Swedish Alcohol Policy Research Articles

The analytical, the political and the personal: Swedish stakeholder narratives about alcohol policy at football stadiums

ABSTRACT For public health interventions to be effective, they need to be supported or at least accepted by those affected, and social policy should therefore be understood as political and strategic. This raises questions about the relationship between the analytical, the political and the personal in policy processes. This article offers an in-depth analysis of such issues, as they were enacted during interviews with Swedish alcohol policy stakeholders. It focuses on the assumptions and a priori ‘truths’ articulated in interviews about Responsible Beverage Services (RBS) at Swedish football stadiums or ‘Football Without Bingeing’. We argue that the participants combined different narrative forms, such as seemingly objective chronological accounts and personal ethical judgments, in talking about the policy initiative. Through such narrative intersections, three key ‘truths’ were produced that reinforced the link between alcohol and violence, necessitated blanket population-level measures to reduce alcohol use and made gendered behavior an irrelevant policy target.

Effects of Local Alcohol Prevention Initiatives in Swedish Municipalities, 2006–2014

Background: Several components of the Swedish alcohol policy, e.g., pricing and availability, weakened when Sweden joined the EU in 1995. To counteract the possible negative effects of this, emphasis was placed on the local level as an important arena of alcohol prevention. Thus, considerable efforts were made to strengthen alcohol prevention in Swedish municipalities. Objectives: The aim of this study was to examine whether local alcohol prevention reduced consumption and alcohol-related harm in Swedish municipalities. Methods: Alcohol prevention was monitored using a composite measure called the Alcohol Prevention Magnitude Measure (APMM), with subcategories of staff and budget, inspections and licenses, policy, activities, and cooperation. APMM and its categories were analysed in relation to alcohol consumption and harm over time, 2006–2014. A fixed effects model was used with 63% (N=182, consumption) and 71% (N=207, harm) of 290 Swedish municipalities, respectively, included in the analyses. Results: The main results suggest that when APMM increases with 1 percent, the alcohol-related mortality decreases with 0.26 percent, controlled for changes in population size, median income, unemployment, and post-secondary education. In light of this result, the estimated effect of APMM on alcohol consumption (sales) is small (0.02 percent decrease); possible explanations for this are discussed in the article. Conclusion: The overall results indicate that local alcohol prevention initiatives in Sweden have reduced some forms of alcohol-related harm, not least alcohol-related mortality, during the period 2006–2014. Further studies are needed to assess the generalizability of the present study.

The impact of relaxed traveller allowances: Fixed-effects analyses of the associations between consumer behaviour and alcohol use.

Aim:To analyse to what extent the gradual relaxation of traveller allowances for alcoholic beverages 2001–2004 changed consumer behaviours and subsequent alcohol consumption patterns within a longitudinal panel data population study in Southern Sweden.Methods:General population random sample panel data study with repeated measurements were collected in 1999, in 2005, and in 2010 in the county of Scania. The study analyses answers from 9770 individuals, who in 1999 were 18–80 years old. A fixed-effects modelling was applied to assess the association between consumer behaviour and change in alcohol use across the study period.Results:Cross-border shopping for alcoholic beverages was associated, on average, with a 3.1% (p < 0.001) increase in alcohol use. Buying imported alcohol from a private person was associated with a mean increase of 2.6% (p < 0.001), with a total additive effect of 5.7%. Furthermore, when stratified for gender, age, and location, significant fixed effects were found. The magnitude was greater among women, younger and older ages, and in particular in the Northeast and Central regions. Both consumer behaviours – cross-border trading (OR 1.6, CI 95% 1.28–1.92) and buying alcohol from a private person (OR 1.4, CI 95% 1.12–1.73) – were significantly associated with heavy alcohol use.Conclusion:The fixed-effects analyses identified significant associations between consumer behaviours and alcohol consumption. The uptake of behaviours that developed because of a relaxation of the Swedish alcohol policy has contributed to an overall long-term increase in alcohol use and higher prevalence of heavy alcohol use within this general population study sample.

