European Journal of Public Health, Vol. 19, No. 3, 278–284 ß The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/ckp007 Advance Access published on 10 February 2009
................................................................................................
The differences in drinking patterns between Finnish-speaking majority and Swedish-speaking minority in Finland Tapio Palja¨rvi1, Sakari Suominen2, Markku Koskenvuo1, Torsten Winter1, Jussi Kauhanen3
Keywords: alcohol drinking, minority groups, social behaviour, social environment.
................................................................................................ Introduction wedish-speaking Finns represent about 6% of the
Spopulation of Finland. Typically ethnic minorities are in
many ways disadvantaged compared with the majority of the population.1–3 The Swedish-speaking Finns are exceptional in that they have lower unemployment rates,4 a higher level of education,5 and greater marital stability6 than the Finnish speakers. The Swedish-speaking Finns also have a significant health advantage over the Finnish-speaking majority as measured by both total mortality7 and other health outcomes,8–10 and which cannot be explained easily by differences in demographic,11 environmental,12 genetic,13 or behavioural factors.11,14,15 There is some evidence that Swedish-speaking Finns would have more moderate drinking habits than Finnish speakers.11,16,17 However, these studies have either been very small in size,16 or alcohol consumption was not examined as an a priori measure.11,17 As such the evidence for the differences in alcohol consumption between the two language groups remains tentative. Since the adverse health effects of heavy alcohol consumption are well documented,18 possible differences in harmful alcohol consumption should be established in order to fully understand the health disparity between the two language groups. It has been suggested that higher levels of social capital in the Swedish-speaking population might explain their health 1 Department of Public Health, University of Helsinki, Helsinki, Finland 2 Folkha¨lsan Research Centre, Helsinki, Finland 3 School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland Correspondence: Tapio Palja¨rvi, Faculty of Medicine, Department of Public Health, University of Helsinki, PO Box 41, Helsinki, Finland00014, tel: +358 9 19127544, fax: +358 9 19126629, e-mail:
[email protected]
advantage over the Finnish speakers.17,19 Although Swedish speakers report more trust in others and more active social participation in some community engagements than the Finnish speakers,17,19 there is no empirical support for this hypothesis so far. One mechanism through which the beneficial effects of social capital could be mediated is alcohol consumption. Studies in Sweden and the United States have shown a negative correlation between measures of social participation and trust (the suggested two key dimensions of social capital) and heavy drinking patterns. Among Swedish men, a high alcohol intake (>250 g/week) has been associated with lower social participation and fewer contacts with friends and relatives.20 Another Swedish study among men found that high social participation combined with low trust was positively associated with a high alcohol intake (168 g/week).21 In the United States, high volunteerism at school among college students was associated with a lower probability of alcohol abuse, frequent drunkenness, and alcohol-related harm.22,23 The main aim of this paper is to examine whether, and to what extent, alcohol consumption differs between the Swedish speakers and the Finnish speakers. The Swedishspeaking Finns are expected to have higher levels of social participation and trust,17,19 potentially indicating higher levels of social capital. Thus, the second aim is to determine whether differences in alcohol consumption can be explained by measures of social capital. To provide information on possible mechanisms of alcohol-related health differences between populations and the relative contribution of social factors in that process.24 In addition, our data enable us to control for several individual and area level confounders. Because the Swedish-speaking population is geographically concentrated to the western and southern coastal regions of Finland, we will include municipality-level information on the area of residence in the analysis. Some of these variables can be considered to measure aspects of social capital (i.e. voting turnout and
Downloaded from http://eurpub.oxfordjournals.org/ by guest on December 27, 2015
Background: This study aims to examine whether the Swedish-speaking minority in Finland differ from the Finnish-speaking majority in respect to alcohol consumption and, whether such differences could be explained by aspects of social capital measured by both individual and area level variables. Methods: This cross-sectional dataset consisted of 17 352 Finnish speakers (baseline response rate 40%) and 2018 Swedish speakers (baseline response rate 37%), aged 25–59 years. Multilevel logistic regression models were used to analyse the differences in alcohol consumption between the language groups, and to adjust for several potential individual and area level confounders. Results: Finnishspeaking men and women reported more frequent drunkenness, suffered more frequent hangovers, and had alcohol-induced pass-outs significantly more often than men and women in the Swedishspeaking population. Demographic, social, or environmental factors did not explain the observed differences in drinking patterns between these groups. Active social participation, social engagement, and trust in others were significantly related to drinking patterns only among Finnish speakers, but not among Swedish speakers. Conclusions: Drinking patterns are likely to have a direct impact on the health differences between the two populations, especially in relation to alcohol-related acute harm. It seems unlikely that the effect of social capital on the health differences between the two populations would be mediated through drinking patterns.
