odds of drunken driving. For working-aged men and women, low income was associated with a higher risk of drunken driving. For working-aged women, also possession of a car was a risk factor.
Social factors are associated with drunken driving. In general, people with a lower social position are more prone to drive after drinking. Social differences are visible already in youth, whereas working and own income of young persons signal different risk mechanisms for youth than for working-aged people. Measures for preventing drunken driving are needed within public health policies.
Alcohol and Alcoholism 06/2011; 46(6):721-8. · 2.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this prospective study was to determine how subjective measures of binge drinking predict suboptimal subjective health. In order to contribute to the understanding of potential causal mechanisms, we also aimed to determine the factors through which subjective health predicts alcohol-specific hospitalizations.
A total of 16,111 alcohol-drinking men and women, aged 20-54 years, participated in the Health and Social Support baseline postal survey in 1998, and also responded to the repeated measurement 5 years later in 2003 (T2). Suboptimal subjective health was defined as self-reported overall health status being fair, rather poor or poor. Subjective measures of binge drinking were frequency of subjective intoxications/drunkenness, frequency of hangovers and frequency of alcohol-induced pass-outs.
Frequency of intoxications, hangovers and alcohol-induced pass-outs, all predicted suboptimal subjective health regardless of several potential confounders, including beverage-specific total intake. Those reporting suboptimal subjective health at baseline had a 5-fold odds ratio (5.08, 95% confidence interval: 3.43, 6.48) for alcohol-related hospitalizations, compared with those rating their health above fair, when gender and age were controlled. Binge drinking, together with concurrent symptoms of depression, explained over 50% of this relationship, and when additionally taking into account smoking, over two-thirds of this relation was explained.
Mental health is an important mediating factor between binge drinking, suboptimal subjective health and alcohol-specific hospitalizations, and symptoms of depression should therefore be taken into account in prevention of alcohol-related adverse health outcomes.
Alcohol and Alcoholism 06/2011; 46(5):607-13. · 2.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The time of drinking in terms of daytime versus evening and weekday versus weekend is charted for regular drinkers in 14 countries in Europe, Asia, Latin America, Africa and Oceania.
National or regional adult population surveys from the GENACIS project.
The weekly rhythm of drinking varies greatly between societies. Drinking was generally more likely after 5 p.m. and on weekends. To this extent, alcohol consumption is now regulated by a universal clock. The relation of time of day and of the week of drinking to problems from drinking varied between societies. Drinking at specific times was more likely to predict problems among men than women, though for men the particular time varied, while weekday evenings were the most problematic time for women. The relation of drinking at a particular time to problems in part reflected that heavy drinkers were more likely to be drinking at that time.
There are commonalities across cultures in drinking by time of day and day of the week, but the implications of the timing for alcohol-related problems are fairly culture-specific.
International Journal of Public Health 05/2011; 57(1):107-17. · 2.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To study the risk factors for hospitalizations and deaths due to alcohol-specific diagnoses.
Representative samples of men (n = 4431) aged 15-69 at the baseline interviews in September 1969, 1976 and 1984 were pooled. Follow-up was 16.3 years or to the first end-point. The main outcome measure was hospitalization (main cause) or death (underlying or contributory cause) due to an alcohol-specific diagnosis.
There were altogether 216 men with either hospitalization or death with an alcohol-specific diagnosis. This outcome was positively associated with smoking, overall alcohol intake, being an ex-drinker and being divorced or widowed. Similar associations and relative risk estimates were found when cases of alcohol dependence were excluded and when focusing on alcohol psychosis or on alcohol-specific diseases of the stomach, liver and pancreas.
Cigarette smoking, overall alcohol intake, being an ex-drinker and marital status associate with alcohol-specific hospitalizations and deaths and can predict these outcomes.
Alcohol and Alcoholism 03/2011; 46(3):342-8. · 2.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To examine the associations between socio-economic characteristics and driving under the influence of drugs (DUID), and to elaborate determinants of drugged driving.
A register-based case-control study.
Finland.
Cases (n = 5859) apprehended by the police and suspected of DUID during 1993-2006 and controls (n = 74 809) drawn from the general Finnish population.
The effects of parents' and own education, urbanization of municipality, socio-economic position (SEP), main activity, income, marital status and living arrangements on DUID were estimated using logistic regression analysis. The analyses were conducted separately for men and women, age groups of under 45 years and aged 45 or over, and for substance groups of benzodiazepines only, benzodiazepines with alcohol, amphetamines and cannabinoids.
Low education, unemployment, disability pension, being divorced and living alone were the strongest individual predictors of DUID in all substance groups. Illicit drug users were more disadvantaged compared to those in the benzodiazepines groups. Contrary to other substance and age groups, higher educational level and higher SEP were associated with DUID among benzodiazepine users aged 45 or over.
