Children with problem drinking parents in Sweden: Prevalence and risk of adverse consequences in a national cohort born in 2001
Mats Ramstedt PhD, Researcher, Head of Research and Adjunct Professor, Jonas Raninen PhD, Research Fellow, Peter Larm PhD, Senior Lecturer, Michael Livingston PhD, Associate Professor.
Abstract
Introduction
To estimate the prevalence of children with problem drinking parents in Sweden and the extent to which they have an elevated risk of poor health, social relationships and school situation in comparison with other children.
Methods
Survey with a nationally representative sample of Swedish youth aged 15–16 years (n = 5576) was conducted in 2017. A short version of The Children of Alcoholics Screening Test (CAST-6) was used to identify children with problem drinking parents. Health status, social relations and school situation were measured by well-established measures. Overall prevalences for girls and boys were presented as well as relative risks (RR) of harm for children with problem drinking parents compared with other children.
Results
A total of 13.1% of the sample had at least one problem drinking parent during adolescence according to CAST-6—a higher proportion of girls (15.4%) than boys (10.8%). This group had an elevated risk of poor general health as well psychosomatic problems compared with other children (RR 1.2–1.9). They were also more likely to use medication for depression, sleeping difficulties and anxiety (RR 2.2–2.6). Their social relations were also worse especially with their father (RR 3.1) and they had more problems at school (RR 2.6).
Discussion and Conclusions
The risk of problems related to parental drinking goes beyond the most severe cases where parents have been in treatment for their alcohol problem. This is important knowledge since the majority of problem drinkers never seek treatment and the major part of parental problem drinking is found in population samples.
Introduction
A number of studies show that children with parents who have received treatment for their alcohol problems are at risk of adverse consequences in many areas, for example substance use problems, mental health problems, bad social relations and poor school adjustment [1-3]. Suggested explanations for these elevated risks are impaired parenting in various respects as a result of drinking but also prenatal alcohol exposure and genetic influence [4]. Given that only a minority of problem drinkers receive treatment [5], it is critical to consider the more numerous group of children with problem drinking parents in the population, including those outside the treatment system. Studies of children with problem drinking parents in the population are however scarce, both regarding estimations of the size of this group and the risks of adverse consequences. For instance, a recent international literature review identified only 23 studies providing estimates of the prevalence of this group in national populations [6]. Another literature review showed that studies that examined outcomes other than substance use in population samples are very rare [7]. Further, population studies of the risks of adverse consequences this group experience are totally lacking in Sweden, but studies from other countries suggest that these children have an elevated risk of several problems, for example attention and conduct problems at school, higher risk of psychosomatic problems and poorer relationships with their parents [3, 8, 9]. A thought-provoking result in the literature is also that girls tend to be more likely to report living with a problem drinking parent [10, 11] whereas gender differences in risk of adverse consequences in this group are more uncertain [8].
- How many children in the Swedish population lives with a problem drinking parent during adolescence and is there a difference between girls and boys?
- To what extent have children with a problem drinking parent a higher risk of adverse consequences in terms of poor health, social relations and school situation and to what extent is the risk different between girls and boys?
- To what extent is parenting practices among problem drinking parents different than among parents whose drinking is not perceived as problematic by their children?
Methods
We used data from Futura01, which is a national prospective longitudinal study of approximately 5549 Swedish youth born in 2001. The baseline data collection (T1) was carried out during spring 2017 when the respondents attended the ninth grade and were 15–16 years old. The sampling was accomplished by Statistics Sweden and includes a random sample of 500 schools. In each school, one class was selected randomly and all students in the selected classes were then asked to participate in the study by filling out a paper and pen questionnaire during school hours. After several reminders 344 schools decided to participate, implying a participation rate of 68.8% at the school level. All in all, 6777 questionnaires were returned of which 5576 had filled in the questionnaire and given informed consent to participate in the study. This corresponds to a response rate of 82.3% at the individual level. Nineteen observations were excluded due to missing answers on individual items and eight respondents had given unrealistic answers. Seventy-two respondents did not answer The Children of Alcoholics Screening Test (CAST-6) resulting in 5477 complete cases in the analytical sample. Analysis of the representativeness of the sample showed no significant differences between schools that participated and those that did not, a high geographical representation and similar results as in other national school surveys conducted at the same time but without demanding informed consent [12].
