Effekter av lördagsöppna Systembolagsbutiker. Uppföljning av de första 17 månaderna

Sedan lördagsöppet infördes har Systembolagets alkoholförsäljningen ökat mer i experiment- än i kontrollområdet. Enligt resultaten ligger nettoökningen på 3.2%. Den statistiska felmarginalen kring denna skattning är liten (ungefär 1 procent). Försäljningsökningen är främst en följd av ökad ölförsäljning i experimentområdena, men även effekten på vin- och spritförsäljningen är statistiskt säkerställd. Effekten är jämnt fördelad över försöksperioden och visar inte tecken på att öka eller minska. Det finns ingen indikation i befintliga data på att den ökade Systembolagsförsäljningen skulle kompenseras med en minskad restaurang- eller svartspritskonsumtion. Dataunderlaget på dessa områden är dock mycket knapphändigt. Skador: I dessa analyser är det utvecklingen under lördag-söndag som fokuserats, eftersom eventuella effekter bör vara koncentrerade till dessa dagar. Enligt resultaten visar ingen av indikatorerna på misshandel någon klar ökning i Stockholm eller Skåne. Emellertid var det en statistisk säkerställd ökning i Nordsverige (11%). Antalet rattfylleribrott ökade mera i experimentområdet än i kontrollområdet, mest i Stockholm. Analyserna tyder dock på att av denna ökning huvudsakligen kan bero på polisens riktade kontroller mot områden nära lördagsöppna Systembolag. Om tidsintervallet för sådana kontroller (lördag 10-14) hålls utanför, är uppgången i rattfylleri inte längre lika markant och ligger inom den statistiska felmarginalen. Felmarginalerna kring de skattade skadeeffekterna är ganska stora (ungefär 5 % för misshandel och 7 % för rattfylleri), vilket gör dessa resultat mer osäkra.-

The public-private decision for alcohol retail systems: examining the economic, health, and social impacts of alternative systems in Finland

Background: Organising alcohol retail systems with more or less public ownership has implications for health and the economy. The aim of the present study was to estimate the economic, health, and social impacts of alcohol use in Finland in 2018 (baseline), and in two alternative scenarios in which current partial public ownership of alcohol retail sales is either increased or fully privatised. Methods: Baseline alcohol-attributable harms and costs were estimated across five categories of death, disability, and criminal justice. Two alternate alcohol retail systems were defined as privately owned stores selling: (1) only low strength alcoholic beverages (public ownership scenario, similar to Sweden); or (2) all beverages (private ownership scenario). Policy analyses were conducted to estimate changes in alcohol use per capita. Health and economic impacts were modelled using administrative data and epidemiological modelling. Results: In Finland in 2018, alcohol use was estimated to be responsible for €1.51 billion (95% Uncertainty Estimates: €1.43 billion, €1.58 billion) in social cost, 3,846 deaths, and 270,652 criminal justice events. In the public ownership scenario, it was estimated that alcohol use would decline by 15.8% (11.8%, 19.7%) and social cost by €384.3 million (€189.5 million, €559.2 million). Full privatisation was associated with an increase in alcohol use of 9.0% (6.2%, 11.8%) and an increase in social cost of €289.7 million (€140.8 million, €439.5 million). Conclusion: The outcome from applying a novel analytical approach suggests that more public ownership of the alcohol retail system may lead to significant decreases in alcohol-caused death, disability, crime, and social costs. Conversely, full privatisation of the ownership model would lead to increased harm and costs

Causal mechanisms proposed for the Alcohol Harm Paradox - a systematic review

Background and Aims The Alcohol Harm Paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another. Methods Systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974 – January 2021) and PsycINFO (1967 – January 2021), supplemented via manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm, and socioeconomic position. Papers were set in Organisation for Economic Co-operation and Development high income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations. Results Seventy-nine papers met the inclusion criteria and initial coding revealed these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: Individual, Lifestyle, Contextual, Disadvantage, Upstream and Artefactual. Explanations related to risk behaviours, which fit within the Lifestyle domain, were the most frequently proposed (n=51) and analysed (n=21). Conclusions While there are many potential explanations for the Alcohol Harm Paradox, most research focuses on risk behaviours while other explanations lack empirical testing

