Characteristics of binge drinkers in Europe

Compassionate Cities: Public Health and End-of-Life Care

The general principles of Bayesian data analysis imply that models for survey responses should be constructed conditional on all variables that affect the probability of inclusion and nonresponse, which are also the variables used in survey weighting and clustering. However, such models can quickly become very complicated, with potentially thousands of poststratification cells. It is then a challenge to develop general families of multilevel probability models that yield reasonable Bayesian inferences. We discuss in the context of several ongoing public health and social surveys. This work is currently open-ended, and we conclude with thoughts on how research could proceed to solve these problems.

Struggles with survey weighting and regression modeling

Governments can intervene to change health-related behaviours using various measures but are sensitive to public attitudes towards such interventions. This review describes public attitudes towards a range of policy interventions aimed at changing tobacco and alcohol use, diet, and physical activity, and the extent to which these attitudes vary with characteristics of (a) the targeted behaviour (b) the intervention and (c) the respondents. We searched electronic databases and conducted a narrative synthesis of empirical studies that reported public attitudes in Europe, North America, Australia and New Zealand towards interventions relating to tobacco, alcohol, diet and physical activity. Two hundred studies met the inclusion criteria. Over half the studies (105/200, 53%) were conducted in North America, with the most common interventions relating to tobacco control (110/200, 55%), followed by alcohol (42/200, 21%), diet-related interventions (18/200, 9%), interventions targeting both diet and physical activity (18/200, 9%), and physical activity alone (3/200, 2%). Most studies used survey-based methods (160/200, 80%), and only ten used experimental designs. Acceptability varied as a function of: (a) the targeted behaviour, with more support observed for smoking-related interventions; (b) the type of intervention, with less intrusive interventions, those already implemented, and those targeting children and young people attracting most support; and (c) the characteristics of respondents, with support being highest in those not engaging in the targeted behaviour, and with women and older respondents being more likely to endorse more restrictive measures. Public acceptability of government interventions to change behaviour is greatest for the least intrusive interventions, which are often the least effective, and for interventions targeting the behaviour of others, rather than the respondent him or herself. Experimental studies are needed to assess how the presentation of the problem and the benefits of intervention might increase acceptability for those interventions which are more effective but currently less acceptable.

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Public acceptability of government intervention to change health-related behaviours: a systematic review and narrative synthesis.

Aims The paper discusses the kinds of reasoning that have been presented as possible mechanisms and reasons for gender differences in alcohol consumption.

Design and methods  An overview of the existing literature from different countries is presented.

Findings  The existing studies provide a picture of great cultural variance in patterns of alcohol use among men and women. The gender differences in drinking behaviour have been shown to be linked with many aspects of biological differences between men and women leading to women's greater vulnerability to alcohol, of women's and men's differing needs, reasons and motivations in relation to drinking, of gender-specific roles in other areas of life and of ways in which societies regulate peoples’ behaviour, often giving women the role of warden or moderator of others’ drinking.

Conclusions  The gender differences in drinking behaviour continue to be considerable and are found in all cultures studied so far. Several studies have argued for reasons underlying these differences, but they still remain largely unexplained.

Gender differences in drinking: why do they still exist?

AIMS: To assess associations between drinking behaviour, gender and age with reported experiences related to drinking. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: Interviews were performed in 1992 with a representative sample of the Finnish population between 15 and 69 years of age (N = 3446). MEASUREMENTS: Annual intake of alcohol, frequency of drunkenness, and 14 negative and eight positive reported experiences related to drinking. FINDINGS: Logistic regression models showed that overall intake and frequency of drunkenness were independently associated with almost all reported positive and negative consequences of drinking. Women more commonly reported that drinking had helped them to sort out interpersonal problems at home or in the work-place, to feel more optimistic about life, and to express their feelings. Men more commonly reported that drinking had helped them to be funnier and wittier and to get closer to the opposite sex. Drunken driving was markedly male behaviour, but women more commonly reported other types of reckless behaviour and adverse consequences of drinking. However, men more commonly said they were criticized by family for their drinking. With the exception of health problems, both positive and negative consequences of alcohol were more common among younger drinkers. CONCLUSIONS: Once overall intake and frequency of drunkenness were controlled for, significant differences between men's and women's perceptions of the costs and benefits of alcohol consumption emerged. Men tended to perceive more hedonic benefits while women perceived more functional benefits. Women reported behaving more recklessly in drinking situations. In light of the results, women were not under selective social control. Language: en

Relationships of drinking behaviour, gender and age with reported negative and positive experiences related to drinking

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. Language: en

The Finnish drinking culture: change and continuity in the past 40 years.

