Alcohol consumption and its related harms in The Netherlands since 1960: relationships with planned and unplanned factors.

AIM: to establish which unplanned (social developments) and planned (alcohol policy measures) factors are related to per capita consumption and alcohol-related harms in the Netherlands. METHODS: linear regression was used to establish which of the planned and unplanned factors were most strongly connected with alcohol consumption and harms. Artificial Neural Analysis (ANN) was used to inspect the interconnections between all variables. RESULTS: mothers age at birth was most strongly associated with increase in consumption. The ban on selling alcoholic beverages at petrol station was associated with a decrease in consumption. The linear regression of harms did not show any relation between alcohol policy measures and harms. The ANN-analyses indicate a very high interconnectedness between all variables allowing no causal inferences. Exceptions are the relation between price of beer and wine and the consumption of these beverages and the relation between a decrease in transport mortality and the increased use of breathalyzers tests and a restriction of paracommercial selling. CONCLUSIONS: unplanned factors are most strongly associated with per capita consumption and harms. ANN-analysis indicates that price of alcoholic beverages, breath testing, and restriction of sales may have had some influence. The study's limitations are noted.

Agreement between self-reports and on-site inspections of compliance with a workplace smoking ban.

INTRODUCTION: This study compares self-reports on compliance with a workplace smoking ban with on-site inspections of the same workplace, in the Netherlands, to assess the validity of self-reported compliance by employees. METHODS: A total of 360 companies had participated in the telephone survey (in October and November 2006) and were also visited by inspectors directly after the survey to establish compliance. The sampling frame included companies with 5 or more employees, stratified according to the number of employees and type of economic activity. We calculated the agreement, the under- or overestimation and the predictive values, and explored nonresponse research. RESULTS: The percent agreement on compliance between the two measures was 77.5%, the McNemar test was not significant, and the agreement coefficient with first order correction was .68, indicating moderately strong agreement. Furthermore, the results indicate a slight overestimation of compliance. Concerning the predictive values, we found most variance among the self-reported noncompliance: 55.2% of those reporting noncompliance did in fact comply. CONCLUSIONS: This study allows to conclude that self-reports on compliance with a workplace smoking ban are largely valid and that social desirability is negligible. For agencies enforcing the workplace smoking ban, these results indicate that a strategy to identify noncompliance among responding companies might be useful. Moreover, such a strategy reduces the burden of inspecting among complying companies.

A Dutch panel study on the relation between structure of everyday life, daily hassles, and alcohol consumption.

BACKGROUND: A widely held assumption within the general public is that one way in which people cope with their daily hassles is by drinking alcohol. Although the idea of drinking to compensate for daily hassles is intuit, empirical evidence is actually rather scarce. This study aimed to test whether structure of everyday life results in more daily hassles and has a protective effect regarding alcohol consumption (as predicted by classic role theory) or - in case the relation between daily hassles and alcohol consumption is positive (as predicted by tension reduction theories) - daily hassles would decrease the protective effect of having a more structured everyday life. METHODS: A general population panel study (N = 2,440; 47% women; age: M = 52 years, SD = 17), measuring structure of everyday life and daily hassles (T1; 90% response rate) as well as alcohol consumption (T2; 85% response rate). RESULTS: In line with classic role theory - structure of everyday life was positively associated with daily hassles and had a negative effect on alcohol consumption. Daily hassles was not associated with alcohol consumption. CONCLUSIONS: Daily hassles did not mediate the relationship between structure of everyday life and alcohol consumption.

Concern about passive smoking and tobacco control policies in European countries: an ecological study.

