Widespread media coverage has been given to news that “British teenagers are the third worst binge drinkers in Europe” (BBC News). The news is based on a report of a Europe-wide survey on alcohol and drug use by teenagers. Only teenagers in Denmark and the Isle of Man fared worse out of the 35 nations that were surveyed.
The complete report covers surveys, conducted in 32 European countries in 2007. Among the conclusions made by the UK investigators in the media (but not specifically mentioned in this report) is the advice on public health policies that might prevent harm. Many newspapers mention the effectiveness of alcohol education or mass media campaigns compared to taxation or minimum pricing strategies.
The overall conclusions of the lead investigator Professor Plant is that “alcohol education and mass media campaigns have a very poor track record in influencing drinking habits”, whereas policies such as taxing alcohol to make it less affordable are far more effective and cost effective.
Where did the story come from?
The study was led by Björn Hibell, Ulf Guttormsson, Salme Ahlström, Olga Balakireva, Thoroddur Bjarnason, Anna Kokkevi and Ludwig Kraus from the European School Survey Project on Alcohol and Other Drugs (ESPAD). The report’s production was funded by The Swedish National Institute of Public Health and the European Monitoring Centre for Drugs and Drug Addiction.
Professor Martin Plant and Dr Patrick Miller of the Alcohol and Health Research Unit at the University of the West of England, Bristol, were responsible for the survey conducted for the ESPAD study in the UK. This report is available online on the ESPAD website.
What kind of scientific study was this?
The European School Survey Project on Alcohol and Other Drugs (ESPAD) aims to collect and compare data on alcohol and drug use among 15 to 16-year-old students in European countries. The researchers have collected data four times so far. In 1995, a survey was conducted in 25 countries, while in 2007 the data collection was carried out in 35 countries.
This new report presents key results from the 2007 survey, as well as the trends found over time between the previous surveys.
During the spring of 2007, more than 100,000 students were surveyed from Armenia, Austria, Belgium, Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroe Islands, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, the Isle of Man, Italy, Latvia, Lithuania, Malta, Monaco, the Netherlands, Norway, Poland, Portugal, Romania, Russian Federation, the Slovak Republic, Slovenia, Sweden, Switzerland, Ukraine and the UK. It involved giving a standardised questionnaire to students born in 1991; these students had an average (mean) age of 15.8 years at the time of data collection.
The researchers say that questionnaires were administered to a class-group, and the students answered the questionnaires anonymously, with teachers or research assistants acting as survey leaders. The six questions on alcohol included one that asked about typical daily consumption during the last 30 days of beer, cider, alcopops, wine or spirits. Answers could range from never to 10 or more drinks.
With two exceptions, the class samples are nationally representative: in Germany, the study was performed in only seven out of 16 federal states, while only the Flemish-speaking part of Belgium was surveyed. Overall, the researchers say that most sample sizes were close to 2,400 students per country (except for the small countries). They also say that any small differences between countries or over time should be interpreted with caution, offering a “rule of thumb” that differences of more than a few percentage points can quite confidently be considered significant.
For the UK part of the study, a target of 120 schools was set, covering two classes from each school. To obtain this number, 203 schools were approached. Out of 203 sampled schools, 104 (51%) did not participate. The most common reasons given for school refusal were that the school had taken part in other research projects, and that staff or students were already overloaded with these commitments. There were no discernible differences in the types of schools choosing to cooperating or not cooperating.
What were the results of the study?
At least two-thirds of the students in each of the countries surveyed had drunk alcohol at least once during their lifetimes.
Across all countries, an average of 90% of students had drunk alcohol at least once in their lifetime. Of these, 82% had drunk once in the past 12 months, and 61% had drunk alcohol in the past 30 days.
The researchers say that, overall, the prevalence of ‘lifetime’ and ‘past 12 months’ of drinking did not change from 1995 to 2007, whereas the ‘past 30 days’ figures increased until 2003 before they dropped a little in 2007, especially among boys.
The range of reported alcohol use among countries varied considerably. For example, the proportion of students reporting alcohol use in the past 30 days was 80% in Austria and Denmark, but only 31% in Iceland and 35% in Armenia.
In nearly all countries, boys drank more than girls. In a large majority of the countries, beer is the dominant beverage among boys, while spirits is the dominant beverage among girls in a little more than half of the countries.
On average, half of the students in these countries admitted to being “intoxicated at least once during their lifetime, to the point of staggering when walking, having slurred speech or throwing up”. The researchers say that this had happened during the past 12 months for 39% of the students, and during the past 30 days for 18% of students. How frequently students got drunk varied between the sexes, with higher figures for boys in some countries and for girls in others.
A number of students reported problems during the past 12 months relating to their alcohol consumption. On average, 15% of them said they had experienced serious problems with parents, while 13% had “performed poorly at school or work”, had “serious problems with friends” and “physical fights”. Countries where many students reported problems relating to their alcohol consumption include Bulgaria, the UK, Latvia and the Isle of Man.
What interpretations did the researchers draw from these results?
Regarding drugs, smoking and alcohol trends, the researchers conclude that “in countries where many students report recent (past 30 days) alcohol use and intoxication, more students are likely to report experience of illicit drugs, inhalants and use of alcohol together with pills, and vice versa”.
They say there is an upward trend for heavy episodic drinking throughout 1995–2007 (a 9% increase). This is mostly explained by the increasing prevalence of drinking among girls in a number of countries.
The overall impression is that the situation has improved in the long-term for substance use “apart from the heavy episodic drinking measure that display an increase throughout the period”.
What does the NHS Knowledge Service make of this study?
The full report contains comprehensive data on the current situation and recent trends in the use of cigarettes, alcohol, illicit drugs and other substances in a cohort of 15 to 16-year-olds in most European counties. This provides useful information for planning services and public health approaches to tackling dangerous drinking.
The researchers make some comments regarding the reliability of this survey. They say that:
- There was a low number of unanswered core questions (1.8%), and that the rates of inconsistent answers to questions about lifetime use, use in the past 12 months and use in the past 30 days were low (0–2%). This suggests that the questionnaires were completed accurately.
- There were 405 questions to answer in the UK questionnaire, which is the highest of all countries. However, the researchers say that the time to answer the questionnaire was below average, and that the length of the questionnaire has probably not negatively influenced the validity of the answers.
- Non-participation can be a problem for surveys, but in this case, even though more than half of the sampled schools in the UK and 60% of the classes did not participate for different reasons, it appears that the non-participating schools were randomly distributed. The researchers say that it can be assumed “that the sample is still representative of the UK student cohort”.
Overall, this data provides a useful basis to decide future policy for reducing harm from alcohol and provides part of the evidence that will be needed by decision makers when considering the extent of the problem. Further evidence regarding the effectiveness of policies to reduce harm will be needed.
The lead investigator of this study in this country, Professor Plant, recommended that a minimum price of 50p per unit of alcohol should be introduced, and that it would save over 3,000 lives each year.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
BBC News, 27 March 2009
The Guardian, 27 March 2009
Daily Mail, 27 March 2009
The Daily Telegraph, 27 March 2009
The Times, 27 March 2009
The Sun, 27 March 2009