Measures
A short version of CAST-6 was used to discriminate between children with problem drinking parents and other children. CAST-6 includes 6 true/false items instead of the 30 items from the original scale and has been shown to have the same validity [13]. The six questions concern four areas; perceptions of parental alcohol problems, attempts to control parental drinking, perceptions of marital discord and efforts to escape adverse consequences. Children responding ‘true’ to at least three statements are defined as living with a problem drinking parent. This cut-off has been suggested to be the most accurate [13] but a sensitivity analysis will be performed to examine to what extent the less conservative cut-off of 2 suggested by a recent paper [14], will change the results. It should be noted that, the wording of the first item in CAST-6 (Did you ever think that a parent drank too much?) differs from the original wording used (Have you ever thought that one of your parents had a drinking problem?). Since these expressions mean roughly the same thing in Swedish, we assume that this version of CAST-6 measures the same thing as the original version.
To assess if children with a problem drinking parent have an elevated risk of adverse consequences, we compared their physical and mental health, their medication for depression, anxiety and sleeping problems, their social relations and school satisfaction to other children. In order to estimate relative risks (RR) for these adverse consequences, the outcomes were dichotomised into a negative and positive category. How these outcomes measured specifically are described below.
- General health status was measured with a 5-point Likert scale ranging from ‘very good’, ‘rather good’, ‘either good or bad’, ‘rather bad’ or ‘very bad’. Respondents were classified as having poor health status if they reported ‘very bad’, ‘rather bad’ or ‘either good or bad’.
- Psycho-somatic problems were measured by questions adapted from the Health Behaviors of School age Children [13] including how often they suffered from stomach pain, stress, sleeping problems and headache. The responses were dichotomised into at least ‘once a week’ and less often based on five response options ranging from ‘everyday’ to ‘seldom/never’.
Medication for depression, anxiety and sleeping problems were measured by questions asking if the respondent had received medicines on prescription for depression, anxiety and sleeping problems (yes/no).
The quality of the respondents' social relations was measured with questions of how satisfied the respondent was with his/her relationship to father, mother and friends ranging from very happy, happy, not so happy to not happy at all. Response options not so happy and not happy at all were assumed to measure a poor relationship.
To measure the school satisfaction, we used the question ‘How do you like school?’ and responses with a 5-point Likert scale ranging from very good, rather good, either good or bad, rather bad or very bad. Low school satisfaction was defined as ‘neither good or bad’, ‘rather bad’ or ‘very bad’. Another aspect of school satisfaction was truancy which was measured by the question ‘Do you skip school?’ with those responding at least ‘some time every semester’ being positive cases. Finally, experiences of having been bullied were measured using questions addressing whether this had happened during the last 12 months.
Parenting practises were measured with six statements, two for each of three components: rules, control and support. The following question was asked for all items: ‘How do the following statements apply to you?’. The statements for parental rules were ‘My parent(s) has definite rules about what I can do at home’ and ‘My parent(s) has definite rules about what I can do outside the home’. Parental control was measured with; ‘My parent(s) know who I am with during the evenings’ and ‘My parent(s) know where I am in the evenings’.
The statements for parental support were: ‘I can easily get warmth and caring from my mother and/or father’ and ‘I can easily get emotional support from my mother and/or father’. Response alternatives were: ‘Almost always’, ‘Often’, ‘Sometimes’, ‘Seldom’ and ‘Almost never’. Response alternatives almost always and often were collapsed and compared to the rest.
To assess the risk of these outcomes for children with problem drinking parents we calculated RRs for this group in relation to other children, both in total and divided by girls and boys. All analyses were performed in SAS (9.4; SAS Institute Inc., Cary, NC, USA).
Results
Proportion of children with a problem drinking parent during adolescence
It was estimated that 13.1% of 15- to 16-year olds in Sweden had an experience of at least one problem drinking parent during adolescence, that is they answered yes to at least three of the six statements of problematic parental drinking included in CAST-6 (Table 1). It was most common to have experienced that a parent drank too much (19.9%), followed by having a wish that they stopped drinking (14.9%) and to have encouraged them to stop drinking (13.4%). Experiences of arguments or fights related to parental drinking were reported by 12% of the respondents and 7.5% had ever felt like hiding or emptying a parent's bottle of liquor.
