{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:52:05Z","timestamp":1789019525680,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2018,8,6]],"date-time":"2018-08-06T00:00:00Z","timestamp":1533513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background. Alcohol misuse is a global public health priority, with a variation in prevalence and impact between countries. Alcohol misuse in adolescence is associated with adverse psychological, social and physical health. Adolescents in Denmark have higher alcohol consumption and problematic alcohol use than adolescents in other European countries. Associations between social determinants of health (SDH), psycho-social factors and alcohol consumption are complex and influenced by national context and cultures. This study explored these associations in Danish adolescents. Method. The European School Survey Project on Alcohol and Other Drugs (ESPAD) survey collects data on alcohol and substance use among 15\u201316-year-old European students. Data contributed by Danish students to the 2011 survey were analyzed. The outcomes of interest were alcohol consumption (any, intoxication and problematic). Health literacy was not directly measured, so self-described educational performance and knowledge about alcohol were used as proxies for health literacy. Exploratory factors thus included socio-demographic, health literacy-related (knowledge about alcohol, educational performance) and psycho-social factors, as well as expectancies of the effect of alcohol (both positive and negative) and self-reported health. Univariate and multivariate logistic regression analyses were undertaken. Results. Of the 2768 adolescents who participated in the survey, 2026 (80%) consumed alcohol during the last 30 days, 978 (38%) were intoxicated at least once during the last 30 days, and 1050 (41%) experienced at least one problem because of alcohol use during the last 12 months. Multivariable analysis showed that the factors associated with higher alcohol intake were gender, poor relationships with parents, expectancies of the impact of alcohol (both positive and negative), and the influence of peers and their alcohol use. Higher school performance was related to lower alcohol consumption. Low socio-demographic status was not associated with higher alcohol consumption. Conclusions. This study confirmed the high levels of alcohol intake, intoxication, and problem drinking amongst the Danish students in the survey and the complexity of the socio-demographic, psychosocial, health literacy-related, and environmental factors associated with alcohol behaviours. Approaches to addressing the issue of alcohol use in Danish adolescents will need to be multi-factorial, including supporting students to develop alcohol-related health literacy skills to enable them to make informed choices.<\/jats:p>","DOI":"10.3390\/ijerph15081671","type":"journal-article","created":{"date-parts":[[2018,8,7]],"date-time":"2018-08-07T03:44:18Z","timestamp":1533613458000},"page":"1671","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Understanding Educational and Psychosocial Factors Associated with Alcohol Use among Adolescents in Denmark; Implications for Health Literacy Interventions"],"prefix":"10.3390","volume":"15","author":[{"given":"Claudia","family":"K\u00f6nig","sequence":"first","affiliation":[{"name":"Department of Public Health, Aarhus University, Bartholins All\u00e9 2, Bygning 1260, 8000 Aarhus C, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7017-8221","authenticated-orcid":false,"given":"Mette V.","family":"Skriver","sequence":"additional","affiliation":[{"name":"Department of Public Health, Aarhus University, Bartholins All\u00e9 2, Bygning 1260, 8000 Aarhus C, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim M.","family":"Iburg","sequence":"additional","affiliation":[{"name":"Department of Public Health, Aarhus University, Bartholins All\u00e9 2, Bygning 1260, 8000 Aarhus C, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian","family":"Rowlands","sequence":"additional","affiliation":[{"name":"Institute of Health and Society, Newcastle University, NE1 7RU Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,8,6]]},"reference":[{"key":"ref_1","unstructured":"WHO (2009). Global health risks. Mortality and Burden of Disease Attributable to Selected Major Risks, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Anderson, P., and Baumberg, B. (2006). Alcohol in Europe. A Public Health Perspective, Institute of Alcohol Studies.","DOI":"10.1080\/09687630600902477"},{"key":"ref_3","unstructured":"Anderson, P., M\u00f8ller, L., and Galea, G. (2012). Alcohol in the European Union. Consumption, Harm and Policy Approaches, WHO Regional Office for Europe."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Saunders, J., and Rey, J. (2011). The short and long-term consequences of adolescent alcohol use. Young People and Alcohol: IMPACT, Policy, Prevention and Treatment, Wiley-Blackwell.","DOI":"10.1002\/9781118785089"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1111\/j.1360-0443.2011.03751.x","article-title":"Interventions to prevent substance use and risky sexual behaviour in young people: A systematic review","volume":"107","author":"Jackson","year":"2012","journal-title":"Addiction"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.nicl.2014.06.011","article-title":"The effect of alcohol consumption on the adolescent brain: A systematic review of mri and fmri studies of alcohol-using youth","volume":"5","author":"Ewing","year":"2014","journal-title":"Neuroimage Clin."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e672","DOI":"10.1542\/peds.2006-0339","article-title":"Influence of multiple risk behaviors on physical activity\u2013related injuries in adolescents","volume":"119","author":"Janssen","year":"2007","journal-title":"Pediatrics"},{"key":"ref_8","unstructured":"Inchley, J., Currie, D., Young, T., Samdal, O., Torsheim, T., Augustson, L., Mathison, F., Aleman-Diaz, A., Molcho, M., and Weber, M. (2016). Growing up unequal: Gender and socioeconomic differences in young people\u2019s health and well-being. Health Behaviour in School-Aged Children (HBSC) Study: Innternational Report from the 2013\/2014 Survey, WHO Regional Office for Europe."