A local and regional Alcohol and Drugs Monitor in the Netherlands: a tale of three cities.

Local and regional policymakers, care providers and prevention workers involved in addiction and addiction care need timely and reliable information. As few data on substance use are available at a local or regional level, an integrated local or regional monitoring system for alcohol and drugs (MAD) was developed. The MAD consists of four modules: a local social and information map, analyses of registration data of (addiction) care organisations, a local/regional survey among the general population and a community-based drug monitoring system aimed at collecting data on hard drug users. Both quantitative and qualitative research methods are used. This paper presents an overview of the MAD results with respect to alcohol and illicit drug use. Both quantitative and qualitative results show a substantial variation between regions, even in a country as small as the Netherlands. The study shows that a monitoring system can be an important source of information for local addiction policy, care and prevention.

Alcohol use and intimate relationships in adolescence: when love comes to town.

The associations between alcohol consumption and intimate relationships in adolescence were examined. Data from a longitudinal study of 1,063 adolescents were used to investigate whether (a) alcohol use was a precursor of partnership and (b) adolescents tended to change their drinking habits once they became involved in a steady relationship. Youngsters who consumed alcohol at the ages of 14 and 15 were more likely to be involved in an intimate relationship 3 years later. Drinking in social settings particularly increased the likelihood of having a partner 3 years later. In addition, for males, partnership was associated with a smaller increase in alcohol consumption in public drinking places compared to the other categories (i.e., adolescents who never had a partner vs. adolescents who had no partner at the time of measurement). In contrast, the increase in consumption at home was the strongest for young men involved in a steady relationship. For females, the differences in changes in consumption between the partnership categories were in most cases not significant.

Young people's alcohol consumption from a European perspective: risks and benefits.

OBJECTIVE: This paper aims to examine the functions of adolescent drinking by (a) comparing drinking patterns in Mediterranean and Northern European countries, and (b) examination of the beneficial aspects of drinking and pub-going in a Dutch survey. DESIGN: Data from cross-sectional European surveys in 1988 (Eurobarometer) and 1995 (ESPAD-study) and a Dutch cohort study (three waves, respondents were followed from 1989 to 1994) were used. SUBJECTS: The participants in the Eurobarometer-study were 11,729 people from 12 countries who were interviewed at home. The participants in the ESPAD study were 15-16 y olds from 26 European countries interviewed at school. The participants in the Dutch cohort study were 1,063 12-18 y-olds interviewed at school (first wave) and at home (second and third wave). RESULTS AND CONCLUSIONS: The drinking patterns of young people in Mediterranean countries can be characterized as innovative and those of young people in Northern countries as rebellious. The main health risk associated with the innovative pattern is the volume of consumption and associated chronic consequences. The main health risk associated with the rebellious drinking is intoxication and the associated risks concerning violence, traffic accidents and acute health consequences. Furthermore, adolescent drinking and going out should not only be interpreted in terms of risk and negative effects, but seem to have important social and developmental benefits for young people.

Visiting public drinking places: an explorative study into the functions of pub-going for late adolescents.

Alcohol consumption by adolescents is a well-established risk factor with a variety of negative consequences such as violence, aggression, and traffic accidents. Only limited attention, however, has been paid to the context in which most of young people' s alcohol consumption takes place. The potential importance of visiting public drinking places is rarely explained from a developmental perspective. This study addresses this issue by focusing on the relation between pub-going and indicators of social integration, maturing out, and psychosocial well-being in a 17 to 18-year-old population. Adolescents who went to pubs and discos had more friends, more often had a best same-sex friend, spent more time with their friends, had more satisfying contacts with friends, and experienced feelings of loneliness less often. They were also more likely to be involved in a romantic relationship, to have a job, and to place less emphasis on educational aspirations. No differences were found on levels of stress and self-esteem between visitors and nonvisitors. The consequences of these outcomes for further research and prevention policies are discussed.

Social resources and alcohol-related losses as predictors of help seeking among male problem drinkers.

