Unrecorded Consumption Research Articles

Trends in alcohol-attributable morbidity and mortality in Germany from 2000 to 2021: A modelling study.

We aimed to assess: (i) trends in alcohol-specific - that is, fully attributable - morbidity and mortality in the German adult population aged 15-69 between 2000 and 2021; and (ii) changes in alcohol-attributable disease burden - that is, fully and partially alcohol-attributable categories - for 2006, 2012, 2018 and 2021. Morbidity data was pulled from hospitalisation and rehabilitation statistics and mortality data was pulled from the causes of death registry. Alcohol use, adjusted for unrecorded consumption, was estimated using the Epidemiological Survey of Substance Abuse and triangulated with per capita consumption from annual sales data. For major disease categories, alcohol-attributable fractions were estimated for males and females by age groups (15-29, 30-49, 50-69 years) using the comparative risk assessment methodology. For males and females, the age-standardised rate of alcohol-specific morbidity peaked in 2012 and decreased thereafter showing a steep decline from 2019 to 2021. The rates of alcohol-specific mortality decreased constantly from 2000 to 2019 but increased from 2019 to 2021. Compared to 2006 the age-standardised alcohol-attributable morbidity and mortality rates in males and females were lower in 2021. For both sexes, the age-standardised alcohol-attributable morbidity and mortality rates and the proportions of morbidity/mortality rates relative to all-cause morbidity/mortality decreased between 2006 and 2021. The declines in alcohol-attributable morbidity and mortality are in line with decreases in consumption and signal that the importance of alcohol in health service utilisation and mortality has weakened. Sex ratios in morbidity and mortality do not indicate a strong converging trend.

The legal framework for the production of alcohol for personal use within the European Union.

Aim: This paper provides an overview of the legal framework for alcohol produced for personal use in European Union (EU) Member States. Methods: We reviewed the national excise duty legislations of EU Member States and conducted an online mapping survey, in which 10 alcohol experts from seven EU Member States plus Iceland participated. Results: We found that the production of alcohol for personal use is tax exempt in 12 jurisdictions, with four countries stipulating a maximum volume of alcohol that can be produced for personal use. The most common alcoholic beverages concerned were beer and wine, while only one country set a tax exemption for spirits. The results were complemented by the alcohol expert mapping survey; tax exemptions were reported for two additional Member States. Conclusion: Legal exemptions for the production of alcohol for personal use were established in every second EU Member State and may therefore contribute to the unrecorded consumption of alcohol in these countries. In light of the detrimental health effects of alcohol, economic interests to support the local small-scale production of alcohol have to be carefully evaluated against public health interests.

The estimated health impact of alcohol interventions in New Zealand: A modelling study.

To estimate the health impacts of key modelled alcohol interventions among Māori (indigenous peoples) and non-Māori in New Zealand (NZ). Multi-stage life-table intervention modelling study. We modelled two scenarios: (1) business-as-usual (BAU); and (2) an intervention package scenario that included a 50% alcohol tax increase, outlet density reduction from 63 to five outlets per 100 000 people, outlet hours reduction from 112 to 50 per week and a complete ban on all forms of alcohol marketing. The model's population replicates the 2018 NZ population by ethnicity (Māori/non-Māori), age and sex. Alcohol consumption was estimated using nationally representative survey data combined with sales data and corrected for tourist and unrecorded consumption. Disease incidence, prevalence and mortality were calculated using Ministry of Health data. We used dose-response relationships between alcohol and illness from the 2016 Global Burden of Disease study and calculated disability rates for each illness. Changes in consumption were based on the following effect sizes: total intervention package [-30.3%, standard deviation (SD) = 0.02); tax (-7.60%, SD = 0.01); outlet density (-8.64%, SD = 0.01); outlet hours (-9.24%, SD = 0.01); and marketing (-8.98%, SD = 0.02). We measured health gain using health-adjusted life years (HALYs) and life expectancy. Compared with the BAU scenario, the total alcohol intervention package resulted in 726 000 [95% uncertainty interval (UI) = 492 000-913 000] HALYs gained during the life-time of the modelled population. Māori experienced greater HALY gains compared with non-Māori (0.21, 95% UI = 0.14-0.26 and 0.16, 95% UI = 0.11-0.20, respectively). When modelled individually, each alcohol intervention within the intervention package produced similar health gains (~200 000 HALYs per intervention) owing to the similar effect sizes. Modelled interventions for increased alcohol tax, reduced availability of alcohol and a ban on alcohol marketing among Māori and non-Māori in New Zealand (NZ) suggest substantial population-wide health gains and reduced health inequities between Māori and non-Māori.

