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Consumption of illegal alcohol among adolescents in Stockholm County.

Since Sweden joined the European Union in 1995, a number of changes affecting the availability of alcohol have taken place. Among other things, the quota for private import of alcoholic beverages when traveling from other member countries has been raised. This has led to an increase in the amount of privately imported alcohol, especially in the southern parts of Sweden. Furthermore, the customs' opportunity to control the border has been reduced, which in all likelihood has led to an increase in the smuggling of alcohol (Trolldal, 1998). The amount of alcohol confiscated by the customs increased from about 52,500 liters in 1995 to more than 433,300 liters in 1998. There are suspicions of an increase in the organized smuggling of alcohol, and there seems to have been a reduction in the price of home-distilled spirits because of the competition with smuggled spirits (SOU 1998:154).

In the beginning of 1997, the Swedish government appointed a committee, OAS, with a commission to coordinate the work of different actors in the field, such as trade associations, insurance companies, and public authorities. One of the areas given priority by the committee is cooperation concerning the prevention of peddling and sales of illegal alcohol to adolescents (SOU 1998:154). Adolescents in general have a relatively high consumption of illegal alcohol. According to annual national surveys performed by the Swedish Council for Information on Alcohol and Other Drugs (CAN), the proportion of adolescents ages 15-16 years who have consumed home-distilled spirits during the last 12 months has increased from 34% among boys and 29% among girls in 1991 to 40% for both sexes in 1997. In 1997, 20% of the boys and 15% of the girls reported consumption of smuggled spirits (Andersson et al., 1998a). The high number of adolescent consumers of home-distilled spirits is particularly serious because binge drinking and intoxication are more prevalent among consumers of home-distilled spirits. Interviews with adolescents have revealed that consumption of home-distilled spirits to a higher degree than consumption of spirits from the Alcohol Retailing Monopoly is associated with a desire to become intoxicated (Andersson & Helling, 1997).

Most adolescents drink home-distilled spirits because they are cheaper and are easier to obtain than spirits sold at the Alcohol Retailing Monopoly (Andersson & Helling, 1997). However, different groups of adolescents may be more or less inclined to drink illegal alcohol. For example, children of wealthier parents are possibly less price sensitive than children with less wealthy parents and may therefore have a lower consumption of home-distilled sprits. Furthermore, previous studies in the adult population have also shown that consumption of home-distilled and smuggled spirits is more prevalent among male manual laborers than among non-manual laborers, even When controlling for differences in income (Leifman et al., 1999). These differences in consumption of illegal alcohol can be compared with other differences in drinking habits previously found in different social groups in the adult population. For example, alcohol consumption in restaurants and consumption of wine have been shown to be more prevalent in higher socio-economic groups (Hradilova Selin, 1998). What and where people choose to drink can be interpreted as signs of different lifestyles associated with different social groups. These differences may also be found among adolescents, since parents, by functioning as role models and by setting norms around the consumption of alcohol, can influence their children's drinking habits. In other words, children whose parents have a lower socio-economic status may be more inclined to drink illegal alcohol not only because of fewer economic resources but also because of reasons related to differences in lifestyle. Social background may also influence adolescents' consumption of illegal alcohol indirectly by influencing availability of illegal alcohol. Since adults with lower socio-economic status have a higher consumption of illegal alcohol, their children may find illegal alcohol more easily obtainable.

Besides social status, the attitude toward illegal alcohol displayed by adolescents' parents and other adults close to them is likely to be influenced by factors such as parents' ethnic origin, family structure, and what type of area one lives in. Parents' ethnic origin has previously been shown to be associated with consumption of legal alcohol (Boman & Romelsjo, 1997) and may also influence consumption of illegal alcohol, whereas living with a single parent can be an indication of fewer economic resources. Availability of illegal alcohol may also differ between areas because of differences in norms and values in the communities. Knowledge of possible associations between social background factors and consumption of illegal alcohol among adolescents can indicate if there are especially vulnerable groups that should be the target of future preventive efforts. The main purpose of this study is to examine the importance of different social background factors in relation to consumption of illegal alcohol, controlling for availability of illegal alcohol, alcohol consumption, and drinking patterns. A distinction is made between home-distilled spirits and smuggled spirits, since it is possible that the relationship between social background factors and consumption of the two types of illegal alcohol is different. Previous studies have shown that consumption of spirits from the Alcohol Retailing Monopoly has a higher status than consumption of home-distilled spirits among older adolescents and among adolescents in higher social groups (Andersson & Helling, 1997). The same may apply to smuggled spirits. Another purpose of this study is to examine the association between use of illegal spirits and alcohol consumption, drinking patterns, smoking, and use of drugs.

Material and methods

Sample and participation rate

The present study is based on an anonymous classroom questionnaire survey conducted by CAN on behalf of the Centre for Alcohol and Drug Prevention (CADP), the Centre for Tobacco Prevention (CTP), and the Child and Adolescent Public Health Unit (CBU) within Community Medicine, Stockholm County Council and Stockholm City. Data were gathered in March 1998. The sample consisted of all the students in the ninth grade (ages 15-16 years) in Stockholm County. The number of participants was 13,087 students. The non-participants included both entire school classes and individual students. Seventy-eight of 775 classes chose not to participate. The non-participation rate of individual students was 15%. Before data processing, the questionnaires were examined manually. About 100 questionnaires, where it was clear that the student had not answered the questions truthfully, were then sorted out. The number of students who were consumers of alcohol and who answered the questions about the dependent measures and other measures of alcohol consumption was 9,451 (4,625 boys and 4,826 girls). In the multivariate analyses, only students who answered all of the questions on alcohol consumption and other measures studied--3,964 boys and 4,113 girls--were included.

