Non-drinking and problem drinking concentrate in the same groups in Helsinki
Helsinki residents consume more alcohol on average than people in the rest of Finland. This has been evidenced in studies on alcohol overuse, binge drinking and alcohol-related mortality. Much less is known about non-drinkers in Helsinki, although they make up 14 per cent of the city population. Total abstention from alcohol is associated with both age and gender. More surprisingly, there are many population groups that simultaneously show high prevalence of non-drinking and harmful use of alcohol. These groups include low-educated people and those in weak health.
Lifestyles and health behaviours among Helsinki residents are, in many respects, in a better shape than with Finns in general. Concerning alcohol use, however, the situation is the opposite. In Helsinki, a larger proportion of the population are heavy drinkers or binge drinkers than elsewhere in Finland. In addition, deaths from alcohol-related diseases or accidental alcohol poisoning are more common in Helsinki (Mäki 2020, Mäki & Martikainen 2016).
Latest data on Helsinki residents’ alcohol consumption, on one hand, and its consequences, on the other hand, appear to be partly conflicting. According to the National FinSote Survey 2018, there is no longer any significant difference in alcohol consumption between Helsinki residents and Finns on average.
Among those aged 20 or older in Helsinki, almost 40 per cent of men and around one in four women drink too much alcohol. The proportion of binge drinkers in Helsinki was 15 per cent among men and barely 4 per cent among women. These figures are more or less in line with corresponding data on all of Finland; only the proportion of women who drink excessively remains statistically higher in Helsinki (Mäki & Ahlgren-Leinvuo 2020.) Meanwhile, fresh data on rising alcohol-related mortality rates following a comprehensive reform of the Finnish alcohol legislation tell another story: it seems that mortality from alcohol-related diseases has risen particularly in Helsinki after 2017 (Mäki 2020).
In a long-term perspective, the number of non-drinkers has fallen in Finland, especially with older people, among whom the proportion was large. This has been shown by the Finnish Institute for Health and Welfare’s Drinking Habits Survey, conducted at regular intervals since 1968. Among men, on average, no major changes have been witnessed. Among older men, however, non-drinking is now somewhat less common than it was, and slightly more common among younger men. Among women, change over time has been more significant. The proportion of non-drinkers in young women has decreased slightly, but among 50–69-year-old women, the proportion has declined from 50 per cent in the late 1960s to around 15 per cent in 2016 (Mäkelä 2018).
While the above figures are for the national level, much less information has been available about non-drinkers in Helsinki. We know that among young people, the proportion of non-drinkers has grown in the 21st century. According to the 2017 School Health Inquiry, their proportion among Helsinki respondents was 64 per cent for junior high school students, 33 per cent for senior high school students, and 28 per cent for those in vocational education.
These figures have risen clearly since the early 2000s. (Lyly-Falk 2018). Hardly any data is available on non-drinking adults in Helsinki, and that is why the present article looks at the situation among Helsinki residents aged 20 or over.
Data material and methods
This article is based on data from the nationwide FinSote survey conducted by the Finnish Institute of Health and Welfare THL in 2018. The survey examined perceived welfare, health and lifestyles among the adult population, and had a total of 3,646 respondents in Helsinki. Possible change over time in the occurrence of total abstention from alcohol was analysed using data from the ATH Regional Health and Well-being Study conducted in 2013–2015 with a total of 9,717 respondents living in Helsinki.
In the present article, non-drinkers refer to those who had given a negative answer to the question (in either the ATH or FinSote survey) of whether they had used alcohol during the last 12 months. In the ATH survey, 1,491 respondents reported they had not, against 602 in the FinSote survey. A corresponding definition of non-drinkers is used in the THL Drinking Habits Survey, for example. Thus the group of non-drinkers may include people who have never tasted alcohol or who had abstained from drinking in the previous 12 months, or people who had stopped drinking altogether.
While examining the different aspects of alcohol use, non-drinkers are compared to the proportion of heavy drinkers or binge drinkers. The FinSote survey measured at-risk drinking using the AUDIT-C assessment tool, frequently used for this purpose. The three questions in AUDIT-C measure the frequency and quantity of the respondents’ alcohol use. One of the questions is how often they have six drinks or more on one occasion. This is interpreted as indicative of binge drinking.