BACKGROUND: Because of the magnitude of the global tobacco epidemic, the World Health Organisation developed the Framework Convention on Tobacco Control (FCTC), an international legally binding treaty to control tobacco use. Adoption and implementation of specific tobacco control measures within FCTC is an outcome of a political process, where social norms and public opinion play important roles. The objective of our study was to examine how a country's level of tobacco control is associated with smoking prevalence, two markers of denormalisation of smoking (social disapproval of smoking and concern about passive smoking), and societal support for tobacco control. METHODS: An ecological study was conducted, using data from two sources. The first source was the Tobacco Control Scale (TCS) from 2011, which quantifies the implementation of tobacco control policies in European Union (EU) countries. Data on smoking prevalence, societal disapproval of smoking, concern about passive smoking, and societal support for policy measures were taken from the Eurobarometer survey of 2009. Data from Eurobarometer surveys were aggregated to country level. Data from the 27 European Union member states were used. RESULTS: Smoking prevalence rates in 2009 were negatively associated with a country's TCS 2011 score, although not statistically significant (r = -.25; p = .21). Experience of societal disapproval was positively associated with higher TCS scores, though not significantly (r = .14; p = .48). The same was true for societal support for tobacco control (r = .27; p = .18). The TCS score in 2011 was significantly correlated with concern about passive smoking (r = .42; p =.03). Support for tobacco control measures was also strongly correlated with concern about passive smoking (r = .52, p = .006). CONCLUSIONS: Smokers in countries with a higher TCS score were more concerned about whether their smoke harms others. Further, support for tobacco control measures is higher in countries that have more of these concerned smokers. Concerns about passive smoking seem central in the implementation of tobacco control measures, stressing the importance of continuing to educate the public about the harm from passive smoking.

Parents' alcohol use: gender differences in the impact of household and family chores.

BACKGROUND: Social roles influence alcohol use. Nevertheless, little is known about how specific aspects of a given role, here parenthood, may influence alcohol use. The research questions for this study were the following: (i) are family-related indicators (FRI) linked to the alcohol use of mothers and fathers? and (ii) does the level of employment, i.e. full-time, part-time employment or unemployment, moderate the relationship between FRI and parental alcohol use? METHODS: Survey data of 3217 parents aged 25-50 living in Switzerland. Mean comparisons and multiple regression models of annual frequency of drinking and risky single occasion drinking, quantity per day on FRI (age of the youngest child, number of children in the household, majority of child-care/household duties). RESULTS: Protective relationships between FRI and alcohol use were observed among mothers. In contrast, among fathers, detrimental associations between FRI and alcohol use were observed. Whereas maternal responsibilities in general had a protective effect on alcohol use, the number of children had a detrimental impact on the quantity of alcohol consumed per day when mothers were in paid employment. Among fathers, the correlations between age of the youngest child, number of children and frequency of drinking was moderated by the level of paid employment. CONCLUSION: The study showed that in Switzerland, a systematic negative relationship was more often found between FRI and women's drinking than men's. Evidence was found that maternal responsibilities per se may protect from alcohol use but can turn into a detrimental triangle if mothers are additionally in paid employment.

Effects of a workplace-smoking ban in combination with tax increases on smoking in the Dutch population.

INTRODUCTION: In the Netherlands, between 2003 and 2005, 3 tobacco control measures were implemented: a workplace-smoking ban and 2 tax increases on tobacco products. This study explores how the combination of measures influences the smoking behavior of the general population divided into subpopulations with and without paid work (all aged 16-65 years). METHODS: Data from the Dutch Continuous Survey of Smoking Habits were used. The total sample consisted of 32,014 respondents (27,150 with paid work and 4,864 without paid work) aged 16-65 years. Analyses were done by linear and logistic regression, controlling for relevant factors. RESULTS: For respondents with paid work, the combination of a smoking ban and 2 tax increases led to a decrease in the number of cigarettes per day and in the prevalence of daily smoking. For respondents without paid work, there was no significant effect on any of the outcome parameters. In both groups, there was no evidence that the effect of the measures on smoking was moderated by the respondent's gender, age, or level of education. CONCLUSIONS: The combination of policy measures has influenced the smoking behavior of respondents with paid work in a positive way. Compared with most other studies, the effect of the workplace-smoking ban alone is smaller. However, the effect of the combined interventions is higher than the that of tax increases in other studies. Among respondents without paid work who were exposed to tax increases only, no significant effects were found.

Contextual determinants of alcohol consumption changes and preventive alcohol policies: a 12-country European study in progress.

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and 2008 are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

The effect of pubertal and psychosocial timing on adolescents' alcohol use: what role does alcohol-specific parenting play?