The impact of alcohol taxation changes on unrecorded alcohol consumption: A review and recommendations.

The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise taxes has been that doing so could potentially result in an increase in unrecorded consumption. This contribution examines whether increases in taxation have in fact led to increases in consumption of unrecorded alcohol, and whether these increases in unrecorded alcohol should be considered to be a barrier to raising taxes. A second aim is to outline mitigation strategies to reduce unrecorded alcohol use. Narrative review of primary and secondary research, namely case studies and narrative and systematic reviews on unrecorded alcohol use worldwide. Unrecorded alcohol consumption did not automatically increase with increases in taxation and subsequent price increases of registered commercial alcohol. Instead, the level of unrecorded consumption depended on: a) the availability and type of unrecorded alcohol; b) whether such consumption was non-stigmatized; c) the primary population groups which consumed unrecorded alcohol before the policy change; and d) the policy measures taken. Mitigation strategies are outlined. Potential increases in the level of unrecorded alcohol consumption should be considered in the planning and implementation of substantial increases in alcohol taxation. However, unrecorded consumption should not be considered to be a principal barrier to implementing tax interventions, as evidence does not indicate an increase in consumption if mitigation measures are put in place by governments.

Cross-sectional study on the characteristics of unrecorded alcohol consumption in nine newly independent states between 2013 and 2017

ObjectivesAs unrecorded alcohol use contributes to a substantial burden of disease, this study characterises this phenomenon in newly independent states (NIS) of the former Soviet Union with regard to the...

Measuring changes in alcohol use in Finland and Norway during the COVID-19 pandemic: Comparison between data sources.

ObjectivesTo examine (1) how a rapid data collection using a convenience sample fares in estimating change in alcohol consumption when compared to more conventional data sources, and (2) how alcohol consumption changed in Finland and Norway during the first months of the COVID‐19 pandemic.MethodsThree different types of data sources were used for the 2nd quarter of 2020 and 2019: sales statistics combined with data on unrecorded consumption; the rapid European Alcohol Use and COVID‐19 (ESAC) survey (Finland: n = 3800, Norway: n = 17,092); and conventional population surveys (Finland: n = 2345, Norway: n1 = 1328, n2 = 2189, n3 = 25,708). Survey measures of change were retrospective self‐reports.ResultsThe statistics indicate that alcohol consumption decreased in Finland by 9%, while little change was observed in Norway. In all surveys, reporting a decrease in alcohol use was more common than reporting an increase (ratios 2–2.6 in Finland, 1.3–2 in Norway). Compared to conventional surveys, in the ESAC survey fewer respondents reported no change and past‐year alcohol consumption was higher.ConclusionThe rapid survey using convenience sampling gave similar results on change in drinking as conventional surveys but higher past‐year drinking, suggesting self‐selection effects. Aspects of the pandemic driving alcohol consumption down were equally strong or stronger than those driving it up.

Drinking and acquisition of unrecorded alcohol across educational groups in Sweden.

It is estimated that 18.5% of total alcohol consumption in Sweden in 2018 was unrecorded. However, little is known about the socio-economic profile of consumers of unrecorded alcohol. The aim of this study was to elucidate this issue by analysing data from a unique Swedish national repeated cross-sectional alcohol use survey. Individual-level information on alcohol consumption and socio-economic status (SES) for the years 2013-2018 was retrieved from the Monitoring Project; a nationally representative monthly alcohol use survey. The analytical sample comprised 64 375 respondents aged 25-74 years. SES was measured by educational level. We used three educational groups: (i) low (<10 years); (ii) intermediate (10-12 years); and (iii) high (13+ years). We included indicators of the following sources of unrecorded alcohol consumption: travellers' import, smuggled alcohol, home production, internet and illicit home-distilling. We estimated adjusted SES-specific means of the various forms of unrecorded consumption. The means were adjusted for the effects of age, sex and region. There were no significant educational differences in the total of unrecorded alcohol consumption; the same holds true for home-production and internet. However, with respect to smuggled and home-distilling, a statistically significant educational gradient was observed with the lowest educational group scoring approximately four times higher than the highest. Our findings suggest that there are no differences across educational groups in the consumption of unrecorded alcohol as a whole. However, consumption of smuggled alcohol and illicitly distilled spirits is elevated in the low educational group.