| Total (n = 5477) | Girls (n = 2774) | Boys (n = 2703) | Relative risk girls (95% confidence intervals) | |
|---|---|---|---|---|
| CAST-6 (at least 3) | 13.1 | 15.4 | 10.8 | 1.42 (1.24–1.64) |
| Did you ever think that a parent drank too much? | 19.9 | 22.7 | 17.1 | 1.33 (1.19–1.48) |
| Did you ever wish that a parent stopped drinking? | 14.9 | 17.4 | 12.2 | 1.41(1.24–1.61) |
| Did you ever encourage one of your parents to quit drinking? | 13.4 | 16.0 | 10.8 | 1.48 (1.29–1.70) |
| Have you ever heard your parents fight when one of them was drunk? | 12.3 | 14.0 | 10.4 | 1.35 (1.17–1.56) |
| Did you ever argue or fight with a parent when he or she was drinking? | 12.2 | 14.0 | 10.3 | 1.36 (1.18–1.58) |
| Did you ever feel like hiding or emptying a parents' bottle of liquor? | 7.5 | 9.3 | 5.7 | 1.65 (1.36–2.00) |
- CAST-6, Children of Alcoholics Screening Test—short version.
A higher proportion of girls reported experiences of parental problematic drinking (15.4%) compared with boys (10.8%). This difference was statistically significant and the RR was estimated to 1.42, that is the risk was 42% higher among girls. A significant gender difference was found across all problem items with the RR ranging from 1.33 to 1.65. No significant difference in the magnitude of the RR was found between the items (the confidence intervals were overlapping) although there was a slight tendency that girls were especially inclined to have felt like hiding or emptying a parent's bottle of liquor (RR 1.65).
Risk of adverse consequences among children with a problem drinking parent
Children with a problem drinking parent were more likely to have poor health status according to all studied health indicators, that is poor general health and experiences of psychosomatic problems such as stomachache, headache, sleeping problems and stress at least once a week (see Table 2). The difference was most pronounced for general health which was poor among 35.3% of those with problem drinking parents compared with 18.7% among others (RR 1.89). The corresponding rates for stomachache were 42% versus 25% (RR 1.68), for headaches 53.1% versus 36.9% (RR 1.44) and for sleeping problems 60.4% versus 44.1% (RR 1.37). The smallest difference was found for stress which was reported by 78.2% among children with problem drinking parents and 65.6% in the other group (RR 1.19).
| Problem drinking parent (%) | No problem drinking parent | Relative risk for children with a heavy drinking parent (95% CI) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Total | Boys | Girls | Total | Boys | Girls | Total | Boys | Girls | |
| Outcome | n = 719 | n = 292 | n = 427 | n = 4758 | n = 2411 | n = 2347 | n = 5477 | n = 2703 | n = 2774 |
| Physical and mental health | |||||||||
| Poor self-reported health | 35.3 | 24.2 | 42.7 | 18.7 | 12.6 | 24.9 | 1.9 (1.7–2.1) | 1.9 (1.7–2.1) | 1.7 (1.5–2.0) |
| Stomachache at least once a week | 42.0 | 27.2 | 52.1 | 25.0 | 15.9 | 34.2 | 1.7 (1.5–1.9) | 1.7 (1.4–2.1) | 1.5 (1.4–1.7) |
| Headache at least once a week | 53.1 | 38.3 | 63.2 | 36.9 | 26.3 | 47.7 | 1.4 (1.3–1.6) | 1.4 (1.2–1.7) | 1.3 (1.2–1.4) |
| Sleeping problems at least once a week | 60.4 | 54.5 | 64.5 | 44.1 | 40.3 | 48.0 | 1.4 (1.3–1.5) | 1.2 (1.2–1.5) | 1.3 (1.2–1.5) |
| Feelings of stress at least once a week | 78.2 | 61.9 | 89.2 | 65.9 | 51.1 | 81.2 | 1.2 (1.1–1.2) | 1.2 (1.1–1.3) | 1.1 (1.1–1.1) |
| Received medication for | |||||||||
| Depression | 4.5 | 2.2 | 6.1 | 1.9 | 1.2 | 2.7 | 2.6 (1.8–3.6) | 2.6 (0.8–4.5) | 2.2 (1.4–3.5) |
