Has he ole o pe sonal income
in alcohol d inking among eenage s
changed be ween 1983 and 2013:
a se ies o na ionally ep esen a i e
su eys in Finland
Tomi Lin onen,
1,2
Jaakko Ne alainen
2
To ci e: Lin onen T,
Ne alainen J. Has he ole o
pe sonal income in alcohol
d inking among eenage s
changed be ween 1983 and
2013: a se ies o na ionally
ep esen a i e su eys in
Finland. BMJ Open 2017;7:
e013994. doi:10.1136/
bmjopen-2016-013994
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To iew hese iles please
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bmjopen-2016-013994).
Recei ed 23 Augus 2016
Re ised 7 Feb ua y 2017
Accep ed 17 Feb ua y 2017
1
Finnish Founda ion o
Alcohol S udies, Helsinki,
Finland
2
Uni e si y o Tampe e,
School o Heal h Sciences,
Tampe e, Finland
Co espondence o
D Tomi Lin onen;
omi.lin onen@
alkoholi u kimussaa io. i
ABSTRACT
Objec i e: A o dabili y is known o be a key
de e minan o alcohol consump ion, possibly e en
mo e impo an in adolescence. Rela ing adolescen
d inking pa e n de elopmen s o e a pe iod o ime o
ends in adolescen income can yield in o ma ion on
he signi icance o pa en al con ol o adolescen
income.
Design: Biannual epea ed c oss-sec ional su eys.
Se ing: Na ionally ep esen a i e samples.
Pa icipan s: 14-yea -old adolescen s in he pe iod
1983–2013 in Finland (N=33 771).
Resul s: Adolescen s’alcohol d inking pa e n was
signi ican ly associa ed wi h hei disposable income.
The OR o mon hly d unkenness e sus abs inence
was 6.6 (95% CI 5.0 o 8.8) among gi ls and 9.0
(6.3 o 13.0) among boys in he highes income g oup
compa ed wi h he lowes . Howe e , he associa ion
be ween income and d inking pa e n weakened
conside ably du ing he 30-yea pe iod.
Conclusions: Disposable income has been a
signi ican p edic o o adolescen alcohol d inking in
he pas 30 yea s. Howe e , in he ecen yea s, he
amoun o disposable money has dec eased in
impo ance.
INTRODUCTION
A he popula ion le el, he p ice o alcohol
is known o be a key de e minan o alcohol
d inking in ensi y.
12
I can be assumed ha
a o dabili y is e en mo e impo an in
adolescence since hei pu chasing powe is
significan ly lowe han in adul hood. In he
ques o de e minan s o adolescen d in-
king,
3
i may hus be use ul o look a he
issue o alcohol a o dabili y among een-
age s. In ac , changes o e ime in adoles-
cen disposable income ha e been shown o
be associa ed wi h adolescen d inking
ends.
4
While popula ion income changes
end o be ela i ely slow, changes in
adolescen income ollow a di e en logic.
5
Fu he mo e, d inking la ge amoun s o
alcohol un il d unk seems mo e a ec ed by
so-called pe iod e ec s (eg, mac oeconomic
changes, alcohol p ice changes) han d ink-
ing small amoun s.
6
The p opo ion o Finnish 14-yea -olds
epo ing ha hey do no d ink alcoholic
be e ages dec eased om 60% in he ea ly
1980s o a ound 30% in 1997–1999, bu
inc eased again o o e 60% in 2013.
7
A he
o he end o he d inking pa e n spec um,
he p opo ion o 14-yea -olds d inking un il
d unk a leas once a week has s ayed
be ween 0% and 2% du ing he 30-yea
pe iod om 1983 o 2013. The mos no able
changes ha e been obse ed in he p opo -
ion o 14-yea -olds d inking un il d unk a
leas once a mon h. Bo h in he ea ly 1980s
and ea ly 2010s, a ound 5% o 14-yea -old
gi ls and boys d ank un il d unk a leas
mon hly. Howe e , in he peak yea o 1999,
16% o gi ls and 11% o boys epo ed d ink-
ing un il d unk a leas once a mon h.
8
Simila findings on ecen dec eases in ado-
lescen d inking ha e been obse ed in he
UK,
9
he USA,
10
Sweden,
11
Aus alia
12
and
many o he high-income coun ies.
13
S eng hs and limi a ions o his s udy
▪La ge na ionally ep esen a i e samples.
▪Thi y-yea ime se ies wi h he iming o he
s udy, sampling and da a collec ion me hod
simila h oughou he s udy pe iod.
▪Possible measu emen bias due o sel - epo ed
indica o s.
▪The esponse a e declined o e he yea s om
83% in 1983 o 38% in 2013.
▪The use o eal income ha accoun s o he
e ec s o in la ion.
Lin onen T, Ne alainen J. BMJ Open 2017;7:e013994. doi:10.1136/bmjopen-2016-013994 1
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While se e al ac o s associa ed wi h adolescen
alcohol ini ia ion ha e been s udied,
14 15
adolescen dis-
posable income has ecei ed li le esea ch in e es ,
al hough i po en ially has significan implica ions o
subs ance use. Recen ly, he Ins i u e o Alcohol S udies
in he UK explo ed po en ial explana ions o declining
you h d inking and wound up ocusing hea ily on
a o dabili y.
16
E en hough he legal alcohol pu chase
age is 18 yea s in Finland, adolescen s widely epo ha
i is easy o pu chase alcoholic be e ages.
17 18
In add-
i ion, he unde aged ha e he op ion o asking olde
iends o pu chase he be e ages using hei money.
Adolescen s’disposable income in wes e n coun ies is
ypically ecei ed as allowances, gi s om pa en s and
ela i es, o om household wo k and ex e nal pa - ime
wo k.
51920
In he USA in 1997, a ound hal o hose
aged 14–15 yea s we e employed a leas pa ime.
21
In
he No dic coun ies, a su ey by Danske Bank in 2012
epo ed ha 19% o hose aged 15–17 yea s ea ned
money om wo k ou side he amily.
22
Ve y ew s udies
ha e analysed income among young people who s ill li e
a home o he sociodemog aphic de e minan s a ec -
ing income.
19 20
Mac o-le el de e minan s include
changes in he na ional economy and in cul u al no ms.
In an economic down u n, eenage s find i ha de o
ge pa - ime jobs because o he highe le el o gene al
unemploymen .
23 24
Mic o-le el de e minan s include
age, gende , amily ype, place o esidence, income and
he socioeconomic s a us o he amily.
25
In e es ingly,
adolescen s om disad an aged backg ounds may ha e
mo e money a hei own disposal han young people
om be e -o amilies.