In scientific literature, early pubertal timing emerges as a risk factor of adolescents' drinking, whereas alcohol-specific rules (the degree to which parents permit their children to consume alcohol in various situations) showed to protect against adolescents' drinking. This study investigated whether alcohol-specific rules mediate and/or moderate the effect that early pubertal and psychosocial timing (personal, relational, socio-institutional) has on adolescents' alcohol use. Mediation and moderation models were tested conducting ordinal logistic structural equation modeling in a cross-sectional sample of 1,893 Dutch adolescents (49% males), aged 13-15 years. Findings showed that early pubertal, relational and socio-institutional timers were at greater risk to initiate alcohol use and for heavy episodic drinking. Alcohol-specific rules more often mediated, rather than moderated, the effect of early timing on alcohol use. Alcohol-specific rules are mostly relaxed when adolescents mature, rather than reinforced, indicating that parents partly facilitate adolescents' drinking.

Adolescents binge drinking when on holiday: an evaluation of a community intervention based on self-regulation.

This paper presents a case study of a community intervention aimed at reducing excessive drinking in young men on holiday in seaside camping resorts in the Netherlands. The self-regulated voluntary covenant of parties concerned was evaluated on the basis of several types of data (all collected in 2004 ): questionnaires administered to young men (N = 191), observations carried out by trained "peers," nuisance questionnaires among city center residents (N = 121), and interviews with local actors. Compliance with measures as well as the effects of measures are discussed. Limitations are noted and recommendations for optimizing the potential of community interventions are made.

Social roles and alcohol consumption: a study of 10 industrialised countries.

The empirical evidence as regards the precise associations between alcohol use and social roles, and these associations across genders and cultures is heterogeneous. The literature tends to focus on two central but conflicting theories. The first - classic role theory - assumes that a higher number of social roles is associated with a more structured life and thus fewer opportunities to drink heavily. The second - the multiple burden hypothesis - posits that the increasing complexity of multiple social roles leads to higher stress levels, and thus to increased alcohol use. Survey data on 25-54-year olds in 10 western industrialised countries which participate in the Gender, Alcohol and Culture: An International Study (GenACIS) project were used to test whether holding the three main social roles - partnership, parenthood, and paid labour - had a more protective or a more detrimental association with problematic alcohol use than holding fewer roles. Age and education were included as possible confounders, while the outcome variables were risky single occasion drinking (RSOD) and heavy-volume drinking. For both men and women and in almost all countries, the study found that those who had all three roles were least likely to drink heavily or engage in RSOD, thus supporting the assumptions of classic role theory. It also found that the protective effect of multiple roles was more consistent for RSOD. There were a few countries where a two-role model gave a better fit. Results for Germany (RSOD), Switzerland, and the Unites States (heavy-volume drinking) indicate that the role of paid labour appears to be particularly relevant for risky alcohol use among women. Despite some variability in the association between paid labour and heavy drinking or RSOD among women, in almost all countries the greater the number of roles a person held, the lower their risk of this type of alcohol use was.

Does the workplace-smoking ban eliminate differences in risk for environmental tobacco smoke exposure at work?

OBJECTIVES: A workplace-smoking ban in the Netherlands was introduced on January 1, 2004. Before the ban male and low educated employees were at higher risk for exposure to environmental tobacco smoke (ETS). Effective implementation of the ban should result not only in an overall decline of exposure, but also in the disappearance of systematic differences in exposure between subgroups of employees. METHODS: Data from a Dutch continuous Internet survey were used. From July 2003 through June 2005, 200 respondents were randomly selected each week. The sample consisted of 11,291 non-smoking, working respondents, aged 16-65 years. RESULTS: ETS exposure decreased among all employees and among subgroups at higher risk before the ban. However, also after the ban, males and low educated employees were still most likely to be exposed to ETS. CONCLUSIONS: The workplace-smoking ban was effective in reducing ETS exposure among employees. However, after the ban still 52.2% of non-smoking workers reported to be exposed. We did not find the expected stronger effect among employees who were at higher risk. Both before and after implementation of the ban, males and lower educated employees were about two times more likely to be exposed to ETS.

The tobacco sales ban and tobacco purchases by adolescents: a general population study in The Netherlands.

