Trends in alcohol consumption in middle-aged and older adults, assessed with self-report and the alcohol marker phosphatidylethanol – A longitudinal HUNT study

Kjerstin Tevik; Ragnhild Bergene Skråstad; Jūratė Šaltytė Benth; Geir Selbæk; Sverre Bergh; Olav Spigset; Steinar Krokstad; Anne-Sofie Helvik

doi:10.1371/journal.pone.0334556

Peer Review History

Original SubmissionJune 11, 2025
3 Sep 2025 Decision Letter - Y-h. Taguchi, Editor PONE-D-25-31670Trends in alcohol consumption in middle-aged and older adults, assessed with self-report and the alcohol marker phosphatidylethanol - A longitudinal HUNT StudyPLOS ONE Dear Dr. Tevik, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Oct 18 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Please revise the manuscript to address the concerns raised by reviewers. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for the invitation to review this article, dear editor. The manuscript provides useful insights into alcohol consumption trends in Norway and makes a valuable contribution. At the same time, a few clarifications and additions could help strengthen the paper and make it more suitable for PLOS ONE readers. [1] The manuscript notes slight differences in how abstinence and heavy episodic drinking were measured across HUNT2, HUNT3, and HUNT4. The authors could provide a brief table or appendix explicitly summarizing these definitional shifts to aid reader interpretation. [2] The discussion could more directly tie findings to implications for public health policy in Norway and other countries. For example, what do trends in abstinence and risky drinking among older adults imply for healthcare resource allocation, prevention campaigns, or even some other external problems such as traffic safety interventions? [3] While the introduction discusses health-related harms of alcohol, it overlooks the well-documented connection between alcohol consumption and external harms such as risky driving on the road. Briefly Including this dimension of risk to other people would strengthen the framing of alcohol as a broader societal risk factor. Consider including these recent literatures, such as https://doi.org/10.1016/j.ijtst.2024.11.009, and https://doi.org/10.1080/23249935.2025.2516817 to strengthen the societal relevance of your work. [4] The limitations of the paper, such as with the data and methodology and some other factors should be well acknowledged. Reviewer #2: Strengths 1. The HUNT study is well explained, with survey waves, dates, and participation rates clearly documented. 2. The introduction is well written and provides clear context for the study. 3. The manuscript acknowledges both strengths (generalizability to Norway/Western health trends) and weaknesses (lack of large cities, fewer immigrants, lower education/income) of the Nord-Trøndelag population. 4. Use of questionnaires, registry data (Statistics Norway), and biobank samples is clearly stated. 5. Self-reports complemented with PEth biomarkers strengthens validity. Minor issues Indicate the type of model (logistic, multinomial, or linear) and link function should be stated. Acknowledgement of potential biases (selection, multiple testing) ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". 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Revision 1
24 Sep 2025 Author Response PONE-D-25-31670 Trends in alcohol consumption in middle-aged and older adults, assessed with self-report and the alcohol marker phosphatidylethanol - A longitudinal HUNT Study ________________________________________ 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters). We would like to thank the reviewers for their valuable contribution to improving the manuscript. For references to page and line numbers in our responses, please see the Revised Manuscript with Track Changes. Reviewer #1: Thank you for the invitation to review this article, dear editor. The manuscript provides useful insights into alcohol consumption trends in Norway and makes a valuable contribution. At the same time, a few clarifications and additions could help strengthen the paper and make it more suitable for PLOS ONE readers. [1] The manuscript notes slight differences in how abstinence and heavy episodic drinking were measured across HUNT2, HUNT3, and HUNT4. The authors could provide a brief table or appendix explicitly summarizing these definitional shifts to aid reader interpretation. Thank you for this