20 26
In Finland, adolescen s
om single-pa en amilies seem o ha e significan ly
highe income han hose om nuclea amilies when
adjus ing o o he amily socioeconomic indica o s.
5
In Finland, he disposable income o 14-yea -olds has
gene ally inc eased om a ound €6 in 1983 o €12 pe
week in 2013, wi h a sligh dec ease in he ea ly 1990s
associa ed wi h an economic dep ession
25
(figu es we e
adjus ed o money alue changes). In he 1980s, boys
aged 14 yea s had oughly 5% mo e money a hei dis-
posal han same-aged gi ls, bu his gende gap widened
o a ound 10% in he 2010s. In ac , s udies ha e sug-
ges ed ha gende is mo e significan in explaining
eenage s’incomes han socioeconomic indica o s like
amily backg ound o place o esidence.
527
Family backg ound may play an impo an ole in
alcohol d inking and disposable income among adoles-
cen s. Mo e d inking among adolescen s om amilies
wi h less educa ed pa en s has been iden ified;
428
howe e , an opposing obse a ion has been epo ed.
29
No di e ences in disposable income among Finnish
14-yea -olds by pa en al educa ion o p o essional s a us
we e obse ed in a ecen s udy.
25
All in all, i seems ha
when s udying he d inking and income o 14-yea -olds,
amily backg ound mus be aken in o accoun .
Since 14-yea -olds ecei e hei income mainly om
hei pa en s, income may se e as a way o con ol hei
o sp ings’d inking. Mo e insigh in o how disposable
income a ec s adolescen d inking can be ob ained by
looking a adolescen d inking pa e n de elopmen s
o e a pe iod o ime, and ela ing he ends o changes
in adolescen income. The cu en pape examines asso-
cia ions be ween alcohol d inking and income among
Finns aged 14 yea s in a 30-yea pe iod om 1983 o
2013. Since p e ious esea ch
30 31
has shown ha , in
addi ion o d inking alcoholic be e ages pe se, d inking
un il d unk is a significan de e minan o p oblems
among adolescen s, he whole spec um o d inking
om abs inence o weekly d unkenness is analysed he e.
METHODS
The s udy da a we e de i ed om a na ionwide moni o -
ing sys em o adolescen heal h beha iou s in Finland,
he Adolescen Heal h and Li es yle Su ey (AHLS).
78
Sel -adminis e ed ques ionnai es we e mailed o mu u-
ally independen , na ionally ep esen a i e samples o
eenage s; o he cu en s udy, we selec ed hose aged
14 yea s, as p e ious esea ch has indica ed ha changes
in d inking pa e ns ha e been la ges in his age
g oup.
6
Two o , ecen ly, h ee einqui ies we e sen o
non- esponden s. In addi ion o he pape ques ion-
nai e, a digi al e sion was a ailable on he in e ne in
2009, 2011 and 2013. Samples we e ob ained om he
Na ional Popula ion Regis e Cen e and we e based on
pa icula da es o bi h, so ha all Finns bo n on he
sample days we e included.
All p ocedu es pe o med in he s udy we e in acco d-
ance wi h he e hical s anda ds o he ins i u ional
esea ch commi ees and wi h he 1964 Helsinki decla -
a ion and i s la e amendmen s o compa able e hical
s anda ds. The su ey se ies o igina ed om 1977 and
ex ends o he yea 2013. Each da a collec ion yea , he
s udy plan and da a collec ion p ocedu e we e e iewed
by e hics commi ees. In he ea ly yea s, he E hics
Commi ees o he Depa men o Public Heal h a he
Uni e si y o Helsinki and he Pi kanmaa Hospi al
Dis ic , Finland, app o ed he s udy p o ocol. Recen ly,
he E hics Commi ee o he Tampe e egion (Finland)
app o ed he s udy p o ocol: filling in he ques ionnai e
was conside ed as adolescen s’consen o pa icipa e.
No pa en al consen was eques ed. In case he espon-
den ’s pa en s wished o inspec he ques ionnai e, he
esponden was ins uc ed o p esen he ques ionnai e
o his/he pa en s be o e answe ing he ques ions.
The mean age o esponden s was 14.6 yea s. Da a
we e collec ed om Feb ua y o Ap il e e y o he yea .
The iming o he s udy, sampling and da a collec ion
me hod we e simila h oughou he s udy pe iod.
Sample sizes a ied; he numbe s o esponden s anged
om 3105 in 1989 o 8390 in 1997, while esponse a es
a ied om 83% in 1983 o 47% in 2011 and 38% in
2013.
7
The esponse a es we e highe among gi ls.
Al oge he , 15 761 boys and 18 010 gi ls esponded o
he su eys.
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The ques ionnai e consis ed o 12 pages each yea .
The majo i y o he ques ions emained unchanged
h oughou he yea s. The equency o alcohol use was
in es iga ed wi h he ques ion ‘How o en do you use
alcohol? T y o include also hose imes you consumed
only small amoun s o alcohol’. The al e na i es we e
‘daily’,‘a ew imes a week’,‘once a week’,‘a ew imes a
mon h’,‘abou once a mon h’,‘abou once in 2
mon hs’,‘3–4 imes a yea ’,‘once a yea o less e-
quen ly’,‘I do no use alcohol’. D unkenness was mea-
su ed wi h he ques ion ‘How o en do you use alcohol
un il you a e eally d unk?’The al e na i es we e ‘once
a week o mo e o en’,‘once o wice a mon h’,‘less e-
quen ly’,‘ne e ’. Using hese wo ques ions, an indica o
o d inking pa e ns was cons uc ed: non-d inke ,
d inks only small amoun s, d inks un il d unk occasion-
ally, d inks un il d unk a leas once a mon h, d inks
un il d unk a leas once a week. The measu es o
d unkenness ha e been ound o be easonably eliable
and alid.
32 33
The ques ion on weekly disposable
income, ‘How much money do you ha e, on a e age, a
you disposal pe week (no including housing, ood
and clo hing expenses)?’, was kep exac ly he same
h oughou he yea s. The esponse ca ego ies, howe e ,
we e changed o eflec changes in mone a y alue and
he adop ion o he eu o in 2002. The esponses we e
ans o med in o 2013 eu o using he cos -o -li ing
index p o ided by S a is ics Finland.