Statistical analyses

The association between consumption of illegal alcohol and other factors was assessed bivariately by contingency tables and comparison of means, and multivariately in logistic regression analyses. In the bivariate analyses, significance testing was performed with Chi-square, and with ANOVA when analyzing the mean consumption of alcohol. The logistic regression analyses were performed by using the procedure CATMOD in SAS (SAS/STAT User's Guide, 1990). Results are presented as relative risks with 95% confidence intervals.

Dependent measures

In this study, illegal alcohol refers to illegally produced and imported spirits--i.e., home-distilled spirits and smuggled spirits. The term home-distilled spirits refers to both "traditional moonshine" and to large-scale distilling of spirits and technical spirits. Smuggled spirits is defined as illegally imported spirits. A measure of both any consumption of illegal alcohol and consumption of illegal alcohol more than five times during the last 12 months (frequent consumption) is studied. It can sometimes be difficult to identify the alcohol one drinks as being illegal. It may also be difficult for the respondent to distinguish between the two types of illegal alcohol. For this reason, only spirits identified as either home-distilled or smuggled by the respondents can be classified as such in this study.

Social background factors

To measure the parents' social status, information about their level of education was used. Level of education was the only measure of this kind in the questionnaire. Education is usually one of several dimensions constituting the concept of social class, and the different dimensions are highly interrelated. The measure of parents' education is based upon the parent with the highest level of education in cases where the respondent lives with both parents or half of the time with each parent. If the respondent lives with only one parent or most of the time with one parent, the measure of education is based upon that parent's level of education. It was not possible to take stepparents' education into account, since the questionnaire provided no such reference. About 30% of the respondents were classified based on only one parent. Nearly 17% of the boys and almost 15% of the girls did not answer the question about their parents' education and were placed in the category "Don't know, no answer." The 87 respondents living with someone other than their parents are not included. Many parents have a university or college education: 46% among the boys and 43% among the girls. A survey conducted in 1998 in Stockholm County shows that the proportion of respondents with a university or college education among respondents ages 34-54 years--the age group likely to include most of the students' parents--is about 38% (personal communication from Mona Backhans, Karolinska Institute, Department of Public Health Sciences). The greater proportion of parents with a university or college education found in this material is probably explained by the ranking order of dominance applied.

In analyses including family structure, only adolescents living with one parent all the time are classified as "living with a single parent." This includes about 18% of the boys and 20% of the girls. Parents' ethnic origin has been divided into three categories: both parents Swedish, one or both parents born in another Nordic country, and one or both parents born in a non-Nordic country. About 17% of the boys have at least one parent who was born in a non-Nordic country, and 9% have at least one parent who was born in another Nordic country. Among the girls, the corresponding proportions are 18% and 10%.

Ethnicity also constitutes one dimension of the measure of area level socio-economic status in the different municipalities used in this study. An index has been created based upon the proportion of immigrants in 1994, the proportion of adults on welfare in 1993, and the proportion of manual laborers in 1990 in the different municipalities in Stockholm County. The 25 municipalities have been assigned index values from 1 (lowest social disadvantage) to 25 (highest social disadvantage). The information is based upon data from the Stockholm Office of Regional Planning and Urban Transportation, and the index values were provided by CBU. Based on the original ranking according to the index values, the municipalities have then been grouped into five different categories, named type of area. Category one--i.e., type one--includes the five municipalities with the lowest level of social disadvantage, category two the five municipalities with the second lowest level of social disadvantage, and so on.

Measures of alcohol consumption, availability smoking, and use of drugs

Different measures of drinking habits that have previously been found to be associated with consumption of illegal alcohol are analyzed. These measures include mean consumption, high alcohol consumption, different consumption categories, binge drinking, and intoxication. To measure the mean conuse sumption of alcohol a Quantity-Frequency scale (QF) was used. The mean consumption has been transformed into 100% alcohol and is displayed as centiliters per year. Only students classified as consumers were included in the analyses. The definition of consumers included those who once a year or less frequently consume at least a glass of beer, two centiliters of wine, two centiliters of spirits, or two centiliters of cider or wine coolers. In accordance with a definition used by CAN, boys who consume more than ten liters of 100% alcohol per year were classified as high alcohol consumers. Girls drinking more than seven liters of 100% alcohol per year were defined as high alcohol consumers. The lower limit for girls is primarily motivated by the fact that women have a lower body weight and a different distribution of fat in comparison with men. The alcohol consumption index used by CAN includes in the lowest category those drinking 2-49 centiliters, the second 50-149, the third 150-299, the fourth 300-499, the fifth 500-999 and the sixth 1,000-10,000 centiliters of 100% alcohol per year. Binge drinking and frequent intoxication were analyzed to examine the association between consumption of illegal alcohol and drinking patterns. Binge drinking is defined as drinking at least half a bottle of spirits, a bottle of wine, four cans of strong beer, or six cans of medium-strong beer three times a month or more often. The same limit is applied to both sexes. Frequent intoxication refers to becoming intoxicated every time when drinking. To measure availability of illegal alcohol, the respondents were asked how they themselves perceived the availability of illegal alcohol: if they found it very difficult, difficult, neither difficult nor easy, easy, or very easy to obtain home-distilled and smuggled spirits. The definition of smokers includes respondents who reported that they smoke every day, almost every day, on weekends, at parties, or sometimes. The measure of use of drugs includes lifetime use of any kind of drag other than alcohol. Smoking and use of drugs are not included in the multivariate analyses presented, since the causal order between these variables and consumption of illegal alcohol is not clear.

Results

Consumption of illegal alcohol, drinking habits, smoking, and use of drugs

During the last 12 months, 41% of the boys and 38% of the girls had consumed home-distilled spirits, while 28% of the boys and 22% of the girls had consumed smuggled spirits. During the last 12 months, 49% of the boys and 45% of the girls had consumed either home-distilled spirits or smuggled spirits or both. Most of the adolescents obtained the homedistilled spirits from a friend; 37% of the boys and 31% of the girls who had consumed home-distilled spirits bought them from a friend, and a friend gave 52% of the boys and 70% of the girls home-distilled spirits. The most common way in which the adolescents' friends obtained home-distilled spirits was buying them from an adult. However, producing them themselves, buying them from someone younger than 20 years, or receiving them from their parents was almost as common.