Long-term effects of changes in Swedish alcohol policy: can alcohol policies effective during adolescence impact consumption during adulthood?

To assess long-term effects of alcohol policy in Sweden by estimating the differences between cohorts growing up during periods with liberal alcohol policies and a cohort growing up during a period with restrictive alcohol policy. The data come from repeated cross-sectional surveys conducted in Sweden between 2002 and 2013, and were collected monthly using telephone interviews with a nationally representative sample. Cohorts were constructed by identifying periods when alcohol policy differed between being more liberal or more restrictive. The liberal-period cohorts were merged into one and compared with the restrictive-period cohort. Sweden. A total of 127480 adult Swedes born between 1951 and 1989. Monthly volume of alcohol consumption in litres of pure alcohol derived from a beverage-specific graduated quantity-frequency scale. Relative to the liberal-period reference cohorts (who turned 15 between 1966 and 1977 or 1992 and 2004), the cohort that grew up during a period with restrictive alcohol policy (turning 15 between 1978 and 1991) was found to have lower alcohol consumption (coeff.=-0.039: confidence interval-0.050 to -0.027: P<0.001). The mean volume for the liberal and restrictive cohorts across all survey years was 0.42 and 0.38 litres of pure alcohol, respectively. Consumption development for the period 2002-13 was, however, the same for both cohort groups. Men and women in Sweden who grew up during a period with more restrictive alcohol policies currently drink less alcohol than those who grew up during periods with more liberal policies.

Between zero tolerance and damage control: policy and parental strategies concerning teenagers and alcohol

This article focuses on the distribution of responsibility between teenagers and parents in relation to teenagers’ alcohol consumption. It does so by contrasting the way in which responsibility is ascribed to parents in public guidelines on underage drinking with parents’ posts made to an online discussion board. In Swedish alcohol policy on underage drinking, to a large extent the replacement of state control over the accessibility of alcohol with individual responsibility translates into parental responsibility. Further, in national information campaigns, parents have been urged to stand their ground and maintain a zero-tolerance stance in order to minimise underage drinking. Like policy-makers, parents who engaged in online discussions on teenagers and alcohol were concerned about the effects of underage drinking. But in addition to the national alcohol policy goals of postponing the alcohol debut and minimising underage drinking, parents were also concerned about the effects of their drinking rules on their relationship with their teenagers, and about the long-term effects of their parenting strategies on their children’s later drinking habits as adults. And in contrast to public policy and national information campaigns, not all parents ascribed to themselves the power to influence their teenage children’s drinking.

Socioeconomic Disparities in Alcohol-Related Mortality in Sweden, 1991-2006: A Register-Based Follow-Up Study.

To examine whether apparent stability of overall alcohol-related mortality in Sweden during a period when traditionally strict alcohol policies went through a series of liberalizations and overall alcohol mortality remained stable, concealed a heterogeneity across socioeconomic groups (defined by educational level); and whether an increase occurred in the contribution of alcohol-related mortality to overall mortality differentials. Drawing on cause of death data linked to census records for the period 1991-2006, we computed annual age-standardized and sex-specific rates of alcohol-related mortality for groups with low, intermediate and high education. Alcohol-related mortality was considerably higher in lower educational groups for both men and women. For men, the trends in alcohol-related mortality were roughly stable for all education groups, and there were no signs of increasing inequalities by education. For women, alcohol-related mortality increased significantly for the low-education group whereas the two higher education groups showed no significant time trends, thus resulting in a widened educational gap in alcohol mortality for women. Alcohol's contribution to the overall mortality differentials declined for men and was basically unchanged for women. The findings provide only partial support to the hypothesis that the liberalizations of Swedish alcohol policy have been followed by a general increase in socioeconomic disparities in alcohol-related mortality.