The yea ly dis ibu ions o all he a iables a e shown
in able 1. The p opo ion o i ems missing da a in he
ou come a iable (d inking s yle) was 1.7% while 2.8%
o he esponses we e missing o he main explana o y
a iable (disposable income). Be ween 1% and 3% o
he in o ma ion was missing in he o he explana o y
a iables, bu anged om 4% o 11% by s udy yea in
he case o he a he ’s educa ion. In he eg ession
models, he ORs o he g oup wi h missing da a on
a he ’s educa ion mos esembled he g oup wi h lowes
educa ion. Indi iduals wi h missing da a on any o he
indica o s we e excluded om he models. The e ec i e
sample sizes we e 13 543 o boys and 15 731 o gi ls,
87% o he su ey esponse.
Sepa a e mul inomial eg ession models we e con-
s uc ed o he gende s o p edic he fi e-ca ego y
d inking pa e n indica o ; abs inence was used as he
e e ence ca ego y. S udy yea and quad a ic s udy yea
e ms we e used as con inuous explana o y a iables
accoun ing o ime ends. The income a iable con-
ained six ca ego ies and he lowes ca ego y (€2 pe
week o less) se ed as he e e ence ca ego y.
In e ac ion e ms be ween income and ime a iables
we e also en e ed in o he models o s udy possible di -
e en ial changes in ime by income ca ego ies. In he
nex s ep, amily backg ound a iables we e en e ed in o
he models. In o de o s udy he in e ac ion be ween
income and ime u he , he s eng h o he associa ion
was s udied by c oss- abula ing income wi h he d inking
pa e n a iable sepa a ely o each s udy yea . A γ
coe ficien
34
wi h 95% CIs is shown o hese associa ions
o each yea . Nex , a simple eg ession o he γcoe fi-
cien on su ey yea was pe o med. The γcoe ficien is
an o e all measu e o associa ion be ween wo o dinal
a iables, and can be in e p e ed much like he o dina y
linea co ela ion coe ficien .
A se o po en ial con ounde s was included in eg es-
sion models. The amily s uc u e is an indica o o
whe he o no he esponden cu en ly li es wi h his o
he pa en s (nuclea amily s non-nuclea amily). The
place o esidence is a combined indica o b inging
oge he sample-based (popula ion egis y) and sel -
epo ed in o ma ion (me opoli an a eas/ci ies/ owns/
illages/ u al a eas). Sel - epo ed da a on he a he ’s
o gua dian’s educa ion was classified in o basic (9 yea s
o less), seconda y (9–12 yea s) and e ia y (o e
12 yea s). The a he ’s o gua dian’s p o essional s a us
was coded om open-ended esponses:
35
uppe whi e
colla , lowe whi e colla , ag icul u e and o es y, blue
colla .
Finally, we conduc ed wo sepa a e sensi i i y analyses:
one o in es iga ing he sensi i i y o he γcoe ficien o
he changes in he income dis ibu ion and he second
o assessing he sensi i i y o he model o alcohol p ice
changes. In he fi s analysis, we agg ega ed he lowes
and highes income ca ego ies so ha , in each s udy
yea , he lowes and highes income ca ego y included as
close o 20% o he o al numbe o esponden s as pos-
sible. In he second analysis, he yea ly eal p ice indices
o alcoholic be e ages, which we e a ailable o he yea
2000 onwa ds, we e added as co a ia es in o he models.
When es ing o he ole o alcohol p ice changes, we
fi s an gende -specific models wi h yea s 2001–2013
wi hou he p ice indices, and hen compa ed he co e-
sponding models wi h he indices added. IBM SPSS
S a is ics so wa e was used o he analyses.
RESULTS
Alcohol d inking and d unkenness inc eased among
bo h gi ls and boys in all income g oups om 1983 o
he la e 1990s, a e which i dec eased (figu e 1).
Weekly d unkenness in he lowes income g oup (€2 pe
week o less) was non-exis en h oughou he pe iod
1983–2013 and mon hly d unkenness was a e. In he
highes income g oup (€17 o mo e pe week), a ound
40% o gi ls and boys d ank un il d unk a leas occa-
sionally in he s udy pe iod o 1983 un il he la e 1990s,
a e which d unkenness dec eased conside ably. The
p opo ion o 14-yea -olds who d ank alcoholic be -
e ages bu ne e un il d unk s ayed la gely unchanged
h oughou he s udy pe iod.
Bo h ime and quad a ic ime we e s a is ically signifi-
can p edic o s in he model when p edic ing mon hly
d unkenness, occasional d unkenness and d inking o
small amoun s o alcoholic be e ages; non-d inke s
o med he e e ence g oup ( able 2). Weekly disposable
income p edic ed d unkenness and d inking only small
Lin onen T, Ne alainen J. BMJ Open 2017;7:e013994. doi:10.1136/bmjopen-2016-013994 3
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Table 1 Dis ibu ions o all a iables used in he s udy by he yea o da a collec ion
1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013
Gende
Boys % 48 48 48 47 46 46 46 45 47 45 45 42 41 42 40 45
Gi ls % 52 52 52 53 54 54 54 55 53 55 55 58 59 58 60 55
Alcohol use
D unk weekly % 0 0 1 1 1 1 1 2 2 1 1 1 1 0 0 0
D unk mon hly % 4 3 5 7 8 10 8 11 11 9 6 5 4 5 3 2
D unk occasionally % 17 13 19 20 20 22 23 25 23 21 18 16 13 15 14 10
