576268
SJP0010.1177/1403494815576268H. Källmén et al.Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT
research-article2015
Scandinavian Journal of Public Health, 2015; 43: 381–384
Short communication
Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT
Håkan Källmén1, P. Wennberg2, M. Ramstedt3 & M. Hallgren4 1STAD,
Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet, Sweden, 2Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Sweden and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden, 3The Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden, and 4Department of Public Health Sciences, Division of Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Sweden
Abstract Background: Alcohol habits in Sweden, assessed as sales and estimates of unrecorded consumption, have changed since joining the EU. Earlier studies using the Alcohol Use Disorders Identification Test (AUDIT) showed that reported consumption is consistent with sales data, which makes it possible to assess consumption according to sex and age. Aims: This study reports the changes in alcohol habits between 2009 and 2014, a period starting a couple of years after Sweden joined the EU. Method: The AUDIT was sent to a random sample of the Swedish population aged between 17 and 80 years old. Results: No statistically significant changes were shown in six age and sex groups. Conclusions: Alcohol habits have stabilised in Sweden but on a higher consumption level than before. Key Words: Alcohol consumption, Alcohol Use Disorders Identification Test, Swedish population
Introduction Per capita alcohol consumption in Sweden increased by approximately 13% between 2001 and 2013 from 8.8 to 9.9 litres of pure alcohol [1], and by 4% between 2009 and 2013. These consumption trends are based on sales data and estimates of unrecorded alcohol consumption from surveys. One limitation of these data is that they cannot identify the characteristics of certain risk groups. However, this is important from a prevention perspective and for public health. The Alcohol Use Disorders Identification Test (AUDIT) [2] is a self-report questionnaire designed to assess problematic drinking habits. When used at the population level, it enables problem drinking in specific age and sex groups to be estimated. In Sweden, the AUDIT has been used to screen problematic drinking in the adult population on five occasions during the harmonisation process with the EU, between 1997 and 2009 [3]. The results
highlighted two important changes. First, the initial increase in alcohol availability was associated with a significant increase in consumption among middleaged women in particular (commencing from a low level), but not among men [4]. This convergence between male and female consumption habits has been referred to as ‘the convergence effect’ [5], and postulates that increased alcohol consumption has followed increased social equality among women. Second, Källmén et al. [3] showed that there was a significant decrease in alcohol consumption between 2005 and 2009 among both men and women aged 17–27 years, a finding supported by other studies [6]. The aim of this study was to evaluate whether the consumption trends shown in previous AUDIT studies have continued through to 2014, and if other groups have changed their consumption significantly. Another aim was to evaluate whether the stability in
Correspondence: Håkan Källmén, STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, Stockholm, 11364, Sweden. E-mail: [email protected] (Accepted 13 February 2015) © 2015 the Nordic Societies of Public Health DOI: 10.1177/1403494815576268