Sweden, the EU and the Alcohol Traveller's Allowances

Restrictive alcohol policies have a long history at the national level in Sweden; however, with the accession to the European Union, the international component of alcohol policy has become clearer, and the national policies have been eroded. Sweden had to abandon low traveller's allowances and gradually adopt the considerably higher European levels by January 1, 2004. On the EU level the traveller's allowances were an issue long before Sweden's accession, and high allowances were a conscious way of forcing down high taxes as an instrument of harmonization. The purpose of the article is to analyze how the changes and the Swedish government's actions on the traveller's allowances issue have been understood. Analyzing this case contributes to understanding the major changes that have occurred in Swedish alcohol policy since the mid-1990s. Different narratives from interviews, official documents, and news articles make it possible to understand alcohol policy developments in Sweden in relation to the EU. The article finds that there are five main narratives which have been used to try to explain the development of the traveller's allowances question: the misinterpretation explanation, the double accounts explanation, the impotence explanation, the humility explanation, and the optimism explanation. The article also shows that the different narratives have developed over time, indicating a learning process among Swedish authorities on the functioning of EU policy processes.

Gendered discourse in Swedish national alcohol policy action plans 1965–2007: Invisible men and problematic women

M. Abrahamson &amp; K. Heimdahl: Gendered discourse in Swedish national alcohol policy action plans 1965-2007: Invisible men and problematic women In a critical discourse analysis of Swedish alcohol policy action plans, we have compared five different documents between 1965–2007 to examine problems with and reasons for women's and men's drinking, and recommendations for policy actions. The results display a hierarchical logic between the genders. During the early years, men's drinking is implicitly constituted as the norm. A basic tenet is that female and male drinking are the same. Women may drink less, but their drinking is not of a different character. It is highly exceptional to make a separation between men's and women's drinking. In later documents, however, the separation of these spheres results in female drinking being depicted as more problematic because of women's more vulnerable condition and individual psychological reasons. In order to highlight female drinking problems, male drinking is being erased from the picture and constructed in a positive contrast. As a consequence, men's drinking is normalised. Finally, in the most recent documents, attention has exceedingly shifted to women as containers of the foetus and to young women's and girls’ sexual behaviour and psychiatric problems.

Working with or against the stores?

PurposeThe purpose of this paper is to describe and analyse the implementation by a non‐governmental organization (NGO) of an intervention with two different strategies – one employing confrontational approaches, the other cooperative ones – aiming to reduce the rate of successful purchase attempts (PAs) of medium‐strength beer in Sweden.Design/methodology/approachThe Swedish Youth Temperance Movement (UNF) has been responsible for the development and implementation of the intervention, and a research team at Örebro University for the evaluation. The outcome analysis is based on 1,475 PA from 25 Swedish cities during 2003‐2006. Annual reports, discussions and telephone interviews have been used to understand the intervention process.FindingsIn 40 per cent of all registered PAs, beer is sold to minors. In the eight cities using a structured strategy, there is a significant decrease from 2003 to 2006 (44‐27 per cent; p&lt;0.001). The confrontation method, compared to no model, is more than four times (OR = 3.8; CI 2.0‐7.0) more likely to yield a positive result. Compared to the cooperation method, it is even more likely to yield a positive result (OR = 4.7; CI 2.1‐10.7).Practical implicationsWorking with a structured strategy gives significantly better results than working without one. The confrontation method is more successful than the cooperation method. Developing a preventive strategy takes time, cooperation perhaps requiring even more time to succeed than confrontation. The result reveals the importance of building local networks in the municipalities.Originality/valueThe advocacy for Swedish alcohol policy by the young members of UNF and participatory research is a unique combination.

The Europeanization of Swedish alcohol policy: the case of ECAS

The recent changes in Swedish alcohol policy have mainly been described by researchers and politicians in terms of a Swedish implementation of EU rules. The European Comparative Alcohol Study (ECAS), however, shows the complexity of Europeanization and can function as an example of the possibilities for the reverse influence. The project was an initiative by the Swedish Ministry of Health and Social Affairs and was presented as a comparative study that could serve as a basis for further discussions about common measures in European alcohol policy. The article analyses how ECAS has been perceived and used politically at national and EU levels. The results show that ECAS was the first attempt from Sweden and Finland to influence EU on the alcohol question, and the expressed political purpose mainly focused on the possibilities to work internationally. The article indicates that ECAS has been quite influential within the research community and within the public health frame. However, the impact within other frames has been more or less limited to the slow process of moulding public opinion.