suggestion. We have created a table illustrating how the questions and definitions of abstinence, current drinking, and heavy episodic drinking have changed from HUNT2 to HUNT3 and HUNT4. We included the questions and definitions of current drinking, as these have also changed across the HUNT surveys. The table has been added as an additional file (see S1 Table), and the following sentence is added in lines 205-207 on page 10: S1 Table describes in detail how the questions and definitions regarding abstinence, current drinking, and heavy episodic drinking have changed from HUNT2 to HUNT3 and HUNT4. [2] The discussion could more directly tie findings to implications for public health policy in Norway and other countries. For example, what do trends in abstinence and risky drinking among older adults imply for healthcare resource allocation, prevention campaigns, or even some other external problems such as traffic safety interventions? We appreciate these valuable suggestions. The following text has been added to the section about Clinical implications in the Discussion. Please read lines 547-551 on page 37: Thus, although the present study found a trend toward increased proportion of participants being abstinent the concurrent rise in risky drinking among both sexes, may increase the demand on the Norwegian healthcare resource allocation due to the elevated risk of alcohol-related conditions such as falls, injuries, adverse medication interactions, and chronic diseases [1]. Women may be of particular risk of the adverse events to alcohol consumption [2-4]. Similar trends in increased risky drinking among middle-aged and older adults have been observed in other countries [5-7] underscoring similar public health implications. Moreover, read lines 562-566 on the same page: Given that older adults with risky or harmful drinking patterns may still be active drivers, general practitioners could consider alcohol screening questionnaires and the use of PEth during the judgments of driver’s license renewals [8, 9]. They could also promote alternatives for safe transportation, especially in rural areas [8]. Lastly, read lines 570-772, on page 38: Health authorities could integrate alcohol prevention efforts or campaigns into general practice, senior centers, voluntary organizations or through social media and print media targeting older adults. [3] While the introduction discusses health-related harms of alcohol, it overlooks the well-documented connection between alcohol consumption and external harms such as risky driving on the road. Briefly Including this dimension of risk to other people would strengthen the framing of alcohol as a broader societal risk factor. Consider including these recent literatures, such as https://doi.org/10.1016/j.ijtst.2024.11.009, and https://doi.org/10.1080/23249935.2025.2516817 to strengthen the societal relevance of your work. We appreciate your observation regarding the omission of the association between alcohol consumption and risky drinking in the Introduction. Thank you for recommending recently published literature, which has now been incorporated into the revised Introduction. Please read lines 99-102 on page 5: It is a well-documented connection between alcohol consumption and external harms such as risky driving and crash injuries [8] with the potential to cause severe harm, not only to themselves but also to others, including pedestrians [8, 10, 11]. [4] The limitations of the paper, such as with the data and methodology and some other factors should be well acknowledged. We appreciate your suggestions regarding the need to more thoroughly acknowledge the limitations in our data and methodology. In response, we have expanded the limitations section from line 598 on page 39 to address potential biases that may affect the generalizability of our findings. Thus, our findings may be influenced by non-response and selection biases, as the oldest individuals – particularly abstainers or heavy drinkers – may have declined participation due to poor health, resulting in a biased sample toward healthier individuals [12]. … Compared to sales data [13, 14], self-reported use of alcohol is substantially lower, and most likely under-reported due to factors such as reporting bias and recall bias because of cognitive impairment, memory errors, social desirability bias, and/or stigma associated with alcohol consumption [15-17]. Gender role-related expectations and taboos surrounding substance use may contribute to sex-specific differences in the risk of misreporting alcohol consumption [18]. Under-reporting of alcohol consumption might have led to misclassification and underestimation of risky drinking and heavy episodic drinking in our study (lines 623-630 on page 40). … PEth is not susceptible to the inherent biases associated with self-reported alcohol consumption as PEth measures the actual ethanol intake during the last 2-4 weeks [19] (lines 633-634 on page 40). Reviewer #2: Strengths 1. The HUNT study is well explained, with survey waves, dates, and participation rates clearly documented. 