OBJECTIVE: This study examined whether factors other than severity of alcohol-related problems add to the explanation of seeking help for drinking problems. METHOD: Help seeking was investigated by comparing male problem drinkers who applied for treatment with male chronic problem drinkers in the general population. Subjects were selected from an outpatient treatment center (n = 129) and from a panel of the general population (n = 86) in the Netherlands. A shortened version of Cahalan's problem-drinking index, including symptoms, social consequences, health problems and frequency of intoxication, was used to indicate the severity of problem drinking. It was hypothesized that in particular drinking problems that indicate losses (social consequences and health problems) were associated with help seeking. Furthermore, resources such as paid work, a spouse, high socioeconomic status, younger age and a "wet" social network were expected to facilitate the continuation of drinking behavior and drinking problems and the avoidance of help seeking. RESULTS: Social and health consequences were associated more strongly with seeking help than were symptoms of problem drinking and intoxication. The effects of type of alcohol-related problem, employment and age were as hypothesized. However, the hypotheses about marital status, socioeconomic status and social network characteristics could not be confirmed. CONCLUSIONS: The results suggest that in particular employed men and men of a younger age deserve attention with regards to detecting problem drinking and targeting prevention.

Predictability of smoking in adolescence: between optimism and pessimism.

AIMS: The present study aimed to assess how far associations between possible explanatory variables and smoking onset depend on the use of cross-sectional versus prospective designs. DESIGN AND SUBJECTS: Data were analysed from a three-wave 5-year longitudinal survey among 1063 secondary schoolchildren (12-18-year-olds) in The Netherlands. MEASUREMENTS: The survey questionnaire contained items on smoking history, smoking-specific beliefs and attitudes, social influence variables and socio-demographic variables in each wave. FINDINGS AND CONCLUSIONS: The cross-sectional analyses showed strong associations between explanatory variables and smoking behaviour (R2 varied from 0.50 to 0.71). However, only 8% of the variance in change of smoking status from non-smoking to regular smoking over a period of 5 years and 14% of the variance over a period of 3 years could be predicted by the model variables. Factors believed to lead to smoking may result from smoking or they may change quickly in ways that make them of low predictive value even though they may be important aetiologically.

Class differences in the food rules mothers impose on their children: a cross-national study.

Many studies indicate that children in middle-class families have healthier eating habits than children in lower class families. Class differences in food rules, which parents and especially mothers impose on their children, may underlie these social inequalities in food consumption. The present study uses education as a classifying variable and analyses whether mothers with higher education prescribe more "healthy" foodstuffs for their children and whether they restrict more "unhealthy" food items than less educated mothers. Moreover, the study examines whether higher class mothers consider health aspects more often and the preferences of their family members less often in their choice of food, and whether class differences in these considerations explain class differences in food rules. To answer these questions, questionnaires on the food practices of 849 women living in middle-class or lower class districts in Maastricht (the Netherlands), Liège (Belgium) and Aachen (Germany) were collected and analysed. The majority of mothers in each city prescribed primarily foods that were served at dinner like meat and vegetables, and most mothers limited their children's consumption of sweet foods, soft drinks and snacks. Higher class mothers restricted more foods, but prescribed as many food items as their lower class counterparts. Class differences in the number of restricted foods were partly, but not completely, explained by class differences in health and taste considerations. Despite national variations in dietary habits and possibly in the education of children, class differences in food rules and the explanatory power of health and taste considerations were comparable in the three cities.

Antecedents of smoking cessation among adolescents: who is motivated to change?

BACKGROUND: In recent years many longitudinal studies have examined the predictors of smoking acquisition. However, only a few studies have focused on the precursors of smoking cessation. The current study is one of the first concentrating on longitudinal predictors of young people's smoking cessation. METHODS: Subjects were 215 smokers ages 14-15 years who were reinterviewed 3 years later. These smokers were allocated to four groups based on their motivation to quit and actual quitting behavior at the last wave. Independent variables were smoking-specific cognitions, social influences, and aspects of smoking habits. RESULTS: Univariate comparisons between the four groups showed that those with a positive attitude toward smoking and lower self-efficacy were less likely to be motivated to quit 3 years later. No long-term effects of environmental influences were found. Aspects of smoking habits, such as intensity and frequency of smoking, and the context of cigarette use affected the motivation to quit. Logistic regression analyses were conducted to examine differences in predictors between the groups in more detail. These analyses revealed that differences mainly in attitudes and self-efficacy affected whether subjects were absolutely not motivated to quit or had actually quit 3 years later. Differences in smoking behavior affected the allocation to the more closely related groups (e.g., preparing versus quitting). CONCLUSIONS: Adolescents' motivation to quit is affected by smoking-related cognitions and habitual factors. More research is needed to decide whether the relation between intensity and frequency of smoking and the likelihood to quit later on should be interpreted in terms of differences in smoking initiation or in terms of preparation to quit.