Finnish, Norwegian, and Swedish alcohol policy after the seminal year of 2004

Aim To assess how Finland, Norway and Sweden reorganised their alcohol policies after the travellers import quotas for alcoholic beverages were abolished in 2004. Data &amp; Methods Alcohol taxation, alcohol programs and other alcohol policy changes, as well as common alcohol policy initiatives by the Nordic Alcohol monopoly countries are examined. In addition to relevant research literature, the main sources used are public reports and documents as well as interviews with nine key informants in the field of alcohol policy. Results Finland is characterized as the country with the highest alcohol consumption and an alcohol policy that is different from the policies in Norway and Sweden. Typical for Norway, apart from an increased availability of alcoholic beverages, is an active engagement in international alcohol policy issues, whereas Sweden is characterized by big administrative alcohol policy changes, and by the rulings of the EC-court in alcohol policy matters. Conclusions Alcohol policy in Finland has not been as prioritized as in Norway and Sweden, and there has not been an active political support for restrictive social alcohol policy in Finland. Despite clear similarities, the differences in Finland's, Norway's and Sweden's alcohol policies have increased since 2004, and it has become increasingly difficult to talk about a common Nordic alcohol policy.

Alcohol habits in Sweden during 1997–2005 measured with the AUDIT

This study aimed to describe changes in Swedish alcohol habits during a period of “harmonization” with European Union alcohol policy. Three random samples collected during the years 1997 (n=997), 2001 (n=893) and 2005 (n=914) were compared. Alcohol habits and hazardous consumption was measured with the AUDIT (Alcohol Use Disorders Identification Test) distributed to the respondents by post. Results were somewhat diverse, but significant changes in alcohol habits occurred among two subgroups of the population: for women and the age group between 28 and 60 years, AUDIT scores peaked in 2001. The results are discussed in relation to the changes made in Swedish alcohol policy during the investigation period.

Estimates of harm associated with changes in Swedish alcohol policy: results from past and present estimates

(i) To compare actual developments of alcohol-related harm in Sweden with estimates derived prior to major policy changes in 1995 and (ii) to estimate the effects on consumption and alcohol-related harm of reducing alcohol prices in Sweden. Alcohol effect parameters expressing the strength of the relationship between overall alcohol consumption and different alcohol-related harms were obtained from ARIMA (Auto Regressive Integrated Moving Average) time-series analyses. Measures of Swedish alcohol-related mortality (liver cirrhosis, alcoholic psychosis, alcoholism and alcohol poisoning), accident mortality, suicide, homicide, assaults and sickness absence from 1950 to 1995. Previous estimates of alcohol-related harm based on changes in alcohol consumption for the period 1994-2002 for Sweden were, in some cases (e.g. violent assaults and accidents), relatively close to the actual harm levels, whereas in other cases (e.g. homicides, alcohol-related mortality and suicide) they diverged from observed harm levels. A tax cut by 40% on spirits and by 15% on wine is estimated to increase total per capita alcohol consumption by 0.35 litre. This increase is estimated to cause 289 additional deaths, 1627 additional assaults and 1.6 million additional sickness absence days. The estimates of future changes in harm based upon even relatively modest increases in alcohol consumption produce considerable negative effects, with large economic consequences for the Swedish economy. The additional alcohol-related deaths, for instance, amount to more than half the number of yearly traffic fatalities in Sweden.

Alcohol Prevention in the Swedish Workplace—Who Cares?

