1. AARHUS UNIVERSITET CHANGES IN ALCOHOL CONSUMPTION IN DENMARK: A COMPARISON OF NATIONAL SURVEYS FROM 2003 AND 2011 Kim Bloomfield, Dr.P.H. 1,2,Ulrike Grittner, Ph.D. 2,3 1 Centre for Alcohol and Drug Research, Aarhus University, Denmark 2 Department for Biostatistics and Clinical Epidemiology, Charité – University Medicine Berlin, Germany 3 Centre for Stroke Research Berlin, Germany For presentation at the 141 st annual meeting of the American Public Health Association, Boston, MA, USA

2. AARHUS UNIVERSITET First dedicated national survey on alcohol and drugs conducted by CRF in 2011 Extensive questions on alcohol use (consumption, problems, harms, contexts, attitudes). Also drug and tobacco use. Almost identical questions on alcohol consumption and problems as were asked in 2003 in relation to the Nordic Tax Study and GENACIS. BACKGROUND 1

3. AARHUS UNIVERSITET ALCOHOL CONSUMPTION, ETHANOL, LITRES PER CAPITA 14+ YEARS, 2000-2010 (SOURCE: STATISTICS DENMARK) 2 2005: rank 18 out of 189 countries (Source: GISAH); among Nordic countries: rank 1 > per day

4. PURPOSE OF THE STUDY 3 To present new prevalence data for alcohol use and problems in Denmark To investigate possible changes over time by comparing present data with those from the 2003 survey.

5. AARHUS UNIVERSITET METHODS - SAMPLE 2003 survey conducted August/September N = 2030 CATI with RDD Cooperation rate = 50% Age range 15-99; 44% men, 56% women 4

6. AARHUS UNIVERSITET METHODS - SAMPLE 2011 survey conducted September/October N = 5133 Split mode: first internet, then telephone Response rate = 64% Age range = 15-79; 47% men, 53% women 5

7. AARHUS UNIVERSITET METHODS - MEASURES Current drinking, heavy drinking (>10/20 grams per day for women/men), RSOD (5+ units/occasion), quantity per drinking day Selected AUDIT problem items Control variables: age, marital status, household status, children, employment, education, income, survey mode, survey year 6

8. AARHUS UNIVERSITET METHODS – STATISTICAL APPROACH prevalence/distributions by gender, age, year, administration mode Multivariate linear and logistic regressions Risk curves for alcohol problems and consumption 7

9. AARHUS UNIVERSITET 8 ***** Current drinking by year and mode

10. AARHUS UNIVERSITET HEAVY DRINKING >10/20 GR. ETHANOL PER DAY BY WAVE AND MODE 9

11. AARHUS UNIVERSITET MONTHLY RSOD BY YEAR & MODE 10

12. AARHUS UNIVERSITET HEAVY DRINKING (10/20+ GRAMS ETHANOL PER DAY, OR (95%CI) 11

13. AARHUS UNIVERSITET HEAVY DRINKING (10/20+ GRAMS ETHANOL PER DAY, OR (95%CI) 12

14. AARHUS UNIVERSITET MONTHLY RSOD OR (95%CI) 13 MenWomen R2R2 0.150.22 Age (centred, in decades)0.62 (0.59-0.66) 0.59 (0.54-0.64) Age (centred, squared)-- Marital status Married or partnership --0.79 (0.64-0.96) Having children0.69 (0.59-0.81) 0.57 (0.47-0.71) Employment status Working, studying /apprentice --1.60 (1.22-2.11) Educational level Middle or high -- Income Middle or high 1.28 (1.08-1.52) -- survey year (forced into the model, ref: 2003) 1.03 (0.87-1.23) 0.98 (0.73-1.32) Admin. Mode for 2011 web (ref: telephone) --1.32 (1.02-1.70) Age*children1.41 (1.27-1.57) 1.58 (1.38-1.82)

15. AARHUS UNIVERSITET QUANTITY PER DRINKING DAY DRINKERS ONLY 14 * *

16. AARHUS UNIVERSITET PROBLEMS SCORE 15

17. AARHUS UNIVERSITET 6+ PROBLEMS SCORE, ALL RESPONDENTS 16 OR (95%CI) MenWomen R2R2 0.21 Age (centred, in decades)0.63 (0.57-0.70) 0.54 (0.47-0.63) Marital status Married or partnership 0.59 (0.44-0.79) 0.48 (0.31-0.72) Having children0.61 (0.43-0.86) 0.56 (0.34-0.93) Employment status Working, studying or apprentice -- Educational level Middle or high 1.49 (1.08-2.04) -- Income Middle or high 0.74 (0.54-0.99) -- survey year (forced into the model, ref: 2003) 1.15 (0.73-1.83) 2.98 (1.63-5.45) Admin. Mode for 2011 web (ref: telephone) 2.45 (1.70-3.53) --

18. AARHUS UNIVERSITET 17 risk curves for young men

19. AARHUS UNIVERSITET 18 risk curves for young women

20. AARHUS UNIVERSITET 1.Current drinking ↓ slightly 2.Heavy drinking ↓ 3.RSOD stable ↔ 4.Problem prevalence ↑ among drinking women 5.Risk curves: higher problems prevalence in 2011 for same drinking amounts in young women 6.administration mode effect (higher values for web-respondents) for some measures 19 SUMMARY

21. AARHUS UNIVERSITET DISCUSSION Paradoxical trends seen earlier in North America? Similar trends have begun to appear in “wet countries” - Europe: Geneva, Île-de-France, now DK 20

22. AARHUS UNIVERSITET DISCUSSION Explanations could be: 1.Items of CAGE + AUDIT measure differing social norms (e.g., guilt) 2.Changing sensibility for problems (only for women) 3.Norms have changed 4.Polarization (e.g., Svensson) 5.Further research to look at consumption distribution and registry/treatment data 6.Methodological analysis on administration mode effect 21

23. AARHUS UNIVERSITET Thank you! 22