title: Alcohol use, heavy episodic drinking and subsequent problems among adolescents in 23 European countries: does the prevention paradox apply?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16-year-old students were analysed.
  
  
  METHODS
  A total of 38,370 alcohol-consuming adolescents (19,936 boys and 18,434 girls) from 23 European countries were included.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 proportion 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.
authors.affiliation: Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden. anna-karin.danielsson@ki.se
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Danielsson
authors.forename: Peter
authors.initials: P
authors.lastname: Wennberg
authors.forename: Björn
authors.initials: B
authors.lastname: Hibell
authors.forename: Anders
authors.initials: A
authors.lastname: Romelsjö
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology* / Q000517:prevention & control; D000434:Alcoholic Beverages / Q000191:economics / Q000706:statistics & numerical data; D000435:Alcoholic Intoxication / Q000453:epidemiology*; D002492:Central Nervous System Depressants / Q000506:poisoning; D003431:Cross-Cultural Comparison; D004522:Educational Status; D000431:Ethanol / Q000506:poisoning; D005060:Europe / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D013334:Students / Q000706:statistics & numerical data; D047568:Unsafe Sex / Q000706:statistics & numerical data; D014754:Violence / Q000706:statistics & numerical data
chemical_list: D002492:Central Nervous System Depressants; D000431:Ethanol