| Anxiety | 6.6 | 4.7 | 7.8 | 2.5 | 1.3 | 3.8 | 2.3 (1.6–3.5) | 3.6 (1.9–6.8) | 2.1 (1.4–3.0) |
| Sleeping problems | 7.6 | 4.4 | 9.7 | 3.5 | 2.6 | 4.4 | 2.2 (1.6–3.0) | 1.7 (0.9–3.1) | 2.2 (1.6–3.2) |
| Social relations | |||||||||
| Poor relationship with father | 34.1 | 27.3 | 38.6 | 11.1 | 8.0 | 14.3 | 3.1 (3.0–3.5) | 3.4 (2.7–4.3) | 2.7 (2.3–3.2) |
| Poor relationship with mother | 15.6 | 14.2 | 16.6 | 6.7 | 5.4 | 8.1 | 2.3 (1.9–2.8) | 2.6 (1.9–3.7) | 2.0 (1.6–2.6) |
| Poor relationship with friends | 13.1 | 13.3 | 13.0 | 7.4 | 6.7 | 8.0 | 1.8 (1.4–2.2) | 2.0 (1.4–2.8) | 1.6 (1.2–2.1) |
| School situation | |||||||||
| Have been bullied at least once | 19.3 | 15.8 | 21.7 | 7.6 | 6.7 | 7.7 | 2.6 (2.1–3.1) | 2.1 (1.5–2.9) | 2.8 (2.2–3.6) |
| Do not enjoy school | 31.1 | 25.1 | 35.2 | 19.3 | 15.2 | 23.5 | 1.6 (1.4–2.8) | 1.6 (1.3–2.1) | 1.5 (1.3–1.7) |
| Have schooled at least once | 35.1 | 40.0 | 31.9 | 24.3 | 24.9 | 23.8 | 1.4 (1.3–1.6) | 1.6 (1.4–1.9) | 1.3 (1.1–1.6) |
| Parenting practices | |||||||||
| Child has definite rules at home | 39.9 | 42.6 | 38.0 | 38.0 | 42.0 | 33.8 | 1.0 (1.0–1.0) | 1.0 (1.0–1.0) | 1.0 (1.0–1.1 |
| Child has definite rules outside home | 39.3 | 36.6 | 41.2 | 37.4 | 35.5 | 39.4 | 1.0 (1.0–1.0) | 1.0 (1.0–1.0) | 1.0 (1.0–1.1) |
| Knows who the child spend time with | 82.0 | 76.8 | 85.5 | 85.1 | 81.4 | 88.9 | 1.0 (0.9–1.0) | 1.0 (0.9–1.0) | 0.9 (0.9–1.0) |
| Knows where the child is in the evening | 81.4 | 74.1 | 86.4 | 87.0 | 84.2 | 90.0 | 0.9 (0.9–1.0) | 0.9 (0.9–1.0) | 0.9 (0.9–1.0) |
| Child can easily get warmth and caring | 76.0 | 74.6 | 77.0 | 89.2 | 89.9 | 88.5 | 0.9 (0.8–0.9) | 0.8 (0.8–0.9) | 0.9 (0.8–0.9) |
| Child can easily get emotional support | 70.0 | 69.8 | 70.0 | 84.1 | 84.8 | 83.3 | 0.9 (0.8–0.9) | 0.9 (0.9–0.9) | 0.9 (0.8–0.9) |
- CI, confidence interval.
A higher risk of having received medication from a doctor for depression, sleeping difficulties and anxiety was also found among children of problem drinking parents. The prevalence of having received medication for depression was 4.5% compared to 1.9% among others (RR 2.6) and corresponding rates for anxiety were 6.6% versus 2.5% (RR 2.3) and for sleeping problems 7.6% versus 3.5% (RR 2.2).
Children with a problem drinking parent also had poorer relationships with both friends and parents. A poor relationship with the father was especially common, with 34% reporting that they were not happy with the relationship compared with 11% for others (RR 3.1). Fully 15% were not happy with their relationship with their mother compared with 7% in the other group (RR 2.3). Finally, 13% were not happy with their relationships with friends compared with 7% among others (RR 1.8).
It was also more common among children with a problem drinking parent to report problems in school. The largest difference was found with respect to experiences of being bullied at least once which were reported by 19.3% of children with a problem drinking parent compared with 7.6% among other children (RR 2.6). Corresponding estimates for not enjoying school were 31.1% versus 19.3% (RR 1.6) and to have skipped school at least once, 35.1% versus 24.3% (RR 1.4).
A comparison of parenting practices between problem drinking parents and parents whose children do not perceive their parents drinking as problematic is also presented in Table 2. No significant difference was found with respect to strict rule setting, knowledge of with whom and where the child spent their evening. However, problem drinking parents were less likely to offer warmth and caring (RR 0.9) as well as emotional support (RR 0.9).