Samband mellan alkohol och självmord på befolkningsnivå: en översikt

I sitt inflytelserika arbete avfärdade Durkheim kategoriskt alkoholkonsumtion eller alkoholmissbruk som en plausibel orsaksfaktor bakom självmord. Detta kan vara ett skäl till att alkoholfaktorn länge var negligerad inom den samhällsvetenskapliga självmordsforskningen. Under de senaste decennierna har dock det publicerats ett växande antal studier på befolkningsnivå där frågeställningen gäller hur förändringar i totalkonsumtionen av alkohol påverkar självmordsfrekvensen i samhället. Föreliggande artikel ger en översikt över den forskning som publicerats på detta område efter 1989. Genom sökningar i MedLine och Social Sciences Citation Index kompletterade med manuella sökningar identifierades 42 relevanta studier. De flesta (34) av de 42 studierna presenterar genusspecifika estimat av sambandet mellan totalkonsumtionen av alkohol och självmord. Av dessa var 53 % signifikant positiva för män, motsvarande siffra för kvinnor var 37 %. Ingen studie rapporterade ett signifikant negativt samband. Det finns en tydlig kulturell variation i sambandets styrka; det tenderar att vara starkare ju mer landets dryckesmönster är inriktat mot berusningsdrickande. Det konkluderas att studierna utgör en breddning av såväl självmordsforskning (genom att inkludera alkoholfaktorn) som alkoholepidemiologisk forskning (genom att bredda utfallspanoramat från somatiska till sociala skador). De flesta studier baseras dock på data från utvecklade västländer. Framtida studier bör vidgas till ett bredare urval av länder. In his influential work Durkheim rejected drinking as a plausible causal factor for suicide. This may be one reason why the alcohol factor was long neglected in sociological suicide research. However, recent decades have witnessed a growing number of studies on the population level where the issue is how changes in alcohol consumption affect the suicide rate. The present article provides an overview of the research published in this area after 1989. Through searches of MedLine and Social Sciences Citation Index supplemented by manual searches 42 relevant studies were identified. Most (34) of the 42 studies present gender-specific estimates of the relationship between alcohol consumption and suicide. Of these, 53 % were significantly positive for males, and 37 % for females. No study reported a significant negative relationship. There is a distinct cultural variation in the strength of the relationship: it tends to be stronger the more the country's drinking patterns are geared towards binge drinking. It is concluded that the studies represent a broadening of the suicide research (by including the alcohol factor) as well as alcohol epidemiological research (by broadening the outcome panorama from somatic to social harm). However, most studies are based on data from developed Western countries. Future studies should include a broader range of countries

The impact of the COVID-19 pandemic on mortality in Sweden—Did it differ across socioeconomic groups?

The characterization of the socioeconomic profle of COVID-19 mortality is limited. Likewise, the mapping of potential indirect adverse outcomes of the pandemic, such as suicide and alcohol abuse, along socioeconomic lines is still meagre. The main aim of this paper is to (i) depict SES-diferences in COVID-19 mortality, and (ii) to assess the impact of the COVID-19 pandemic on suicide and alcohol mortality across socioeconomic groups. We used Swedish monthly data spanning the period January 2016–December 2021. We chose education as indicator of socioeconomic status (SES). The following causes of deaths were included in the analysis: COVID-19, all-cause mortality excluding COVID-19, suicide and a composite index of alcohol-specifc deaths. SARIMA-modelling was used to assess the impact of the pandemic on suicide and alcohol-specifc mortality. Two alternative measures of the pandemic were used: (1) a dummy that was coded 1 during the pandemic (March 2020 and onwards), and 0 otherwise, and (2) the Oxford COVID-19 Government Response Tracker’s Stringency Index. There was a marked SES-gradient in COVID-19 mortality in the working-age population (25–64) which was larger than for other causes of death. A SES-gradient was also found in the old-age population, but this gradient did not difer from the gradient for other causes of death. The outcome from the SARIMA time-series analyses suggested that the pandemic did not have any impact on suicide or alcohol-specifc mortality in any of the educational and gender groups

The link between per capita alcohol consumption and alcohol-related harm in educational groups.

INTRODUCTION AND AIMS: Research based on individual-level data suggests that the same amount of alcohol yields more harm in low-socioeconomic status (SES) groups than in high-SES groups. Little is known whether the effect of changes in population-level alcohol consumption on harm rates differs by SES-groups. The aim of this study was to elucidate this issue by estimating the association between per capita alcohol consumption and SES-specific rates of alcohol-related mortality. DESIGN AND METHODS: Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres 100% alcohol per capita 15+). Quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2017Q4. We used two outcomes: (i) alcohol-specific mortality (deaths with an explicit alcohol diagnosis); and (ii) violent deaths. SES was measured by education. We used three educational groups: (i) low (<10 years); (ii): intermediate (10-12 years); and (iii) high (13+ years). We applied error correction modelling to estimate the association between alcohol and alcohol-specific mortality, and seasonal autoregressive integrated moving average-modelling to estimate the association between alcohol and violent deaths. RESULTS: The estimated associations between per capita consumption and the two outcomes were positive and statistically significant in the two groups with low and intermediate education, but not in the high education group. There was a significant gradient in the level of association between alcohol consumption and alcohol-related harm by educational group; the association was stronger the lower the educational group. DISCUSSION AND CONCLUSIONS: Our findings suggest that the association between per capita consumption and alcohol-related harm was stronger the lower the educational group

The use of epidemiology in alcohol research

Aims This paper presents examples to illustrate the utility and limitations in the use of epidemiology in alcohol research and discusses some promising new directions. Methods Review of literature, concentrating on epidemio-logical alcohol research with relevance to public health. Findings and conclusion Epidemiology offers tools for assessment of causes and effects of alcohol consumption as well as the effects of efforts to prevent alcohol consumption and its consequences. Epidemiological studies have made significant contributions to alcohol research with respect to public health and public policy. Fixed-effects modelling, difference-in-differences estimation and integrated qualitative and epidemiological methods are promising but underused methods in epidemiological studies. Many epidemiological studies have limited transferability of knowledge to other cultures and jurisdictions