D inks bu no un il d unk % 28 25 27 26 30 28 31 28 31 29 30 26 22 27 21 21
Does no d ink % 50 58 46 45 39 38 36 33 32 35 43 50 60 53 61 66
Missing % 1 1 2 1 1 2 1 1 2 5 3 3 0 1 1 0
Weekly disposable income
€17 o mo e % 2 4 7 4 5 4 5 6 8 7 11 9 13 16 21 20
€10–€16 % 5 6 12 9 13 11 12 13 13 14 19 17 20 25 27 27
€7–€9 % 11 17 18 16 19 18 17 18 19 18 14 12 12 12 13 11
€5–€6 % 24 30 30 22 24 22 21 23 21 19 26 28 26 22 19 19
€3–€4 % 34 26 20 26 21 24 24 22 22 20 17 18 15 12 11 8
€2 o less ( e e ence) % 23 16 10 20 16 19 18 17 16 15 12 15 13 9 7 10
Missing % 1 2 4 2 2 2 2 1 2 7 2 2 2 4 4 6
Place o esidence
Me opoli an a ea % 10 10 9 11 10 9 11 11 10 14 16 16 16 15 16 14
Ci ies % 17 16 17 16 15 15 15 16 16 16 15 15 15 15 14 18
Towns %27273329333235353331323331333432
Villages % 27 28 26 26 26 26 22 23 24 20 21 20 22 20 19 20
Ru ala eas %19171416151616151515151516161615
Missing % 0 2 1 1 2 2 1 1 2 4 2 2 1 1 1 2
Fa he ’s/gua dian’s educa ion
Basic % 78 72 70 65 63 61 56 57 59 54 57 51 54 45 52 48
Seconda y % 12 13 12 13 15 17 18 15 13 13 12 14 12 11 12 11
Te ia y % 10 11 13 16 17 18 20 23 21 23 25 28 33 41 37 40
Missing % 0 4 5 6 5 5 6 5 6 11 5 7 0 2 0 1
Fa he ’s/gua dian’s p o essional s a us
Uppe whi e colla % 15 16 18 21 22 22 24 24 34 36 33 34 36 39 40 43
Lowe whi e colla % 25 25 27 27 27 29 29 29 22 20 24 25 23 23 16 17
Ag icul u e and o es y % 13 11 10 9 9 7 6 6 7 6 6 6 6 4 6 6
Blue colla % 46 46 43 42 39 40 37 38 35 35 34 32 32 31 36 31
Missing % 1 2 2 2 4 2 3 2 3 3 2 2 3 3 2 4
Family s uc u e
Nuclea amily % 80 79 78 79 77 77 76 75 74 73 75 74 76 76 79 78
Non-nuclea amily % 19 20 21 20 23 22 24 24 25 24 24 25 23 24 21 21
Missing % 1 0 1 0 0 1 0 1 1 3 1 1 0 1 0 1
To al N 3721 3353 8113 3105 7634 8189 8382 8390 8219 7292 6761 6503 5840 5516 4566 3535
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amoun s in a consis en manne : he highe he income,
he highe he odds we e o d inking. The in e ac ions
be ween money and ime, and money and quad a ic
ime we e bo h s a is ically significan . This eflec s he
p esence o non-mono onic ime ends. Model-based
es ima ed cumula i e p opo ions (p obabili ies) o
d inking pa e ns o e ime a e displayed in figu e 1.
Owing o he appa en in e ac ion, γcoe ficien s
be ween d inking pa e ns and income a e seen o
change in ime (figu e 2). In he 1980s, he associa ion
was weake in 1985 and 1987. Since 1989, he γcoe fi-
cien s gene ally dec eased. Howe e , he associa ion may
ha e been somewha s onge in 2011 and 2013 han in
he p eceding h ee measu emen s. In eg ession
models o he γcoe ficien on su ey yea , he es ima ed
eg ession coe ficien is −0.049 pe 10-yea in e al, sug-
ges ing a declining end (p=0.00025). This is in ag ee-
men wi h he in e ac ion es s epo ed abo e.
Finally, po en ial con ounde s (place o esidence,
a he ’s o o he gua dian’s educa ion, a he ’s o o he
gua dian’s labou ma ke posi ion, amily ype) we e
included in he eg ession models. The place o esi-
dence was gene ally no a s a is ically significan p e-
dic o o d inking pa e ns ei he among gi ls o boys;
gi ls’mon hly d unkenness was mo e p obable in places
o he han u al a eas. Low a he ’s o o he gua dian’s
educa ion and low a he ’s o o he gua dian’s labou
ma ke posi ion we e associa ed wi h sligh ly mo e se e e
d inking pa e ns. Li ing in a amily o he han one con-
sis ing o wo pa en s was associa ed wi h significan ly
mo e se e e d inking, especially among gi ls.
Sensi i i y analysis showed ha he income dis ibu ion
change o e he yea s seems no o ha e a ec ed he
ela ionship be ween income and d inking significan ly
as he γcoe ficien s esul ing om his we e e y close
o he o iginal ones p esen ed in figu e 2.
In he second sensi i i y analysis, alcoholic be e age
p ice indices we e added o he models. Among bo h
gende s, he es ima es o pe sonal disposable income
changed only ma ginally and no in a uni o m di ec ion.
The es ima es o he p ice indices we e no s a is ically
significan p edic o s in he models excep among boys
o d inking un il d unk occasionally (yea s 2009 s
2003: p=0.045) and among gi ls o d inking bu no
un il d unk (yea s 2007 s 2003: p=0.047). These wo a e
likely o be chance findings ou o 56 s a is ical es s.
DISCUSSION
On he basis o a compa able se ies o na ionally ep e-
sen a i e su eys in Finland since 1983, we conclude ha
14-yea -old adolescen s’alcohol d inking became mo e
Figu e 1 Es ima ed alcohol d inking (weekly d unkenness, mon hly d unkenness, occasional d unkenness, d inking bu no un il
d unk, does no d ink) p obabili ies among 14-yea -olds in he pe iod 1983–2013 in he lowes income g oup (€0–€2/week), he
mos common income g oup (€5–€6/week) and he highes income g oup (€17 o mo e/week).
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Table 2 Mul inomial logis ic eg ession models o 14-yea -old boys’and gi ls’d inking pa e ns.