The relationship of the prevalence of non-drinking to several sociodemographic, socioeconomic, and health-related background variables was analysed by using cross-tabulation and a logistic regression model so that the effect of age structure, for instance, was adjusted for. Besides gender, age and education, the association between non-drinking and perceived economic difficulties and with main activity status were also examined. Economic worries were measured by asking how well a household’s income covered its costs. Main activity status refers to the type of economic activity with which respondents are mainly engaged. We also used several different variables to describe the association between, on one hand, health and quality of life and, on the other, total abstention from alcohol. As an example, severe activity limitation was measured by looking at how severe and permanent a health-based limitation was. This question is addressed by the Global Activity Limitation Indicator (GALI), a validated indicator of activity limitations (Mäki et al. 2013).
The findings of the logistic regression analysis are presented as an odds ratio. In practice, the models always give the value 1.00 to the proportion of non-drinkers in the reference category of a certain variable, and the proportions of non-drinkers in the other categories of the same variable are then compared against that specified reference category. The analysis was made using the codes in the SAS EG 8.1 analysis software. The impact of possible survey bias was compensated by weighting the results to correspond to the age, gender, marital status, education and language structure of the population.
Non-drinking more common among women and elderly
Gender and age were associated with non-drinking. In 2018, roughly 12 per cent of men and 16 per cent of women in Helsinki were non-drinkers. However, percentages varied strongly by age group (Table 1). Of under-55-year-olds, slightly less than 10 per cent of men and slightly over 10 per cent of women abstained from alcohol completely. Of 55–74-year-olds, around 15 per cent were non-drinkers. Among those aged 75+, one-quarter of men and almost half of women were non-drinkers.
An analysis of the proportion of non-drinkers by five-year age group showed that, among those under 50, age does not have a linear correlation with non-drinking. Among those aged over 50, each five-year increase in age corresponds to a 36 per cent rise in the proportion of non-drinkers.
Compared with the period 2013–2015, the proportion of non-drinkers has grown from 13 to 14 per cent. This change is not statistically significant but it shows a similar trend for both men and women.
The three larger cities in the Helsinki Metropolitan Area – Helsinki, Vantaa and Espoo – all had a 15 per cent age-standardised proportion of non-drinkers, while Kauniainen had a clearly lower proportion, only 9 per cent. This is in spite of the fact that Kauniainen had a similar proportion of heavy drinkers as the other cities and a significantly smaller proportion of binge drinkers.
Both non-drinking and heavy drinking are common among those with economic worries
Besides age and gender, many other socioeconomic factors have an association with non-drinking. For example, non-drinking is slightly more common among single dwellers, who are also more often heavy drinkers or binge drinkers (Figure 1). A similar polarisation can be seen with many other variables as well. For instance, the proportion of non-drinkers is clearly larger among low-educated people (age-standardised proportion 21%) than among high-educated (10%), and there is a difference of a similar kind for heavy drinkers (33% among low-educated, 30% among high-educated) and binge drinkers (low-educated 10%), high-educated 8%).
Figure 2 shows the relation between economic worries and non-drinking or alcohol use. In those groups that find it difficult or very difficult to make ends meet the proportion of non-drinkers is considerably larger than for those without economic worries. Similarly, the proportion of heavy drinkers and, partly, binge drinkers is larger among those with economic worries.
Table 2 shows the relation between certain socioeconomic background factors and the probability of non-drinking. In model 1 in the table, age and gender have been adjusted for, while in model 2 the analysed variables have also been adjusted for each other. The probability of non-drinking in the reference class of each variable analysed is always given the value 1.00, and the probability of non-drinking in the other categories of the same variable are then compared against that.
For example, the probability of non-drinking is more than twice as high among low-educated as among high-educated. A more detailed analysis showed that this difference was explained, in particular, by differences between educational groups in the occurrence of economic worries. Even after the effects of main activity and economic worries were adjusted for, the differences in non-drinking between low- and high-educated remained significant.
Differences in the probability of non-drinking were very significant when looking at the variable ‘main activity’. Those receiving a disability pension or a rehabilitation subsidy were nine times more likely to be non-drinkers as those working full-time. Similarly, for all the other ‘main activity’ categories – including the unemployed – non-drinking was more common than among the full-time employed. However, heavy drinking or binge drinking was no more common in these groups than among full-time workers – with the exception of the unemployed who ran twice as high a risk (Mäki & Ahlgren-Leinvuo 2020).
Among those finding it very difficult to cover their expenses with their income, the probability of being a non-drinker was four times as high as in the reference group. This association remained rather strong even after the impact of differences of education and main activity were adjusted for.
Thus, differences in economic worries explained part of the difference between categories in the other variables for socioeconomic status. For example, there was no longer a difference in non-drinking between unemployed and full-time workers when we adjusted for the difference in economic worries. This, in other words, explained the higher occurrence of non-drinkers among unemployed people compared to the full-time employed. Economic worries also explained part of the high probability of non-drinking among disability pensioners.
