title: Does the prevention paradox apply to various alcohol habits and problems among Swedish adolescents?
abstract: BACKGROUND
  The prevention paradox states that a majority of alcohol-related problems in a population come from moderate drinkers because they are more numerous than heavy drinkers, although the latter have a higher individual risk of adverse outcomes. We examined the extent to which the prevention paradox applies to the relationship between alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems in adolescents; an area in which studies are lacking.
  
  
  METHODS
  A total of 7288 alcohol-consuming adolescents aged 13-17 years were examined. The proportions (%) of problems related to drinking measures [the upper 10% and bottom 90% of drinkers by annual alcohol intake, and those with frequent (monthly), less frequent, and no heavy drinking episodes] were calculated.
  
  
  RESULTS
  The bottom 90% of consumers by annual intake accounted for a large majority of the alcohol-related problems among boys and girls at all ages. The share of problems accounted for by monthly HEDs increased with age, from ∼10% among those aged 13 years to >50% among those aged 17 years. Attributable proportions for the top 10% alcohol consumers ranged between 22% and 37%.
  
  
  CONCLUSIONS
  Our analyses suggest that the prevention paradox is valid for adolescent boys and girls aged ≥15 years and applies to a large range of alcohol-related problems of varying severity. Our results imply that not only that prevention directed at all adolescents is essential, but also that HED should be particularly noticed.
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. anders.romelsjo@ki.se
authors.forename: Anders
authors.initials: A
authors.lastname: Romelsjö
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Danielsson
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control*; D019973:Alcohol-Related Disorders / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D000437:Alcoholism / Q000453:epidemiology / Q000517:prevention & control*; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D000431:Ethanol; D005260:Female; D006184:Habits; D006801:Humans; D008297:Male; D012307:Risk Factors; D012309:Risk-Taking; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology
chemical_list: D000431:Ethanol