Introduction Social inequalities in adverse consequences of alcohol consumption, i.e. alcohol-related disease and death, have consistently been found in adult populations with people from lower socioeconomic position experiencing harm more frequently, also when level of alcohol consumption is taken into account. This phenomenon is known as the alcohol harm paradox. Among adolescents, alcohol use is the leading global risk factor for years of life lost due to premature mortality or disability. In Europe, 13% of adolescents aged 15–16 years have been intoxicated within a 30-day period. Therefore, it is relevant to explore if alcohol consumption pattern translates into an alcohol harm paradox already in adolescence. In this age group, alcohol causes acute harms such as violence, accidents, problems with parents or friends, unprotected sexual intercourse and illicit drug use. We aim at testing the hypothesis that in Danish teenagers, lower socioeconomic position is associated with higher odds of experiencing alcohol related harm, also after taking level of alcohol consumption into account. Methods Data from the Danish National Youth Study 2014 including a total of 70,566 high school students from 119 high schools were included. Socioeconomic position was measured as parents’ educational level, family income, parents’ occupational status and financial strain. The former three were obtained by linkage to Danish national registers with high validity whereas financial strain was self-reported. Alcohol related harm was measured as having been in a fight, been involved in an accident, had problems with family or friends, had sex that was regretted afterwards, and done drugs that was regretted afterwards. A combined measure was constructed defined as having experienced any of the individual harms more than once. Analyses were adjusted by age, sex, perceived ethnicity, school type and frequency of binge drinking. Results Higher frequency of binge drinking was associated with higher odds of alcohol related harm in all socioeconomic groups. Lower socioeconomic position measured by parents’ educational level, family income, parents’ occupational status, and financial strain was associated with higher odds of having experienced alcohol related harm more than once as compared to higher socioeconomic position. For example, students having parents with elementary school as the highest education had the highest odds of experiencing alcohol related harm more than once (OR = 1.26, 95%CI: 1.12;1.42) compared to students with parents with long education. Lower socioeconomic position was associated with higher odds of being in a fight, having problems with family or friends, having sex and regretting afterwards, or doing drugs and regretting afterwards. All associations were similar between boys and girls. There was no statistical significant interaction between frequency of binge drinking and socioeconomic position ( P = 0.2). Conclusions A dose-response relationship was observed between frequency of binge drinking and odds of alcohol related harm, and this was consistently observed in all social strata. However, odds of alcohol related harm were generally higher among students whose parents had low socioeconomic position as compared to those with high socioeconomic position.
Read full abstract