2. The introduction is well written and provides clear context for the study. 3. The manuscript acknowledges both strengths (generalizability to Norway/Western health trends) and weaknesses (lack of large cities, fewer immigrants, lower education/income) of the Nord-Trøndelag population. 4. Use of questionnaires, registry data (Statistics Norway), and biobank samples is clearly stated. 5. Self-reports complemented with PEth biomarkers strengthens validity. Minor issues Indicate the type of model (logistic, multinomial, or linear) and link function should be stated. Acknowledgement of potential biases (selection, multiple testing) We appreciate these suggestions. We have now included the required details regarding the type of the model in the Statistical analyses part of the manuscript, stating that the outcome variable was dichotomous, implying logistic regression model, and the logit link function which is a standard choice in the case of such an outcome variable. Please see lines 263-264 on page 15. Please read lines 598-601 on page 39 regarding potential biases (also added as a response to reviewer 1): Thus, our findings may be influenced by non-response and selection biases, as the oldest individuals – particularly abstainers or heavy drinkers – may have declined participation due to poor health, resulting in a biased sample toward healthier individuals [12]. … Compared to sales data [13, 14], self-reported use of alcohol is substantially lower, and most likely under-reported due to factors such as reporting bias and recall bias because of cognitive impairment, memory errors, social desirability bias, and/or stigma associated with alcohol consumption [15-17]. Gender role-related expectations and taboos surrounding substance use may contribute to sex-specific differences in the risk of misreporting alcohol consumption[18]. Under-reporting of alcohol consumption might have led to misclassification and underestimation of risky drinking and heavy episodic drinking in our study (lines 623-630 on page 40). … PEth is not susceptible to the inherent biases associated with self-reported alcohol consumption as PEth measures the actual ethanol intake during the last 2-4 weeks [19] (lines 633-634 on page 40). References 1. WHO. Global status report on alcohol and health and treatment of substance use disorders. Available from: https://www.who.int/publications/i/item/9789240096745o 2024. 2. Alfonso-Loeches S, Pascual M, Guerri C. Gender differences in alcohol-induced neurotoxicity and brain damage. Toxicology. 2013;311(1-2):27–34. Epub 20130314. doi: 10.1016/j.tox.2013.03.001. PubMed PMID: 23500890. 3. Bradley KA, Badrinath S, Bush K, Boyd-Wickizer J, Anawalt B. Medical risks for women who drink alcohol. Journal of general internal medicine. 1998;13(9):627–39. doi: 10.1046/j.1525-1497.1998.cr187.x. PubMed PMID: 9754520; PubMed Central PMCID: PMCPMC1497016. 4. Ceylan-Isik AF, McBride SM, Ren J. Sex difference in alcoholism: who is at a greater risk for development of alcoholic complication? Life Sci. 2010;87(5-6):133–8. Epub 20100616. doi: 10.1016/j.lfs.2010.06.002. PubMed PMID: 20598716; PubMed Central PMCID: PMCPMC2913110. 5. Ahlner F, Sigstrom R, Sterner TR, Fassberg MM, Kern S, Ostling S, et al. Increased alcohol consumption among Swedish 70-year-olds 1976 to 2016: Analysis of data from The Gothenburg H70 Birth Cohort Studies, Sweden. Alcoholism: Clinical and Experimental Research. 2018;42(12):2403–12. doi: http://dx.doi.org/10.1111/acer.13893. PubMed PMID: 2018-63313-013. 6. Bosque-Prous M, Espelt A, Sordo L, Guitart AM, Brugal MT, Bravo MJ. Job Loss, Unemployment and the Incidence of Hazardous Drinking during the Late 2000s Recession in Europe among Adults Aged 50-64 Years. PloS one. 2015;10(10):e0140017. Epub 20151007. doi: 10.1371/journal.pone.0140017. PubMed PMID: 26445239; PubMed Central PMCID: PMCPMC4596847. 