382 H. Källmén et al. overall drinking levels can be observed in problem drinking based on the AUDIT. Method Participants in the 2014 survey A random sample of 1459 people (50% male) living in Sweden was drawn from an official national register of addresses for all Swedish citizens (Dafa/Spar). The participants were aged between17 and 80 years old. The 2014 sample size was equivalent to the number of participants in previous AUDIT investigations [3,4,7,8], with a proportional increase among adults aged 72–80 years The response rate after two reminders had been sent (three waves) was 60% (n=863). Ninety-two respondents did not disclose their sex, resulting in a final distribution of 344 men (45%) and 422 women (55%). Participants in the 2009 survey In 2009, a random sample of 1250 people (50% men) was drawn from the same national register (Dafa/Spar). All potential respondents were aged between 17 and 71 years, and their addresses were distributed evenly across Sweden. Ten people who had changed their address without registering a new one were excluded from the sample. Two reminders were sent out three and six weeks after the first questionnaire was sent. Before the first reminder was sent out, 314 people (25%) had responded to the AUDIT questionnaire; before the second reminder, 483 (39%) had completed the questionnaire. The final response rate was 54% (665 people). Data are available on request from the first author. The AUDIT questionnaire. The AUDIT is recommended by the World Health Organisation and is used internationally to screen for problem drinking among the general population. The Swedish version of the test has been described elsewhere [7] and shows good psychometric properties. Since the authors have previously used the AUDIT to estimate changes in Swedish alcohol habits [3], this study added a fifth measurement point, making it possible to follow Swedish drinking habits (alcohol consumption and related harm) in different strata over a 13-year period. The AUDIT consists of 10 items: the first three items estimate the frequency and quantity of alcohol consumed on a typical occasion, with four response alternatives. Item 3 is an estimate of the frequency of heavy episodic drinking, also referred to as ‘binge drinking’. AUDIT items 4–8 assess levels of alcohol dependency or the ability to control drinking
behaviour, and refer to drinking during ‘the last year’. The final two AUDIT items assess the harm arising from alcohol use, and are scored on a 3-item scale. The maximum score is 40 points. In this study, total AUDIT scores and AUDIT-C (the first three items comprising the consumption subscale) were analysed, in addition to the alcohol problems subscale (items 4–10). Changes observed between 2009 and 2014 are described. The cut-off for hazardous drinking was set to 8 points for men [2] and 6 points for women, as is common in Sweden [8]. Design and procedure. This study employed a repeated cross-sectional design with two repeated measurements taken in 2009 and 2014. The procedure used to collect the data has been described elsewhere [3]. The AUDIT questionnaire together with an introductory letter and a stamped, self-addressed envelope were mailed to each respondent. The random selection of addresses for respondents and the distribution of the paper questionnaires and reminders were performed by a marketing corporation (PAR AB). PAR also recorded all responses in a Microsoft Excel file that was sent to the authors. PAR ensured the anonymity of the respondents, with the authors being unaware of respondents’ names or addresses. A small financial incentive of SEK 50 (about US$8) in the form of a gift voucher was sent to the respondents if they called the project leader and revealed the individual reference code. No telephone call was registered. This study was authorised by the Ethical Review Board in Stockholm (Dnr 2013/176-31/5 and Dnr 2013/086-32). Results Changes in alcohol consumption habits between 2009 and 2014 are shown in Table I. As 2014 was the first time that data were collected for the entire age span (17–80 years), no comparison was possible for the oldest age group (72–80 years). Two-way analyses of variance (ANOVAs) showed no significant change in AUDIT total score between 2009 and 2014. There were no significant changes in any of the subgroup analyses. On average, men scored higher than women did in the age groups older than 28 years. There were similar changes in AUDIT scores for both sexes (but no interaction effect) across years. Analyses of the consumption subscale (AUDIT-C) and the ‘alcohol problem scale’ showed a similar pattern (p>0.2). Discussion This study is the latest in a series of cross-sectional surveys using AUDIT in the general Swedish
Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT 383 Table I. Mean (standard deviation) for total scores and the two subscales, AUDIT-C and the alcohol problem scale of the Alcohol Use Disorders Identification Test. Proportion of risk consumers and 95% confidence intervals (%) for 2009 and 2014. Age group
Sex
AUDIT AUDIT-C Alcohol problem
2009
2014
Risk consumers 2009 (%)
Risk consumers 2014 (%)
17–27
Men Women
10.5 (5.5–15.5) 11.4 (6.6–16.2)
17.1 (11.7–22.5) 10.3 (6.4–14.2)
61–71
Men Women
8.9 (1.5–16.3) 5.7 (0.3–11.1)
11.5 (4.8–18.2) 5.3 (0.8–9.8)
72–80
Men Women
All
Men Women
6.27 (5.09) 4.31 (2.81) 2.04 (2.68) 6.00 (5.10) 3.83 (2.28) 2.17 (3.28) 4.59 (3.84) 3.48 (2.05) 1.14 (2.37) 2.94 (2.63) 2.47 (1.54) 0.48 (1.51) 3.66 (2.99) 2.87 (1.81) 0.79 (1.71) 2.33 (2.16) 2.15 (1.77) 0.19 (0.70) 3.15 (2.88) 2.54 (1.84) 0.61 (1.39) 1.88 (1.74) 1.77 (1.55) 0.12 (0.40) 4.31 (3.71) 3.28 (2.07) 1.05 (2.16) 2.98 (2.99) 2.44 (1.76) 0.56 (1.68)
30.8 (13.1–48.5) 50.0 (34.9–65.1)
Men Women
7.82 (6.67) 4.30 (3.07) 2.37 (4.19) 5.09 (3.63) 3.06 (2.16) 1.38 (2.21) 4.43 (2.78) 3.20 (1.97) 0.80 (1.51) 3.11 (2.24) 2.32 (1.55) 0.45 (1.15) 3.46 (4.53) 2.45 (1.97) 0.62 (2.95) 2.66(1.70) 2.10 (1.59) 0.17 (0.54)
42.4 (25.6–59.2) 35.2 (22.5–47.9)
28–60
AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem
4.73 (4.20) 3.15 (2.24) 1.02 (2.55) 3.38 (2.59) 2.40 (1.73) 0.56 (1.37)
population. The previous ones were undertaken in 1997, 2001, 2005 and 2009 [3]. When contrasting the results of the 2014 survey against data from 2009, the differences appear rather small and do not reach statistical significance. However, both the means and the prevalence of risk consumers for younger men and women (17–27 years) change in the opposite direction, indicating a tendency towards a sex convergence (meaning a lower consumption among boys and higher among the girls) but this trend was not seen in the other age groups. Thus, after two decades of turmoil in the Swedish alcohol landscape, including Sweden’s membership with the EU and rapid fluctuations in alcohol consumption, levels of drinking and the prevalence of problem drinking appear to have stabilised on a higher level compared with the period prior to joining the EU. Conflict of interests The authors declare that there is no conflict of interests.
15.1 (10.6–19.6) 15.0 (10.9–19.1)
4.9 (0.0–11.5) 2.1 (0.0–6.1)
15.2 (11.6–18.9) 12.3 (9.2–15.4)
Funding The authors are grateful to the Swedish Research Council for Health, Working life and Welfare for funding this study (grant number 2009-1705). References [1] Leifman H and Trolldal B. Alkoholkonsumtionen I Sverige 2013 [The alcohol consumption in Sweden 2013] CAN-rapport 142. Stockholm: EO Grafiska, 2014. [2] Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption – II. Addiction 1993;88:791–804. [3] Källmén H, Wennberg P, Lefman H, et al. Alcohol habits in Sweden during 1997–2009 with particular focus on 2005– 2009, assessed with the AUDIT: a repeated cross sectional study. Eur Addict Res 2011;17:90–96. [4] Källmén H, Wennberg P, Berman AH, et al. Alcohol habits in Sweden during 1997–2005 measured with the AUDIT. Nord J Psychiatry 2007;61:466–470. [5] Neve RJM, Drop MJ, Lemmens PH, et al. Gender differences in drinking behavior in the Netherlands: convergence or stability? Addiction 1994;91:357–373. [6] Leifman H and Ramstedt M. Svenska folkets alkoholvanor under senare år med fokus på 2004–2009 [The Swedish alcohol habits during recent years with focus on 2004–2009]. Stockholm: STAD, 2009.
384 H. Källmén et al. [7] Bergman H and Källmén H. Alcohol use among Swedes and a psychometric evaluation of the Alcohol Use Disorders Identification Test. Alcohol 2002;37:245–251. [8] Bergman H and Källmén H. Kvinnor har fått mer riskfyllda och skadligare alkoholvanor. Undersökning av
förändringar i svenskarnas alkoholvanor åren 1997 och 2001 [Women have riskier and more harmful alcohol habits. Investigation of alcohol habits in the Swedish population 1997–2001]. Läkartidningen 2003;100:1028– 1035.
