title: The country-level effects of drinking, heavy drinking and drink prices on pre-drinking: An international comparison of 25 countries.
abstract: The practice and adverse consequences of pre-drinking have been documented within a dozen countries, but little remains known about the differences between countries or the country-specific determinants of pre-drinking. This study aims to estimate the percentage of pre-drinkers in different countries and the impact of country-level indicators such as the price of alcohol and the prevalence of drinkers and of heavy drinkers.
  
  
  
  Using data from the Global Drug Survey, the percentage of pre-drinkers was estimated for 25 countries from 65 126 respondents. Bivariate and multivariate multilevel models were used to model the impact of the on-premise/off-premise drinks price ratio, the prevalence of current drinkers and of heavy drinkers on the percentage of pre-drinkers.
  
  
  
  The estimated percentage of pre-drinkers per country ranged from 17.7% (Greece) to 85.4% (Ireland). Across all countries, the higher the prevalence of current drinkers, the higher the percentage of pre-drinkers. In addition, an interaction between the prevalence of heavy drinkers and the price ratio was found. In countries with a low price ratio, the higher the prevalence of heavy drinkers, the higher the percentage of pre-drinkers. The opposite effect was observed in countries with high price ratios.
  
  
  
  Pre-drinking appears to be a worldwide phenomenon. The significant effects of all three indicators demonstrate the role of country-level determinants underpinning the prevalence of pre-drinking across countries. Policy makers could use the reported findings for initiating campaigns to reduce pre-drinking behaviour. [Labhart F, Ferris J, Winstock A, Kuntsche E. The country-level effects of drinking, heavy drinking and drink prices on pre-drinking: An international comparison of 25 countries.
authors.affiliation: Addiction Switzerland Research Institute, Lausanne, Switzerland.|Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands.
authors.forename: Florian
authors.identifier: 0000-0002-6646-9544
authors.initials: F
authors.lastname: Labhart
authors.affiliation: Institute for Social Science Research, The University of Queensland, Brisbane, Australia.
authors.forename: Jason
authors.identifier: 0000-0001-7474-0173
authors.initials: J
authors.lastname: Ferris
authors.affiliation: University College London, London, UK.|Global Drug Survey Ltd., London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Winstock
authors.affiliation: Addiction Switzerland Research Institute, Lausanne, Switzerland.|Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.|Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Kuntsche
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000191:economics* / Q000453:epidemiology / Q000523:psychology*; D000434:Alcoholic Beverages / Q000191:economics*; D000435:Alcoholic Intoxication / Q000191:economics* / Q000453:epidemiology / Q000523:psychology*; D044362:Australasia / Q000453:epidemiology; D003132:Commerce / Q000191:economics*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D009656:North America / Q000453:epidemiology; D013020:South America / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: cross-country comparison; drinking culture; pre-drinking; prevalence; price