The findings are also stratified by gender in Table 2. A significantly higher proportion of girls than boys report problems in almost all areas independently of whether they have a problem drinking parent or not. The only exception is truancy where a higher proportion of boys reported to have skipped school. Furthermore, there was no gender difference in the proportion reporting a poor relationship with friends among those with a problem drinking parent.
No significant gender difference was found with respect the extent to which those with a problem drinking parent had difficulties with health, relationships and school. Thus, given the experience of a problem drinking parent, boys and girls were equally likely to have an elevated risk of poor health, impaired social relationships and problems at school. This is indicated by overlapping confidence intervals for estimated RRs shown in Table 2. (This conclusion was also supported by interaction analyses showing that no gender differences in the association are present).
Finally, no significant gender differences were found in the extent parental practices differed between children of problem drinking parents compared with other children. Thus, both girls and boys with a problem drinking parent were less likely to get warmth and caring as well as emotional support compared with other children.
Discussion
The aim of this paper was to estimate the prevalence of children with problem drinking parents in Sweden and to examine to what extent they are at risk of adverse consequences in terms of poor health, poor social relations and problems in school. We also examined if there were any indication of impaired parental practices among problem drinking parents.
On the basis of data from a national cohort of 15- to 16-year olds (born in 2001) and the screening instrument CAST-6, it was estimated that 13.1% of these adolescences had experienced at least one parent with problematic alcohol consumption during adolescence. This estimate was lower than in a Swedish study published in 2013 where 20% of adolescents aged 16 to 19 years reported to have lived with a problem drinking parent according to CAST-6 [10]. This study was however not based on a nationally representative youth sample but a web panel with uncertain representativeness and a dropout rate of 75%. Thus, we believe that our estimate is likely more accurate. It should also be mentioned that the present estimate of 13.1% falls within the broad range of estimates found in a recent review of population studies of the prevalence of children with problem drinking parents, showing a range between 2% and 20% [6]. Thus, although 13.1% should not be regarded as a precise estimate, it seems reasonable in relation to previous research.
An intriguing finding was that more girls (15%) than boys (11%) reported problematic parental drinking. This difference was found for each item included in CAST-6 and thus all areas addressed; perceptions of parental alcohol problems, attempts to control parental drinking, perceptions of marital discord and efforts to escape adverse consequences. A similar gender difference has also been observed in previous Swedish studies based on CAST-6 [10] and in the international literature [3, 8, 11]. It should be noted that this result differs from what is shown in studies based on register data where approximately the same proportion of women and men have a parent in treatment for alcohol abuse [15]. That more girls report problematic experiences thus suggests a higher vulnerability to parental problem drinking [16] as well as family conflict [17] and a subsequent higher tendency to perceive and report such problems. The understanding of these gender differences is insufficiently addressed in previous research. One possible explanation could be that girls during adolescence are more focused on activities that favour close relationships with peers while boys are more engaged in group-related activities [18]. Such differences may involve differences in the extent sensitive issues are brought up and in subsequent higher awareness of the behaviour of others, including parents who drink too much. However, it is of great interest to understand these gender differences in more depth and to address this question in future studies. Such studies would preferably have a qualitative approach allowing male and female respondents to explain the rationale for how they respond to questions on their parents drinking.
Previous studies examining children of parents in treatment for alcohol-related problems have found an elevated risk for poor health, poor social relations and problems in school. In this nationally representative sample, we found the same patterns with increased risk of poor health, poor social relations and problems in school among children with problem drinking parents. We found especially large RRs for receiving medication for depression, anxiety and sleeping problems, having a poor relationship with parents and for being bullied at school. These problems were between 2.2 and 3.1 times more common in this group compared with other children, whereas the other elevated RRs were in the range of 1.2 and 1.9.
The RRs were not significantly different for girls and boys with problem drinking parents, a finding in accordance with previous population-based research [8]. Thus, although more girls than boys perceive parental drinking as problematic, once this is the case, the risk of harm seems to be similar.
Although explaining these differences was beyond the aim of this paper it was intriguing to find that one aspects of parenting were poorer among problem drinking parents, namely support. More specifically it was found to be more common that their children reported difficulties in getting warmth and caring as well as emotional support. Although it should be noted that sufficient support was found among a majority, this may offer some explanation for the generally elevated risk of adverse outcomes in this group.