Analysis of the Collection of Excise Taxes on Alcoholic Beverages in Europe

The article analyzes the total, recorded and unrecorded consumption of alcoholic beverages in Europe, analysis of the level of excise rates on alcoholic beverages, including VAT. An analysis of prices was provided and the level of availability of alcoholic beverages in Europe was calculated. The revenues from the collection of excise taxes on alcoholic beverages and their share in budget revenues and in GDP by European countries in 2018 were estimated.

Estimating Unrecorded International Trade of Alcohol and Forgone Revenue in Bangladesh

This study attempted to estimate the value of unrecorded liquor trade in Bangladesh. In addition, tried to estimate the revenue government lost through unrecorded liquor trade. Globally, a significant share of liquor trade takes place through informal or illegal channels and remain unrecorded. In Bangladesh, average annual per capita alcohol consumption reached 0.9 liters in 2016. About 3.5% of the male and 1% of the female adult Bangladeshi population regularly intake alcoholic beverages. Estimated demand for liquor in Bangladesh was nearly 2.5 million liters in 2016, whereas, legally permitted level of consumption was only 0.10 million liters. As both production and import of liquor is highly regulated, trade through informal channels meet the excess demand in Bangladesh. In this paper, using official data from the Department of Narcotics Control (DNC), Bangladesh, we estimate the market value of unrecorded liquor production and trade. We find that the estimated annual value of unrecorded consumption of liquor from domestic production is nearly between USD 11 million and USD 28 million; while, unrecorded trade of liquor is nearly between USD 120 million and USD 190 million. Hence, the government is losing potential revenue equivalent to about USD 0.9 million to USD 2.2 million at production stage and USD 9.5 million to USD 15.2 million at import stage.

Unrecorded Alcohol Consumption in Seven European Union Countries

Introduction: Unrecorded alcohol, that is, alcohol not reflected in official statistics of the country where it is consumed, contributes markedly to overall consumption of alcohol. However, empirical data on unrecorded alcohol consumption are scarce, especially in high-income countries. This study measures the contribution of unrecorded alcohol in 7 member states of the European Union. Methods: Two categories of unrecorded consumption were assessed in general population surveys (reducing alcohol related harm Standardized European Alcohol Survey; n = 11,224): home-made alcohol and cross-border shopping. Country-specific logistic regressions were used to link respondent characteristics to odds of acquisition of unrecorded alcohol. Total per capita alcohol consumption was estimated under different assumptions of calculating unrecorded alcohol consumption. Results: Individuals with higher drinking levels were more likely to acquire unrecorded alcohol in all 7 countries. In some countries, male sex and more affluent social class were also positively linked to acquisition of unrecorded alcohol. There was a substantial contribution of unrecorded alcohol to overall consumption in 5 out of 7 member states (Croatia, Finland, Greece, Hungary, Portugal), but not in Poland or Spain. In Greece, up to two-thirds of all alcohol consumed was estimated to be unrecorded. Conclusion: Unrecorded alcohol contributes to overall consumption even in high-income countries, and thus needs to be monitored. In monitoring, as many categories of unrecorded alcohol as possible should be clearly defined (e.g., surrogate alcohol) and included in future surveys.