Tables 1 and 2 show a marked association between mean alcohol consumption, high alcohol consumption, binge drinking, intoxication, smoking, and use of drugs on the one hand, and consumption of home-distilled spirits on the other. This was true for both sexes. This association was also found with regard to consumption of smuggled spirits. There was also an association between consumption of home-distilled spirits and smuggled spirits.

The association between consumption of home- distilled spirits, frequency during the last 12 months, and other habits among boys in Stockholm County, 1998, centiliters and percentages
                                         Frequency home distilled

Independent                              None       Once     4-Feb
variables                               n=2,742    n=731     n=623

Mean             Centilitres 100%
consumption(*)   alcohol per year         230       491       834

High alcohol     More than 10 litres
consumption(**)  100% alcohol per year    6         14        30

Binge
drinking (1 **)  Once a week              3         7         13
                 1-3 times a month        7         14        24
                 Once a month             12        21        24
                 A few times a year       21        25        24
                 Less often, never        57        33        15

Intoxication (2) Every time when
(**)             drinking                 11        23        30
                 Almost every time        21        35        43
                 Sometimes                15        18        16
                 Seldom, never            52        25        12

Smuggled
spirits(**)      No consumption           86        69        50
                 Once last 12 months      7         16        17
                 2-4 times                5         9         22
                 5-10 times               1         3         8
                 11-20 times              0         1         2
                 More than 20 times       1         1         2

Smoking(**)      Smokes every day -
                 sometimes                24        42        54

Use of drugs(**) Have used some kind
                 of drug                  8         18        27

                                         spirits last twelve months
Independent                             5-10    11-20  more than 20
variables                               n=294   n=113     n=122

Mean             Centilitres 100%
consumption(*)   alcohol per year         1399      1584      2652

High alcohol     More than 10 litres
consumption(**)  100% alcohol per year    53        54        75

Binge
drinking (1 **)  Once a week              23        27        36
                 1-3 times a month        30        35        27
                 Once a month             28        23        27
                 A few times a year       11        10        6
                 Less often, never        8         6         4

Intoxication (2) Every time when
(**)             drinking                 37        35        51
                 Almost every time        43        44        38
                 Sometimes                13        12        8
                 Seldom, never            7         8         3

Smuggled
spirits(**)      No consumption           33        28        21
                 Once last 12 months      15        14        8
                 2-4 times                31        24        20
                 5-10 times               14        19        13
                 11-20 times              4         8         12
                 More than 20 times       3         6         25

Smoking(**)      Smokes every day -
                 sometimes                64        62        61

Use of drugs(**) Have used some kind
                 of drug                  40        39        42


(*) ANOVA F=416.62, p<0.0001. (**) Chi-Square p<0.001. (1) Consumption of at leat half a bottle of spirits or a bottle of wine or four cans of strong beer or six cans of medium strong beer. (2) Feeling intoxicated when drinking.

The association between consumption of home- distilled spirits, frequency during the last 12 months, and other habits among girls in Stockholm County, 1996, centiliters and percentages
                                       Frequency home distilled

Independent                             None     Once     2-4
variables                               n=2,981  n=775    n=622

Mean             Centilitres 100%
consumption(*)   alcohol per year        124      293      477

High alcohol     More than 7 litres
consumption(**)  100% alcohol per year    3       11       19

Binge
drinking (1 **)  Once a week              1        5        4
                 1-3 times a month        3        7       13
                 Once a month,            8       20       26
                 A few times a year      16       27       29
                 Less often, never       72       41       27

Intoxication (2) Every time when
(* *)            drinking                 8       19       24
                 Almost every time       21       42       49
                 Sometimes               15       18       16
                 Seldom, never           56       22       11

Smuggled
spirits(***)     No consumption          89       75       60
                 Once last 12 months      6       13       17
                 2-4 times                4        8       17
                 5-10 times               1        3        4
                 11-20 times              0        0        1
                 More than 20 times       0        1        0

Smoking(**)      Smokes every day -
                 sometimes               31       56       67

Use of drugs(**) Have used some kind
                 of drug                  5       12       23

                                        spirits last twelve months

Independent                             5-10    11-20   More than 20
variables                               n=272    n=100    n=76

Mean             Centilitres 100%
consumption(*)   alcohol per year        685      932     1766

High alcohol     More than 7 litres
consumption(**)  100% alcohol per year   36       48       79

Binge
drinking (1 **)  Once a week              7       10       25
                 1-3 times a month       22       31       32
                 Once a month,           29       34       33
                 A few times a year      25       15        9
                 Less often, never       17       10        1

Intoxication (2) Every time when
(* *)            drinking                21       30       32
                 Almost every time       59       58       57
                 Sometimes               15        8        9
                 Seldom, never            5        4        3

Smuggled
spirits(***)     No consumption          51       41       16
                 Once last 12 months     16        9       12
                 2-4 times               20       25       30
                 5-10 times              10       16       24
                 11-20 times              2        8       16
                 More than 20 times       1        1        3

Smoking(**)      Smokes every day -
                 sometimes               77       85       89

Use of drugs(**) Have used some kind
                 of drug                 25       30       43


(*) ANOVA F=316.16, p<0.0001. (**) Chi-Square p<0.001. (***) Chi-Square not a valid test, 28% of the cells have expected counts less than five. (1) Consumption of a least half a bottle of spirits or a bottle of wine or four cans of strong beer or six cans of medium strong beer. (2) Feeling intoxicated when drinking.

