Reasons Not to Drink Alcohol among 9th Graders in Sweden

Abstract

Aim

Alcohol is one of the leading contributors to the disease burden among young people. Drinking motives are one of the strongest factors influencing drinking behaviors among youth, yet we know little about reasons for why young people do not drink. The aim of the present study is to examine reasons for not drinking in a nationally representative sample of Swedish youth.

Data and methods

Data from a survey of a nationally representative sample of students in year 9 (15-16 years old) was used. Data was collected in 2017 and the total sample comprise 5549 respondents. Ten items measured reasons not to drink alcohol. Comparisons were made between drinkers and nondrinkers in endorsement of the reasons for not drinking. A multivariable logistic regression model was fitted to examine the relative importance of the different reasons.

Results

That alcohol is bad for health and parents disapproval of drinking was the most commonly endorsed reasons both among drinkers and nondrinkers. The multivariable analysis showed that the strongest association with being a nondrinker was found for “Alcohol tastes horrible” (OR 2.995), “I have religious reasons for not drinking” (OR 2.775), “People who drink lose control in an unpleasant way” (OR 2.460) and “Drinking is too likely to lead to serious accidents” (OR 2.458).

Discussion and conclusions

Harm avoidance and religious reasons are the most important reasons not to drink among Swedish youth. Future research should examine how different reasons predict abstinence.

Keywords:

• Alcohol
• not drinking
• youth
• Sweden
• reasons

Introduction

Over the past two decades alcohol consumption has been declining among Swedish youth. During this period the prevalence of drinking among Swedish 9^th graders has more than halved, from 81 per cent in the year 2000 to 39 per cent in 2018 (Zetterqvist, 2018). Similar developments have been reported for many other countries (Looze et al., 2015; Raitasalo et al., 2021; Vashishtha et al., 2020). Even though this development has been going on for an extended period, and has attracted considerable research interest, we know very little about the underlying causes and mechanisms behind it (Pape et al., 2018; Raninen & Livingston, 2018).

The literature on reasons and motives to drink is extensive and has consistently shown that drinking motives have a strong association with drinking behavior (Kuntsche et al., 2014; Mackinnon et al., 2017; Sjödin et al., 2021). In fact, drinking motives have been shown to be one of the strongest driving forces behind why young people drink (Kuntsche et al., 2005; Kuntsche & Kuntsche, 2009). It is thus plausible that motives and reasons not to drink would similarly be important in understanding why young people do not drink. The motivation not to drink has, however, received less attention (Anderson et al., 2011; Epler et al., 2009. A recent review showed that among adults who had no interest in drinking, disliking the effects of alcohol and health reasons were important motives to abstain (Rosansky et al., 2020). The review also showed that most studies are from the U.S. and that very few quantitative studies have identified motives among adolescents (Rosansky et al., 2020).

Previous studies of young people have found that motives to abstain are associated with alcohol consumption. In particular, harm avoidance motives were associated with lower drinking (Anderson et al., 2013). Recent qualitative studies have also identified fear of losing control as a reason not to drink (Caluzzi et al., 2020). Authenticity and self-improvement (Caluzzi et al., 2020) as well as healthier lifestyle choices (Caluzzi et al., 2021; Torronen et al., 2019, 2021) have been identified as other important motives to abstain from drinking. Adding to the few extant studies on the topic, the aim of this study is to explore reasons not to drink in a nationally representative sample of Swedish 9^th graders and how these are associated with drinking status.

Data and methods

This study used a nationally representative sample of Swedish 9^th graders (15-16 year olds) collected in 2017. A random sample of 500 schools was drawn by Statistics Sweden. A probability proportional-to-size sampling design (PPS) was applied where a school’s inclusion probability was proportional to its number of 9th-grade students. The participation rate at the school level was 68.6% (n = 343). In each of the sampled schools one class was then selected using a PPS sampling procedure. All students in the selected class who were present on the day of the survey were asked to participate in the study. Those agreeing to participate were asked to fill out a self-administered paper-and-pen questionnaire during school hours. The sample comprise 5549 9^th grade students and the response rate were 82.3%, with 50.5% females and a good geographical spread across the country (Raninen, 2020). The study was approved by the ethical review board of Stockholm (2017/103-31/5).