Perception of alcohol policies by consumers of unrecorded alcohol - an exploratory qualitative interview study with patients of alcohol treatment facilities in Russia

BackgroundOver the last decade Russia has introduced various policy measures to reduce alcohol consumption and alcohol-related harm at the population level. Several of these policies, such as higher pricing and taxation or restrictions of availability, may not work in the case of unrecorded alcohol consumption; they may encourage consumers to switch to unrecorded alcohol and even increase consumption. In the present qualitative interview study we explore the perception of the recently implemented alcohol policies by patients diagnosed with alcohol dependence in two Russian cities in the years 2013–2014 and shed light on possible entry-points to prevention.MethodsSemi-structured in-depth expert interviews were conducted with 25 patients of state-run drug and alcohol treatment centers in two Russian cities in 2013 and 2014. The interviews were analyzed using thematic content analysis.ResultsAll of the interviewed participants have consumed unrecorded at some point with the majority being regular consumers, mostly switching between recorded and unrecorded alcohol depending on the situation, as predominantly defined by available money and available sources of alcohol. Low price and high availability were reported as the main reasons for unrecorded consumption. Participants voiced a general mistrust of the recently implemented alcohol regulations and viewed them largely as ineffective. They expressed particular concerns over price increases and restriction of night sales of alcoholic beverages. Substantial shifts within the unrecorded alcohol market were reported, with a decreasing availability of home-made beverages in favor of alcohol surrogates in the form of non-beverage alcohol, medicinal and cosmetic compounds. At the same time consumption of home-made alcoholic beverages was seen as a strategy to avoid counterfeit alcohol, which was frequently reported for retail sale.ConclusionsDespite the alcohol policy changes in the last years in Russia, consumption of unrecorded alcohol remained common for people with alcohol dependence. Reduction of availability of unrecorded alcohol, first and foremost in the form of cheap surrogates, is urgently needed to reduce alcohol-related harm. Implementation of screening and brief interventions for excessive alcohol consumption in various contexts such as primary healthcare settings, trauma treatment services or the workplace could be another important measure targeting consumers of unrecorded alcohol.

The connection between per capita alcohol consumption and alcohol-specific mortality accounting for unrecorded alcohol consumption: The case of Finland 1975-2015.

Unrecorded alcohol consumption has increased strongly in Finland after 1995 when the country joined the European Union. This development may have rendered alcohol sales less trustworthy as a proxy for population drinking, and less powerful as predictor of alcohol-related harm. The study aims to test this contention by analyzing the association between recorded and unrecorded alcohol consumption on the one hand, and alcohol-specific mortality on the other. We analysed age-standardised rates of alcohol-specific deaths for the working-age (15-64 years) population. For alcohol consumption, we used (i) alcohol sales in litres of 100% alcohol per capita, and (ii) estimated unrecorded consumption in litres of 100% alcohol per capita. The data spanned the period 1975-2015. As the data were cointegrated, the relations between mortality and the alcohol indicators were estimated through time-series analysis of the raw data. A one litre increase in alcohol sales was associated with an increase in alcohol-specific deaths of 7.590 deaths per 100 000; the corresponding figure for unrecorded consumption was 9.112 deaths per 100 000. Both estimates were statistically significant (P < 0.001), but the difference between them was not significant (P = 0.293). Although recoded consumption captured the main feature of the trends in alcohol-specific mortality, it accounted for only half of its marked increase in 1975-2007, while unrecorded consumption explained the remaining part. Our study confirms previous findings that recorded alcohol consumption is an important determinant of alcohol-specific mortality in Finland. A more novel insight is the importance of unrecorded consumption in this context.

The global proportion and volume of unrecorded alcohol in 2015.

BackgroundAlcohol consumption is associated with elevated risks of disease and injury, and the best indicator of the level of consumption in a country is total alcohol per capita (APC) consumption among adults which comprises recorded consumption and unrecorded consumption. While recorded consumption can be assessed with small measurement bias via taxation or other governmental records, unrecorded consumption is more difficult to assess. The objectives of this study were to estimate the country-specific proportion and volume of unrecorded APC in 2015, to identify main sources of unrecorded alcohol and to assess to what extent experts perceive unrecorded alcohol as a public health, social, and financial problem.MethodsEstimates of unrecorded APC were based on a multilevel fractional response regression model using data from World Health Organization’s (WHO) STEPwise approach to surveillance surveys (16 countries, 66 188 participants), estimates from the routine WHO reporting on key indicators of alcohol use (189 countries), and a nominal group expert assessment (42 countries, 129 experts). Expert assessments also included data on the sources of unrecorded alcohol and the perception of unrecorded alcohol as a public health, social, and financial problem.ResultsThe volume of global unrecorded APC was 1.6 L pure alcohol, representing 25% of the total APC. The volume of unrecorded APC was highest in Europe (2.1 L per capita), while the proportion of unrecorded APC was highest in the WHO Eastern Mediterranean region (57% of the total alcohol). In countries with available data, homemade alcohol was identified as a major source of unrecorded alcohol. The majority of experts considered unrecorded alcohol to be a public health (62%), social (60%), and financial problem (54%).ConclusionsHigh volumes of unrecorded alcohol are consumed globally; however, the volumes consumed and the sources of the unrecorded alcohol exhibit large geographical variation.

