Harms from others drinking in Sweden

-findings from a pilot study comparing three different survey approaches

Mats Ramstedt, Erica Sundin

STAD (Stockholm Prevents Alcohol and Drug Problems)

Background

• Increasing interest in alcohol’s harm to others (HTO) in Sweden - the new Swedish ANDT-strategy contains as one specific goal that HTO should be reduced.

• In order to follow-up this goal, questions on HTO have been included in a pilot study on use and harm related to ANDT initiated by the Ministry of health and social affairs

• STAD in collaboration with KI were commissioned to set up this pilot study which also focuses on assessing abuse/dependence of ANDT and to address methodological issues in surveys.

AimOverall: present some basic findings from this study

with regards to the experience of HTO in the Swedish population.

Specific questions:1. How common is it that people experience HTO and

are some groups more exposed than others e.g. depending on gender, age and drinking habits?

2. To what extent do estimates of HTO differ between different survey approaches in particular surveys with low and high non-response rates?

The pilot study• 3 different survey approaches with different

ambitions to increase response rates and with different modes of data collection.

• Surveys include identical questions about:

Background, Use of ANDT, Abuse/dependence of ANDT (e.g. DSM-4), Harms from others use of ANDT substances

• Data collection nov 2011 – april 2012• Report submitted to the Soc. Ministry in June 2012

The surveysTwo extra ambitious procedures with introductory letter and reward voucher

1. Post and web questionnaires –Choose between post or web survey2. Diagnostic telephone interviews –Telephone interview with interviewers specially trained in assessing dependence

Standard procedure3. Regular telephone interview

•Swedish “Monitoring project” – the same standard procedure

Characteristics of the samples Diagnostic telephone interview

Postal/Web survey

Regular telephone interview

SCB

Response rate (%)

67 64 42

Sample size 1344 2575 3005

Women (%) 51,3 53,7 53,2 50,2

17-24(%) 13,4 12,0 8,6 13,8

75-84(%) 6,1 8,2 10,5 7,4

Questions about harms from others drinking

Inspired by work in Austalia/WHO but no space for any detailed questions in this pilot – only a few rough items applied

1. Harm from whom?•Harm from people close to the respondent•Harm from strangers

2. How serious?• A lot – A little (subjective)

Harm from someone close to the respondent

1. In the last 12 months, are there people in your life, who you would consider to be a fairly heavy drinker, or someone who drinks a lot sometimes? (for example anyone in you family, ex-partner, friends, co-worker)

2. Have that person/those persons drinking negatively affected you in some way within the last 12 months?

3. Overall, how much has that person/those persons drinking affected you negatively?

- A lot – A little

Harm from someone close to the respondentDiagnostic telephone interview

Postal/Web survey

Regular telephone interview

Having someone close drinking too much (%) 44,3 33,5 42,2

Negatively affected (%) 17,2 15,9 14,9

A lot (%) 7,5 5,8 5,3

Gender: Women 21,7 20,7 16,7

Men 12,8 11,1 13,1

Age groups: 17-29 21,3 22,4 17,4

30-59 19,4 17,3 18,0

60+ 10,2 8,4 8,0

Alc.dep./abuse 36,4 34,9 30,8

Harm from a “stranger”

1. Have you, within the last 12 months, been negatively affected by a stranger or a person you do not know?

2. Overall, how much has that person/those persons drinking affected you negatively?- A lot – A little

Negatively affected by a strangerDiagnostic telephone interview

Postal/Web survey

Regular telephone interview

Total (%) 16,3 11,1 12,7

“A lot” 3,8 2,1 2,8

Women 19,0 12,2 12,1

Men 13,6 10,1 13,4

17-29 26,1 24,0 21,2

30-59 15,7 10,1 12,9

60+ 9,5 3,1 6,9

Alc.dep./abuse 22,1 34,4 37,6

Importance of “own” drinking habits

• Drinking frequency – no association to harm from strangers or drinkers known to the respondent

• Binge drinking frequency – association with harm from strangers but not with people known to respondent

• Alcohol dependence/abuse – strongly related with harm from strangers and known to respondent

ConclusionsMany people experience harm from others drinking in Sweden:• in particular: women, younger people, people with drinking problems• somewhat more common to experience harm from

known persons than from strangers – in particular more serious harm (a lot)

On the other hand: •a majority have no close person drinking too much and of those who have, only a minority experience harm •most people report that they were only “a little” affected

Conclusions• Methodological findings

– The non-response rate was not as crucial as expected for HTO-questions – at least similar results were often obtained in surveys with low compared and with high response rates

– Still, the highest figures were obtained in the diagnostic interview with highest response rate

Limitations

• Our knowledge of what the respondents really mean is limited e.g. – What they mean by “negatively affected” – in

what sense?– Relationship between respondent and the

known drinker unknown – family friends etc.– The context – private or public?– Magnitude of the harm unknown – what is “a

little” and “ a lot”?

Proceeding

• More analyses will be conducted: overlap between ANDT use and problems including harms from others substance use

• Hopefully, it will be decided that a larger study will be conducted this fall (2012)