Consumption of illegal alcohol, social factors, availability, and drinking Habits

Among male consumers of alcohol, 19% find it very easy to obtain home-distilled spirits and 10% report finding it very easy to obtain smuggled spirits. The corresponding figures among girls are 13% and 5%. Bivariate analyses show that boys and girls whose parents have a high level of education less frequently report finding it very easy to obtain home-distilled spirits and that boys with highly educated parents find it less easy to obtain smuggled spirits. Finding it very easy to obtain home-distilled spirits and smuggled spirits is also less frequent among adolescents who live with both their parents.

Among girls whose parent(s) were born in another Nordic country the number finding it very easy to obtain home-distilled spirits was higher, whereas boys whose parent(s) were born in a non-Nordic country more often report finding it easy to obtain smuggled spirits. Furthermore, adolescents living in the least socially disadvantaged area to a lower degree report finding it very easy to obtain home-distilled spirits, and boys living in such areas also find it less easy to obtain smuggled spirits.

Consumption of home-distilled spirits is significantly lower among adolescents whose parents have the highest level of education and among adolescents who live in the least socially disadvantaged area. Frequent consumption of homedistilled spirits is also significantly lower among adolescents in the least socially disadvantaged area and among boys whose parents have the highest level of education. No significant differences regarding consumption of smuggled spirits were found. Both any consumption and frequent consumption of home-distilled spirits is less prevalent among adolescents whose parent(s) were born in a non-Nordic country and among adolescents who live with both their parents. Consumption of smuggled spirits was also significantly less common among adolescents with non-Nordic parents and among girls living with both parents.

Tables 3 through 6 display the relative risks associated with different social background factors when controlling for availability, alcohol consumption, and binge drinking. A higher consumption of alcohol is associated with a significantly greater likelihood of being a consumer of illegal spirits. However, binge drinking is significantly associated only with frequent consumption of home-distilled spirits among boys. Associations with parents' education and type of area found in the bivariate analysis remain in the multivariate analysis, whereas the only significant association with ethnicity that remains is a decreased risk of being a consumer of home-distilled spirits among boys whose parent(s) were born in a non-Nordic country. With the exception of a greater risk of being a consumer of home-distilled spirits among girls living with a single parent, the associations between family structure and consumption of illegal alcohol are no longer significant.

TABLE 3

Consumption of Illegal alcohol among boys; multivariate logistic regression analysis; relative risks (RR) with 95% confidence intervals (CI)
                                                     Home distilled
                                                           spirits

Predictors                   Categories                      RR

Patents'education            University/college             0.81
                             Secondary grammar                -
                             school (ref. Category)
                             Grammar school                 1.05
                             Less than 7 years              0.88
                             Other                          1.05
                             Don't know, no answer          1.01

Parents' ethnic origin       Both parents Swedish
                             (ref. category)
                             One/both Nordic                0.92
                             One/both non-Nordic            0.82

Family structure             Lives with a single parent     1.13

Type of area                 Type 1                         0.70
                             Type 2                         0.93
                             Type 3                         0.97
                             Type 4                         0.91
                             Type 5 (ref. category)           -

Availability of illegal      Finds it very easy to
alcohol                      obtain illegal alcohol         2.08

Mean consumption
cl 100% alcohol year         2-49 cl                        0.43
                             50-149 cl (ref. category)
                             150-299 cl                     1.23
                             300-499 cl                     1.60
                             500-999 cl                     1.89
                             1,000-10,000 cl                2.28

Binge drinking               Consuming an amount of
                             alcohol equivalent to 1/2      1.06
                             bottle of spirits three
                             times or more a month

                                                     Home distilled
                                                           spirits

Predictors                   Categories                      CI

Patents'education            University/college           0.70-0.92
                             Secondary grammar                -
                             school (ref. Category)
                             Grammar school               0.84-1.27
                             Less than 7 years            0.52-1.34
                             Other                        0.76-1.37
                             Don't know, no answer        0.86-1.17

Parents' ethnic origin       Both parents Swedish             -
                             (ref. category)
                             One/both Nordic              0.75-1.10
                             One/both non-Nordic          0.70-0.96

Family structure             Lives with a single parent   0.99-1.28

Type of area                 Type 1                       0.56-0.86
                             Type 2                       0.75-1.14
                             Type 3                       0.80-1.15
                             Type 4                       0.78-1.05
                             Type 5 (ref. category)           -

Availability of illegal      Finds it very easy to
alcohol                      obtain illegal alcohol       1.95-2.20

Mean consumption
cl 100% alcohol year         2-49 cl                      0.35-0.52
                             50-149 cl (ref. category)        -
                             150-299 cl                   1.05-1.42
                             300-499 cl                   1.41-1.80
                             500-999 cl                   1.71-2.06
                             1,000-10,000 cl              2.12-2.42

Binge drinking               Consuming an amount of
                             alcohol equivalent to 1/2    0.84-1.29
                             bottle of spirits three
                             times or more a month

                                                          Smuggled
                                                           spirits

Predictors                   Categories                      RR

Patents'education            University/college             0.88
                             Secondary grammar
                             school (ref. Category)
                             Grammar school                 1.05
                             Less than 7 years               148
                             Other                          1.12
                             Don't know, no answer          0.77

Parents' ethnic origin       Both parents Swedish
                             (ref. category)
                             One/both Nordic                1.09
                             One/both non-Nordic            0.94

Family structure             Lives with a single parent     0.92

Type of area                 Type 1                         0.77
                             Type 2                         0.84
                             Type 3                         0.88
                             Type 4                         0.90
                             Type 5 (ref. category)

Availability of illegal      Finds it very easy to
alcohol                      obtain illegal alcohol         2.90

Mean consumption
cl 100% alcohol year         2-49 cl                        0.31
                             50-149 cl (ref. category)
                             150-299 cl                     1.48
                             300-499 cl                     2.24
                             500-999 cl                     2.86
                             1,000-10,000 cl                3.94

Binge drinking               Consuming an amount of
                             alcohol equivalent to 1/2      1.08
                             bottle of spirits three
                             times or more a month