Boys
D unk weekly D unk mon hly
D unk
occasionally
D inks bu no
un il d unk
OR 95% CI OR 95% CI OR 95% CI OR 95% CI
Weekly disposable money
€17 o mo e 14.58 (6.82 o 31.17) 9.01 (6.25 o 12.97) 3.47 (2.80 o 4.30) 1.95 (1.64 o 2.33)
€10–€16 10.84 (5.22 o 22.49) 7.79 (5.54 o 10.94) 3.62 (3.01 o 4.37) 1.90 (1.63 o 2.22)
€7–€94.75 (2.21 o 10.18) 5.45 (3.88 o 7.66) 3.10 (2.58 o 3.71) 1.99 (1.72 o 2.30)
€5–€6 1.96 (0.88 o 4.37) 3.19 (2.28 o 4.47) 2.22 (1.87 o 2.64) 1.56 (1.37 o 1.78)
€3–€4 0.60 (0.21 o 1.68) 1.90 (1.33 o 2.73) 1.65 (1.38 o 1.97) 1.37 (1.19 o 1.57)
€2 o less ( e e ence) 1 1 1 1
Place o esidence
Me opoli an a ea 1.27 (0.63 o 2.59) 1.09 (0.78 o 1.52) 1.13 (0.92 o 1.37) 1.00 (0.85 o 1.18)
Ci ies 0.71 (0.35 o 1.43) 1.00 (0.74 o 1.35) 0.84 (0.69 o 1.01) 0.84 (0.72 o 0.97)
Towns 1.00 (0.54 o 1.85) 1.19 (0.91 o 1.55) 0.97 (0.83 o 1.14) 0.85 (0.75 o 0.97)
Villages 1.38 0.74 o 2.59 1.13 (0.85 o 1.50) 1.06 (0.90 o 1.25) 0.97 (0.85 o 1.12)
Ru al a ea ( e e ence) 1 1 1 1
Fa he ’s/gua dian’s educa ion
Basic 0.75 (0.45 o 1.26) 1.38 (0.97 o 1.96) 1.14 (0.99 o 1.32) 0.94 (0.83 o 1.06)
Seconda y 0.51 (0.26 o 1.00) 1.28 (1.01 o 1.62) 0.87 (0.73 o 1.04) 0.96 (0.83 o 1.10)
Te ia y ( e e ence) 1 1 1 1
Fa he ’s/gua dian’s p o essional s a us
Uppe whi e colla 0.44 (0.25 o 0.79) 0.94 (0.74 o 1.18) 0.92 (0.80 o 1.06) 1.04 (0.92 o 1.18)
Lowe whi e colla 1.02 (0.67 o 1.56) 1.03 (0.84 o 1.25) 1.03 (0.91 o 1.17) 1.05 (0.94 o 1.17)
Ag icul u e and o es y 0.51 (0.19 o 1.35) 0.90 (0.62 o 1.30) 0.96 (0.77 o 1.19) 1.07 (0.89 o 1.27)
Blue colla ( e e ence) 1 1 1 1
Family s uc u e
In a nuclea amily 0.38 (0.26 o 0.56) 0.47 (0.39 o 0.56) 0.63 (0.55 o 0.70) 0.86 (0.77 o 0.95)
No in a nuclea amily ( e e ence) 1 1 1 1
Gi ls
D unk weekly D unk mon hly
D unk
occasionally
D inks bu no
un il d unk
OR 95% CI OR 95% CI OR 95% CI OR 95% CI
Weekly disposable money
€17 o mo e 14.17 (7.06 o 28.48) 6.63 (5.01 o 8.78) 4.13 (3.38 o 5.05) 2.37 (1.99 o 2.84)
€10–€16 9.71 (5.12 o 18.42) 5.10 (4.02 o 6.47) 2.96 (2.50 o 3.50) 1.68 (1.46 o 1.94)
€7–€96.35 (3.32 o 12.16) 3.88 (3.06 o 4.91) 2.88 (2.45 o 3.39) 1.77 (1.54 o 2.04)
€5–€62.21 (1.10 o 4.44) 2.53 (2.01 o 3.18) 2.27 (1.95 o 2.64 1.60 (1.41 o 1.81)
€3–€4 1.67 (0.82 o 3.41) 1.29 (1.00 o 1.65) 1.63 (1.40 o 1.90 1.22 (1.08 o 1.39)
€2 o less ( e e ence) 1 1 1 1
Place o esidence
Me opoli an a ea 1.42 (0.73 o 2.77) 1.35 (1.02 o 1.78) 1.05 (0.88 o 1.26) 1.17 (1.00 o 1.37)
Ci ies 1.12 (0.58 o 2.14) 1.26 (0.97 o 1.63) 0.91 (0.77 o 1.08) 0.91 (0.79 o 1.06)
Towns 1.72 (0.98 o 3.04) 1.65 (1.31 o 2.08) 1.04 (0.90 o 1.21) 1.03 (0.90 o 1.17)
Villages 1.04 (0.56 o 1.94) 1.57 (1.24 o 2.00) 1.13 (0.97 o 1.31) 0.99 (0.87 o 1.14)
Ru al a ea ( e e ence) 1 1 1 1
Fa he ’s/gua dian’s educa ion
Basic 1.55 (0.96 o 2.50) 1.52 (1.26 o 1.84) 1.28 (1.12 o 1.45) 1.06 (0.95 o 1.19)
Seconda y 0.96 (0.53 o 1.74) 1.21 0.96 o 1.51) 1.05 (0.90 o 1.22) 1.03 (0.90 o 1.18)
Te ia y ( e e ence) 1 1 1 1
Fa he ’s/gua dian’s p o essional s a us
Uppe whi e colla 0.51 (0.31 o 0.84) 0.77 (0.64 o 0.92) 0.95 (0.84 o 1.08) 1.07 (0.95 o 1.20)
Lowe whi e colla 0.95 (0.66 o 1.36) 0.93 (0.79 o 1.09) 0.98 (0.87 o 1.10) 1.01 (0.91 o 1.12)
Ag icul u e and o es y 0.65 (0.28 o 1.49) 0.73 (0.53 o 0.99) 0.73 (0.60 o 0.90) 0.99 (0.84 o 1.18)
Blue colla ( e e ence) 1 1 1 1
Family s uc u e
In a nuclea amily 0.28 (0.21 o 0.39) 0.42 (0.36 o 0.48) 0.53 (0.47 o 0.59) 0.71 (0.64 o 0.78)
No in a nuclea amily ( e e ence) 1 1 1 1
The ORs a e based on main e ec s eg ession models. Income has been adjus ed o money alue changes.
Models include linea and quad a ic ime a iables.
S a is ically signi ican coe icien s a e higligh ed in bold.
6Lin onen T, Ne alainen J. BMJ Open 2017;7:e013994. doi:10.1136/bmjopen-2016-013994
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se e e h ough he whole d inking pa e n spec um
om 1983 un il he la e 1990s, a e which d inking
became less p e alen . Disposable income among his
age g oup inc eased wo old du ing he 30-yea pe iod.
The alcohol d inking pa e n was significan ly associa ed
wi h disposable income a ailable o he adolescen . The
OR o mon hly d unkenness e sus abs inence was 6.6
(95% CI 5.0 o 8.8) among gi ls and 9.0 (6.3 o 13.0)
among boys in he highes income g oup, ecei ing €17
pe week o mo e when con as ed wi h he lowes
income g oup ha had €2 o less. Income seems o ha e
been s ongly associa ed wi h hea y d inking, which
equi es mo e money. The associa ion was conside ably
mo e mode a e o d inking small amoun s; he ORs
we e unde 3.0 o all income ca ego ies when com-
pa ed wi h he lowes income g oup. D inking la ge
amoun s o alcohol un il d unk seemed mo e a ec ed
by pe iod e ec s han d inking small amoun s.
Fu he mo e, he associa ion be ween income and
d inking pa e n weakened conside ably du ing he
30-yea pe iod. Conside ing simila obse a ions on
declining adolescen d inking in nume ous o he coun-
ies
13
and heo e ical delibe a ions,
16
i is likely ha he
findings on dec easing impo ance o disposable income
a ailable o adolescen s o hei d inking a e gene alis-
able o high-income coun ies.
