@article{ref1,
title="Alcohol use, heavy episodic drinking, and subsequent problems among adolescents in 23 European countries: Does the prevention paradox apply?",
journal="Addiction",
year="2012",
author="Danielsson, Anna-Karin and Wennberg, Peter and Hibell, Björn and Romelsjö, Anders",
volume="107",
number="1",
pages="71-80",
abstract="Aims  According to the prevention paradox a majority of alcohol-related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED), and alcohol-related problems among adolescents in 23 European countries. Design and Setting  Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16-year-old students were analyzed. Participants  A total of 38 370 alcohol-consuming adolescents (19 936 boys and 18 434 girls) from 23 European countries were included. Measurements  The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol-related problems. Findings  Although the mean levels of consumption and alcohol-related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol-related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems. Conclusions  The prevention paradox, based on measures of annual consumption and heavy episodic drinking seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large part of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives, combined with targeted interventions.<p /> <p>Language: en</p>",
language="en",
issn="0965-2140",
doi="10.1111/j.1360-0443.2011.03537.x",
url="http://dx.doi.org/10.1111/j.1360-0443.2011.03537.x"
}