Alcohol related harms to children and youth and ways to address it Case of Finland

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1 Alcohol related harms to children and youth and ways to address it Case of Finland Researcher Jaana Markkula Injury prevention unit European Child Safety Alliance meeting 6th of June 2013, Cluj-Napoca, Romania

2 Alcohol consumption and harms in Finland A. Total consumption B. Consumption among underaged C. Consumption in families THL 2

3 A. Total alcohol consumption in Finland, litres 100 % alcohol /capita l + 10 % l + 10 % l + 46 % 2 0 Source: THL. Alko Grocery trade On-premise Unrecorded THL 3

4 B. Alcohol use among under-aged in Finland In contrast to adults, alcohol use among adolescents has slightly decreased and the proportion of adolescents abstaining from alcohol has increased in the past decade. However, Finnish adolescents get drunk more often and drink larger amounts in one session than other European adolescents. Heavy drinking culture is reflected to alcohol use among adolescents: prevalence of lifetime intoxication among teenagers is high THL 4

5 B. Binge drinking during past month, risk awareness and good availability of alcohol, % Boys Käyttö Binge drinking Riski awareness Saatavuus Availability of alc Year Source: The 2011 ESPAD Report The Substance abuse among students in 36 countries (pdf) THL 5

6 B. Binge drinking during past month, risk awareness and good availability of alcohol, % 60 Girls Käyttö Binge drinking Riski awareness Saatavuus Availability of alc Year Source: The 2011 ESPAD Report The Substance abuse among students in 36 countries (pdf) THL 6

7 B. Risky drinking and drunkenness in European context Source: HBSC 2009/ THL 7

8 B. Alcohol related harms injury deaths Proportion (%) of intoxicated of all injury deaths of year-olds in % of intoxicated of all deaths Boys Girls Unintentional injuries (incl. alcohol intoxications, n=672) Suicides (n=595) Violence (n=61) Injuries of undetermined intent (n=46) 70 Source: Official Statistics of Finland (OSF) - Causes of Death THL 8

9 B. Hospitalisations due to poisonings Hospitalisations (1/100,000) ( ) 5% due to alcohol 73% due to alcohol Boys Girls Age Source: THL, Hospital Discharge register THL 9

10 Incidence / 1000 B. Incidence rate of drink-driving according to age ( ) 25,0 20,0 15,0 10,0 5,0 0, (Source: Impinen et al. Suomen Lääkärilehti : ) Pirjo Lillsunde

11 B. Self-reported harms Portugal Lithuania Denmark Iceland Belgium (Flanders) Italy Sweden Greece Norway Romania Poland Hungary Malta ESPAD in average (excl. UK) France Finland Slovenia Ireland Cyprus Croatia Estonia UK Slovak Republc Czech Republic Germany (5 Bundesl.) Bulgaria Latvia Experienced accident or injury due to personal alcohol use during the last 12 months, % Girls Boys % Source: The 2011 ESPAD Report The Substance abuse among students in 36 countries (pdf) THL 11

12 C. Impacts of mother s substance use to children under 7 years Alcohol use among women is 6 times more common than in the end of 1960s (Mäkelä & al. 2010) How common are harms caused by it to small children? Injury-related hospitalisation / cohort Substance abusing mother Yes, % (n) No, % (n) p-value (khi2) (38) 4.7 (3040) Ns (147) 13.6 (7987) < (157) (7413) <.0001 Source: [In Finnish]: Holmila M, Raitasalo K, Autti-Rämö, Notkola I-L (2013). Children of substance abusing mothers. In Warpenius K, Holmila M & Tigerstedt C (eds.) Alkoholi- ja päihdehaita läheisille, muille ihmisille ja yhteiskunnalle. THL: Tampere THL 12

13 Preventive actions A. Alcohol policy B. Schoolbased prevention D. Early interventions C. Families THL 13

14 A. National level alcohol policy Luxembourg Malta Austria Switzerland Germany Portugal Italy Bulgary Belgium Spain Greece Hungary Slovakia the Netherlands Macedonia Czech Republic Denmark Cyprus Mean Romania Latvia UK Estonia Croatia Slovenia Lithuania Ireland Poland Turkey France Iceland Finland Sweden Norway Amphora points Strict Medium Liberal Immense differences on how alcohol is governed in Europe Finland scores as one of the strictest alcohol policy countries Higher policy score associated with lower consumption (with the exception of Southern Europe) Source: Anderson P et al (eds.) (2012): Alcohol policy in Europe: Evidence from AMPHORA. The AMPHORA project. (pdf) THL 14

15 A. National alcohol policy in Finland The Finnish alcohol control policy as an preventive system is fairly strict: Age limits + enforcement (18 years: beer/wine, 20 years: spirits) (Local Alcohol Policy Pakka-model) On- and off-premise licenses (store and bars etc). Restricted sales hours (9-21, off-premise) and days (Alko closed on Sundays) Alcohol advertising for strong spirits banned, restricted for milder beverages BAC limits of 0.5 and 1.2 on roads, and 1 on water Alcohol monopoly system in off-premise sale of liquers => Universal measures have an effect on total consumption and thus on under-aged children and families too THL 15

16 Example of successful local level alcohol policy PAKKA -work model Aims Adolescents and young people drink, smoke and gamble less The age initiating alcohol use increases Heavy drinking with its harms decreases Alcohol harms are prevented in an organised manner Key elements Strict age limit control and no selling to those clearly intoxicated Learning to identify difficult sale and retail situations and to cope with them Informing the public about alcohol harms and mobilize them through media and citizen activism Ensuring that alcohol is not marketed to those under-aged THL 16

17 PAKKA -work model: tasks and partnerships Coordination Ministry of social affairs and health THL Regional State Administrative Agencies Pakka-coordinator Municipal stakeholders Monitoring & supervision Ministry of social affairs and health National Supervisory Authority for Welfare and Health Ministry of Internal Affairs Police Board Local Police Sales in offpremises and onpremises Underaged & party people Education THL Regional State Administrative Agencies Pakkacoordinator Municipal stakeholders, NGOs Families/ Adolescents Media Families Adolescents THL 17

18 B. School-based substance abuse prevention Substance abuse prevention forms part of the wider promotion of well-being and health in schools. It may avoid mentioning intoxicants at all and instead focus on building up overall life management skills (protective factors). Combination of general and targeted prevention: 1) school education (National core curriculum and local curricula) and 2) practices of school health care (so called early intervention methods, e.g. ADSUME model for screening of the protective and risk factors related to substance use) targeted support for those with special needs THL 18

19 Lessons learnt & recent discussions A shift towards stricter age-limit control during the last years Still need to control the advertising, marketing and sponsorship of alcohol beverages How to challenge the intoxication-oriented drinking culture? Taking children of substance abusing parents into account in all services as well as in the society as a whole Control of drunk driving: Blood alcohol limits in traffic lower limits for youth and early interventions for those caught by police? THL 19

20 Aiming to change the drinking culture In 1969 In 2009 Thank you! THL 20