Does the prevention paradox apply to various alcohol habits and problems among Swedish adolescents?

Abstract

Background: The prevention paradox states that a majority of alcohol-related problems in a population come from moderate drinkers because they are more numerous than heavy drinkers, although the latter have a higher individual risk of adverse outcomes. We examined the extent to which the prevention paradox applies to the relationship between alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems in adolescents; an area in which studies are lacking. Methods: A total of 7288 alcohol-consuming adolescents aged 13-17 years were examined. The proportions () of problems related to drinking measures [the upper 10 and bottom 90 of drinkers by annual alcohol intake, and those with frequent (monthly), less frequent, and no heavy drinking episodes] were calculated. Results: The bottom 90 of consumers by annual intake accounted for a large majority of the alcohol-related problems among boys and girls at all ages. The share of problems accounted for by monthly HEDs increased with age, from ∼10 among those aged 13 years to >50 among those aged 17 years. Attributable proportions for the top 10 alcohol consumers ranged between 22 and 37. Conclusions: Our analyses suggest that the prevention paradox is valid for adolescent boys and girls aged 15 years and applies to a large range of alcohol-related problems of varying severity. Our results imply that not only that prevention directed at all adolescents is essential, but also that HED should be particularly noticed. © 2012 The Author 2012. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.