{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T11:49:38Z","timestamp":1790509778072,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2011,9,21]],"date-time":"2011-09-21T00:00:00Z","timestamp":1316563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2012,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p><jats:bold>Aims\u2003<\/jats:bold> According to the prevention paradox, a majority of alcohol\u2010related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED) and alcohol\u2010related problems among adolescents in 23 European countries.<\/jats:p><jats:p><jats:bold>Design and setting\u2003<\/jats:bold> Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16\u2010year\u2010old students were analysed.<\/jats:p><jats:p><jats:bold>Participants\u2003<\/jats:bold> A total of 38\u2003370 alcohol\u2010consuming adolescents (19\u2003936 boys and 18\u2003434 girls) from 23 European countries were included.<\/jats:p><jats:p><jats:bold>Measurements\u2003<\/jats:bold> The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol\u2010related problems.<\/jats:p><jats:p><jats:bold>Findings\u2003<\/jats:bold> Although the mean levels of consumption and alcohol\u2010related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol\u2010related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems.<\/jats:p><jats:p><jats:bold>Conclusions\u2003<\/jats:bold> The prevention paradox, based on measures of annual consumption and heavy episodic drinking, seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large proportion of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives combined with targeted interventions.<\/jats:p>","DOI":"10.1111\/j.1360-0443.2011.03537.x","type":"journal-article","created":{"date-parts":[[2011,6,14]],"date-time":"2011-06-14T14:48:53Z","timestamp":1308062933000},"page":"71-80","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["Alcohol use, heavy episodic drinking and subsequent problems among adolescents in 23 European countries: does the prevention paradox apply?"],"prefix":"10.1111","volume":"107","author":[{"given":"Anna\u2010Karin","family":"Danielsson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wennberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Hibell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Romelsj\u00f6","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2011,9,21]]},"reference":[{"key":"e_1_2_8_2_2","volume-title":"The 2007 ESPAD Report: Substance Use Among Students in 35 European Countries","author":"Hibell B.","year":"2009"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2010.05.001"},{"key":"e_1_2_8_4_2","first-page":"567","article-title":"High\u2010school drinking and its consequences","volume":"38","author":"Arata C.","year":"2003","journal-title":"Adolescence"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/10550880903182978"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckn007"},{"key":"e_1_2_8_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2003.10.009"},{"key":"e_1_2_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(00)00330-0"},{"key":"e_1_2_8_9_2","volume-title":"Youth Drinking Cultures: European Experiences","author":"Anderssson B.","year":"2007"},{"key":"e_1_2_8_10_2","volume-title":"Alcohol Problems among Adolescents: Current Directions in Prevention Research","author":"Boyd G.","year":"1995"},{"key":"e_1_2_8_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.1995.9045155.x"},{"key":"e_1_2_8_12_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.1999.94575113.x"},{"key":"e_1_2_8_13_2","first-page":"1555","article-title":"Alcohol and the so\u2010called prevention paradox: how does it look today?","volume":"101","author":"Skog O. 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WickiM.Evaluation des effets sur les intoxications alcooliques suite aux mesures visant \u00e0 r\u00e9duire le degr\u00e9 d'accessibilit\u00e9\u00e0 l'alcool dans le canton de Gen\u00e8ve [Prevention in the Canton of Geneva: the effect of measures restricting access to alcohol](Rapport no. 54\u2010B). 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