@article {Thern1072, author = {Emelie Thern and Ting Jia and Mikaela Willmer and Jeroen de Munter and Thor Norstr{\"o}m and Mats Ramstedt and George Davey Smith and Per Tynelius and Finn Rasmussen}, title = {No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment}, volume = {71}, number = {11}, pages = {1072--1077}, year = {2017}, doi = {10.1136/jech-2017-209164}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background A strict high legal age limit for alcohol purchases decreases adolescents{\textquoteright} access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality.Methods A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5\%{\textendash}5.6\% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14{\textendash}20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95\% CIs were obtained by Cox regression analysis.Results In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95\% CI 0.96 to 1.02) or mortality (HR: 1.02, 95\% CI 0.95 to 1.10) was found.Conclusion The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.}, issn = {0143-005X}, URL = {https://jech.bmj.com/content/71/11/1072}, eprint = {https://jech.bmj.com/content/71/11/1072.full.pdf}, journal = {Journal of Epidemiology \& Community Health} }