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Alcohol Alcohol. 2018 Jan 1;53(1):104-111. doi: 10.1093/alcalc/agx069.

The effect of increased alcohol availability on alcohol-related health problems up to the age of 42 among children exposed in utero: a natural experiment.

Author information

Department of Public Health Sciences, Karolinska Institutet, Torsplan, Solnavägen 1E, 113 65 Stockholm, Sweden.
MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
Centre of Epidemiology and Community Council, Health Care Services, Torsplan, Solnavägen 1E, 113 65 Stockholm, Sweden.
Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden.



To examine whether exposure to increased alcohol availability in utero is associated with later alcohol-related health problems.


Register-linked population-based longitudinal study using data from a natural experiment setting, including 363 286 children born 1965-71. An experimental alcohol policy change was piloted in two regions of Sweden in 1967-68, where access to strong beer increased for 16-20 year old. Children exposed in utero to the policy change were compared to children born elsewhere in Sweden (excluding a border area), and to children born before and after the policy change. The outcome was obtained from the National Hospital Discharge Register using the Swedish index of alcohol-related inpatient care. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated by Cox regression analysis.


The results suggest that children conceived by young mothers prior to the policy change but exposed to it in utero had a slightly increased risk of alcohol-related health problems later in life (HR 1.26, 95% CI 0.94-1.68). A tendency towards an inverse association was found among children conceived by older mothers (HR 0.88, 95% CI 0.74-1.06).


Results obtained from a natural experiment setting found no consistent evidence of long-term health consequences among children exposed in utero to an alcohol policy change. Some evidence however suggested an increased risk of alcohol-related health problems among the exposed children of young mothers.

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