Next Article in Journal
Mapping Environmental Inequalities Relevant for Health for Informing Urban Planning Interventions—A Case Study in the City of Dortmund, Germany
Next Article in Special Issue
Are Non-Pharmacological Interventions Effective in Reducing Drug Use and Criminality? A Systematic and Meta-Analytical Review with an Economic Appraisal of These Interventions
Previous Article in Journal
Health Impacts from Corn Production Pre-and Post-NAFTA Trade Agreement (1986–2013)
Previous Article in Special Issue
Alcoholic Beverage Consumption and Chronic Diseases
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
IJERPH
Volume 13
Issue 7
10.3390/ijerph13070710
ijerph-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

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

by
Pham Bich Diep
1,*,†,
Frans E. S. Tan
2,
Ronald A. Knibbe
1 and
Nanne De Vries
1
1
Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, Maastricht 6200 MD, The Netherlands
2
Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University, Debeyeplein 1 (1st Floor), Postbus 616, Maastricht 6200 MD, The Netherlands
*
Author to whom correspondence should be addressed.
†
Current address: No. 1 Ton That Tung Street, Dong Da District, Hanoi City, Vietnam
Int. J. Environ. Res. Public Health 2016, 13(7), 710; https://doi.org/10.3390/ijerph13070710
Submission received: 13 April 2016 / Revised: 31 May 2016 / Accepted: 4 July 2016 / Published: 13 July 2016
(This article belongs to the Special Issue Advances in Substance and Drug Abuse Prevention)
Versions Notes

Abstract

:
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.

1. Introduction

Heavy drinking among students in developed countries is well documented. In 2011, a study including 36 European countries showed a prevalence of drinking five or more drinks on one occasion in the last 30 days of 27%–61% among male students and 12%–53% among female students [1]. However, very few studies have investigated young people in developing countries [2] and, in particular, in Vietnam [3]. Available studies among medical students in Vietnam showed that 15.1% of students were abstainers; 65.5% of students consumed alcohol in the past year of which 12.5% reported alcohol-related problems; 6.1% of the female students reported drinking at least four standard drinks per occasion and 36.4% of male students drank at least five standard drinks per occasion; and male students were 14.3 times more likely to have alcohol-related problems than female students [4,5]. Factors associated with alcohol consumption in Vietnam have not yet been described. Therefore, this study examines the effects of individual factors (age and drinking motives) and contextual factors (drinking with whom, drinking duration, drinking relationship, drinking location, main purpose of drinking, drinking with food) on alcohol intake per occasion among university students in Vietnam.
Conceptually, environmental factors are important for etiological explanations of drinking behavior [6]. Individuals might not drink in the same way on different occasions, and actual drinking might be as much the result of the individual adjusting his/her drinking to situational aspects as to individual characteristics explaining his/her drinking in a particular situation [7]. Studies using self-reported data found that some aspects of the drinking context are associated with alcohol consumption among students: aspects of timing (weekend; duration of drinking sessions) [8]; social aspects (gender composition, size of group, relation with drinking group members, number of intoxicated people) [9,10,11]; and aspects of location (bar or tavern; off-campus party) [12,13,14]. Additionally, observational studies of drinking situations also show similar results in terms of social aspects, such as being in a larger group, in a group of mixed/male gender; loudness of the music [15,16]; poor cleanliness, loud music and crowdedness [17].
Drinking context is very rarely studied in Vietnam. Only one study among young people aged over 15 years in three provinces in Vietnam showed that most people drink in the late afternoon (87% for wines/spirits and 31% for beer). In terms of the drinking place, the most frequently reported location was at home (55.5% when drinking wine and 22.2% when drinking beer), followed by parties/weddings (39.6% for wine and 16.4% for beer) and street bars (11.6% when drinking wine and 12.5% for beer) [18].
While the study of contextual aspects is based on the assumption that the individual adjusts their drinking to the situation, most theories (such as motivational or expectancy theory) assume that individual characteristics have the strongest influence on drinking. The assumption of this model is that motives are the most proximate determinant of an individual’s drinking and that other factors, like biochemical factors, personality characteristics, situational and other cognitive factors should be considered as antecedent factors, which are reflected in the motives of drinking [19,20,21]. It has been suggested that motives mediate the influence of other important individual factors like expectancies [22,23,24,25]. For young people, the most dominant type of motive is social drinking motive, followed by enhancement, coping and conformity motives [26]. The different motives are associated with different aspects of drinking patterns. Social motives are strongly and positively related to drinking frequency [26]; enhancement and coping motives are positively associated with heavy drinking and alcohol-related problems [27,28], while conformity motives are negatively associated with alcohol use [26].
The present study is based on the assumption that both drinking motives and drinking context characteristics are explanatory variables for alcohol consumption. Individuals might seek to participate in drinking environments that are consistent with their motivations. On the other hand, individuals interact with each other and the drinking environment that they are participating in. Therefore, the same individual may drink differently on different occasions [11,16]. Drinking motives and drinking context may influence each other in two ways: motives may determine the selection of the drinking contexts someone drinks in and, depending on the drinking context, a particular motive may be more prominent in determining drinking behavior than it is in another context. However, this relationship has not yet been studied. As a first step, this study determines how much variance in alcohol intake per occasion is explained by drinking context characteristics and by individual characteristics, such as motives.
A few multilevel studies included context and individual levels in order to examine the association with alcohol consumption. Kypri et al. [14] studied alcohol use as a function of only one situational variable (i.e., drinking location) and of individual characteristics (age, living arrangement, drinking history, etc.). College students drinking before, during and after they went to a certain setting, were also studied in relation to the socio-demographic characteristics [29]. The results show a positive association between drinking settings and alcohol use. A multilevel analysis among American students combined observational measures of party environment (party size, loud music, exit time, number of intoxicated people, etc.) with a brief self-administered questionnaire about individual factors (gender, motivation to go to the party, etc.) and collected breath samples from partygoers. It was shown that party characteristics explained more variance in blood alcohol concentration at both the individual and party level, than the individual variables [13]. This study examines to what extent drinking motives, indicating individual characteristics, and drinking context characteristics explain alcohol consumption per occasion.

