Health Policy 101 (2011) 29–36 Contents lists available at ScienceDirect Health Policy journal homepage: www.elsevier.com/locate/healthpol Children of substance abusing parents: A national survey on policy and practice in Swedish schools Tobias H. Elgán ∗ , Håkan Leifman STAD, Stockholm Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Stockholm County Council Health Care Provision and Karolinska Institutet, Box 6031, 102 31 Stockholm, Sweden article info Keywords: Adolescent School Children of impaired parents Policy Substance abuse abstract Objectives: This study aims at examining policy and practice within the Swedish school setting pertaining to children of substance abusing parents/caregivers. Methods: A cross-sectional survey, involving a representative sample of randomized schools (n = 443) throughout Sweden was conducted using a self-completed questionnaire. Descrip- tive analysis was performed including bivariate analysis combined with logistic regression modeling to examine possible correlates between variables. Results: The response rate was 66%, and participants reported that 37% had been trained in issues related to children of substance abusing parents, 33% of the schools had a policy document, and 73% of the schools had identified students with this complex of problems. Whether or not schools identify these students depends upon the occurrence of schools being “compulsory” or “upper secondary”, “public” or “independent”, the “school size”, and respondents’ participation in further training, which in turn is associated with the presence of a policy document. Conclusions: It appears as if a policy document does not directly predict whether schools identify students having substance abusing parents. However, it does influence whether respondents have participated in further training, which subsequently predicts the identi- fication of students having substance abusing parents. Implications for policy and practice within the school setting are discussed. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction In Sweden, there are more than 1.9 million children and adolescents below 18 years of age (Statistics Sweden, www.scb.se). Based on the National Public Health Survey, “Health on equal terms” [1], the Swedish National Insti- tute of Public health has estimated that approximately 20% of all children (∼385,000) grow up in families where at least one parent (or other caregiver) has a risky alcohol consumption [2]. How many of these children who grow ∗ Corresponding author. Tel.: +46 08 123 455 21; fax: +46 08 123 455 09. E-mail addresses: tobias.elgan@sll.se, tobias.elgan@ki.se (T.H. Elgán), hakan.leifman@sll.se, hakan.leifman@ki.se (H. Leifman). up in families where at least one parent abuses alcohol or other drugs is debated. Although, it has been estimated that 10–15% (∼190,000–288,000) of all Swedish children are born into families with at least one substance abus- ing parent [3]. These numbers, however, may be greater today due to the fact that the yearly alcohol consump- tion (including unregistered alcohol) has increased by 20% compared to the late 1990s [4,5]. Nevertheless, the above mentioned figures compare well with those presented in the United States and in the European Union. For instance, it has been estimated that in the United States 28.6% of all children below the age of 18 years are exposed to alcohol abuse or dependence within the family [6], while it has been reported that 6.8–11.7% of all children under the age of 15 years who reside in 15 European Union countries and Norway are affected by parental alcohol misuse [7]. 0168-8510/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2010.10.009