'Are The Times A-Changin'? Trends in adolescent substance use in Europe.

AIMS: To estimate temporal trends in adolescents' current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence. DESIGN AND SETTING: Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]. PARTICIPANTS: A total of 223 814 male and 211 712 female 15-16-year-old students. MEASUREMENTS: Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi-level mixed-effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion. FINDINGS: Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time. CONCLUSIONS: Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence.

Alcohol use, heavy episodic drinking and subsequent problems among adolescents in 23 European countries: does the prevention paradox apply?

AIMS: According to the prevention paradox, a majority of alcohol-related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems among adolescents in 23 European countries. DESIGN AND SETTING: Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16-year-old students were analysed. PARTICIPANTS: A total of 38,370 alcohol-consuming adolescents (19,936 boys and 18,434 girls) from 23 European countries were included. MEASUREMENTS: The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol-related problems. FINDINGS: Although the mean levels of consumption and alcohol-related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol-related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems. CONCLUSIONS: The prevention paradox, based on measures of annual consumption and heavy episodic drinking, seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large proportion of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives combined with targeted interventions.

Long-term trends in drinking habits among Swedish teenagers: National School Surveys 1971-1999.

The purpose of the study is to describe the long-term trends in drinking habits among Swedish students aged 15-16 years. Data were collected from 1971 to 1999, using self-administered questionnaires from nationally representative random cluster samples of school classes, totalling on average 6000 students per year. The highest proportion of alcohol consumers among both boys and girls, about 90%, was seen in the 1970s; this percentage decreased to about 80% in the 1980s and remained at that level through the 1990s. The estimated average annual consumption of pure alcohol was 4 litres for boys in 1977. It fell to 2.1 litres in 1988 and rose to 3.9 litres in 1999. The tendency was similar for girls, with 3.5 litres consumed in 1977, about 1.5 litres in the 1980s and 2.3 litres in 1999. Also frequent binge drinking and intoxication were reported by the largest proportions in the 1970s; the figures decreased in the 1980s and rose again among both boys and girls in the first part of the 1990s. Hence, although fewer of the students in this age group are alcohol consumers at the end of the 1990s compared with the 1970s, those who drink are approaching the high consumption levels of the 1970s. The beverages of choice are beer and spirits.