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Age\u2013period\u2013cohort (APC) models offer the potential for understanding these paradoxical trends. This study aimed to use an APC model approach to measure long\u2010term trends in alcohol abstention and consumption in England from 2001 to 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and participants<\/jats:title><jats:p>The study used grouped and proxy\u2010variable APC models of repeat cross\u2010sectional survey data, set in England (2001\u201319). Participants were residents in England aged 13\u2009years or over who took part in the Health Survey for England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Outcome variables were alcohol abstention and consumption in units. We created nine age groups (13\u201315, 16\u201317, 18\u201324, 25\u201334, until 65\u201374 and 75+, reference 45\u201354\u2009years), four periods (2001\u201304, 2005\u201309, 2010\u201314 to 2015\u201319, reference 2005\u201309) and 18 5\u2010year birth cohorts (1915\u201319 to 2000\u201304, reference 1960\u201364). We proxied age effects (systolic and diastolic blood pressure), period effects (alcohol affordability, internet usage and household alcohol expenditure) and birth cohort effects (prevalence of smoking and prevalence of overweight).<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>The odds of abstaining were considerably larger at young ages, 13\u201315\u2009years [odds ratio (OR)\u2009=\u20095.38; 95% confidence interval (CI)\u2009=\u20094.50\u20136.43], were lowest during the first period, 2001\u201304 (OR\u2009=\u20090.83; 95% CI\u2009=\u20090.79\u20130.86) and had a U\u2010shaped pattern by birth cohort. For units of alcohol, the incidence rate ratio (IRR) increased until age 18\u201324\u2009years (IRR\u2009=\u20091.41, 95% CI\u2009=\u20091.34\u20131.48) and decreased afterwards, were highest during the first period, 2001\u201304 (IRR\u2009=\u20091.07; 95% CI\u2009=\u20091.05\u20131.08) and showed an inverted J\u2010shape by birth cohort. Our proxy variable approach revealed that using blood pressure measures, alcohol affordability and prevalence of overweight as proxies resulted in APC effects that differed from our base\u2010case model. However, internet usage, household expenditure on alcohol and smoking prevalence resulted in APC effects similar to our base\u2010case model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The discrepancy between decreasing alcohol consumption and increasing alcohol\u2010related deaths observed in England from 2001 to 2019 may, in part, be explained by the halt in abstention trends since 2010 and a slight consumption decline since 2001.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16599","type":"journal-article","created":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T10:17:48Z","timestamp":1721643468000},"page":"1726-1736","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Expanding our understanding of long\u2010term trends in alcohol abstention and consumption in England (2001\u201319) using two age\u2013period\u2013cohort approaches"],"prefix":"10.1111","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1226-7541","authenticated-orcid":false,"given":"Magdalena","family":"Opazo Breton","sequence":"first","affiliation":[{"name":"Unit of Mental Health and Clinical Neurosciences, School of Medicine University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Henney","sequence":"additional","affiliation":[{"name":"SCHARR, Sheffield Centre for Health and Related Research, Division of Population Health, School of Medicine and Population Health University of Sheffield  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8799-8963","authenticated-orcid":false,"given":"Inge","family":"Kersbergen","sequence":"additional","affiliation":[{"name":"SCHARR, Sheffield Centre for Health and Related Research, Division of Population Health, School of Medicine and Population Health University of Sheffield  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1025-312X","authenticated-orcid":false,"given":"Alan","family":"Brennan","sequence":"additional","affiliation":[{"name":"SCHARR, Sheffield Centre for Health and Related Research, Division of Population Health, School of Medicine and Population Health University of Sheffield  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9283-2151","authenticated-orcid":false,"given":"John","family":"Holmes","sequence":"additional","affiliation":[{"name":"SCHARR, Sheffield Centre for Health and Related Research, Division of Population Health, School of Medicine and Population Health University of Sheffield  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61766-8"},{"key":"e_1_2_9_3_1","unstructured":"Office for National Statistics (ONS).Alcohol\u2010specific deaths in the UK: registered in 2019.2021. 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