                                                          Smuggled
                                                           spirits

Predictors                   Categories                      CI

Patents'education            University/college           0.74-1.05
                             Secondary grammar
                             school (ref. Category)
                             Grammar school               0.79-1.37
                             Less than 7 years            0.86-2.35
                             Other                        0.75-1.62
                             Don't know, no answer        0.61-0.96

Parents' ethnic origin       Both parents Swedish
                             (ref. category)
                             One/both Nordic              0.85-1.37
                             One/both non-Nordic          0.76-1.15

Family structure             Lives with a single parent   0.76-1.10

Type of area                 Type 1                       0.58-1.00
                             Type 2                       0.63-1.11
                             Type 3                       0.69-1.12
                             Type 4                       0.74-1.10
                             Type 5 (ref. category)

Availability of illegal      Finds it very easy to
alcohol                      obtain illegal alcohol       2.51-3.29

Mean consumption
cl 100% alcohol year         2-49 cl                      0.23-0.43
                             50-149 cl (ref. category)
                             150-299 cl                   1.I7-1.83
                             300-499 cl                   1.84-2.66
                             500-999 cl                   2.46-3.27
                             1,000-10,000 cl              3.55-4.28

Binge drinking               Consuming an amount of
                             alcohol equivalent to 1/2    0.84-1.36
                             bottle of spirits three
                             times or more a month


Discussion

The validity of the results can be affected by certain factors. Non-participation of individual students is more problematic than the non-participation of entire school classes, as there is no reason to believe that the classes that did not participate differ systematically from the classes that did participate. Analyses from the school survey in 1993 showed that nonparticipating students have a higher consumption of alcohol than the students who did participate (Andersson et al., 1998b). However, the results changed by only a few percent when the non-participants were taken into consideration. The non-response of individual students may thus lead to a minor underestimation of, for example, mean consumption and number of high alcohol consumers. A certain amount of underreporting is also likely to exist in this study, but it is also possible that some adolescents reported a level of consumption higher than the actual. The fact that the questionnaires where it was clear that the student had not answered the questions truthfully were sorted out somewhat reduces the problem with overreporting. When estimating the consumption of illegal alcohol, telescoping may also be a problem. Since consumption of illegal alcohol can be assumed to be a less common event, it may become overestimated in relation to more common events, such as consumption of legal alcohol. If this is the case, the proportion of respondents stating a higher frequency of consumption of illegal alcohol may be somewhat overestimated. On the other hand, difficulties identifying the alcohol one drinks as being illegal may lead to underreporting of consumption of illegal alcohol.

TABLE 4

Consumption of Illegal alcohol among girls; multivariate logistic regression analysis; relative risks (RR) with 95% confidence Intervals (CI)
                                                     Home distilled
                                                           spirits

Predictors                   Categories                      RR

Parents' education           University/college             0.84
                             Secondary grammar school         -
                             (ref. category)
                             Grammar school                 1.02
                             Less than 7 years              0.95
                             Other                          1.06
                             Don't know, no answer          1.05

Parents' ethnic origin       Both parents Swedish             -
                             (ref. category)
                             One/both Nordic                0.92
                             One/both non-Nordic            0.89

Family structure             Lives with a single parent     1.18

Type of area                 Type 1                         0.81
                             Type 2                         1.09
                             Type3                          1.08
                             Type4                          0.89
                             Type 5 (ref. category)           -

Availability of illegal      Finds it very easy to obtain
alcohol                      illegal alcohol                1.92

Mean consumption
cl 100% alcohol/year         2-49 cl                        0.32
                             50-149 cl (ref. category)        -
                             150-299 cl                     1.22
                             300-499 cl                     1.38
                             500-999 cl                     1.69
                             1,000-10,000 cl                1.86

Binge drinking               Consuming an amount of
                             alcohol equivalent to 1/2      1.27
                             bottle of spirits three
                             times or more a month

                                                     Home distilled
                                                           spirits

Predictors                   Categories                      CI

Parents' education           University/college           0.74-0.95
                             Secondary grammar school         -
                             (ref. category)
                             Grammar school               0.86-1.19
                             Less than 7 years            0.65-1.28
                             Other                        0.83-1.30
                             Don't know, no answer        0.91-1.20

Parents' ethnic origin       Both parents Swedish             -
                             (ref. category)
                             One/both Nordic              0.78-1.07
                             One/both non-Nordic          0.77-1.01

Family structure             Lives with a single parent   1.06-1.29

Type of area                 Type 1                       0.67-0.97
                             Type 2                       0.92-1.26
                             Type 3                       0.93-1.24
                             Type 4                       0.77-1.01
                             Type 5 (ref. category)

Availability of illegal      Finds it very easy to
alcohol                      obtain illegal alcohol       1.82-2.01

Mean consumption
cl 100% alcohol/year         2-49 cl                      0.27-0.39
                             50-149 cl (ref. category)
                             150-299 cl                   1.09-1.36
                             300-499 cl                   1.23-1.53
                             500-999 cl                   1.53-1.82
                             1,000-10,000 cl              1.68-2.01

Binge drinking               Consuming an amount of
                             alcohol equivalent to 1/2    0.94-1.58
                             bottle of spirits three
                             times or more a month

                                                          Smuggled
                                                           spirits

Predictors                   Categories                      RR

Parents' education           University/college             0.96
                             Secondary grammar school         -
                             (ref. category)
                             Grammar school                 1.02
                             Less than 7 years              1.23
                             Other                          1.17
                             Don't know, no answer          0.78

Parents' ethnic origin       Both parents Swedish             -
                             (ref. category)
                             One/both Nordic                1.05
                             One/both non-Nordic            0.97

Family structure             Lives with a single parent     1.03

Type of area                 Type 1                         0.96
                             Type 2                         0.86
                             Type 3                         0.99
                             Type 4                         0.92
                             Type 5 (ref. category)           -

Availability of illegal      Finds it very easy to
alcohol                      obtain illegal alcohol         3.71