Changes in social roles as predictors of changes in drinking behaviour.

AIM: To assess the possible effects of changes in marital status, employment status and having children at home on alcohol consumption and the frequency of heavy drinking. With role theory as a starting point it was expected that a shift into more social roles would decrease consumption and heavy drinking while the shift away from social roles would be associated with an increase in consumption and heavy drinking. DESIGN: Prospective cohort study. SETTING: The province of Limburg, The Netherlands (1980-89). PARTICIPANTS: 1327 men and women aged 16-69 years at first measurement. MEASUREMENTS: Weekly consumption of standard units (10 g ethanol) of alcoholic beverages; frequency of drinking six units or more; self-reported social role. FINDINGS: The acquisition of a spouse role and a parental role but not an employment role was associated with a decrease in consumption or heavy drinking. The loss of the spouse role among women was associated with an increase in heavy drinking. Otherwise, losing a role was not linked with a change in consumption and heavy drinking. CONCLUSIONS: Limited support was found for the expectation that role transitions influence drinking behaviour. Our study suggests that other theories must be sought to explain social differences in drinking behaviour.

Homogeneity of cigarette smoking within peer groups: influence or selection?

Many studies stress the relevance of peer group influence as a determinant of smoking behavior of adolescents. Recent research, however, concludes that homogeneity of behavior in friendships is also due to selection; youngsters choose new friends whose behavioral patterns are similar to their own. Data from a three-wave longitudinal study among students of secondary education (N = 1,063) was used to examine sources of peer similarities. The results demonstrated that both influence and selection processes contributed to peer group homogeneity, but the largest part of similarities in smoking status had to be attributed to selection. No support was found for friendships breaking down for reasons of dissimilarity in smoking status. Our findings underscore the complexity of processes and interactions with regard to the relationships of teenagers and offer new views on prevention programs.

Inconsistencies in adolescents' self-reports of initiation of alcohol and tobacco use.

This study focuses on errors in estimations of age at which alcohol and tobacco are used for the first time. The data come from a 5-year longitudinal study with three measurements. Self-reports about age of first use at the baseline measurement were compared with similar self-reports at two follow-up surveys. Adolescents were more likely to report a higher age of first use at follow-up measurements. Those who at the baseline measurement reported having smoked (n = 338) or consumed alcohol (n = 523) 61.7% and 89%, respectively, underestimated their years of use. By comparison with estimations at the first and third measurement, 13.6% for smoking and 4.6% for drinking were consistent about their age of first use. Self-reports about the age of onset at the baseline measurement were correlated with frequency and intensity of tobacco and alcohol use 5 years later to assess the predictive power of age of onset for later use. With one exception (correlation with intensity of alcohol use 5 years later, r = .14) no significant correlation was found. The results show that the concept age of first use should be utilized with caution for two reasons: (1) the reliability of assessment is insufficient, and (2) correlations of different estimates with actual frequency and intensity of consumption at the third wave are inconsistent. Explanations for errors in measurement, and recommendations for improvement, are discussed.

Social class differences in women's fat and fibre consumption: a cross-national study.

This study focuses on social class variation in the intake of fat and fibre in Maastricht, Liège and Aachen, based on food frequency questionnaires of 849 women from nuclear families with schoolgoing children. In Maastricht and Liège higher-middle class women consumed less fat than working class women, while in Aachen no class difference was apparent. The intake of fibre was highest among the higher-middle class women, although this tendency was not significant in Aachen. Analysis of food groups that contribute to the intake of fat and fibre revealed that not all food groups showed this pattern. Higher-middle class women consumed less bread, less potatoes and more cheese than working class women. Moreover, they chose more often high-fat cheese and fats. Yet, working class women consumed more meat, milk and fats, and less grain, fruit and vegetables. In general, social class variations in fat and fibre intake were uniform across the cities, although in Aachen class differences were small or absent. In conclusion, these results suggest that the diet of higher-middle class women is more in accordance with the dietary recommendations regarding fat and fibre than the diet of working class women.

Changes in alcohol consumption in a general population in The Netherlands: a 9-year follow-up study.