In this article we discuss what interest, and whose interest, there is in working with alcohol and drug prevention in workplaces. As the Swedish alcohol policy has weakened, alternative ways for primary prevention are sought. Public reports have pointed out the workplace as one arena for prevention that could compensate for the government's diminishing alcohol control. Will this work? What conditions are necessary in order to work successfully with these issues in a corporate environment? Several studies have suggested that there is little interest in working with prevention in workplaces, and this study supports this finding. This study involved interviews at 16 companies in Sweden with personnel managers, employees (in focus groups), union representatives, and in some cases the company's health care department. In a preliminary stage the findings verified our hypothesis that the overall interest in primary prevention in reality is not that strong. The participants in the study believed that the responsibility lies in intervention when the alcohol or drug problem has arisen, and there is really not much the company can do to prevent people from using alcohol or drugs.

Drinking policy or a political drink? Illegal alcohol in the Swedish press

During the last 10 years the Swedish tradition of restrictive alcohol policy has been seriously threatened. One of the most important causes of change has been Sweden's entry into the European Union. Entrance into the EU gave rise to arguments for consumer's rights and free trade. Swedish alcohol policy was questioned both with ideological arguments and on practical grounds. The alcohol policy was expected to be weakened in several ways by harmonization of taxes, demonopolization, increased import quotas and also illegal imports due to reduced boarder controls between EU-countries. At the end of the 1990s, illegal alcohol (smuggled or illegally homeproduced alcohol) became an important factor in the alcohol policy field: in 1999 the Minister of Health and Social Affairs stated that the fight against illegal alcohol is the most important issue for Swedish alcohol policy. The aim of this study was to explore how illegal alcohol was described in 10 Swedish newspapers during 1990, 1994 and 1999. The number of articles increased dramatically during the 1990s. In the first year most articles were found in the local press, but at the end of the period most of the articles were published in the nationwide press, indicating the greater importance of the topic. In 1990 and 1994 illegal alcohol was presented as a future problem if Sweden adapted the wrong alcohol policy. In the later years it was presented as an existing fact to which Sweden has to adjust. It was used as an argument for a wide range of liberal proposals. There was also a change when it came to the actors in the debate as representatives of different sectors of the alcohol industry entered the field. One of the most interesting features is that the industry and the public authorities together started a media campaign against illegal alcohol with a focus on the connection between illegal alcohol and organized crime syndicates. This is also an example of how the perceived problems with illegal alcohol depend very much on the interests of the actors. We argue that the focus on illegal alcohol can be understood as an example of the use of a good enemy. Several actors, including the public authorities, have had an interest in the fact that illegal alcohol is viewed as a serious problem. For the alcohol industry it is a way to combat a competitor, and for public authorities it can be a way of legitimizing changes in alcohol policy which they had to make anyway. Factors like this seem to have been very important in the formulation of illegal alcohol as a problem.

Consumption of Illegal Alcohol among Adolescents in Stockholm County

One primary long-standing goal in Swedish alcohol policy is that youths should not consume alcoholic beverages. Nevertheless about 80% of teenagers age 16 years have consumed alcoholic beverages, according to annual national surveys of representative samples. In the spring of 1998 we conducted an anonymous classroom questionnaire survey of smoking, alcohol and drug habits, availability, and alcohol-related problems in all pupils in the ninth grade (age 16 years) in Stockholm County, with a participation rate of 83% (n=12,860). About 40% in each sex reported that they had drunk home-distilled spirits, and 8%–9% said they had done so at least five times. More than 25% had consumed smuggled spirits. We have analyzed the association between experiences of illegal alcohol and social factors, controlling for availability and drinking habits. Besides a very clear association with volume of drinking, there were certain other significant findings within the social sphere.