Mean consumption
cl 100% alcohol/year         2-49 cl                        0.29
                             50-149 cl (ref. category)        -
                             150-299 cl                     1.65
                             300-499 cl                     2.58
                             500-999 cl                     2.81
                             1,000-10,000 cl                3.54

Binge drinking               Consuming an amount of
                             alcohol equivalent to 1/2      1.08
                             bottle of spirits three
                             times or more a month

                                                          Smuggled
                                                           spirits

Predictors                   Categories                      CI

Parents' education           University/college           0.80-1.15
                             Secondary grammar school
                             (ref. category)
                             Grammar school               0.78-1.33
                             Less than 7 years            0.73-1.94
                             Other                        0.81-1.64
                             Don't know, no answer        0.61-0.99

Parents' ethnic origin       Both parents Swedish             -
                             (ref. category)
                             One/both Nordic              0.83-1.31
                             One/both non-Nordic          0.78-1.19

Family structure             Lives with a single parent   0.87.1.23

Type of area                 Type 1                       0.74-1.24
                             Type 2                       0.64-1.14
                             Type 3                       0.78-1.25
                             Type 4                       0.75-1.12
                             Type 5 (ref. category)           -

Availability of illegal      Finds it very easy to
alcohol                      obtain illegal alcohol       3.15-4.21

Mean consumption
cl 100% alcohol/year         2-49 cl                      0.22-0.38
                             50-149 cl (ref. category)
                             150-299 cl                   1.35-1.99
                             300-499 cl                   2.19-2.99
                             500-999 cl                   2.39-3.23
                             1,000-10,000 cl              3.02-4.02

Binge drinking               Consuming an amount of
                             alcohol equivalent to 1/2    0.75-1.53
                             bottle of spirits three
                             times or more a month


The results show that consumption of illegal alcohol is common among young boys and girls and that it is related to consumption level, binge drinking and intoxication. This is consistent with other Swedish data (Andersson & Helling, 1997). According to our results, high consumption level is of greater importance than binge drinking. The association between mean consumption level and consumption of illegal alcohol was even greater with regard to frequent consumption of illegal alcohol. Thus increased availability to cheaper spirits may contribute to an increased skewness in alcohol consumption among adolescents. However, our data do not permit a calculation of the proportion of the total alcohol consumption that is made up of illegal spirits.

TABLE 5

Frequent consumption(*) of illegal alcohol among boys; multivariate logistic regression analysis; relative risks (RR) with 95% confidence intervals (CI)
                                                     Home distilled
                                                           spirits

Predictors                  Categories                       RR

Parents' education          University/college              0.74
                            Secondary grammar                 -
                            school (ref. category)
                            Grammar school                  1.47
                            Less than 7 years               1.54
                            Other                           0.79
                            Don't know, no answer           1.14

Parents' ethnic origin      Both parents Swedish              -
                            (ref. category)
                            One/both Nordic                 1.11
                            One/both non-Nordic             0.89

Family structure            Lives with a single parent      1.22

Type of area                Type 1                          0.58
                            Type 2                          0.85
                            Type 3                          0.92
                            Type 4                          0.97
                            Type 5 (ref. category)            -

Availability of illegal     Finds it very easy to
alcohol                     obtain illegal alcohol          4.27

Mean consumption
cl 100% alchohol/year       2-49 cl                         0.12
                            50-149 cl (ref. category)         -
                            150-299 cl                      1.39
                            300-499 cl                      3.82
                            500-999 cl                      5.68
                            1,000-10,000 cl                 11.30
Binge drinking              Consuming an amount of
                            alcohol equivalent to 1/2       1.47
                            bottle of spirits three
                            times or more a month

                                                     Home distilled
                                                           spirits

Predictors                  Categories                       CI

Parents' education          University/college            0.55-0.99
                            Secondary grammar                 -
                            school (ref. category)
                            Grammar school                0.94-2.26
                            Less than 7 years             0.63-3.63
                            Other                         0.40.1.53
                            Don't know, no answer         0.81-1.61

Parents' ethnic origin      Both parents Swedish              -
                            (ref. category)
                            One/both Nordic               0.75-1.63
                            One/both non-Nordic           0.62-1.26

Family structure            Lives with a single parent    0.92-1.62

Type of area                Type 1                        0.36-0.93
                            Type 2                        0.54-1.33
                            Type 3                        0.63-1.36
                            Type 4                        0.70-1.33
                            Type 5 (ref. category)            -

Availability of illegal     Finds it very easy to
alcohol                     obtain illegal alcohol        3.43-5.28

Mean consumption
cl 100% alchohol/year       2-49 cl                       0.04-0.36
                            50-149 cl (ref. category)
                            150-299 cl                    0.75-2.55
                            300-499 cl                    2.25-6.31
                            500-999 cl                    3.56-8.78
                            1,000-10,000 cl              7.58-16.03
Binge drinking              Consuming an amount of
                            alcohol equivalent to 1/2     1.08-1.98
                            bottle of spirits three
                            times or more a month

                                                          Smuggled
                                                           spirits

Predictors                  Categories                       RR

Parents' education          University/college              0.79
                            Secondary grammar                 -
                            school (ref. category)
                            Grammar school                  0.95
                            Less than 7 years               1.74
                            Other                           1.00
                            Don't know, no answer           0.74

Parents' ethnic origin      Both parents Swedish              -
                            (ref. category)
                            One/both Nordic                 0.88
                            One/both non-Nordic             1.25

Family structure            Lives with a single parent      0.93

Type of area                Type 1                          0.86
                            Type 2                          1.39
                            Type 3                          1.04
                            Type 4                          1.08
                            Type 5 (ref. category)            -

Availability of illegal     Finds it very easy to
alcohol                     obtain illegal alcohol          5.17