A disadvantaged social background is a significant predictor of driving while under the influence of drugs for all substance use groups in Finland. The gradient is greater for amphetamines and cannabinoids than benzodiazepines.
Addiction 03/2011; 106(8):1448-59. · 4.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The present study aimed to evaluate the frequency and the target group of alcohol screening and brief interventions in health-care settings and how well this level of activity reflects public opinion.
A general population survey.
A random sample of Finns aged 15-69 years with a 74% response rate (n = 2725).
Frequency counts were used to evaluate the level of activity. Logistic regression models were used to examine which groups were asked and advised about alcohol use and which groups considered it useful.
More than 90% had positive attitudes towards being asked about their alcohol use. Of those who had been in contact with health care (n = 2062) in the 12 months before the survey, 33.3% had been asked about their alcohol use, being most often men, young, heavy drinkers and those of high socio-economic status. Thirty-seven per cent of those who had been asked were given advice, being most often heavy drinkers and those with a normal body mass index. However, 50% of heavy drinkers who had been asked about their alcohol use had not been advised about it. Of those who had been advised, 71.9% considered it useful, especially older subjects, and also including heavy episodic drinkers, although less than others.
In Finland, the frequency of health-care professionals asking and giving advice on alcohol is relatively low. However, public opinion towards these discussions is positive. Our results encourage the support and uptake of systematic screenings and brief interventions in health-care settings.
Addiction 12/2010; 106(7):1239-48. · 4.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Finland experienced a large reduction in alcohol prices in 2004 due to in the lowering of alcohol taxes by about one-third and the abolition of duty-free allowances for travellers from the European Union. We examined the effects of these changes on alcohol-related hospitalizations.
Time-series intervention analyses of monthly aggregations of hospitalization for acute and chronic causes among men and women aged 15-39, 40-49, 50-69 and more than 69 years.
Finland, 1996-2006.
After the price reduction the chronic hospitalization rate for men increased among those below age 70 years. It was largest among those aged 50-69 years: 22%, which implies an increase of 18.0 monthly hospitalizations per 100,000 person-years, and there was an 11% and 16% (11.5 and 4.8 monthly hospitalizations) increase among those aged 40-49 and 15-39, respectively. Among the women the rate increased by 23% (4.0 monthly hospitalizations) in the 50-69-year-olds, and decreased in the under-40s. The increase in all the population groups was due mainly to an increase in mental and behavioural disorders due to alcohol. Acute hospitalizations increased by 17% and 20% (6.2 and 7.0 per month) among men aged 40-49 and 50-69 years, respectively, and by 38% among women aged 50-69 years (2.3 per month).
The results, obtained in a natural experimental setting when trends and seasonal variation had been taken into account, suggest that the reduction in alcohol prices led to increases in alcohol-related hospitalization in certain population groups, mainly among 50-69-year-olds, in Finland.
Addiction 11/2010; 106(4):759-67. · 4.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Exclusion of, for example, the homeless and institutionalized from survey sampling frames has been suggested to be one important reason for low coverage rate of surveys. We assess this, using mortality data from Finland, where in 2004 alcohol taxes were lowered by one-third, and surveys were unable to capture the 10% increase in per capita consumption.
We compared the level of and the change in alcohol-related mortality in 2001-03 and 2004-05 in (1) the whole population, (2) the population included in the sampling frame of many Finnish surveys and (3) the population excluded from the sampling frame.
Finns aged 15 years and above, linked individually to cause of death data.
The population outside survey sampling frames constituted 1.4% of the whole population and had a high rate of alcohol-related deaths. For example, among men the rate of directly alcohol-attributable causes was 3.7 times higher than in the survey population. Among women the rate ratio was 4.6. The exclusion of the non-survey population reduced the estimated level of alcohol-related mortality by 1-4%. Similarly, the non-survey population had only a marginal effect on the estimates of temporal change.
Alcohol-related mortality, and hence probably also alcohol consumption, is on average much higher in the subgroups of populations excluded from survey sampling frames. Due to the small size of the excluded group in the Finnish context, this has only a small effect on population-level estimates.
Addiction 11/2010; 105(11):1935-41. · 4.31 Impact Factor
-
Addiction 07/2010; 105(7):1203-4. · 4.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to examine the overall and cause-specific mortality of DUI arrestees compared to a reference population with no history of DUI and to recognize the risk factors of premature death.
The data used were a register of all DUI arrestees between April 1988 and December 2006. All drivers with drug-positive samples were excluded. DUI arrestees were compared to a reference population with no previous history of DUI. Overall and cause-specific hazard ratios were calculated and risk factors were estimated.