BACKGROUND: The study aimed to assess the effect of the introduction on 1 January 2003 of a legal tobacco sales ban in The Netherlands on tobacco purchases by smoking and non-smoking adolescents aged <16 years. METHODS: Two cross-sectional surveys were conducted among adolescents aged 13 through 15 years, one at end 1999 (n = 4751) and the other at end 2003 (n = 13 298). RESULTS: The percentage of adolescents buying tobacco decreased significantly from 26.3% in 1999 to 10.8% in 2003 (P < 0.001). Further analysis showed that, after the ban, the proportion of smokers among buyers almost tripled [Odds Ratio (OR) = 2.9], while the likelihood of non-smokers buying tobacco decreased strongly (OR = 0.17). A difference in the pattern of purchasing tobacco also emerged after the ban. In 2003, the proportion of smokers buying at least weekly in commercial outlets was larger than in 1999. For non-smokers there was no difference between 1999 and 2003 in the proportion buying weekly. The variety of commercial outlets in which purchases were made increased among both smoking and non-smoking purchasers of tobacco. CONCLUSIONS: Implementation of the 2003 tobacco sales ban has had the (intended) effect of lowering tobacco purchases among adolescents. This was mainly due to the decrease in the likelihood of buying tobacco among those who regard themselves as a non-smoker. The decrease in buying tobacco is associated with a decrease in prevalence of smoking. The sales ban has probably contributed to a stronger decrease in prevalence of smoking.

Prevention of alcohol problems in Dutch youth: missed opportunities and new developments.

Binge drinking among young people is a problem in the Netherlands. This article outlines the current Dutch approach to alcohol prevention in this target group. It is argued that well-enforced evidence-based control measures are lacking despite renewed political interest in them. Politicians often favor alcohol education, but to increase the effectiveness of alcohol prevention, a combined approach of policy measures, enforcement, and education is needed. Translation of education and policy-based measures is discussed.

Sociometric status and social drinking: observations of modelling and persuasion in young adult peer groups.

Because young adult drinking occurs primarily in peer groups, this should be taken into account when studying influences on drinking behaviour. This paper aimed to assess influences on drinking by observing existing peer groups in a naturalistic setting. We first analysed the basic levels at which two types of influence take place. The first, modelling (imitating others' drinking), was found to significantly influence individual drinking, whereas for the second one, persuasion (drinking resulting from others offering drinks), no predictions were found. Subsequently, we examined whether peer group members' sociometric status in the group affected the amount of influence and persuasion exerted and received. No indications were found that sociometric status had an impact on influence in alcohol consumption within a drinking situation. Features and weaknesses of the study are discussed.

Single-session expectancy challenge with young heavy drinkers on holiday.

Expectancy challenges (ECs) were used to change alcohol expectancies and alcohol consumption in young heavy drinking men (age 16-24) on holiday. The intervention took place in community centers and bars. Alcohol expectancies and consumption were assessed with paper and pencil measures prior to the intervention (N=301) and 2 days afterwards (EC: n=178; controls: n=86). Six weeks after the EC, participants were interviewed by telephone (EC: n=163; controls: n=71). The intervention resulted in an increase in sedation expectancies in the EC group. Furthermore, the EC led to a differential reduction in alcohol consumption on a night out at the six-week posttest in the heaviest drinkers only. The reduction in alcohol consumption on a night out was not mediated by the change in sedation expectancies. These findings suggest that further research on the mechanisms of change is necessary before a single-session EC may be used in a real-life prevention setting.

Pastime in a pub: observations of young adults' activities and alcohol consumption.

Alcohol consumption typically takes place in a time-out situation, which can be spent by engaging in several leisure time activities. Usually, conversation is the dominant pastime in a bar, but this may take place during other activities, like watching TV or playing games. These activities may inhibit drinking because of the physical difficulties of drinking and being active at the same time. Findings of an observational study on drinking in young adults (N=238) in a bar lab will be discussed. In the present study, we followed the ad-lib drinking of peer groups (7-9 persons) during 1-h periods. The results suggest that (1) selection of activities is not related to initial drinking level or personality characteristics; (2) active pastime is related to slower drinking than passive pastime (in males); (3) male problem drinkers appear to compensate for the "lost" amount of drinking after an active phase; and (4) involvement in active pastime is not related to total alcohol consumption. Implications of these findings are discussed.

Street-level effects of local drug policy on marginalization and hardening: an ethnographic study among chronic drug users.

This study focuses on the effects of increased enforcement on marginalization of and quality of relations between chronic drug users in the region of Parkstad Limburg (The Netherlands). Data were mainly gathered by ethnographic community fieldwork, verified by interviews with key informants and supported by a survey sample of 100 drug users. The results show direct effects of repression on stigmatization and marginalization of drug users, and on the availability of drugs. More indirect effects are the hectic reactions of drug users and dealers, greater visibility of drug users in public places, and increased tensions in and deterioration of relations between the drug users. The impact of the increased enforcement on reports of drug-related nuisance in general population surveys and on police control is also discussed.

