{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:58:16Z","timestamp":1790715496772,"version":"4.1.0"},"reference-count":41,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T00:00:00Z","timestamp":1682294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Drug and Alcohol Review"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In the 21st century, there has been a decline in alcohol use among adolescents in most Nordic countries, while trends of cannabis use have diverged. We explore how alcohol and cannabis use, respectively, and co\u2010use of the two substances, have changed among Nordic adolescents. Three hypotheses are used to frame the study: (i) cannabis use has substituted alcohol use; (ii) there has been a parallel decline in both substances; and\/or (iii) there has been a \u2018hardening\u2019 of users, implying that alcohol users increasingly use cannabis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from the European School Survey Project on Alcohol and Other Drugs, conducted among 15\u2010 to 16\u2010year\u2010olds in Denmark, Finland, Iceland, Norway and Sweden (<jats:italic>N<\/jats:italic>\u2009=\u200974,700, 49% boys), were used to explore trends of past\u2010year alcohol and cannabis use in the period 2003\u20132019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The proportion of adolescents reporting alcohol use decreased significantly in all Nordic countries except Denmark. The proportion of those using cannabis only was low (0.0%\u20130.7%) and stable in all countries. The total number of substance use occasions declined among all adolescents in all countries but Denmark. Among alcohol users, cannabis use became increasingly prevalent in all countries but Denmark.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>We found no support for the \u2018parallel decline hypothesis' in alcohol and cannabis use among Nordic adolescents. Partially in line with the \u2018substitution hypothesis\u2019, cannabis use accounted for an increasing proportion of all substance use occasions. Our results suggests that the co\u2010use of alcohol and cannabis has become more common, thus also providing support to the \u2018hardening\u2019 hypothesis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.13672","type":"journal-article","created":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T04:41:29Z","timestamp":1682397689000},"page":"616-624","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Changes in co\u2010use of alcohol and cannabis among Nordic adolescents in the 21st century: Results from the European School Survey Project on Alcohol and Other Drugs study"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7909-8562","authenticated-orcid":false,"given":"Kirsimarja","family":"Raitasalo","sequence":"first","affiliation":[{"name":"Department of Public Health and Welfare, Finnish Institute for Health and Welfare  Helsinki 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