Effects of Local Alcohol Prevention Initiatives in Swedish Municipalities, 2006–2014

Abstract

Background: Several components of the Swedish alcohol policy, e.g., pricing and availability, weakened when Sweden joined the EU in 1995. To counteract the possible negative effects of this, emphasis was placed on the local level as an important arena of alcohol prevention. Thus, considerable efforts were made to strengthen alcohol prevention in Swedish municipalities. Objectives: The aim of this study was to examine whether local alcohol prevention reduced consumption and alcohol-related harm in Swedish municipalities. Methods: Alcohol prevention was monitored using a composite measure called the Alcohol Prevention Magnitude Measure (APMM), with subcategories of staff and budget, inspections and licenses, policy, activities, and cooperation. APMM and its categories were analysed in relation to alcohol consumption and harm over time, 2006–2014. A fixed effects model was used with 63% (N=182, consumption) and 71% (N=207, harm) of 290 Swedish municipalities, respectively, included in the analyses. Results: The main results suggest that when APMM increases with 1 percent, the alcohol-related mortality decreases with 0.26 percent, controlled for changes in population size, median income, unemployment, and post-secondary education. In light of this result, the estimated effect of APMM on alcohol consumption (sales) is small (0.02 percent decrease); possible explanations for this are discussed in the article. Conclusion: The overall results indicate that local alcohol prevention initiatives in Sweden have reduced some forms of alcohol-related harm, not least alcohol-related mortality, during the period 2006–2014. Further studies are needed to assess the generalizability of the present study.

Keywords:

• Alcohol
• composite
• measure
• index
• prevention
• policy
• municipality

Acknowledgements

This study was funded by the Alcohol Research Council of the Swedish Alcohol Retailing Monopoly, grant number 2014-0036.

We would like to acknowledge the Public Health Agency of Sweden for providing prevention data.

An early version of this study was presented and discussed at the 42nd Annual Alcohol Epidemiology Symposium of the Kettil Bruun Societyin Stockholm in May/June 2016. We are grateful for the comments made by the discussants regarding our draft.

A late (submitted) version of this study/manuscript was included in the thesis Local alcohol prevention in Sweden - Construction of a prevention index and assessments of prevention effects on consumption and harm at Karolinska Institutet.

Disclosure statement

The authors report no conflicts of interest.

Figure A1. Prevention categories within APMM. Average points based on 207 municipalities, 2006–2014.