Alcohol-related health problems and crime : studies on the long-term consequences of increased alcohol availability and unemployment

Abstract: Background: The well-being of young people with respect to health and life opportunities is of high importance in society. This thesis examines the long-term adverse consequences of two periods in Sweden marked by high vulnerability for young people; one period with a drastic increase in alcohol availability for young people and one period with exceptionally high youth unemployment. Research has demonstrated immediate beneficial effects of restricting alcohol availability among adolescents and young adults. Less is known about the long-term consequences of exposure to increased alcohol availability during adolescence for the individual’s themselves and the health and well-being of subsequent generations. Evidence suggests that youth unemployment is related to worse self-reported mental and physical health in the long-term. There remains a discussion in the literature regarding the effect of prior poor health and contextual influences on the association, especially in relation to youth unemployment.: Aim: The aim of this PhD thesis was therefore to investigate the potential effects of exposure to increased alcohol availability during adolescence and in utero on disability pension (Study I), alcohol-related health problems (Study II) and criminal behavior (Study III). This thesis also aimed at investigating the effects of youth unemployment on mental health during periods of high and low unemployment rates and to explore whether there was any interaction in mental health between labor force status and levels of unemployment in society (Study IV). Methods: Studies I to III were register-based population-based longitudinal studies using a natural experiment setting of an alcohol policy experiment. During the late 1960s, strong beer became available in regular grocery stores in two regions of Sweden for adolescents under the age of 21 years, instead of being available only in the state-owned monopoly store “Systembolaget” with an age limit of 21 years. Study I investigated the effect of exposure to increased alcohol availability during adolescence on disability pension compared with same- aged unexposed adolescents (age 14–20 years). Studies II and III focused on the long-term effects of increased alcohol availability on children in utero during the time of the alcohol policy experiment. Study IV was a register-linked population-based cohort study based on individuals who had completed the nationwide Labour Force Survey between the ages of 17– 24 years at times of high or low national unemployment rates. Results: An increased risk of being granted disability pension due to an alcohol use disorder and a mental disorder was found among adolescents exposed to increased alcohol availability. No consistent evidence of any long-term consequences in subsequent generations was found. However, a slightly increased risk of alcohol-related health problems later in life was observed among exposed children conceived by young mothers. The results from Study IV showed a positive association between youth unemployment and mental health problems, irrespective of the overall national level of unemployment. Conclusion: Exposure to increased alcohol availability during adolescence can have long-term health consequences, for both the individual and subsequent generations. Furthermore, youth unemployment is longitudinally related to mental health problems, independent of the overall national unemployment rate. These findings are of importance, as alcohol remains a leading cause of morbidity and mortality and youth unemployment rates are currently at a stable high level both nationally and globally.