Changes in drinking patterns are described for men and women and per age group using data from a 9-year follow-up study in The Netherlands (n = 1327). Aspects of drinking patterns in our study are drinking status, level of consumption and frequency of heavy drinking. The average consumption and average frequency of heavy drinking are used to examine changes at aggregate level. Changes at individual level are examined in terms of adopting certain drinking patterns (incidence) and continuing certain drinking patterns (chronicity). A small decrease is found in the proportion of drinkers for both sexes. Only women show a decrease in mean consumption. Average frequency of heavy drinking is stable for both sexes. At individual level, proportions of chronicity and incidence of drinking patterns are higher among men. Small aggregate changes in drinking patterns are accompanied by rather large shifts in individual's up-and-down level of consumption and frequency of heavy drinking. No or only very small period effects are observed and little evidence is found for a cohort effect among men. A negative association between incidence and age is found for drinking status among women, for low, moderate and high level of consumption and for heavy drinking for both sexes. In terms of chronicity, negative associations with age are found for drinking status of both sexes, and for high level of consumption and heavy drinking among men.

Modernization and geographical diffusion as explanations for regional differences in the consumption of wine and beer in the European Community.

Mediterranean and Northern countries in Europe differ strongly in drinking cultures and drinking patterns. However, since about 1960 the Mediterranean and Northern countries in Europe have converged with respect to per capital consumption and beverage choice. This paper explores whether modernization and/or geographical diffusion explain the convergence in beverage choice for countries belonging to the EC. The results show that for wine and two of the indicators of modernization, the expected results are found. The diffusion of beer is not related with the indicators of modernization used in this study. There is no or only very limited support for the relevance of geographical proximity for the diffusion of beer and wine.

Predictors for hidden problem drinkers in general practice.

In The Netherlands general practice attenders are not usually questioned about their drinking habits. The objective of this study was to determine to what extent easily available data (e.g. age, gender) can be used to identify categories of patients who are at risk of problem drinking as a preliminary to more intensive screening. Sixteen practices with a total population of 32,000 patients were involved in the study. All problem drinkers known by their GPs and a random sample of one in ten patients not thought to be problem drinkers were admitted to the study at their first surgery visit during a 1-year period. A screening questionnaire was used to find hidden problem drinkers amongst the individuals thought to be non-problem drinkers. The overall response rate was 91% (n = 1405). Problem drinking was detected in 6% (n = 82) of the group regarded by the GPs as non-problem drinkers (n = 1283). Male gender, smoking, life events and chronic social problems were the strongest non-alcohol-related predictors of hidden problem drinking. We conclude that a pre-selection of patients with a greater risk of problem drinking can be made without information related directly to alcohol. Case-finding in this category is much more effective and probably much more acceptable both to the GP and the patients, than the screening of all patients.

The medical profile of unidentified problem drinkers in general practice: test of an hypothesis.

In order to facilitate general practitioner (GP) detection of problem drinkers the Dutch College of General Practitioners developed a standard specifying the differences in medical profile between problem drinker and non-problem drinkers. The standard mentions 35 Reasons for Encounter (RFEs) and GP Evaluations (Es) that are thought to be specific for problem drinkers. The studies referred to in the standard base their conclusions about differences in medical profile upon a comparison of problem drinkers already identified by the GP with other patients. This study tests the hypothesis that the medical profile specified by the standard also applies to unidentified problem drinkers. All known problem drinkers in the practices of 16 GPs, as well as a one in 10 random sample of patients considered to be non-drinkers were admitted to the study at their first surgery visit during a 1-year period. Hidden problem drinkers were detected by means of a screening questionnaire, although the results were not conveyed to the GP until the study was completed. Over the 1-year study period the GPs then registered all RFEs and Es of the study population. RFE and E sum scores were then constructed based on the Alcohol Standard. The estimated population prevalence of problem drinking, corrected for the one in 10 sample fraction was 7%. We found 6% problem drinkers (n = 78) in the category regarded by the GPs as non-problem drinkers (n = 1254). Differences in RFEs and Es between hidden problem drinkers and those regarded as non-problem drinkers were significant for irregular heartbeat and psychological problems. Sexual problems were significant at the RFE level, social problems at the E level. When identified problem drinkers are compared with non-problem drinkers more differences in the medical profile are found (four times both RFE and E; twice RFE and once E). We conclude that most of the published differences in the medical profile between problem drinkers and other GP patients are not found for unidentified problem drinkers. The observed differences between unidentified problem drinkers and non-problem drinkers are too small to be helpful to the GP to detect problem drinkers.