Mean consumption
cl 100% alchohol/year       2-49 cl                           -
                            50-149 cl (ref. category)         -
                            150-299 cl                      1.47
                            300-499 cl                      3.20
                            500-999 cl                      6.64
                            1,000-10,000 cl                 14.84
Binge drinking              Consuming an amount of
                            alcohol equivalent to 1/2       1.09
                            bottle of spirits three
                            times or more a month

                                                          Smuggled
                                                           spirits

Predictors                  Categories                       CI

Parents' education          University/college            0.56-1.11
                            Secondary grammar
                            school (ref. category)
                            Grammar school                0.53-1.68
                            Less than 7 years             0.68-4.37
                            Other                         0.47-2.10
                            Don't know, no answer         0.48-1.14

Parents' ethnic origin      Both parents Swedish              -
                            (ref. category)
                            One/both Nordic               0.53-1.45
                            One/both non-Nordic           0.84-1.87

Family structure            Lives with a single parent    0.65-1.33

Type of area                Type 1                        0.50-1.47
                            Type 2                        0.83-2.31
                            Type 3                        0.64-1.67
                            Type 4                        0.72-1.60
                            Type 5 (ref. category)

Availability of illegal     Finds it very easy to
alcohol                     obtain illegal alcohol        3.87-6.88

Mean consumption
cl 100% alchohol/year       2-49 cl                           -
                            50-149 cl (ref. category)         -
                            150-299 cl                    0.64-3.30
                            300-499 cl                    1.55-6.44
                            500-999 cl                   3.56-11.91
                            1,000-10,000 cl              8.63-23.86
Binge drinking              Consuming an amount of
                            alcohol equivalent to 1/2     0.77-1.54
                            bottle of spirits three
                            times or more a month


(*) Consumption of illegal spirits five times or more during the last 12 months.

We also found a marked association between use of illegal alcohol and prevalence of smoking and use of narcotic drugs. Previous studies have shown an association between consumption of alcohol, smoking, and use of other drugs (see, for example, Jessor & Jessor, 1977), and that use of other substances is also related to consumption of illegal alcohol is not surprising. According to Jessor and Jessor (1977), smoking, consumption of alcohol, and use of other drugs can be seen as different indications of proneness to problem behavior.

TABLE 6

Frequent consumption(*) of illegal alcohol among girls; multivariate logistic regression analysis; relative risks (RR), with 66% confidence intervals (CI)
                                                     Home distilled
                                                           spirits

Predictors                  Categories                       RR

Parents' education          University/college              0.84
                            Secondary grammar                 -
                            school (ref. category)
                            Grammar school                  1.38
                            Less than 7 years               0.49
                            Other                           0.83
                            Don't know, no answer           0.85

Parents' ethnic origin      Both parents Swedish              -
                            (ref. category)
                            One/both Nordic                 0.81
                            One/both non-Nordic             0.79

Family structure            Lives with a single parent      1.24

Type of area                Type 1                          0.57
                            Type 2                          1.00
                            Typc 3                          1.21
                            Type 4                          0.94
                            Type 5 (ref. category)            -

Availability of illegal     Finds it very easy to
alcohol                     obtain illegal alcohol          4.78

Mean consumption
cl 100% alcohol/year        2-49 cl                         0.10
                            50-149 cl (ref. category)         -
                            150-299 cl                      2.02
                            300499 c1                       3.27
                            500-999 cl                      5.32
                            1,000-10,000 cl                 7.83

Binge drinking              Consuming an amount of
                            alcohol equivalent 10 1/2       1.05
                            bottle of spirits three
                            times or more a month

                                                     Home distilled
                                                           spirits

Predictors                  Categories                       CI

Parents' education          University/college            0.62-1.12
                            Secondary grammar                 -
                            school (ref. category)
                            Grammar school                0.91-2.06
                            Less than 7 years             0.17-1.40
                            Other                         0.43-1.57
                            Don't know, no answer         0.59-1.22

Parents' ethnic origin      Both parents Swedish              -
                            (ref. category)
                            One/both Nordic               0.54-1.20
                            One/both non-Nordic           0.54-1.14

Family structure            Lives with a single parent    0.95-1.62

Type of area                Type 1                        0.35-0.94
                            Type 2                        0.63-1.58
                            Typc 3                        0.84-1.74
                            Type 4                        0.68-1.29
                            Type 5 (ref. category)

Availability of illegal     Finds it very easy to
alcohol                     obtain illegal alcohol        3.87-5.85

Mean consumption
cl 100% alcohol/year        2-49 cl                       0.05-0.23
                            50-149 cl (ref. category)
                            150-299 cl                    1.35-2.99
                            300499 c1                     2.23-4.69
                            500-999 cl                    3.79-7.25
                            1,000-10,000 cl              5.62-10.46

Binge drinking              Consuming an amount of
                            alcohol equivalent 10 1/2     0.66-1.65
                            bottle of spirits three
                            times or more a month

                                                          Smuggled
                                                           spirits

Predictors                  Categories                       RR

Parents' education          University/college              1.19
                            Secondary grammar                 -
                            school (ref. category)
                            Grammar school                  1.21
                            Less than 7 years               0.81
                            Other                           0.60
                            Don't know, no answer           0.69

Parents' ethnic origin      Both parents Swedish              -
                            (ref. category)
                            One/both Nordic                 0.96
                            One/both non-Nordic             1.03

Family structure            Lives with a single parent      1.05

Type of area                Type 1                          1.13
                            Type 2                          0.54
                            Typc 3                          0.97
                            Type 4                          1.37
                            Type 5 (ref. category)            -

Availability of illegal     Finds it very easy to
alcohol                     obtain illegal alcohol          5.97

Mean consumption
cl 100% alcohol/year        2-49 cl                         0.11
                            50-149 cl (ref. category)         -
                            150-299 cl                      1.64
                            300499 c1                       2.58
                            500-999 cl                      5.05
                            1,000-10,000 cl                 11.16

Binge drinking              Consuming an amount of
                            alcohol equivalent 10 1/2       1.22
                            bottle of spirits three
                            times or more a month