Copyright of Scandinavian Journal of Public Health is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
SJP0010.1177/1403494815576268H. Källmén et al.Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT
research-article2015
Scandinavian Journal of Public Health, 2015; 43: 381–384
Short communication
Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT
Håkan Källmén1, P. Wennberg2, M. Ramstedt3 & M. Hallgren4 1STAD,
Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet, Sweden, 2Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Sweden and Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden, 3The Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden, and 4Department of Public Health Sciences, Division of Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Sweden
Abstract Background: Alcohol habits in Sweden, assessed as sales and estimates of unrecorded consumption, have changed since joining the EU. Earlier studies using the Alcohol Use Disorders Identification Test (AUDIT) showed that reported consumption is consistent with sales data, which makes it possible to assess consumption according to sex and age. Aims: This study reports the changes in alcohol habits between 2009 and 2014, a period starting a couple of years after Sweden joined the EU. Method: The AUDIT was sent to a random sample of the Swedish population aged between 17 and 80 years old. Results: No statistically significant changes were shown in six age and sex groups. Conclusions: Alcohol habits have stabilised in Sweden but on a higher consumption level than before. Key Words: Alcohol consumption, Alcohol Use Disorders Identification Test, Swedish population
Introduction Per capita alcohol consumption in Sweden increased by approximately 13% between 2001 and 2013 from 8.8 to 9.9 litres of pure alcohol [1], and by 4% between 2009 and 2013. These consumption trends are based on sales data and estimates of unrecorded alcohol consumption from surveys. One limitation of these data is that they cannot identify the characteristics of certain risk groups. However, this is important from a prevention perspective and for public health. The Alcohol Use Disorders Identification Test (AUDIT) [2] is a self-report questionnaire designed to assess problematic drinking habits. When used at the population level, it enables problem drinking in specific age and sex groups to be estimated. In Sweden, the AUDIT has been used to screen problematic drinking in the adult population on five occasions during the harmonisation process with the EU, between 1997 and 2009 [3]. The results
highlighted two important changes. First, the initial increase in alcohol availability was associated with a significant increase in consumption among middleaged women in particular (commencing from a low level), but not among men [4]. This convergence between male and female consumption habits has been referred to as ‘the convergence effect’ [5], and postulates that increased alcohol consumption has followed increased social equality among women. Second, Källmén et al. [3] showed that there was a significant decrease in alcohol consumption between 2005 and 2009 among both men and women aged 17–27 years, a finding supported by other studies [6]. The aim of this study was to evaluate whether the consumption trends shown in previous AUDIT studies have continued through to 2014, and if other groups have changed their consumption significantly. Another aim was to evaluate whether the stability in
Correspondence: Håkan Källmén, STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, Stockholm, 11364, Sweden. E-mail: [email protected] (Accepted 13 February 2015) © 2015 the Nordic Societies of Public Health DOI: 10.1177/1403494815576268