Alcohol causes, diseases of the circulatory system and accidents constituted the most common causes of death among DUI arrestees. Suspected DUI was linked with higher mortality in every observed cause of death. The risk of death by alcohol-related or external cause was especially high. Among women DUI arrests caused sharper increase to the risk of death than increase found among male arrestees. Within the group of DUI arrestees the risk of death was affected by age, sex, marital status, education, multiple arrests as well as time and observed blood alcohol level of the arrest. Half of the suspected DUI cases and one in five of the references had alcohol as a contributing factor to death.
Arrest on suspicion of drunk-driving is an indicator for elevated risk of death. Alcohol is often related to deaths of DUI arrestees. Drunk-drivers should be efficiently guided with respect to evaluations and treatments for harmful drinking.
Drug and alcohol dependence 03/2010; 110(1-2):80-4. · 3.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: European Union travelers' allowances for alcohol import to Denmark, Sweden, and Finland were abolished in 2004. In addition, excise taxes on alcohol were lowered in 2003 and 2005 in Denmark, and in 2004 in Finland. Using northern Sweden as a control site, this study examines whether levels of reported alcohol problems have changed in Denmark, Finland, and southern Sweden as a consequence of these policy changes.
Annual cross-sectional surveys were conducted in Denmark, Finland, and Sweden from 2003 to 2006. Five dependency items and seven extrinsic alcohol-related problems were examined. Changes were analyzed within each country/region with logistic regressions and tested for short- and long-term changes. Differential change was also tested between each country and the control site, northern Sweden.
Prevalence of alcohol problems decreased over the study period. Only in selected subgroups did problems increase. This mainly occurred in the samples for northern Sweden and Finland, and mostly among older age groups and men. In relation to the control site, however, no increases in problem prevalence were found.
Our findings on a decline in reported alcohol problems largely agree with published reports on alcohol consumption over the same period in the study countries. They do not agree, however, with findings on changes in health and social statistics in Finland and Denmark, where some significant increases in alcohol-related harm have been found.
Journal of studies on alcohol and drugs 01/2010; 71(1):32-40. · 2.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We examined the effect of a large reduction in the price of alcohol that occurred in Finland in 2004 on alcohol-related and all-cause mortality, and mortality due to cardiovascular diseases (CVDs) from which alcohol-attributable cases were excluded.
Time series intervention analysis modelling was applied to the monthly aggregations of deaths in Finland for the period 1996-2006 to assess the impact of the reduction in alcohol prices. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. Analyses were carried out for men and women aged 15-39, 40-49, 50-69 and >69 years.
Alcohol-related deaths increased in men aged 40-49 years, and in men and women aged 50-69 years, after the price reduction when trends and seasonal variation were taken into account: the mean rate of alcohol-related mortality increased by 17% [95% confidence interval (CI) 1.5, 33.7], 14% (95% CI 1.1, 28.0) and 40% (95% CI) 7.1, 81.7), respectively, which implies 2.5, 2.9 and 1.6 additional monthly deaths per 100,000 person-years following the price reduction. In contrast to alcohol-related mortality, CVD and all-cause mortality decreased: among men and women aged >69 years a decrease of 7 and 10%, respectively, in CVD mortality implied 19 and 25 fewer monthly deaths per 100,000 person-years, and a decrease of 7 and 14%, respectively, in all-cause mortality similarly implied 42 and 69 fewer monthly deaths.
These results obtained from the time series analyses suggest that the reduction in alcohol prices led to an increase in alcohol-related mortality, except in persons <40 years of age. However, it appears that beneficial effects in older age, when CVD deaths are prevalent, counter-balance these adverse effects, at least to some extent.
International Journal of Epidemiology 12/2009; 40(2):441-54. · 6.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Studying drugged drivers gives complementary information about mortality of drug users, which mainly has been studied among opioid abusers. The aim of this study was to analyse mortality rates and causes of death among drivers under the influence of drugs (DUID) in Finland and compare them with the general Finnish population during 1993-2006.
Register data from 5832 DUID suspects apprehended by the police were studied, with a reference group (n=74 809) drawn from the general Finnish population. Deaths were traced from the National Death Register. Survival and differences in mortality hazards were estimated using Kaplan-Meier plots and Cox regression models.
The hazard of death was higher among male (HR 9.6, CI 8.7 to 10.6) and female (HR 9.1, CI 6.4 to 12.8) DUID suspects compared to the reference population. Among male DUID suspects, cause-specific hazards were highest for poisoning/overdose, violence and suicide. 24% of DUID suspects and 8% of reference subjects were under the influence of drugs/alcohol at the time of death. Poly-drug findings indicated excess in mortality among drugged drivers. Hazard of death was higher among male DUID suspects who had findings for benzodiazepines only (HR 10.0, CI 8.4 to 11.9) or benzodiazepines with alcohol (HR 9.6, CI 8.2 to 11.2), than with findings for amphetamines (HR 4.6, CI 2.7 to 7.6).