The changes in ime in he ela ionship be ween
income and d inking alcoholic be e ages a e also
a ec ed by changes in be e age p ices. The de elop-
men o alcohol p ices cap u ed by he eal p ice index
indica ed inc easing a e age p ice o alcohol om he
yea 2000 un il 2003, when i was 7% mo e expensi e
han a he u n o he millennium.
36
Owing o ax
changes, p ices hen ell o 4% lowe han in 2000; his
again changed, bo h due o he global financial c isis
and na ional ax inc eases, so ha in 2013 alcohol was,
on a e age, 28% mo e expensi e han in he yea 2000.
Bee , he be e age a ou ed by he unde aged who
d ink hea ily,
37
was 35% mo e expensi e in eal e ms
han in he yea 2000. This figu e is, in ac , e y close o
he co esponding inc ease in income among
14-yea -olds in he same pe iod.
25
Thus, he a o dabili y
o alcohol among 14-yea -olds did no change du ing
he pe iod.
Money has been p esen ed as a key media o be ween
pa en s and adolescen s.
19 38
In he No dic coun ies,
14-yea -olds do no wo k in la ge numbe s and hei
wo k income is ela i ely low.
22
Thus, pa en s ha e had
he means o con ol adolescen consump ion, including
alcohol d inking. O he pa en ing ac o s,
15
howe e ,
complica e he pic u e. In Finland, a epo published
in 2007 obse ed ha pa en al con ol o e hei o -
sp ings’alcohol use had no igh ened.
17
Subsequen
pape s om Finland wi nessed a g adual igh ening o
pa en al a i udes owa ds adolescen d inking,
14 18
alcohol- ela ed pa en ing p ac ices
39
and con ol o
selling alcoholic be e ages o mino s.
18 40
Simila obse -
a ions om o he coun ies include igh ening o
alcohol-specific pa en ing p ac ices be ween he yea s
2007 and 2011 in he Ne he lands,
41
which was shown o
be associa ed wi h dec eased d inking among hose
unde 16 yea s o age, and pa en al supe ision being
associa ed wi h lesse d inking among 11-yea -olds in he
UK.
42
Alcohol d inking is also a ec ed by pe iod- ela ed o
coho - ela ed ac o s.
43
This pape makes an a emp o
un eil he coho e ec s: he ac ha changes in he
su ounding socie y a ec people o di e en ages in di -
e en ways, c ea ing commonali ies o indi iduals.
Coho e ec s we e iden ified using his same da a se in
Finland:
6
con ex ual ac o s con ibu ed mo e o he
de elopmen o d unkenness han d inking small
amoun s. One possible explana ion o ou esul s can
be ha ecen coho s a e mo e in e es ed in o he ways
Figu e 2 The γcoe icien s and
hei 95% CIs o he associa ions
be ween alcohol d inking and
disposable income among
14-yea -olds.
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o spending ime and money, o example, using digi al
echnology, han in d inking, especially o d unkenness.
On he basis o su ey da a om 2006 in Finland,
alcoholic be e ages do no seem o be a p io i y on he
lis o possible ways o spend money.
44
Boys aged
11–17 yea s epo ed ha hey p e e o spend hei
income on swee s, digi al games, mobile phones and
hobbies, while same-aged gi ls p io i ised swee s, clo h-
ing, mobile phones and going ou o ca es, o example.
Alcohol and obacco we e he eigh h i em on bo h
gende s’lis s. Un o una ely, no ime end in o ma ion
exis s on adolescen consump ion p e e ences. Since he
u n o he millennium, spending o income on alco-
holic be e ages has me wi h new compe i ion om, o
example, digi al gaming and o he amusemen and
pas ime ac i i ies, including spo s,
45 46
which a e no
eadily compa ible wi h d inking alcohol. We can only
specula e ha he obse ed weakening connec ion
be ween income and alcohol d inking in he ecen
decade may eflec a change in he impo ance o
alcohol in eenage s’consump ion—i may ha e been
pa ly eplaced by spending on digi al echnology.
Pa en al con ol o income does no seem an e ficien
way o con olling alcohol d inking; emphasis may need
o be di ec ed owa ds ensu ing ha eenaged adoles-
cen s spend hei ime and ene gy on mo e cons uc i e
ac i i ies han simply hanging ou .
The indica o s ha e been de i ed om mailed sel -
epo su eys and a e subjec o measu emen biases.
Howe e , he bes possible ca e was aken o ensu e com-
pa abili y ac oss he s udy yea s; o example, ega ding
he iming, ques ions and sampling emained unchanged
h oughou he yea s. The esponse a e was good un il
ecen yea s; howe e , i was down o 38% in 2013. In
o de o inc ease he esponse, he op ion o pa icipa e
using he in e ne was in oduced in 2009; a ound 50%
o he esponses ha e since been ecei ed ia he in e -
ne . While e en in 2013 he a e emained 46% among
gi ls, he esponse a e o only 30% among boys in 2013
means ha he esul s conce ning boys in ecen yea s
mus be judged wi h cau ion. In analyses based on
esponse iming and es – e es subsamples, i has been
concluded ha while i is likely ha he p e alence o
alcohol use is equal among esponden s and non-
esponden s, d inking un il d unk is mo e common
among non- esponden s.
43
Simila conclusions we e
d awn om compa isons wi h he School Heal h
P omo ions Su ey (SHPS), which is a na ionally ep e-
sen a i e class oom su ey wi h a ound a 90% esponse
a e.
47
The a es o abs en ion o 14–16 yea s old, o
example, we e 27% (AHLS) and o 15–16 yea s old 25%
(SHPS) in he yea 2001, and 52% (AHLS) and 50%
(SHPS) in he yea 2013.
48
Owing o he declining
esponse and esponden selec ion based on d inking
habi s, i is likely ha he figu es p esen ed he e conce n-
ing d unkenness among 14-yea -olds a e sligh ly unde es-
ima ed, especially a e he yea 2009. Since s udy
d op-ou was mo e p onounced among hea ie d inke s,
he dec ease in he associa ion be ween income and
d inking pa e ns may be a ec ed such ha he dec ease
in he s eng h o associa ion is o e es ima ed. Howe e ,
he selec ion bias is mos likely no enough o influence
he gene al dec easing end such ha i would be an
a e ac . Un o una ely, non- esponse analysis o dispos-
able income is no a ailable in his s udy, and no
14-yea -olds’income ends ha e been published om
o he adolescen da a se , ei he . School-based su ey
da a wi h an a e age yea ly esponse a e o a ound 90%
show a end o inc easing disposable income o
15–16 yea s old be ween he yea s 1995 and 2011,
39
in
good ag eemen wi h he figu es p esen ed in his pape .