Problem drinking in a general practice population: the construction of an interval scale for severity of problem drinking.

The main aim of this article is to describe the construction of an interval scale measuring the severity of problem drinking among patients of general practitioners. A questionnaire, including the existing screening instruments CAGE, SMAST, a shortened version of the SAAST and some additional items on alcohol-related problems, was given to three categories of patients: those who, according to the general practitioner, were not problem drinkers (Group 1), those who perhaps were (Group 2) and those who were known by the general practitioner to be problem drinkers (Group 3). According to the Classical Test Theory, the three existing screening instruments and the combination of all questions form a reliable scale. Advanced scaling techniques were applied to select the best items for the construction of an interval scale. These analyses showed that 18 of the 28 questions in the complete screening list fitted in a unidimensional Rasch scale. These questions can be used to estimate the severity of problem drinking. For research purposes an interval scale is attractive, since no information is lost by dichotomization. Such a scale enables the level of problem drinking to be specified at which correlations with other factors, whether as a cause or as an effect, can be found. The scale could also be a help to general practitioners for referral decisions. In more specialized settings it can be used to assign patients to various treatments.

Alcohol consumption in the European community: uniformity and diversity in drinking patterns.

Within the European Community (EC) drinking patterns in the southern countries can be characterised by daily consumption of wine at meals, and in the northern countries by less frequent consumption of beer outside meals. Yet, as in past decades in the southern countries beer consumption and in the northern countries wine consumption strongly increased, the question is whether the distinction in drinking patterns still applies. This paper (1) describes for each country of the EC total alcohol consumption, (2) examines the frequency and the context of consumption of the new beverage type and (3) analyses whether subpopulations, defined by sex, age and educational level, differ in the adoption of the new beverage type. In all countries wine is consumed more often at meals compared to beer. Older people consume wine in greater numbers and more frequently than younger people, who consume beer in greater numbers. People of higher educational level consume the new beverage type more often compared to people of lower educational level, who consume the traditional beverage type more frequently. Finally, males and females differ less in the frequency of consumption of the new beverage type than in the frequency of the traditional beverage type.

Developments in drinking behavior in The Netherlands from 1958 to 1989, a cohort analysis.

Alcohol consumption in the Netherlands increased at a very fast rate from 1960 to 1975, especially among young men. The question is raised whether members of the cohort that started drinking during the 1960s show a lasting deviation from cohorts born earlier with respect to drinking behavior. Cohort analysis is used to assess the effects of aging, period and cohort membership on changes in abstinence, mean consumption and heavy drinking in the Netherlands in the last three decades. Social interaction theory (Skog, 1980) is used as an interpretative framework. Conclusions are that abstinence is related to aging, while mean consumption and heavy drinking are associated with period effects. Populations of men and women appear to change drinking behavior collectively. Results on women are more regular than those on men.

Seasonal variation in survey and sales estimates of alcohol consumption.

Time variation of drinking is substantial and has an effect on aggregate estimates of consumption. In this article it is shown that because of a considerable seasonal variation in consumption (+/- 20%) a serious bias in annual consumption estimates can be expected in surveys with a limited time frame. The present study analyzes drinking data collected in the general population of the Netherlands from March 1985 through December 1985 (including Christmas and New Year's Eve). Since it was expected that sensitivity to temporal fluctuations might not be equal for different methods of measurement, several indices of consumption were compared. Although the assessed seasonal effect varies indeed across types of measurement, across male and female subsample and across types of alcoholic beverage, the general tendency is for consumption to be highest in the spring season and lowest in the autumn. Sales figures fluctuate accordingly. It is evident that the risk of biased estimates is larger the shorter the time frame of the survey. Seasonal variation was highest in the frequency domain. Furthermore, exclusion from the time frame of collective holidays, during which people drink more often and more per occasion (viz., Christmas), increases the risk of biased estimates. Even estimates of abstention, but also regular heavy drinking among women, appear to vary considerably over the three seasons in this study. The main conclusion is that results of comparisons of survey data on drinking, particularly those over time, are more or less invalid if the respective time frames of the surveys do not correspond.