                                                          Smuggled
                                                           spirits

Predictors                  Categories                       CI

Parents' education          University/college            0.79-1.78
                            Secondary grammar                 -
                            school (ref. category)
                            Grammar school                0.66-2.22
                            Less than 7 years             0.22-2.88
                            Other                         0.22-1.63
                            Don't know, no answer         0.39-1.19

Parents' ethnic origin      Both parents Swedish
                            (ref. category)
                            One/both Nordic               0.55-1.66
                            One/both non-Nordic           0.63-1.66

Family structure            Lives with a single parent    0.71-1.55

Type of area                Type 1                        0.60-2.09
                            Type 2                        0.23-1.24
                            Typc 3                        0.55-1.71
                            Type 4                        0.86-2.18
                            Type 5 (ref. category)            -

Availability of illegal     Finds it very easy to
alcohol                     obtain illegal alcohol        4.03-8.70

Mean consumption
cl 100% alcohol/year        2-49 cl                       0.04-0.34
                            50-149 cl (ref. category)         -
                            150-299 cl                    0.85-3.11
                            300499 c1                     1.38-4.71
                            500-999 cl                    2.89-8.61
                            1,000-10,000 cl              6.65-17.76

Binge drinking              Consuming an amount of
                            alcohol equivalent 10 1/2     0.72-2.06
                            bottle of spirits three
                            times or more a month


(*) Consumption of illegal spirits five times or more during the last 12 months.

Our analyses show that there is an association between social background factors and the consumption of home-distilled spirits even when controlling for drinking habits and perceived availability of home-distilled spirits. Use of home-distilled spirits was lower in adolescents coming from families where at least one parent had a university degree and also in those coming from more affluent areas. Parents' ethnic origin was, with one exception, not significantly associated with consumption of illegal alcohol. However, there was a clear pattern of lower use of home-distilled spirits among adolescents with a non-Nordic background. Family structure was significantly associated with consumption of illegal alcohol only in one case, but as with ethnicity a clear pattern could be seen--a pattern indicating a higher consumption of home-distilled spirits among adolescents living with single parents.

These results indicate a negative association between better economic resources and use of home-distilled spirits. According to our results, there are differences between consumers of smuggled spirits and consumers of home-distilled spirits among adolescents. Consumption of home-distilled spirits seems to be associated with a lower social status, whereas consumption of smuggled spirits is less influenced by social factors.

In a press release of May 1999, the Ministry of Social Affairs declared that an important part of the official alcohol policy was to wage an offensive combat against illegal alcohol (Socialdepartementet, 1999). In this press release, criminalization of purchase and possession of home-distilled spirits was being proposed (this was later decided by the Swedish government). The focus in future prevention was said to be age control and increased local and individual responsibility, as well as efforts to influence attitudes and to spread knowledge. A main activity was to be information and campaigns against illegal alcohol, not least stressing the association between organized criminality and illegal alcohol. This was a focus in the new information campaign initiated by the OAS in May 1999, when this paper was being finalized. Information campaigns and criminalization of purchase may reduce availability in general, thereby causing a decline in the consumption of illegal alcohol among adolescents. However, our results also indicate that special attention should be directed toward socially disadvantaged youth.

References

Andersson, B, Gronberg, K & Hibell, B (1998a). Skolelevers drogvanor 1997, Stockholm, CAN.

Andersson, B, Gronberg, K & Hibell, B (1998b). Drogvanor i arskurs 9 Stockholms lan 1998, Stencil-serie nr. 36, Stockholm, CAN.

Andersson, B & Helling, S (1997). Ungdomar och hermbrant--fran Malmo till Malmberget, Stockholm, CAN.

Boman, U & Romelsjo, A (1997). Alkohol- och drogvanor bland hogstadieelever i Stockholms lan--en analys av utvecklingen mellan 1990 och 1996 samt av saraband med andra vanor och psykosociala forhallanden 1996, Huddinge, CADP.

Hradilova Selin, K (1998). "Utbildningsbakgrund och dess betydelse for alkoholkonsumtionsniva och konsumtionsmonster," pp. 146-169 in Kuhlhorn, E & Bjor, J (eds.), Svenska alkoholvanor i forandring. Om utvecklingen fram till EU-medlemskapet, Stockholm, Sober forlag.

Jessor, R & Jessor, SL (1977). Problem behavior and psychosocial development: A longitudinal study of youth, New York, Academic Press.

Leifman, H, Arvidsson, O, Hihell, B et al. (1999). Svensson och Svartspriten. Konsumtion och attityder 1998, Stockholm, Socialdepartermentert

SAS/STAT User's Guide, Version 6, Fourth Edition, Volume 1 (1990), SAS Institute Inc, Gary, NC, USA.

Socialdepartementet (1999). Pressmeddelande. Svartsprit kriminaliseras, Stockholm, Regeringskansliet.

SOU 1998:154, OAS--Oberoende Alkoholsamarbetet i framtiden, Stockholm, Fritzes.

Trolldal, B (1998). "Andrade villkor for svensk alkoholpolitik," pp.10-20 in Kuhlhorn, E & Bjor, J (eds.), Svenska alkoholvanor i forandring, Stockholm, Sober Forlag.

ANDERS ROMELSJO and MARIA BRANTING are on the staff of the Centre for Alcohol and Drug Prevention (Box 175 33, SE 118 91 Stockholm, Sweden; anders.romelsjo@smd.sll.se). A medical epidemiologist, Romelsjo has published on a wide range of topics, recently including alcohol and stroke, drunk driving, and social class and drinking. He is a coauthor of European Integration and Nordic Alcohol Policies (1998) and of Alcohol Policy and the Public Good (1994). Ms. Branting is a graduate student in sociology at Stockholm University.
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Author:Rommelsjo, Anders; Branting, Maria
Publication:Contemporary Drug Problems
Geographic Code:4EUSW
Date:Jun 22, 2000
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