7. Grucza RA, Sher KJ, Kerr WC, Krauss MJ, Lui CK, McDowell YE, et al. Trends in Adult Alcohol Use and Binge Drinking in the Early 21st‐Century United States: A Meta‐Analysis of 6 National Survey Series. Alcoholism: Clinical & Experimental Research. 2018;42(10):1939–50. doi: 10.1111/acer.13859. PubMed PMID: 132090333. Language: English. Entry Date: 20181004. Revision Date: 20181005. Publication Type: Article. Journal Subset: Biomedical. 8. Adeyemi O, Bukur M, Berry C, DiMaggio C, Grudzen CR, Konda S, et al. Substance use and pre-hospital crash injury severity among U.S. older adults: A five-year national cross-sectional study. PloS one. 2023;18(10):e0293138. Epub 20231025. doi: 10.1371/journal.pone.0293138. PubMed PMID: 37878571; PubMed Central PMCID: PMCPMC10599556. 9. Dyrkorn R, Skråstad RB, Aamo TO. [Bruk av fosfatidyletanol i førerkortsaker]. Use of phosphatidylethanol in driver’s license assessments. Only in Norwegian. Tidsskr Nor Laegeforen. 2019;139(3). Epub 20190211. doi: 10.4045/tidsskr.18.0973. PubMed PMID: 30754945. 10. Abdulrazaq MA, Fan WD. Temporal dynamics of pedestrian injury severity: A seasonally constrained random parameters approach . Available from: https://doi.org/10.1016/j.ijtst.2024.11.009 (11.09.2025). International Journal of Transportation Science and Technology. 2024. 11. Abdulrazaq MA, Fan WD. A priority based multi-level heterogeneity modelling framework for vulnerable road users. Available from: https://doi.org/10.1080/23249935.2025.2516817 (11.09.2025). Transportmetica A: Transport Science. 2025. doi: 10.1080/23249935.2025.2516817. 12. Goulden R. Moderate Alcohol Consumption Is Not Associated with Reduced All-cause Mortality. The American journal of medicine. 2016;129(2):180–6.e4. Epub 2015/11/03. doi: 10.1016/j.amjmed.2015.10.013. PubMed PMID: 26524703. 13. Høyer G, Nilssen O, Brenn T, Schirmer H. The Svalbard study 1988-89: a unique setting for validation of self-reported alcohol consumption. Addiction (Abingdon, England). 1995;90(4):539–44. doi: 10.1046/j.1360-0443.1995.9045397.x. PubMed PMID: 7773116. 14. Ramstedt M. How much alcohol do you buy? A comparison of self-reported alcohol purchases with actual sales. Addiction (Abingdon, England). 2010;105(4):649–54. Epub 20100209. doi: 10.1111/j.1360-0443.2009.02839.x. PubMed PMID: 20148793. 15. Kamsvaag B, Bergh S, Šaltytė Benth J, Selbaek G, Tevik K, Helvik AS. Alcohol consumption among older adults with symptoms of cognitive decline consulting specialist health care. Aging & mental health. 2022;26(9):1756–64. Epub 20210729. doi: 10.1080/13607863.2021.1950618. PubMed PMID: 34323134. 16. Moriconi PA, Nadeau L, Demers A. Drinking habits of older Canadians: a comparison of the 1994 and 2004 national surveys. Canadian journal on aging = La revue canadienne du vieillissement. 2012;31(4):379–93. Epub 2012/12/06. doi: 10.1017/s0714980812000347. PubMed PMID: 23211564. 17. Merrick EL, Horgan CM, Hodgkin D, Garnick DW, Houghton SF, Panas L, et al. Unhealthy drinking patterns in older adults: prevalence and associated characteristics. Journal of the American Geriatrics Society. 2008;56(2):214–23. Epub 2007/12/19. doi: 10.1111/j.1532-5415.2007.01539.x. PubMed PMID: 18086124. 18. Northcote J, Livingston M. Accuracy of self-reported drinking: observational verification of 'last occasion' drink estimates of young adults. Alcohol and alcoholism (Oxford, Oxfordshire). 2011;46(6):709–13. Epub 20110921. doi: 10.1093/alcalc/agr138. PubMed PMID: 21949190. 19. Skråstad RB, Spigset O, Aamo TO, Andreassen TN. Stability of Phosphatidylethanol 16:0/18:1 in Freshly Drawn, Authentic Samples from Healthy Volunteers. J Anal Toxicol. 2021;45(4):417–21. doi: 10.1093/jat/bkaa082. PubMed PMID: 32754728; PubMed Central PMCID: PMCPMC8040374. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0334556.r002
29 Sep 2025 Decision Letter - Y-h. Taguchi, Editor Trends in alcohol consumption in middle-aged and older adults, assessed with self-report and the alcohol marker phosphatidylethanol - A longitudinal HUNT Study PONE-D-25-31670R1 Dear Dr. Tevik, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Y-h. Taguchi, Dr. Sci. Academic Editor PLOS ONE Additional Editor Comments (optional): The paper was accepted. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: No ******** https://doi.org/10.1371/journal.pone.0334556.r003
Formally Accepted
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