Understanding Educational and Psychosocial Factors Associated with Alcohol Use among Adolescents in Denmark; Implications for Health Literacy Interventions

Background. Alcohol misuse is a global public health priority, with a variation in prevalence and impact between countries. Alcohol misuse in adolescence is associated with adverse psychological, social and physical health. Adolescents in Denmark have higher alcohol consumption and problematic alcohol use than adolescents in other European countries. Associations between social determinants of health (SDH), psycho-social factors and alcohol consumption are complex and influenced by national context and cultures. This study explored these associations in Danish adolescents. Method. The European School Survey Project on Alcohol and Other Drugs (ESPAD) survey collects data on alcohol and substance use among 15–16-year-old European students. Data contributed by Danish students to the 2011 survey were analyzed. The outcomes of interest were alcohol consumption (any, intoxication and problematic). Health literacy was not directly measured, so self-described educational performance and knowledge about alcohol were used as proxies for health literacy. Exploratory factors thus included socio-demographic, health literacy-related (knowledge about alcohol, educational performance) and psycho-social factors, as well as expectancies of the effect of alcohol (both positive and negative) and self-reported health. Univariate and multivariate logistic regression analyses were undertaken. Results. Of the 2768 adolescents who participated in the survey, 2026 (80%) consumed alcohol during the last 30 days, 978 (38%) were intoxicated at least once during the last 30 days, and 1050 (41%) experienced at least one problem because of alcohol use during the last 12 months. Multivariable analysis showed that the factors associated with higher alcohol intake were gender, poor relationships with parents, expectancies of the impact of alcohol (both positive and negative), and the influence of peers and their alcohol use. Higher school performance was related to lower alcohol consumption. Low socio-demographic status was not associated with higher alcohol consumption. Conclusions. This study confirmed the high levels of alcohol intake, intoxication, and problem drinking amongst the Danish students in the survey and the complexity of the socio-demographic, psychosocial, health literacy-related, and environmental factors associated with alcohol behaviours. Approaches to addressing the issue of alcohol use in Danish adolescents will need to be multi-factorial, including supporting students to develop alcohol-related health literacy skills to enable them to make informed choices

Socioeconomic Position, Type 2 Diabetes and Long-Term Risk of Death

<div><p>Background</p><p>Both socioeconomic position (SEP) and type 2 diabetes have previously been found to be associated with mortality; however, little is known about the association between SEP, type 2 diabetes and long-term mortality when comorbidity is taken into account.</p><p>Methods</p><p>We conducted a population-based cohort study of all Danish citizens aged 40-69 years with no history of diabetes during 2001-2006 (N=2,330,206). The cohort was identified using nationwide registers, and it was followed for up to 11 years (mean follow-up was 9.5 years (SD: 2.6)). We estimated the age-standardised mortality rate (MR) and performed Poisson regression to estimate the mortality-rate-ratio (MRR) by educational level, income and cohabiting status among people with and without type 2 diabetes.</p><p>Results</p><p>We followed 2,330,206 people for 22,971,026 person-years at risk and identified 139,681 individuals with type 2 diabetes. In total, 195,661 people died during the study period; 19,959 of these had type 2 diabetes. The age-standardised MR increased with decreasing SEP both for people with and without diabetes. Type 2 diabetes and SEP both had a strong impact on the overall mortality; the combined effect of type 2 diabetes and SEP on mortality was additive rather than multiplicative. Compared to women without diabetes and in the highest income quintile, the MRR’s were 2.8 (95%CI 2.6, 3.0) higher for women with type 2 diabetes in the lowest income quintile, while diabetes alone increased the risk of mortality 2.0 (95%CI 1.9, 2.2) times and being in the lowest income quintile without diabetes 1.8 (95%CI 1.7,1.9) times after adjusting for comorbidity. For men, the MRR’s were 2.7 (95%CI 2.5,2.9), 1.9 (95%CI 1.8,2.0) and 1.8 (95%CI 1.8,1.9), respectively.</p><p>Conclusion</p><p>Both Type 2 diabetes and SEP were associated with the overall mortality. The relation between type 2 diabetes, SEP, and all-cause mortality was only partly explained by comorbidity.</p></div

Age-standardized mortality rates according to educational level, income level and cohabitation status among people with and without diabetes in the Danish population aged 40–69 years at inclusion, mean follow-up 9.5 years.

<p>Red: People with diabetes, Blue: People without diabetes.</p

MRR for all-cause mortality among people with and without diabetes in the Danish population aged 40–69 years at inclusion, mean follow-up: 9.5 years.

<p>Model 1. Adjusted for age, duration of diabetes, calendar time. Model 2. Further adjusted for CVD and cancer before study start. Model 3. Further adjusted for CVD and cancer before study start and CVD, cancer and no. of other diseases according to Charlson Comorbidity Index during follow-up. Reference: Highest SEP-level among people without diabetes, Interaction between SEP and diabetic status, p<0.001</p><p>MRR for all-cause mortality among people with and without diabetes in the Danish population aged 40–69 years at inclusion, mean follow-up: 9.5 years.</p

Characteristics of people with and without diabetes and the general population aged 40–69 years, 2001–06.

<p>Characteristics of people with and without diabetes and the general population aged 40–69 years, 2001–06.</p

Characteristics of individuals diagnosed with clinically-incident diabetes between 2001 and 2009 in <i>ADDITION-Denmark</i> general practices, by trial group.

<p>Characteristics of individuals diagnosed with clinically-incident diabetes between 2001 and 2009 in <i>ADDITION-Denmark</i> general practices, by trial group.</p

Rates of redeemed cardio-protective medication over time among individuals diagnosed with clinically-incident diabetes between 2001 and 2009 in <i>ADDITION-Denmark</i> general practices, by trial group.

<p>Rates of redeemed cardio-protective medication over time among individuals diagnosed with clinically-incident diabetes between 2001 and 2009 in <i>ADDITION-Denmark</i> general practices, by trial group.</p