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Publication - Professor George Davey Smith

    No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades

    a natural experiment

    Citation

    Thern, E, Jia, T, Willmer, M, Munter, Jd, Norstrom, T, Ramstedt, M, Smith, GD, Tynelius, P & Rasmussen, F, 2017, ‘No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment’. Journal of Epidemiology and Community Health.

    Abstract

    Background: A strict high legal age limit for alcohol purchases decreases adolescents’ access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality.
    Methods: A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%–5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14–20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis.
    Results: In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found.
    Conclusion: The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.

    Full details in the University publications repository