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1046\/j.1360-0443.2003.00496.x","article-title":"Tracking drinking behaviour from age 15\u201319 years","volume":"98","author":"Andersen","year":"2003","journal-title":"Addiction"},{"key":"ref_10","unstructured":"Currie, C., Zanotti, C., Morgan, A., Currie, D., Looze, M.D., Roberts, C., Samdal, O., Smith, O.R.F., and Barnekow, V. (2012). Social determinants of health and well-being among young people. Health Behaviour in School-Aged Children (HBSC) Study: International Report from the 2009\/2010 Survey, WHO Regional Office for Europe."},{"key":"ref_11","unstructured":"Hibell, B., Guttormsson, U., Ahlstr\u00f6m, S., Balakireva, O., Bjarnason, T., Kokkevi, A., and Kraus, L. (2011). The 2011 ESPAD report. Substance Use Among Students in 36 European Countries, The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Council of Europe, Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs (Pompidou Group)."},{"key":"ref_12","unstructured":"Kraus, L., Guttormsson, U., Leifman, H., Arpa, S., Molinaro, S., Monshouwer, K., Trapencieris, M., Vicente, J., Arnarsson, \u00c1.M., and Balakireva, O. (2016). ESPAD report 2015. Results from the European School Survey Project on Alcohol and Other Drugs, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)."},{"key":"ref_13","unstructured":"CSDH (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health, World Health Organization."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S39","DOI":"10.1016\/j.jadohealth.2014.08.024","article-title":"Predictors of substance use among vulnerable adolescents in five cities: Findings from the well-being of adolescents in vulnerable environments study","volume":"55","author":"Olumide","year":"2014","journal-title":"J. Adolesc. Health Off. Publ. Soc. Adolesc. Med."},{"key":"ref_15","unstructured":"Respress, B.N. (2018, July 27). Social Determinants of Adolescent Risk Behaviors: An Examination of Depressive Symptoms and Sexual Risk, Substance Use, and Suicide Risk Behaviors. Available online: https:\/\/etd.ohiolink.edu\/pg_10?0::NO:10:P10_ACCESSION_NUM:case1270238396."},{"key":"ref_16","first-page":"w13901","article-title":"Social and regional variations in health status and health behaviours among Swiss young adults","volume":"143","author":"Abel","year":"2013","journal-title":"Swiss Med. Wkly."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1159\/000357319","article-title":"Influence of parental alcohol-related attitudes, behavior and parenting styles on alcohol use in late and very late adolescence","volume":"20","year":"2014","journal-title":"Eur. Addict. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s00112-011-2612-2","article-title":"Health risk behaviour in adolescence","volume":"160","author":"Kolip","year":"2012","journal-title":"Monatsschr. Kinderheilkund."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.healthplace.2015.03.005","article-title":"Neighbourhood disadvantage and individual adversities in adolescence and total alcohol consumption up to mid-life-results from the northern Swedish cohort","volume":"33","author":"Johansson","year":"2015","journal-title":"Health Place"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/pubmed\/fdq072","article-title":"Association between area-level socioeconomic deprivation and a cluster of behavioural risk factors: Cross-sectional, population-based study","volume":"33","author":"Lakshman","year":"2011","journal-title":"J. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1037\/hea0000135","article-title":"Community, family, and subjective socioeconomic status: Relative status and adolescent health","volume":"34","author":"Quon","year":"2015","journal-title":"Health Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e984","DOI":"10.1542\/peds.2006-3172","article-title":"Family breakup and adolescents\u2019 psychosocial maladjustment: Public health implications of family disruptions","volume":"120","author":"Roustit","year":"2007","journal-title":"Pediatrics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.drugalcdep.2014.08.012","article-title":"Proximal and distal social influence on alcohol consumption and marijuana use among middle school adolescents","volume":"144","author":"Salvy","year":"2014","journal-title":"Drug Alcohol Depend."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"S\u00f8rensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., and Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-80"},{"key":"ref_25","unstructured":"World Health Organization (2016, January 21\u201324). Shanghai declaration on promoting health in the 2030 agenda for sustainable development. Proceedings of the 9th Global Conference on Health Promotion, Shanghai, China."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1093\/heapro\/15.3.259","article-title":"Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century","volume":"15","author":"Nutbeam","year":"2000","journal-title":"Health Promot. Int."},{"key":"ref_27","first-page":"99","article-title":"Benchmarking alcohol literacy: A multi-country study","volume":"18","author":"Siemieniako","year":"2013","journal-title":"Mod. Manag. Rev."},{"key":"ref_28","unstructured":"Hibell, B., Andersson, B., Bjarnson, T., Balikireva, O., Davidaviciene, A., Muscat, R., Nociar, A., Sabroe, S., and Veresies, K. (2000). Do They Tell the Truth? A Methodological Study in Seven Countries about the Validity in School Surveys, The Swedish council for Information on Alcohol and Other Drugs."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1016\/S0140-6736(12)60149-4","article-title":"Adolescence and the social determinants of health","volume":"379","author":"Viner","year":"2012","journal-title":"Lancet"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.pec.2014.07.019","article-title":"Health literacy, alcohol expectancies, and alcohol use behaviors in teens","volume":"97","author":"Chisolm","year":"2014","journal-title":"Patient Educ. Couns."},{"key":"ref_31","unstructured":"Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings."},{"key":"ref_32","unstructured":"Johnston, L.D., O\u2019Malley, P.M., Bachman, J.G., and Schulenberg, J.E. (2002). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/8\/1671\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:16:59Z","timestamp":1760195819000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/8\/1671"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,6]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2018,8]]}},"alternative-id":["ijerph15081671"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15081671","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,6]]}}}