Population differences in drinking patterns
proportion of single parents).10 In order to take into account the possible area effects on alcohol consumption, we will utilize a multilevel method where municipality of residence is used as an area unit.
Methods
Individual level variables Based on the official language status, the respondent was classified as a Finnish or Swedish speaker. The official language status is based on information derived from the national population register, and is linked using a personal identification number. Because Swedish is an official language in Finland, Swedish-speaking Finns have certain constitutional rights, if they register their mother tongue as Swedish. Individual level variables thought to be potential confounders that were controlled for in the analysis included: gender, age, educational level (high/low), whether respondent was living alone (yes/no), and unemployment (yes/no).26 Individual level social engagement was assessed as at least monthly engagement in the following leisure time social activities: organizational participation, cultural participation, participation in religious events, and visiting relatives and friends. The frequency of visiting restaurants/pubs was also measured. This can be considered as a form of social engagement, but also as a measure of drinking pattern because drinking at restaurants and pubs is associated with higher intake and more frequent drunkenness than drinking, e.g. at home. The choice of cutoff was based on the distributions of the responders across the various frequency levels with the aim of capturing aspects of social participation that are more frequent than just occasional, thus indicating a potentially stronger impact on health behaviour. Expressed mistrust towards others was based on the Cook-Medley Cynical Hostility Scale.27 We used one of the several statements to measure mistrust (‘It is better not to trust anyone’), where the response options on a five-point scale ranged from ‘I totally disagree’ to ‘I totally agree’. A dichotomous measure was used
to indicate mistrust for those responders who chose either ‘I totally agree’ or ‘I somewhat agree’. Other individual level measures of social characteristics were social support and negative childhood experiences. Social support was measured by the Brief Social Support Questionnaire.28 Lowest decile (score under 6) of the sum score (range 0–36) was used as a cutoff point for low social support.29 We used information on parental divorce30 and the presence of an alcohol problem in a childhood family member as an indicator of a childhood social environment. Only consistent ‘yes’ responses on both T1 and T2 were used. The presence of an alcohol problem in a family member was considered an indication of a familial predisposition to heavy drinking.31 The inclusion of childhood social environment provides a life-course perspective32 into the development of values and attitudes towards social engagement in later life. Measures of alcohol consumption included overall annual frequency of drinking, beverage specific quantity of intake, and pattern of drinking. For the estimation of total quantity of alcohol intake, the respondent was asked to estimate their average consumption, by type of alcoholic beverage (see Appendix 1). The beverage specific consumption was converted to grams of absolute alcohol and summed up as total weekly consumption. Abstainers were classified as participants who had not consumed any alcohol in their lifetime or those who had not used any alcohol during the preceding year of the survey. Pattern of drinking was measured by annual frequency of drunkenness, and number of hangovers and alcohol-induced pass-outs (in Finnish and Swedish, there is a specific expression for this loss of consciousness due to drinking too much alcohol). The term used for alcoholinduced pass-out refers to loss of consciousness without reference to loss of memory (blackout). For the purposes of this study, we dichotomized the measures of alcohol consumption using a cutoff point of ‘At least twice weekly’ for frequency of drinking, indicating possibly heavy drinking, but also frequent social drinking such as drinking with meals. Heavy weekly intake was defined as >260 g/week for men, and >170 g/week for women.33 The cutoff point for categorizing the frequency of drunkenness and frequency of hangovers was set at ‘At least monthly’ and the cutoff point for pass-outs was set at ‘At least once a year’.34
Area level variables Municipality of residence of the respondent was selected as the area unit in the study. A finer classification of postal code areas could have been used here, but because of the sample size, we chose to use municipalities as the area unit. In Finland, there were 446 municipalities in 2003. Our data consist of 435 municipalities with a population size varying from 233 to 559 330 (with a mean size of 12 083). Some of the smallest municipalities were not represented in the data because of no respondents. Area level information was obtained through public databases of the Statistic Finland and the National Research and Development Centre for Welfare and Health (SOTKA database). We used the following measures to indicate the area level social environment of the respondents: Unemployment rate (range 1–30%), Educational index (range 152–531), which indicates the average length (in years) of the highest educational qualification after compulsory basic education per person in a population aged over 19 (e.g. the value 531 shows that the average length of education is 5.31years per person after basic education), voting turnout (range 51–90%) in most recent municipality elections (year 2004), proportion of Swedish speakers in the population (range