Direct and indirect effects of alcohol expectancies through drinking motives on alcohol outcomes among students in Vietnam.

OBJECTIVE: To investigate whether the links between alcohol expectancies (tension reduction; global positive change; improved cognitive and motor abilities; and change in social behavior) and alcohol outcomes (drinking volume, 6+ drinks, alcohol problems, and symptoms of alcohol dependence) are mediated by drinking motives (social, enhancement, conformity, and coping). METHOD: A multi-stage sampling strategy was used in four Vietnamese provinces, resulting in a final sample of 4756 students (43.2% females) with mean age 20.6 (SD 1.8) years. Structural equation models, including indirect effects, were estimated for women and men separately. RESULTS: Overall, there were many cases of full mediation (indirect effects range from -0.006 to 0.083 and p-values from <0.05 to <0.001) and little indication of partial mediation (indirect effects range from -0.009 to 0.025 and p-values from <0.05 to <0.001). In both men and women, coping motives most frequently mediated the influence of expectancies on alcohol outcomes. Among men, enhancement motives and, to a lesser extent, social motives also played a role in mediating the effects of expectancies on alcohol outcomes. Among women, full mediation was found far less often and less consistently. CONCLUSION: By confirming that, in Vietnam, motives mediate the link between expectancies and drinking behavior, this study supports the cultural robustness of a key assumption of the motivational model (i.e. that drinking motives are more closely associated with alcohol use than expectancies). Enhancement, coping and social motives are most frequently found as mediators among male students whereas coping motive only is most frequently found as a mediator among female students. As most of the effects of expectancies were mediated by motives, drinking motives appear to be a promising factor for interventions.

A Multilevel Study of Students in Vietnam: Drinking Motives and Drinking Context as Predictors of Alcohol Consumption.

BACKGROUND: This study used multi-level analysis to estimate which type of factor explains most of the variance in alcohol consumption of Vietnamese students. METHODS: Data were collected among 6011 students attending 12 universities/faculties in four provinces in Vietnam. The three most recent drinking occasions were investigated per student, resulting in 12,795 drinking occasions among 4265 drinkers. Students reported on 10 aspects of the drinking context per drinking occasion. A multi-level mixed-effects linear regression model was constructed in which aspects of drinking context composed the first level; the age of students and four drinking motives comprised the second level. The dependent variable was the number of drinks. RESULTS: Of the aspects of context, drinking duration had the strongest association with alcohol consumption while, at the individual level, coping motive had the strongest association. The drinking context characteristics explained more variance than the individual characteristics in alcohol intake per occasion. CONCLUSIONS: These findings suggest that, among students in Vietnam, the drinking context explains a larger proportion of the variance in alcohol consumption than the drinking motives. Therefore, measures that reduce the availability of alcohol in specific drinking situations are an essential part of an effective prevention policy.

The effects of alcohol expectancies on drinking behaviour in peer groups: observations in a naturalistic setting.

AIMS: To study the functionality of alcohol expectancies in predicting drinking behaviour in existing peer groups of young adults in a 'naturalistic' setting. DESIGN AND SETTING: Young adults were invited to join an experiment with their peer group in a bar annex laboratory. During a 'break' of 50 minutes in this experiment, their activities, social behaviour and drinking behaviour were observed with digital video and audio equipment. PARTICIPANTS: Twenty-eight peer groups were involved in this study. A peer group consisted of seven to nine people, with relationships ranging from intimate relations and close friendships to being acquaintances. A total of 238 participants were involved. Measurements Information of the drinking behaviour from observations and questionnaire data on alcohol expectancies provide the opportunity to look at how and which expectancies are related to actual drinking patterns. Multiple regression and multi-level analyses were applied. FINDINGS: Expectancies on the positive and arousing effects of alcohol consumption were related to alcohol consumption in a naturalistic, social drinking situation, in addition to group effects of drinking. Expectancies on the negative and sedative effects of drinking, however, were not related to drinking. CONCLUSIONS: The findings indicate that among young adults observed in a peer group and naturalistic drinking setting, positive expectancies about the effects of alcohol and expectancies about the effects of alcohol on arousal are related positively to drinking level.