Drinking status

Drinking status was measured with the question “Have you ever had a drink of alcohol?,” with the response alternatives “No/Yes, during the past 30 days/Yes, during the past year/Yes, more than 12 months ago.” This was dichotomized into “No = 0” and “Yes = 1.”

Reasons not to drink

All respondents were asked to answer ten statements. The initial question was the same for all statements: “How well does the following apply to you?.” The response alternatives were “Agree” or “Disagree.” Table 1 presents the wording of each statement.

Table 1. Prevalence (%) of reasons not to drink, entire sample and among drinkers and nondrinkers.

	All (n = 4501)	Drinkers (n = 1823)	Nondrinkers (n = 2678)	Odds Ratio *	95% Confidence intervals
1. Drinking is bad for your health	89.3%	82.5%	94.0%	1.675	1.331	2.109
2. Drinking costs too much	83.3%	80.7%	84.9%	0.805	0.667	0.971
3. I have religious reasons for not drinking	12.6%	4.8%	17.7%	2.775	2.146	3.587
4. People who drink lose control in an unpleasant way	60.9%	41.7%	73.9%	2.460	2.123	2.849
5. My parents disapprove of me drinking	90.2%	87.9%	91.8%	0.834	0.662	1.052
6. Drinking makes you put on weight	62.4%	60.7%	63.6%	0.734	0.634	0.849
7. Drinking has destroyed somebody that I know well	29.4%	31.2%	28.2%	0.549	0.471	0.640
8. Alcohol tastes horrible	59.6%	39.6%	73.1%	2.995	2.603	3.446
9. Some of the effects, eg. hangovers, dizziness and vomiting, are awful	83.2%	75.8%	88.4%	1.319	1.092	1.595
10. Drinking is too likely to lead to serious accidents	77.9%	62.7%	88.0%	2.458	2.059	2.934

*Odds ratios are derived from a multivariable logistic regression model. Values > 1.0 indicate that nondrinkers endorse the item more than drinkers and values < 1.0 indicate that drinkers endorse the item more often than nondrinkers, with adjustment for all other items.

Analysis

First, we compared the prevalence of each reason for not drinking between drinkers and nondrinkers. We then fitted a multivariable logistic regression model predicting being a nondrinker from the ten non-drinking reasons. The regression analyses adjusted for the clustering of respondents in school classes by using cluster robust standard errors. An analytic sample was created based on valid answers on all variables used in this study, n = 4501.

Results

Table 1 shows the proportion of the sample agreeing with each of the different reasons not to drink. The most prevalent reasons endorsed were “My parents disapprove of me drinking” and “Drinking is bad for your health.” There were, however, small differences between drinkers and nondrinkers for these items. The largest differences were instead observed for “Alcohol tastes horrible,” “I have religious reasons for not drinking” and “People who drink lose control in an unpleasant way.” Table 2 shows the correlation between the ten items measuring reasons not to drink. In general a strong inter-relationship was found for all variables, with only the association between “Drinking costs too much” and “I have religious reasons for not drinking” and between “Drinking is bad for your health” and “Drinking has destroyed somebody I know well” found not to be significant.

Table 2. Correlation matrix with all the items measuring reasons not to drink, entire sample n = 4501.

	1.	2.	3.	4.	5.	6.	7.	8.	9.	10.
1. Drinking is bad for your health	1.000	0.180	0.078	0.198	0.135	0.110	0.035	0.198	0.174	0.234
2. Drinking costs too much		1.000	0.026	0.141	0.043	0.151	0.053	0.136	0.113	0.166
3. I have religious reasons for not drinking			1.000	0.217	0.083	0.071	0.181	0.154	0.071	0.149
4. People who drink lose control in an unpleasant way				1.000	0.130	0.153	0.120	0.257	0.210	0.365
5. My parents disapprove of me drinking					1.000	0.087	0.047	0.127	0.111	0.129
6. Drinking makes you put on weight						1.000	0.095	0.109	0.176	0.181
7. Drinking has destroyed somebody that I know well							1.000	0.065	0.075	0.114
8. Alcohol tastes horrible								1.000	0.183	0.246
9. Some of the effects, eg. hangovers, dizziness and vomiting, are awful									1.000	0.297
10. Drinking is too likely to lead to serious accidents										1.000

Bold text indicates significant correlation (p < 0.01).

