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Research Summary

The Prevention Paradox Applies to Alcohol Use and Problems among Adolescents

The prevention paradox refers to the notion that individuals at highest risk for alcohol-related problems are responsible for a large number of such problems per person; but, because they are a small group, they account for only a small fraction of the total number. This gives support to targeting interventions to all drinkers—not only those with high-risk consumption. To investigate whether this paradox applies to adolescents, researchers in Sweden conducted a cross-sectional analysis of school-based survey results from 7288 alcohol-consuming adolescents aged 13–17. Alcohol-related problems* among adolescents whose annual alcohol intake was in the upper 10% (based on a quantity-frequency measure) were compared with those reported by the bottom 90%. Frequency of heavy episodic drinking** (HED) was also assessed.

  • The bottom 90% of consumers accounted for the majority of alcohol-related problems among boys and girls at all ages (61–77%).
  • At age 17, HED was frequent (89% among boys and 82% among girls).
  • A large majority in the bottom 90% reported HED, and the share of problems accounted for by monthly HED in this group increased with age (10% at age 13 to >50% at age 17).
Age 13
Age 17
Mean past-year alcohol consumption (liters)
Mean number of past-year alcohol-related problems

*Defined in this study as arguments; fights; accidents; lost money or other valuables; destroyed clothes/other things; poor relationships with friends, parents or teachers; lower achievement at school; unwanted/unprotected sex; being robbed; being admitted to the hospital; and trouble with the police.
**Defined as drinking ≥1/2 bottle of spirits, 1 bottle of wine, 4 cans (50 cl) of strong beer, or 6 cans of medium-strong beer on a single occasion.


Because group selection was based on annual alcohol intake in this study, the prevention paradox applied. Nevertheless, given the drinking profile in this population, annual alcohol intake may not be the best measure of adolescent drinking in terms of alcohol-related problems. The results show that the majority of problems were accounted for by HED, a highly prevalent drinking behavior among adolescents that should be targeted with population strategies as well as personalized interventions when possible. Nicolas Bertholet, MD, MSc


Romelsjö A, Danielsson AK. Does the prevention paradox apply to various alcohol habits and problems among Swedish adolescents? Eur J Public Health. February 24, 2012 [Epub ahead of print]. doi: 10.1093/eurpub/ckr178.