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

SummaryBackgroundAlcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.MethodsUsing 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.FindingsGlobally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.InterpretationAlcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.FundingBill & Melinda Gates Foundation.

Consumption in the Dark: Estimating Unrecorded Expenditures of Households in Croatia

The unofficial sector is generally regarded as an important liability for the development of a post-transitional society. In this paper we adopt a new approach to estimate the unofficial economy by estimating the unrecorded consumption of households in Croatia. This is done by means of conducting a nationally representative survey on payment habits of the Croatian consumers and by pairing these data with the household consumption survey. Our main focus concerns cash payments without an issued receipt, which is assumed to represent the unofficial part of transactions. In this way we circumvent some notable deficiencies of direct surveys on income reporting and selective reviews. We find that the part of unofficial economy arising from household consumption was around 0.69 percent of GDP in 2014.

Drinking patterns and harm of unrecorded alcohol in Russia: a qualitative interview study

Background: Consumption of unrecorded alcohol (alcohol, consumed as a beverage, but not reflected in official statistics) has been linked to heavy drinking and alcohol-related mortality in Russia, with different studies looking for possible toxic components or other explanations. This study explores self-reported drinking behaviors of people diagnosed with alcohol dependence to elicit the perspectives of consumers of unrecorded alcohol.Methods: Semi-structured in-depth expert interviews were conducted with patients (n = 25) of state-run addiction treatment centers of two Russian cities. Interviews were analyzed using thematic content analysis.Results: A strict hierarchy between different types of unrecorded alcohol products, their ascribed quality, and the subjective harm caused by their consumption was found, with home-made spirits for own consumption at the top and technical fluids at the bottom. The ranking order correlated with product price, social status of associated consumers, and severity of their alcohol dependence. Binge drinking was the prevailing drinking pattern and shifts from recorded to unrecorded consumption within a single binge or a zapoi (continuous drinking for at least two days) were typical. Consumption of low-quality unrecorded alcohol was associated with stronger hang-overs, zapois, alcohol psychoses and poisonings, and other indicators of alcohol attributable harm, while no such connection was found for spirits for own consumption.Conclusions: In the dominant explanation patterns of the consumers, the experienced alcohol-induced harm is attributed to alcohol quality, while a thorough analysis of their reported drinking behaviors cannot exclude specific drinking patterns linked to the severity of alcohol dependence as the main determinants of the described health detriments.

Coverage of alcohol consumption by national surveys in South Africa.

Evidence suggests that adult per-capita alcohol consumption, as estimated from self-reports of nationally representative surveys, underestimates 'true' consumption, as measured as the sum of recorded and unrecorded consumption. The proportion of total adult alcohol per capita reported in representative surveys is usually labelled 'coverage'. The aim of the present paper was to estimate coverage for South Africa under different scenarios of alcohol use assessment and 'true' consumption. Five nationally representative surveys from South Africa were used to estimate the prevalence of drinking and the grams per day among current drinkers. All surveys used a complex multi-stage sampling frame that was accounted for by using survey weights. The total (recorded and unrecorded), the recorded and the adjusted total adult per-capita alcohol consumption in South Africa served as different estimates of the 'true' consumption. South Africa. Alcohol use information was assessed on a total of 8115, 16 398 and 13 181 adults (15years or older) in surveys from the years 2003, 2005 and 2008, respectively. Two surveys in 2012 included 27 070 and 18 688 adults. Coverage of the alcohol use reported in the surveys was calculated, compared with the 'true' adult per-capita alcohol. The survey data covered between 11.8% [2005; 95% uncertainty interval (UI)=9.3-16.2%)] and 19.4% (2003; 95% UI=14.9-24.2%) of the total alcohol used per capita. The highest coverage of 27.9% (95% UI=22.4-36.8%) was observed when looking only at recorded alcohol in 2003. Evidence from five nationally representative surveys assessing alcohol use suggests that less than 20% of the total adult per-capita alcohol consumption in South Africa is reported in surveys.