Aims To assess the effects of an alcohol prevention programme to reduce the serving of alcoholic beverages to intoxicated clients on licensed premises. Research design A controlled pre‐ (2004) and post‐intervention study (2006) design. Intervention A community‐based programme combining law enforcement, responsible beverage service training, information campaigns and policy initiatives in one Finnish town (Jyvaskyla). Participants and measurements A male actor pretended to be clearly under the influence of alcohol and tried to buy a pint of beer at licensed premises. For the baseline measurement, every bar and nightclub was visited in the intervention and the control areas (94 licensed premises in total). Post‐intervention data were gathered with the same principles (100 licensed premises in total). A researcher observed every visit and documented the results. Results In the post‐intervention study there was a statistically significant increase in refusals to serve denials alcohol to the actor in the intervention area (from 23% to 42% of the licensed premises) compared to refusals in the control area (from 36% to 27% of the licensed premises). Conclusion Previous research has documented that multi‐component community‐based interventions can have a significant impact on over‐serving of alcohol when training and house policies are combined with effective law enforcement. The present findings also demonstrate that comprehensive Responsible Beverage Service (RBS) interventions applied at a local community level can be effective in decreasing service to intoxicated clients in a Nordic context.

Effects of a community intervention to reduce the serving of alcohol to intoxicated patrons

The dynamics of change in drinking patterns is discussed using the data from the drinking habits surveys conducted in Finland in 1984 and 1992. The results are compared with a respective analysis on the EU countries from 1988 by Hupkens, Knibbe & Drop (1993). The analysis is based on changes in beverage preferences. In the Finnish case, both wine and mild beer appear as new beverages, gaining popularity in the late 1980s. For beer, both the elites and the population at large were involved in that process. For wine, the interest in the new beverage was stronger among the elites. There were notable gender differences in adopting the new beverage. Some of the differences were related to the older cultural patterns of wine as a woman's drink and beer as a male beverage. The results also point to difficulties in analysing the dynamics of change on the basis of cross-sectional data, as was done in the earlier analysis on the EC countries. The Finnish data shows that even the inter-group dynamics of drinking patterns may change over a relatively short period of time.

New beverages, new drinking contexts? Signs of modernization in Finnish drinking habits from 1984 to 1992, compared with trends in the European Community

Aim: This article looks at alcohol policy opinions from the point of view of the possibilities and frames for creating local alcohol control policy. Local action against harms related to drinking is a compromise between different points of view, and the question of public support is important for community-based prevention. Data and analyses: The respondents of a postal questionnaire were asked if they supported different alcohol policy measures, and logistic regression analyses were carried out to examine the impact of the demographic characteristics, drinking measures and observations of alcohol-related harms in the community. Results: The wide majority of the population supported such measures suitable for community-based prevention as enforcement of the minimum legal age to purchase alcohol, surveillance of restaurants and shops, and the ban to sell alcohol to a drunken person. Decreasing numbers of outlets of restaurants or their opening hours were least popular. There was a relationship between drinking habits and alcohol policy opinions. Abstainers and moderate drinkers were most likely to support all alcohol policy measures examined, whilst heavier drinkers were least likely to support them. There was a connection between awareness of alcohol problems in one’s locality, and favourable opinions on alcohol control measures. The result is similar with the ones found earlier in other countries. Conclusion: Potential members of local alcohol policy coalitions seem to have some similarities in different countries.

Heli Mustonen

Papers

Relationships of drinking behaviour, gender and age with reported negative and positive experiences related to drinking

The Finnish drinking culture: change and continuity in the past 40 years.

Effects of a community intervention to reduce the serving of alcohol to intoxicated patrons

New beverages, new drinking contexts? Signs of modernization in Finnish drinking habits from 1984 to 1992, compared with trends in the European Community

Public opinion and community-based prevention of alcohol-related harms