Table 1 also shows the results from the multivariable regression model. All reasons were significantly associated with being a nondrinker, except for “My parents disapprove of me drinking.” The strongest association with being a nondrinker was found for “Alcohol tastes horrible,” “I have religious reasons for not drinking,” “People who drink lose control in an unpleasant way” and “Drinking is too likely to lead to serious accidents,” all with odds ratios greater than 2.0.

Discussion

This study has explored how reasons not to drink alcohol among Swedish youth are associated with drinking status. Our result echo findings found in previous qualitative studies (Caluzzi et al., 2021; Torronen et al., 2019, 2021) in that nine out of ten agree that drinking is bad for your health. Even among drinkers a clear majority endorsed this statement. Nine out of ten also reported that their parents disapprove of them drinking. This is in line with previous research indicating the importance of parents in relation to alcohol consumption in youth (Larm et al., 2018; Raitasalo et al., 2018, 2021). This was, however, the only item found not to be significant in the multivariable analysis, with drinkers and nondrinkers equally likely to note parental disapproval.

Of the reasons showing the strongest association with being a nondrinker, two pertain to loss of control and fear of accidents, while another related to not liking the taste of alcohol. This indicates that harm avoidance is a strong driver for not engaging in drinking among Swedish youth, which is in line with what has previously been found (Anderson et al., 2013). Religious reasons were one of the other items displaying a strong association with drinking status, but this statement was only endorsed by a relatively small share of respondents. Several reasons were found to lower the probability of being a nondrinker in the multivariable analyses, these were items that also showed small differences in endorsement between the two groups. This indicates that these items are less important when it comes to discriminating between the two groups when the other items are controlled for.

The present study was based on self-reported cross-sectional data. This needs to be kept in mind when interpreting the results. The drinking status of the youth might have been wrongly reported and was only measured on one occasion. Since data was collected at an age when many begin experimenting with alcohol several respondents reporting being the nondrinkers might have transitioned to drinking shortly after participating in the survey. The drinking status should thus not be interpreted as a persistent trait of the respondents. There was also a high degree of inter-relationship found between all the reasons not to drink, so one should be cautious when interpreting and comparing the importance of individual reasons. The major strength of the current study is the high-quality data with a large nationally representative sample and a high response rate. Data covers roughly 5-6 per cent of all 9th graders in Sweden in 2017. Our findings should therefore be highly generalizable for Swedish youth.

Youth drinking has been declining for two decades in Sweden and this development is still unexplained. Understanding the drivers behind this trend is important from a public health perspective as alcohol consumption is one of the leading contributors to the burden of disease among young people (Agardh et al., 2016). Previous research has identified drinking motives as the most proximal factor for drinking (Kuntsche et al., 2005), but this is the first study to provide a quantitative exploration of the reasons not to drink endorsed by Swedish youth. Our results show that several reasons that can be classified as harm avoidance show a strong association with not drinking, along with religious reasons. Future studies examining the importance of these reasons for the longitudinal development of drinking status are needed.

Declaration of interest

We declare that none of the authors is in receipt of financial support or has any relationship that may pose a conflict of interest in relation to the content presented in the submitted manuscript.

Additional information

Funding

J.R. was funded by the Swedish Research Council for Health, Working Life and Welfare (FORTE) grant 2017-01741. P.K was funded by the Swedish Research Council for Health, Working Life and Welfare (FORTE), grant 2019-00378. P.L. was funded by Systembolagets Research Council on Alcohol (SRA) grant 2018-0019. J.S. was funded by the Swedish Research Council for Health, Working Life and Welfare (FORTE) grant 2021-01725. M.L. was funded by an Australian National Health and Medical Research Council Career Development Fellowship (GNT1123840).