DUID suspects had an increased risk of death in all observed causes of death. Findings for benzodiazepines indicated excessive mortality over findings for amphetamines. Preventive actions should be aimed especially at DUID subgroups using benzodiazepines.
Journal of epidemiology and community health 11/2009; 64(6):506-12. · 3.04 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Despite the long tradition for asking about the negative social and health consequences of alcohol consumption in surveys, little is known about the dimensionality of these consequences. Analysing cross-sectional and longitudinal data from the Nordic Taxation Study collected for Sweden, Finland, and Denmark in two waves in 2003 and 2004 by means of an explorative principal component analysis for categorical data (CATPCA), it is tested whether consequences have a single underlying dimension across cultures. It further tests the reliability, replicability, concurrent and predictive validity of the consequence scales. A one-dimensional solution was commonly preferable. Whereas the two-dimensional solution was unable to distinguish clearly between different concepts of consequences, the one-dimensional solution resulted in interpretable, generally very stable scales within countries across different samples and time.
07/2009; 17(1):2-16.
-
[show abstract]
[hide abstract]
ABSTRACT: Aims: Removal of import quotas for alcoholic beverages from other EU countries and cuts on alcohol taxes by one third on average resulted in approximately a 10% increase in per capita alcohol consumption in 2004, and a further 3% in 2005. Our aim was to study which population groups accounted for this increase, and what happened to self-reported alcohol-related harm. Methods: A panel survey with a general population random sample was carried out. The current data are the first and third waves of the panel. A questionnaire was sent in autumn 2003 to 4000 Finns aged 15 to 69. In 2005, the questinnaire was mailed to 1209 persons who responded both in 2003 and in 2004 and who agreed to participate in the follow-up. Findings: The respondents themselves reported no increase in either their own consumption or in alcohol-related harm from 2003 to 2005, and there were few changes by subgroup of the population either. Conclusions: The survey data did not capture the increase in consumption that has been observed in per capita consumption. The permanent consequences of the changes in the alcohol situation in 2004 remain to be seen in future statistics and studies.
07/2009; 14(6):513-527.
-
[show abstract]
[hide abstract]
ABSTRACT: Only few prospective population studies have been able so far to investigate depression and drinking patterns in detail. Therefore, little is known about what aspect of alcohol consumption best predicts symptoms of depression in the general population.
In this prospective population-based two-wave cohort study, a cohort of alcohol-drinking men and women (n = 15 926) were followed-up after 5 years. A postal questionnaire was sent in 1998 (response proportion 40%) and again in 2003 (response proportion 80% of the baseline participants) to Finnish adults aged 20-54 years at baseline.
Alcohol consumption was measured by average intake (g/week) and by measures of binge drinking (intoxications, hangovers and alcohol-induced pass-outs). Depressive symptoms were assessed with the 21-item Beck Depression Inventory. In addition, information from hospital discharge register for depression and alcohol abuse were linked to the data.
This study found a positive association between baseline binge drinking and depressive symptoms 5 years later. Adjustment for several possible confounders attenuated the observed relationships only slightly, suggesting that binge drinking contributes independently to the occurrence of depressive symptoms. Binge drinking was related to symptoms of depression independently of average intake.
This study supports the hypothesis that heavy drinking, and in particular a binge pattern involving intoxications, hangovers or pass-outs, produces depressive symptoms in the general population. The frequency of hangovers was the best predictor for depressive symptoms.
Addiction 06/2009; 104(7):1168-78. · 4.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To review the consequences of the changes in Finnish alcohol policy in 2004, when quotas for travellers' tax-free imports of alcoholic beverages from other European Union (EU) countries were abolished, Estonia joined the EU and excise duties on alcoholic beverages were reduced in Finland by one-third, on average.
A review of published research and routinely available data.
Finland.
Prices of alcoholic beverages, recorded and unrecorded alcohol consumption, data on criminality and other police statistics, alcohol-related deaths and hospitalizations, service use.
Alcohol consumption increased 10% in 2004, clearly more than in the early 2000s. With few exceptions, alcohol-related harms increased. Alcohol-induced liver disease deaths increased the most, by 46% in 2004-06 compared to 2001-03, which indicates a strong effect on pre-2004 heavy drinkers. Consumption and harms increased most among middle-aged and older segments of the population, and harms in the worst-off parts of the population in particular.
Alcohol taxation and alcohol prices affect consumption and related harms, and heavy drinkers are responsive to price. In Finland in 2004, the worst-off parts of the population paid the highest price in terms of health for cuts in alcohol prices. The removal of travellers' import quotas, which was an inherent part of creating the single European market, had serious public health consequences in Finland.
Addiction 05/2009; 104(4):554-63. · 4.31 Impact Factor