All in all, these results show that the risk of problems related to parental drinking goes beyond the most severe cases where parents have been in treatment for their alcohol problem. This is important knowledge since the majority of problem drinkers never seek treatment [5] and since the major part of parental problem drinking is found in population samples. This is also in line with recent research suggesting that even relatively low levels of parental drinking are associated with increased risk to children, especially if parents have other problems [19].
As to the policy implications of this study, our findings point at two arenas having the potential of identifying these children and offer them support. First, the high occurrence of problems in school suggests that the school environment has the potential to be an important arena for screening of these children. Furthermore, the high proportion of these children receiving medication for psychosomatic problems by a doctor, means that health care also has a potential to be a successful arena for detecting this group of children.
Limitations
There are some limitations in this study that need to be acknowledged. As to the estimated prevalence of children with problem drinking parents, CAST-6 is based on self-reported information from children and their perceived experience of problems related to their parents drinking. Thus, there is no direct or objective information on whether the parents drinking can be defined as risk drinking or if they are dependent in a clinical sense. There are thus other possible interpretations that should be acknowledged. For instance, we could have used ‘children who perceive their parents to have alcohol problems’ used in Elgán et al. [10] and thus not take for granted that such parental drinking is problematic. Another broader interpretation of this group of children with several elevated risks for problem, could be the ‘prevalence of vulnerable children who are at-risk of poor adjustment, and who are likely to have a problem drinking parent’. Still, we believe that if children perceive several negative effects from their parents drinking, this is an important marker for problematic parental drinking, independent of whether the parents are risk drinkers or alcohol dependent. Another issue is the validity of CAST-6 in terms of using a cut-off of at least three reported problems. In order to test the robustness of our findings we also performed analyses of the less conservative cut-off of 2 problems. The major difference from applying this approach was that the prevalence of children with problem drinking parents increased to 19.4% (compared to 13.1%) with a similar increase for girls (22.4% vs. 15.4%) and boys (16.3% vs.10.8%). As to the estimated RRs of harm, however, these were still significant and were only slightly weaker. For instance, the RR for poor self-reported health among children with problem drinking parents was reduced from 1.9 to 1.8, a reduction that was similar for the majority of estimates of RRs. Another limitation is that CAST-6 refers to lifetime experiences of parental problem drinking whereas the problem outcomes refer to the last 12 months. This means that some parents defined as problem drinking parents may have stopped or reduced their drinking and that current parental drinking has no or little adverse impact on the child. Although experiences of problematic parental drinking during adolescence may have longstanding effects, the estimated RRs may be somewhat underestimated compared with an exact temporal match in exposure.
Another limitation is that causality cannot be established on the basis of the cross-sectional data and that lack of temporality increases the risk of reverse causality. However, although it cannot be excluded, it seems unlikely that the perception of parents' alcohol use as problematic should be a result of health problems, poor social relationships or problems in school among adolescents. Another challenge is that parental drinking problems often are embedded in a nexus of other problems and risk factors among parents which makes it hard to identify the precise role of parental drinking. For instance, socio-economic differences in alcohol problems among adults are well known and there is strong evidence of high comorbidity between mental disorders and alcohol use disorder [20]. Thus, parental mental illness and low socioeconomic status may have increased the risk for problems in these children in addition to parental alcohol consumption. The present data did, however, not include such information among parents, and the role of socioeconomic status and comorbidity needs to be examined with other data and preferably with a longitudinal design [7].
Strengths
Most previous studies on parental alcohol problems and related effects for children have been based predominantly on more severe (and often clinical) cases of parental alcohol problems with limited generalisability, whereas this study used a large and high-quality population sample of young people in terms of a high representativeness. Another strength is that this is the first study in Sweden where health, relationships and school situation for children to problem drinking parents have been examined from a population perspective.
Conclusion
Our findings show that almost one in eight children in Sweden experience problems with their parents drinking and that these children have an elevated risk of poor health, social relations and in school. Girls are more attentive and vulnerable to parental drinking than boys but no gender difference in risk of harm was found among those perceiving their parents drinking as problematic. A possible explanation is that these children have more difficult to get emotional support from their parents. The results provide further evidence for the notion that the risk of problems related to parental drinking goes beyond the most severe cases where parents have been in treatment for their alcohol problem. This is important knowledge since the majority of problem drinkers never seek treatment and since the major part of parental problem drinking is found in population samples.
