Older and younger male alcoholics in outpatient treatment.

In the coming decades, the proportion of the older age groups in the total population, and, therefore, in the alcoholic population, will be increasing. The aim of the study is to assess to what extent older alcoholics form a distinct group within the problem-drinking population. Alcoholics in outpatient treatment of over 50 years of age (n = 52) are compared with those from the modal age group (ages 35-44, n = 55). Results indicate that problems with alcohol are less severe among older alcoholics. Contrary to expectation, older alcoholics did not report more health problems. No differences were observed in the duration of the treatment career. It is concluded that older alcoholics show the same types of problems, but less so than younger alcoholics. Further research is indicated regarding late onset, older alcoholics with multiple diagnosis, and drinking problems in the age group over 70.

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.

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.

Gender differences in alcohol use and alcohol problems: mediation by social roles and gender-role attitudes.

This study assesses the causal place of Traditional Gender Role Attitudes (TGRA) in models for men and women, which also include social roles by explanatory variables for alcohol use and alcohol problems. Mediation of gender differences by TGRA occurs mainly in abstinence. Interaction effect is weak for alcohol consumption and frequency of "heavy drinking." The most important explanatory variables are the status factors age and education, which are mediated by TGRA in a small way. Specific aspects of alcohol-related problems are analyzed separately for the problem drinking category. Differences in results with other studies are discussed, and further study is proposed.

Selection for postgraduate training for general practice: the role of knowledge tests.

BACKGROUND: Postgraduate training for general practice is a legal requirement in most countries of the European Community, and includes posts in general practice as well as in hospitals. The effectiveness of the training has not been fully evaluated, and it is largely unknown whether the results are satisfactory or what the impact of the separate training components is--nor is it known which characteristics or prior achievements of the trainee influence the end-of-training performance. AIM: To determine the value of knowledge tests in the context of entry selection for postgraduate training in general practice. METHODS: Three (equated) knowledge tests were administered during the two years' postgraduate training of 85 Dutch trainees. The first test was taken at entrance, the second eight months later, and the third shortly before the end of the entire training period. Complete data for 57 trainees were available for analysis. A multiple regression analysis was performed to estimate the predictive values of test 1 and test 2 scores, separately and in combination, for test 3 scores. Since the knowledge test may be used for selection purposes, the analysis was repeated using logistic regression with two pass/fail criteria: a 'minimum criterion' and an 'excellence criterion'. RESULTS: Neither of the two analyses yielded a predictive value of test 1 that was high enough to warrant the use of knowledge tests in the context of entry selection. A 'below minimum' score on test 2 correlated 100% with a 'below minimum' score on test 3. However, the positive predictive value of an above minimum score on test 2 was only 86%. CONCLUSIONS: The knowledge tests used in this study are not suitable in the context of entry selection. However, trainees that score 'below minimum' after eight months of training may be regarded as 'at risk' in that they will probably score 'below minimum' at the end of training.

Drinking careers of older male alcoholics in treatment as compared to younger alcoholics and to older social drinkers.

OBJECTIVE: In order to answer the question whether older alcoholics form a distinct group among problem drinkers and within their age cohort, drinking histories of male, older (over 50 years of age) alcoholics in treatment (n = 52) are compared to those of younger alcoholics (n = 55), and to those of older social drinkers (n = 46). Within the older alcoholics category, comparisons are made by age of onset. Changes in consumption volume and onset and remission of heavy drinking, morning drinking and solitary drinking are related to events in other spheres of life. METHOD: In face-to-face interviews, respondents were asked to report drinking behavior in subsequent drinking phases, from the beginning of regular drinking to the present. Events that marked a transition to a new drinking phase, as well as the impact that these events had on the general well-being of the respondents, were assessed using a semistructured interview format. RESULTS: Compared to younger alcoholics, older alcoholics were older when they started drinking regularly, and they report later age at onset of heavy drinking. Older alcoholics and social drinkers were similar with respect to the first years of their drinking career. Older alcoholics with onset of heavy drinking before the age of 35 were similar to younger alcoholics, while older alcoholics with later onset of heavy drinking resembled social drinkers with respect to their earlier drinking history. Alcoholics with later onset more often reported onset in connection with events such as marital disruption. CONCLUSION: Among older alcoholics, a distinct group can be distinguished that may benefit from specific prevention and treatment measures.

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.

Factors influencing the growth in knowledge of trainees in general practice.

OBJECTIVES: The relation between the content of postgraduate training for general practice and the outcome in terms of the growth in knowledge of trainees was investigated. The training variables included were: (1) the number of patients seen per day, (2) the trainer, (3) the practice and (4) the theoretical curriculum. METHODS: Subjects were 58 trainee-trainer pairs. Growth in knowledge was assessed by two written tests administered with eight months interval. Training variables were evaluated by means of questionnaires and logbook-registration. The correlation was explored between each of the training variables and the knowledge tests scores. To correct for interactional effects, a step-wise multiple regression analysis was performed with the second test as dependent variable and the first test as well as the training variables as independent variables. RESULTS: Significant growth in knowledge was demonstrated. Non of all training variables investigated explained the variance in scores on the second test equally good or better than the scores on the entry test. CONCLUSIONS: The impact of the separate training-components on the growth in knowledge, remains unclear. We may speculate, that the sort of knowledge assessed with the written literature based true/false test is different from the sort of knowledge transferred during every day training: evidence based knowledge versus experience based knowledge. Equally valid is the conclusion that these findings fit into the theory that in adult learning the outcome is more learner than teacher dependent.

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.

Gender differences in drinking behaviour in the Netherlands: convergence or stability?

Gender differences in drinking behavior are analysed with emphasis on their relationship with changes in roles and positions of men and women in society. The 'convergence hypothesis' is used as a starting point. From its implications, a number of specific hypotheses are derived and tested using data from six surveys of the general population of the Netherlands, held between 1958 and 1993. No convergence of gender differences is found for abstinence and heavy frequent drinking. Convergence of male-female differences in average weekly consumption appeared in the 1980s, but it is no longer significant at 5% level after controlling for age, education and family situation. Further elaboration of the gender by year interaction shows that convergence is related to a decrease in consumption among higher educated men. Contrary to expectation, an increase in consumption has occurred among women over 40 years of age. No relationship appears with female employment and religion. Having a family is related to lower consumption among women, while it has no significant effect on men's consumption. Although some evidence for convergence was found, results are not in agreement with expectations formulated from the perspective of the convergence hypothesis.

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.

Change in knowledge of general practitioners during their professional careers.

In this study the level of knowledge of general practitioners (GPs) in different stages of their career, from the undergraduate level onwards to more than 20 years after certification, has been investigated. The total body of knowledge as well as the knowledge about different aspects of care was established. Participants were 108 medical students, 445 postgraduate trainees in six different stages of their training and 351 GPs with 5 to more than 20 years of experience. They all took the same written test, designed to assess knowledge closely related to patient care. An increase in test score was found from the start of postgraduate training onwards followed by a decrease starting 5-10 years after certification. The curves for the different aspects of care varied. It is concluded that the body of knowledge of GP-trainees increases during postgraduate training and reaches the level of knowledge of GPs who are less than 10 years certified. From 10 years after certification onwards the knowledge decreases as well as changes over time. The latter had also been found in two American studies relating to the knowledge of certified GPs and internists. The results seem important for the organization and content of postgraduate training and continuous medical education.

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.