The wo sensi i i y analyses, one es ing o sensi i i y
o income dis ibu ion changes and he o he o sensi-
i i y o alcohol p ice changes, showed ha he esul s
we e obus o hese wo possible explana ions/con oun-
de s. I is likely ha p ice is, howe e , a significan issue
a he ime o pu chase, and he p ices 14-yea -olds a e
o ced o pay o acqui ing alcohol illegally may be
highe han he a e age e ail p ice. Un o una ely,
in o ma ion on his phenomenon was no a ailable o
he analyses. In addi ion, while alcohol a ailabili y is ce -
ainly a significan ac o in unde aged d inking, alid
indica o s o he expe ienced a ailabili y a he indi id-
ual le el we e no a ailable o analyses.
The dec eases in adolescen d inking simila o he
ones epo ed he e o Finland ha e aised esea ch
in e es in many o he high-income coun ies
13
and a
decline in 11–15 yea s old d inking be ween he yea s
2002 and 2010 has been obse ed in 20 o he pa icipa -
ing 28 coun ies. A ange o explana ions o his phe-
nomenon ha e been specula ed on, including income
changes, een cul u e changes, s ic e legal en o ce-
men , changes in adul d inking and adul a i udes
owa ds adolescen d inking, as well as policy and p e-
en ion aimed a dec easing d inking.
12 13 16 49
Empi ical e idence on he dec ease in 14–17 yea s old
d inking obse ed ecen ly in Aus alia shows he phe-
nomenon o be dis ibu ed ac oss all socioeconomic sub-
sec ions o he popula ion examined.
12
O he
hypo heses and e idence e iewed ecen ly in he UK,
he declining alcohol a o dabili y and be e pa en ing
we e seen as he mos c edible explana ions o declin-
ing you h d inking.
16
CONCLUSIONS
I is jus as impo an o iden i y ac o s behind ecen
dec eases in adolescen d inking as i is o analyse pas
inc eases in d inking. The ac o s causing he down u n
can be used in u u e alcohol policies and in e en-
ions,
3
as well as in de eloping public policies and ac ion
in gene al. In con as wi h he clea e ec s o alcohol
policy changes in consump ion in he adul popula ion,
1
policy measu es including ax changes do no seem o
ha e had a no iceable influence on alcohol d inking o
e en d unkenness among he unde aged in Finland.
8
8Lin onen T, Ne alainen J. BMJ Open 2017;7:e013994. doi:10.1136/bmjopen-2016-013994
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The cu en analyses u he complica e he pic u e: a
p e iously iden ified p edic o o adolescen alcohol use,
disposable income, has dec eased in impo ance, and
he influence o pocke money, which has been an
impo an ins umen o he pa en s o influence hei
child en’s alcohol d inking, seems o ha e weakened
o e he yea s.
Con ibu o s Bo h au ho s join ly concei ed o he s udy idea and design, as
well as pa icipa ed in he analysis o he da a and in e p e a ions o he
esul s. TL w o e he i s d a , which was hen c i ically e ised by bo h
au ho s. The inal e sion o he manusc ip was app o ed by bo h au ho s.
Funding The da a collec ion was unded by he Minis y o Social A ai s and
Heal h (Finland).
Compe ing in e es s None decla ed.
E hics app o al E hics Commi ee o he Tampe e egion (Finland).
P o enance and pee e iew No commissioned; ex e nally pee e iewed.
Da a sha ing s a emen Da a se a ailable on eques om he Uni e si y o
Tampe e, School o Heal h Sciences, Tampe e, Finland.
Open Access This is an Open Access a icle dis ibu ed in acco dance wi h
he C ea i e Commons A ibu ion Non Comme cial (CC BY-NC 4.0) license,
which pe mi s o he s o dis ibu e, emix, adap , build upon his wo k non-
comme cially, and license hei de i a i e wo ks on di e en e ms, p o ided
he o iginal wo k is p ope ly ci ed and he use is non-comme cial. See: h p://
c ea i ecommons.o g/licenses/by-nc/4.0/
REFERENCES
1. Babo TF, Cae ano R, Casswell S, e al.Alcohol: no o dina y
commodi y: esea ch and public policy. Ox o d: Ox o d Uni e si y
P ess, 2010.
2. Wagenaa AC, Salois MJ, Kom o KA. E ec s o be e age alcohol
p ice and ax le els on d inking: a me a-analysis o 1003 es ima es
om 112 s udies. Addic ion 2009;104:179–90.
3. Pennay A, Li ings on M, MacLean S. Young people a e
d inking less: i is ime o ind ou why. D ug Alcohol Re
2015;34:115–18.
4. Lin onen T, Rimpelä M, Vika A, e al. The e ec o socie al changes
on d unkenness ends in ea ly adolescence. Heal h Educ Res
2000;15:261–9.
5. Lin onen T, Wilska T, Koi usil a L, e al. T ends in disposable
income among eenage boys and gi ls in Finland om 1977 o 2003.
In J Consum S ud 2007;31:340–8.
6. Lin onen T, Hä könen J, Rai asalo K, e al.Dec easing
adolescen d inking: is he e e idence o con inua ion on o u u e
adul coho s? APC-analysis o adolescen d inking in Finland,
1983–2013. Scand J Public Heal h 2016. doi:10.1177/
1403494816665505. [Epub ahead o p in 26 Aug 2016].
7. Kinnunen JM, Lind o s P, Pe e L, e al.The Adolescen Heal h and
Li es yle Su ey 2013. Adolescen smoking, alcohol and subs ance
use in 1977–2013. Helsinki: Minis y o social a ai s and heal h,
2013.
8. Lin onen T, Ka lsson T, Ne alainen J, e al. Alcohol policy changes
and ends in adolescen d inking in Finland om 1981 o 2011.
Alcohol Alcohol 2013;48:620–6.
9. Heal h and Social Ca e In o ma ion Cen e. S a is ics on alcohol:
England. London: O ice o Na ional S a is ics, 2008.
10. Johns on L, O’Malley PM, Bachman JG, e al.Moni o ing he u u e
—na ional su ey esul s on d ug use, 1976–2012, Vol. 1, seconda y
school s uden s. Ann A bo : Ins i u e o Social Resea ch, Uni e si y
o Michigan, 2013.