382 H. Källmén et al. overall drinking levels can be observed in problem drinking based on the AUDIT. Method Participants in the 2014 survey A random sample of 1459 people (50% male) living in Sweden was drawn from an official national register of addresses for all Swedish citizens (Dafa/Spar). The participants were aged between17 and 80 years old. The 2014 sample size was equivalent to the number of participants in previous AUDIT investigations [3,4,7,8], with a proportional increase among adults aged 72–80 years The response rate after two reminders had been sent (three waves) was 60% (n=863). Ninety-two respondents did not disclose their sex, resulting in a final distribution of 344 men (45%) and 422 women (55%). Participants in the 2009 survey In 2009, a random sample of 1250 people (50% men) was drawn from the same national register (Dafa/Spar). All potential respondents were aged between 17 and 71 years, and their addresses were distributed evenly across Sweden. Ten people who had changed their address without registering a new one were excluded from the sample. Two reminders were sent out three and six weeks after the first questionnaire was sent. Before the first reminder was sent out, 314 people (25%) had responded to the AUDIT questionnaire; before the second reminder, 483 (39%) had completed the questionnaire. The final response rate was 54% (665 people). Data are available on request from the first author. The AUDIT questionnaire. The AUDIT is recommended by the World Health Organisation and is used internationally to screen for problem drinking among the general population. The Swedish version of the test has been described elsewhere [7] and shows good psychometric properties. Since the authors have previously used the AUDIT to estimate changes in Swedish alcohol habits [3], this study added a fifth measurement point, making it possible to follow Swedish drinking habits (alcohol consumption and related harm) in different strata over a 13-year period. The AUDIT consists of 10 items: the first three items estimate the frequency and quantity of alcohol consumed on a typical occasion, with four response alternatives. Item 3 is an estimate of the frequency of heavy episodic drinking, also referred to as ‘binge drinking’. AUDIT items 4–8 assess levels of alcohol dependency or the ability to control drinking
behaviour, and refer to drinking during ‘the last year’. The final two AUDIT items assess the harm arising from alcohol use, and are scored on a 3-item scale. The maximum score is 40 points. In this study, total AUDIT scores and AUDIT-C (the first three items comprising the consumption subscale) were analysed, in addition to the alcohol problems subscale (items 4–10). Changes observed between 2009 and 2014 are described. The cut-off for hazardous drinking was set to 8 points for men [2] and 6 points for women, as is common in Sweden [8]. Design and procedure. This study employed a repeated cross-sectional design with two repeated measurements taken in 2009 and 2014. The procedure used to collect the data has been described elsewhere [3]. The AUDIT questionnaire together with an introductory letter and a stamped, self-addressed envelope were mailed to each respondent. The random selection of addresses for respondents and the distribution of the paper questionnaires and reminders were performed by a marketing corporation (PAR AB). PAR also recorded all responses in a Microsoft Excel file that was sent to the authors. PAR ensured the anonymity of the respondents, with the authors being unaware of respondents’ names or addresses. A small financial incentive of SEK 50 (about US$8) in the form of a gift voucher was sent to the respondents if they called the project leader and revealed the individual reference code. No telephone call was registered. This study was authorised by the Ethical Review Board in Stockholm (Dnr 2013/176-31/5 and Dnr 2013/086-32). Results Changes in alcohol consumption habits between 2009 and 2014 are shown in Table I. As 2014 was the first time that data were collected for the entire age span (17–80 years), no comparison was possible for the oldest age group (72–80 years). Two-way analyses of variance (ANOVAs) showed no significant change in AUDIT total score between 2009 and 2014. There were no significant changes in any of the subgroup analyses. On average, men scored higher than women did in the age groups older than 28 years. There were similar changes in AUDIT scores for both sexes (but no interaction effect) across years. Analyses of the consumption subscale (AUDIT-C) and the ‘alcohol problem scale’ showed a similar pattern (p>0.2). Discussion This study is the latest in a series of cross-sectional surveys using AUDIT in the general Swedish
Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT 383 Table I. Mean (standard deviation) for total scores and the two subscales, AUDIT-C and the alcohol problem scale of the Alcohol Use Disorders Identification Test. Proportion of risk consumers and 95% confidence intervals (%) for 2009 and 2014. Age group
Sex
AUDIT AUDIT-C Alcohol problem
2009
2014
Risk consumers 2009 (%)
Risk consumers 2014 (%)
17–27
Men Women
10.5 (5.5–15.5) 11.4 (6.6–16.2)
17.1 (11.7–22.5) 10.3 (6.4–14.2)
61–71
Men Women
8.9 (1.5–16.3) 5.7 (0.3–11.1)
11.5 (4.8–18.2) 5.3 (0.8–9.8)
72–80
Men Women
All
Men Women
6.27 (5.09) 4.31 (2.81) 2.04 (2.68) 6.00 (5.10) 3.83 (2.28) 2.17 (3.28) 4.59 (3.84) 3.48 (2.05) 1.14 (2.37) 2.94 (2.63) 2.47 (1.54) 0.48 (1.51) 3.66 (2.99) 2.87 (1.81) 0.79 (1.71) 2.33 (2.16) 2.15 (1.77) 0.19 (0.70) 3.15 (2.88) 2.54 (1.84) 0.61 (1.39) 1.88 (1.74) 1.77 (1.55) 0.12 (0.40) 4.31 (3.71) 3.28 (2.07) 1.05 (2.16) 2.98 (2.99) 2.44 (1.76) 0.56 (1.68)
30.8 (13.1–48.5) 50.0 (34.9–65.1)
Men Women
7.82 (6.67) 4.30 (3.07) 2.37 (4.19) 5.09 (3.63) 3.06 (2.16) 1.38 (2.21) 4.43 (2.78) 3.20 (1.97) 0.80 (1.51) 3.11 (2.24) 2.32 (1.55) 0.45 (1.15) 3.46 (4.53) 2.45 (1.97) 0.62 (2.95) 2.66(1.70) 2.10 (1.59) 0.17 (0.54)
42.4 (25.6–59.2) 35.2 (22.5–47.9)
28–60
AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem AUDIT AUDIT-C Alc problem
4.73 (4.20) 3.15 (2.24) 1.02 (2.55) 3.38 (2.59) 2.40 (1.73) 0.56 (1.37)
population. The previous ones were undertaken in 1997, 2001, 2005 and 2009 [3]. When contrasting the results of the 2014 survey against data from 2009, the differences appear rather small and do not reach statistical significance. However, both the means and the prevalence of risk consumers for younger men and women (17–27 years) change in the opposite direction, indicating a tendency towards a sex convergence (meaning a lower consumption among boys and higher among the girls) but this trend was not seen in the other age groups. Thus, after two decades of turmoil in the Swedish alcohol landscape, including Sweden’s membership with the EU and rapid fluctuations in alcohol consumption, levels of drinking and the prevalence of problem drinking appear to have stabilised on a higher level compared with the period prior to joining the EU. Conflict of interests The authors declare that there is no conflict of interests.
15.1 (10.6–19.6) 15.0 (10.9–19.1)
4.9 (0.0–11.5) 2.1 (0.0–6.1)
15.2 (11.6–18.9) 12.3 (9.2–15.4)
Funding The authors are grateful to the Swedish Research Council for Health, Working life and Welfare for funding this study (grant number 2009-1705). References [1] Leifman H and Trolldal B. Alkoholkonsumtionen I Sverige 2013 [The alcohol consumption in Sweden 2013] CAN-rapport 142. Stockholm: EO Grafiska, 2014. [2] Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption – II. Addiction 1993;88:791–804. [3] Källmén H, Wennberg P, Lefman H, et al. Alcohol habits in Sweden during 1997–2009 with particular focus on 2005– 2009, assessed with the AUDIT: a repeated cross sectional study. Eur Addict Res 2011;17:90–96. [4] Källmén H, Wennberg P, Berman AH, et al. Alcohol habits in Sweden during 1997–2005 measured with the AUDIT. Nord J Psychiatry 2007;61:466–470. [5] Neve RJM, Drop MJ, Lemmens PH, et al. Gender differences in drinking behavior in the Netherlands: convergence or stability? Addiction 1994;91:357–373. [6] Leifman H and Ramstedt M. Svenska folkets alkoholvanor under senare år med fokus på 2004–2009 [The Swedish alcohol habits during recent years with focus on 2004–2009]. Stockholm: STAD, 2009.
384 H. Källmén et al. [7] Bergman H and Källmén H. Alcohol use among Swedes and a psychometric evaluation of the Alcohol Use Disorders Identification Test. Alcohol 2002;37:245–251. [8] Bergman H and Källmén H. Kvinnor har fått mer riskfyllda och skadligare alkoholvanor. Undersökning av
förändringar i svenskarnas alkoholvanor åren 1997 och 2001 [Women have riskier and more harmful alcohol habits. Investigation of alcohol habits in the Swedish population 1997–2001]. Läkartidningen 2003;100:1028– 1035.
Copyright of Scandinavian Journal of Public Health is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