Non-drinking more common among functionally impaired and those who score low on perceived life quality
Many health and quality-of-life-related factors had a relation to the probability of total abstention from alcohol. Those who felt they had a poor health or low quality of life, as well as those who felt lonely or had had suicidal thoughts, had twice as high a probability of being non-drinkers compared to those who had not felt that way (Table 3).
Similarly, severe activity limitation – here measured in terms of how severe and permanent the health-related limitation was – raised the probability of non-drinking more than fourfold. However, these severe activity limitations had no association with heavy drinking. However, an alternative indicator of activity limitations – measuring the ability to carry out certain activities such as walking or reading a newspaper, or memory-related tasks – was associated with excessive alcohol use. Those who were had severe activity limitations by these standards had twice as high a risk of binge drinking as those with better health.
Nonetheless, several activity limitation explained, to a fairly large extent, the link between total abstention from alcohol and the other factors of health and quality of life. Perceived quality of life also had a link to non-drinking – even after standardisation – and those with a low perceived life quality had a 60 per cent higher probability of being non-drinkers. After the other variables had been standardised, the association between activity limitation and non-drinking weakened as well, but the functionally impaired still remained three times more likely to be non-drinkers.
Poor health does not explain the prevalence of non-drinkers in lower socioeconomic status
Although severe activity limitation, which indicates poor health, was more common among both low-educated and especially people with economic worries, it did not explain at all why these groups had a larger proportion of non-drinkers. Instead, these groups had an independent association with non-drinking.
Similarly, the adjustment of socioeconomic differences reduced the probability of those with severe activity limitation to be non-drinkers only slightly. Instead, differences in socioeconomic status did explain the increased probability of non-drinking among those with a lower perceived life quality.
We know that in the last few years, total abstention from alcohol has become more common among young people, but we know less about non-drinking adults. The proportion of those who do not drink among Helsinki residents – 12 per cent of men and 16 per cent of women – is very similar to the figures for the whole of Finland presented in the Finnish Institute for Health and Welfare THL’s Drinking Habits Survey. The fact that a larger proportion of older people and women are non-drinkers has been shown earlier as well. Moreover, the proportion of non-drinkers in various educational brackets in Helsinki is also very similar to that in all of Finland: in the capital, 21 per cent of low-educated residents are non-drinkers, against 23 per cent in the entire country.
Correspondingly, 10 per cent of those with a high level of education are non-drinkers in Helsinki, and 9 per cent in all of Finland (Lintonen & Mäkelä 2018, Mäkelä 2018).
A less expected finding was that many factors associated with non-drinking also have a link to increased alcohol consumption. For example, the proportion of non-drinkers was considerably greater among those respondents who had economic worries than among those finding it easy to cover their expenses with their income. Nonetheless, excessive alcohol use and binge drinking were also more common among those who struggled to make ends meet. A similar polarisation could be seen for the low-educated.
These findings can partly be a matter of how non-drinking is defined. The present material describes alcohol consumption during the 12 months immediately preceding the survey. Thus, some of the respondents classified as non-drinkers may have consumed alcohol earlier, and then quit for various reasons. We know from other indicators measuring alcohol use that non-drinking men, in particular, may include a large number of former problem-drinkers now seeking to quit alcohol altogether (Rahkonen et al. 2003).
Correspondingly, both non-drinking and heavy drinking was more common among those who, according to various indicators. According to the Drinking Habits Survey, non-drinkers most typically explained their choice with lifestyle reasons and with concrete benefits such as having more time for hobbies or friends and relatives. Half of non-drinking respondents also reported that alcohol did not suit them for reasons of health. Compared with lifelong abstainers, those who had quit drinking later put more emphasis on health factors. A previous history of binge drinking among non-drinkers was also associated with emphasising health-related reasons (Katainen & Härkönen 2018.)
Although lifelong abstainers could not distinguished from recent quitters in the present research data, it is likely that some of Helsinki’s non-drinkers are former problem drinkers. Nonetheless, we see that non-drinking is associated with morbidity, poor health and lower quality of life. In a cross-section material, it is impossible to determine what is cause and what effect, or which other background variables also explain the correlation. In any case, the present study serves as a reminder that not even those population subgroups customarily linked with higher risks of problem drinking are, by any means, uniform in this respect.
Netta Mäki, PhD (social science), adjunct professor, works as Senior Researcher at the Urban Research and Statistics Unit of the City of Helsinki Executive Office.
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