11. Raninen J, Li ings on M, Lei man H. Declining ends in alcohol
consump ion among Swedish you h—does he heo y o collec i i y
o d inking cul u es apply? Alcohol Alcohol 2014;49:681–6.
12. Li ings on M. T ends in non-d inking among Aus alian adolescen s.
Addic ion 2014;109:922–9.
13. Looze MD, Raaijmake s Q, Bog TT, e al. Dec eases in adolescen
weekly alcohol use in Eu ope and No h Ame ica: e idence om 28
coun ies om 2002 o 2010. Eu J Public Heal h 2015;25(Suppl 2):
69–72.
14. Rai asalo K, Holmila M. Alkoholinkäy ö apojen pe iy yminen ja
anhempien kas a uskäy ännö ”[He i abili y o alcohol use pa e ns
and he pa en al educa ional p ac ices]. In: Lammi-Taskula, J,
Ka onen S. eds. Lapsipe heiden hy in oin i 2014 [The well-being o
amilies wi h child en 2014]. Helsinki: Na ional Ins i u e o Heal h
and Wel a e, 2014:196–204.
15. Ryan SM, Jo m AF, Lubman DI. Pa en ing ac o s associa ed wi h
educed adolescen alcohol use: a sys ema ic e iew o longi udinal
s udies. Aus N Z J Psychia y 2010;44:774–7.
16. Bha acha ya A. You h ul abandon—Why a e young people d inking
less? London: Ins i u e o Alcohol S udies, 2016.
17. Ka lsson T, Rai asalo K, Holmila M. Alaikäis en alkoholihankin ojen
sie ämä ön helppous [The unbea able ease o access o alcohol
among adolescen s]. In: Tige s ed C. ed. Nuo e ja alkoholi [You h
and alcohol]. Helsinki: The Finnish Socie y o Alcohol and D ug
Resea ch & Finnish You h Resea ch Socie y, 2007:149–160.
18. Rai asalo K, Huh anen P, Ahls öm S. Nuo en päih eiden käy ö
sekä käsi ykse niihin lii y is ä iskeis ä ja saa a uudes a Suomen
ESPAD-aineis on uloksia 1995–2011 [The use o in oxican s and
pe cep ions o isk and a ailabili y based on he ESPAD Da a in
Finland 1995–2011]. Yh eiskun apoli iikka 2012;77:72–80.
19. B usdal R, Be g L. A e pa en s gende neu al when inancing hei
child en’s consump ion? In J Consum S ud 2010;34:3–10.
20. Wes P, Swee ing H, Young R, e al. A ma e ial pa adox:
socioeconomic s a us, young people’s disposable income and
consume cul u e. J You h S ud 2006;9:437–62.
21. Besen-Cassino Y. The cos o being a gi l: gende ea ning
di e en ials in ea ly labo ma ke s. NWSA J 2008;20:146–60.
22. Danske Bank. Financial li e acy among 15–17 yea -old eenage s—
based on a ma ke esea ch su ey among eenage s 15–17 yea s
old in Denma k, No way, Sweden and Finland. Copenhagen:
Danske Bank co po a e epo , 2013.
23. de Lange M, Ges huizen M, Wolbe s MHJ. “You h labou ma ke
in eg a ion ac oss Eu ope”.Eu Soc 2014;16:194–212.
24. Mo ime JT. The e olu ion, con ibu ions, and p ospec s o he you h
de elopmen s udy: an in es iga ion in li e cou se social psychology.
Soc Psycholy Q 2003;75:5–27.
25. Wilska T, Lin onen T. The gende gap in eenage s’incomes.
A 30-yea end in Finland 1983–2013. J You h S ud 2015;19:
421–37.
26. Koo eman P. Time, money, pee s, and pa en s; some da a and
heo ies on eenage beha io . J Popul Econ 2007;20:9–33.
27. Raijas A, Wilska T. Huolenpi oa ja jakamis a— ahan ja ajan
jakau uminen suomalaisissa lapsipe heissä [Ca ing and sha ing—
he alloca ion o ime and money in households]. Discussion and
wo king pape s 104/2007. Helsinki: Na ional Consume Resea ch
Cen e , 2007.
28. Melo i R, He on J, Hickman M, e al. Adolescen alcohol and
obacco use and ea ly socioeconomic posi ion: he ALSPAS bi h
coho . Pedia ics 2011;127:e948–955.
29. Rich e M, Leppin A, Gabhainn S. The ela ionship be ween pa en al
socio-economic s a us and episodes o d unkenness among
adolescen s: indings om a c oss-na ional su ey. BMC Public
Heal h 2006;6:289.
30. Kun sche E, Rossow I, Simons-Mo on B, e al. No ea ly d inking
bu ea ly d unkenness is a isk ac o o p oblem beha io s among
adolescen s om 38 Eu opean and No h Ame ican Coun ies.
Alcohol Clin Exp Res 2012;37:308–14.
31. Samposalo H. Rela ionship be ween d inking pa e n and
alcohol- ela ed ha ms and isk beha io s among 14- o 16-yea -old
adolescen s in Finland. Tampe e: Tampe e Uni e si y P ess, 2013.
32. Lin onen T, Ahls öm S, Me so L. The eliabili y o d inking
sel - epo s in adolescence. Alcohol Alcohol 2004;39:362–8.
33. Lin onen T, Rimpelä M. The alidi y o he concep o ‘sel -pe cei ed
d unkenness’in adolescen heal h su eys. J Subs Use
2001;6:145–50.
34. Ag es i A. Ca ego ical da a analysis, hi d ed. New Yo k: Wiley,
2012.
35. In e na ional Labou O ganisa ion. In e na ional S anda d
Classi ica ion o Occupa ions. Gene a: In e na ional Labou O ice,
1990.
36. O icial S a is ics o Finland. Yea book o alcohol and d ug s a is ics
2015. Helsinki: Na ional Ins i u e o Heal h and Wel a e, 2015.
37. Lin onen T, Konu A. D unkenness- ela ed alcoholic be e age
choices among adolescen s. J Subs Use 2001;6:16–21.
38. Scho JB. Bo n o buy: he comme cialized child and he new
consume cul u e. New Yo k: Sc ibne , 2004.
39. Rai asalo K, Holmila M. P ac ices in alcohol educa ion among
Finnish pa en s: Ha e he e been changes be ween 2006 and
2012? D ugs Educ P e Pol, 2016. doi: 10.1080/
09687637.2016.1183587. [Epub ahead o p in 1 Jun 2016].
Lin onen T, Ne alainen J. BMJ Open 2017;7:e013994. doi:10.1136/bmjopen-2016-013994 9
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