Estimation of Unrecorded Alcohol Consumption in Low-, Middle-, and High-Income Economies for 2010.

Consumption of unrecorded alcohol is prevalent, especially in low-income countries (LIC). Monitoring and reduction of unrecorded consumption have been asked for in the World Health Organization (WHO) global strategy to reduce the harmful use of alcohol. To date, only a few countries have installed monitoring systems, however. As part of the WHO global monitoring, an expert survey using the nominal group technique, a variant of Delphi studies, was conducted to assess level and characteristics of unrecorded consumption in 46 member states. One hundred experts responded. Descriptive statistics and repeated analysis of covariance were used to analyze the data. The study showed feasibility of the chosen methodology to elicit information of unrecorded consumption with experts responding for 74% of the countries. Response rate was lower for LIC. Compared to prior WHO estimates, experts tended to estimate higher unrecorded consumption for LIC, and lower unrecorded consumption for high-income countries. Unrecorded consumption was seen as a financial, public health, and social problem by the majority of experts. Homemade alcohol was the most prevalent subcategory of unrecorded consumption globally. The chosen methodology was feasible, and new information about consumption of unrecorded consumption could be gathered. There is still a need for increasing efforts of national monitoring, especially in LIC.

On monitoring unrecorded alcohol consumption

Unrecorded alcohol consumption is a global problem, with about 25% of all alcohol consumption concerning this category. There are different forms of unrecorded alcohol, legally produced versus illegally produced, artisanal vs industrially produced, and then surrogate alcohol, which is officially not intended for human consumption. Monitoring and surveillance of unrecorded consumption is not well developed. The World Health Organization has developed a monitoring system, using the Nominal Group Technique, a variant of the Delphi methodology. Experiences with this methodology over the past two years are reported. Finally, conclusions for the monitoring and surveillance at the national level are given.

Is there a link between per capita alcohol consumption and youth drinking? A time-series analysis for Sweden in 1972-2012.

AimsTo estimate the relationship between per capita alcohol consumption and youth drinking in Sweden during the last 40 years and to estimate the relationship between female and male youth drinking during the 40‐year study period.Design, setting, participants and measurementsPer capita alcohol consumption was proxied by official sales data, supplemented by data on unrecorded consumption. Youth consumption was measured by a question on heavy episodic drinking (HED) included in an annual school survey of alcohol and drug habits among Swedish 9th ‐grade students (15–16 years of age). The annual samples comprise approximately 5000 individuals (with roughly equal numbers of boys and girls) with response rates in the range 80–93%. The study spans the period 1972–2012. Autoregressive integrated moving average (ARIMA) time–series analysis was used to estimate the relation between per‐capita alcohol consumption and youth drinking. Ocular inspection of the time–series data suggested a stronger synchronization between the two series in the early period, before the mid‐1990s, than in the later period, indicating a structural shift in the relation at issue. We therefore conducted period specific time–series analyses with 1995 as the year of division.ResultsThere was a statistically significant relation between per capita alcohol consumption and HED among youth for 1972–94. A 1% increase in per capita alcohol consumption was associated with an increase in HED of 1.52% (P = 0.008). The estimate for 1995–2012 (0.12) was well below statistical significance (P = 0.580). The estimated elasticity of the association between boys’ and girls’ HED during 1972–94 was close to unity (0.98, P < 0.001), suggesting proportional changes in boys’ and girls’ drinking. When controlling for per capita consumption, the association was halved (to 0.55) but still significant in table 3 (P = 0.045).ConclusionsAdult and youth drinking in Sweden were synchronized closely during the two last decades of the 20th century, but youth drinking developed an independent trajectory shortly before 2000.