New narratives, new narrators? Alcohol and alcohol policies in the Swedish press during the 1990s

During the years around 1990, several policy and economic events occurred which had significant effects on the Swedish society. In this context, critique against the welfare state grew and the traditional roles of the state and the individual were challenged. The legitimacy and efficiency of Swedish alcohol policy was also called into question. The article describes and analyses how portrayals of alcohol, alcohol problems and alcohol policies have changed during the 1990s in the Swedish press. Despite the growth of media like television and the Internet, the daily press must still be considered an important source of information and also an active constructor of reality. The analysis is based on different samples of press articles during the studied period. Special attention is paid to different actors/narrators, their argumentation and how they perceive the individual and the state as legitimate actors and controllers of our drinking habits. The analysis shows that the dominant restrictive alcohol discourse, based on the total consumption model, public health perspectives and universal and restrictive alcohol policy measures, gradually has been challenged by a liberal discourse in which individual freedom, market liberalism and consumer perspectives are put forward as guiding principles for alcohol policies. A ‘sensible drinking’ perspective has seriously weakened the traditional perspective where alcohol- related problems have been situated as the legitimate foundation for policies. Finally, the ongoing redefinition of the alcohol issue also has made it possible for new narrators, for instance, business representatives, to take part in and significantly influence the alcohol discourse.

Alcohol habits among teenagers in Sweden: factors of importance.

This study of 689 secondary school students (13-16 years of age) in Sweden investigates the association between alcohol habits, the availability of alcohol and age, gender, socioeconomic status, ethnic origin and family structure. Data were obtained by anonymous questionnaires in 1991. The availability of alcohol increased from the seventh grade to the ninth as did the proportion of alcohol consumers and students with regular alcohol consumption. Boys in the seventh and eighth grades showed somewhat more advanced alcohol habits than girls, but in the ninth grade the opposite was seen. Students with more advanced alcohol habits and a higher availability of alcohol more often belonged to a lower socioeconomic strata and they lived more often with a single parent. Students of foreign background drank alcohol (especially wine) more regularly. An association was also found between the parents' liberal attitude toward offering alcohol at home and frequent intoxication and the students' experience of illicitly produced liquor, especially among the youngest students. In spite of the Swedish alcohol policy the availability of alcohol is rather high among young people. Special attention in alcohol preventive work should be paid to girls, young people living with one parent, young people in lower socioeconomic groups and young people of foreign origin.

Swedish alcohol and restaurant policy in the 1980s: A historical perspective

This article discusses factors contributing to the rapid proliferation of restaurants in Sweden in the 1980s and to the current tension between restrictive legislation, legal praxis and public alcohol culture. Transformations in towns and in public life, the transition from modernity to post-modernity, the emergence of a new middle class and the redefinition of women's use of alcohol were among the important changes. Departures from the traditionally strict control of restaurants were made in the late '50s and in the early '60s. Competititon grew and Swedish restaurant culture loosened up. In the 1980s, the restrictive laws governing restaurants began to lose legitimacy. Legal praxis was applied in a more liberal spirit. The Stockholm Water Festival, which allowed central parts of the city to be transformed into a gigantic beer hall, is one example of this. As in many other countries, age limits have become almost the only actual restriction to the availability of alcohol. The aim of alcohol and especially restaurant policy today is on minimization of damage, not protection, as formerly.

The relationship between alcohol consumption and social status in Stockholm. Has the social pattern of alcohol consumption changed?

Data from the Stockholm Health of the Population Study in 1984 (n = 6217) show small differences in mean alcohol consumption and in the prevalence of high consumers in various socioeconomic and educational categories of both sexes. Among young people mean consumption was higher in those who had low formal education, equal to 18.8 g 100% ethanol among men aged 18-24 years and 5.9 g for those with public elementary school education, while the corresponding figures for young women were 16.7 and 1.8 g respectively. Those reporting a high alcohol consumption (greater than or equal to 35 g 100% ethanol/day among men and greater than or equal to 25 g among women) had a relative risk over 7 of having been inpatients with alcohol-related diseases during 1980-1984. Our results, together with other recent Swedish survey data, indicate a change in the socioeconomic distribution of alcohol consumption over time. This change is analysed in relation to Swedish alcohol policy, changes in various socioeconomic categories, and the increase in information about alcohol.