2. Method

2.1. Setting

This study involved 6011 students from the first to the last academic years of total 10 universities from four provinces: Hanoi (HN) in the north; HoChiMinh (HCM) in the south; Hue in the middle and BuonMeThuat (BMT) in a remote region of Vietnam. In three of the cities (HN, HCM, Hue) the three largest universities focusing on Economics, Technology and Medicine were selected for this study. BMT has only one university; therefore, in that university the three faculties focusing on Economics, Technology and Medicine were selected.

2.2. Sampling

A multi-stage sampling strategy was used with the city as the first stratum, the university/faculty as the second stratum, and the academic year (from the first to the last academic year) the third stratum. Since medical undergraduate education takes six years to complete, while the technological and economics/nature, and the technology science/agriculture & forestry undergraduate education takes only five and four years, respectively, the numbers of students in each academic year in those universities/faculties were 85 for medical, 100 for technological, and 125 for economic studies. Within each academic year, one or two classes (depending on the total number of students per class) were randomly selected for this study, ensuring that the sample size per academic year was sufficient. As a result, 6011 students who were in the classes at the data collection time all agreed to participate in the research.

2.3. Data Collection

The structured questionnaire contained pictures of the most common beverages in Vietnam (with their ethanol levels, and number of standard drinks (SDs) per container (bottle, can, etc.)). In this way students were supported to correctly report the number of drinks. Standard drink (SD) = 1 can beer (330 mL at 5%) = 1 glass wine (140 mL at 12%) = 1 shot spirit (40 mL at 40%) = 12.6 g of pure alcohol. Investigators instructed students on how to fill out the questionnaire. The students were assured of their right to withdraw from the study. If a student had any queries related to the questions, the investigators provided clarification. This study was approved by the Biomedical Research Ethics Committee of School of Public Health in Hanoi, Vietnam (Code: 136/2012/YTCC-HD3).

2.4. Questionnaire

General information concerned the city; the university/faculty; gender and age.
Outcome variable: Number of glasses reported for each of the three drinking occasions is the outcome variable in our analysis. Since students will considerably differ in the time span over which these three occasions were distributed, this measure is not indicative of level of consumption understood in the more common way as for example number of glasses per week or month. It appears that the correlation of number of glasses per occasion with consequences due to drinking (measured with the Alcohol Use Disorders Identification Test (AUDIT) questionnaire) is about the same as the correlation of the correlation of level of consumption (defined by AUDIT questions on frequency of drinking and number of glasses per drinking day and consequences. For men these correlations were 0.43 (number of glasses per occasion) and 0.49 (AUDIT measure of volume), respectively and the correlations for women were 0.36 and 0.41, respectively. Therefore the informative value of our outcome variable for experiencing negative consequences due to drinking is about as good as an outcome defined in terms of level of consumption.
Drinking behavior and context: Each student was asked: “How often did you drink in the last 12 months” with the five answers of categories: never/maximum of 1 time a month/2–4 times a month/2–3 times a week, and at least 4 times a week. Students who answered “never” in the last year (n = 1021) and who answered “no” to the question “Did you drink at least three times in the last year” (n = 725) were excluded from the analysis. As a result, 4265 individuals who drank on at least three occasions remained in the analysis.
Drinking context characteristics: Students were asked to name and describe the last three occasions at which they drank; there were 12,795 drinking occasions in the analysis. For each drinking occasion, students described how many SDs they consumed; the drinking day (week days, weekend, holiday); the time of day (morning/lunch, afternoon, evening/midnight), duration of drinking (≤1 h, 1–2 h, 2–3 h, ≥3 h); main purpose of drinking occasion (party, meeting of friends, specific events (e.g., wedding or other celebration), and no specific purpose); drinking with food, even a snack (yes, no); drinking location (at home, in a restaurant, tavern/at the pavement/outside, in a discotheque/karaoke bar/others); number of people that they drank with (none, 1–3 people, 4–9 people, more than 10 people); the gender of the people they drank with (male only, female only, mixed gender); and the relationship with the people they drank with (family members/relatives, friends, casual relationship).
Drinking motives: For this study we used the Drinking Motive Questionnaire Revised, as developed by Cooper [30].This was found to be a valid and reliable instrument in different age groups and has also been used in non-English speaking countries. The questionnaire on drinking motives was first translated from English into Vietnamese (by the first author) and then back translated into English by professional native-speaking persons. Also, before conducting the study, the questionnaire was piloted among students to ensure that they correctly understood the included questions. Students were asked to indicate on a 5-point Likert scale ranging from “Never = 1” to “Almost always = 5” how often they consumed alcohol for each of the 20 motive items. Exploratory factor analysis detected four factors covering five items per factor, similar to the dimensions of Cooper, all with adequate internal consistency: Social (Cronbach’s alpha = 0.80), Enhancement (Cronbach’s alpha = 0.87), Coping (Cronbach’s alpha = 0.85) and Conformity (Cronbach’s alpha = 0.71). The average score of the relevant items was used as the scale score. Male students scored significantly higher than females on social (Median; interquartile range (IQR) = 3.4 (2.8, 3.8) vs. 3.0 (2.2, 3.6)), enhancement (1.6 (1.2, 2.2) vs. 1.4 (1.0, 1.8)) and coping motives (1.4 (1.0, 2.0) vs. 1.2 (1.0, 1.8)), as well as on conformity motives (2.0 (1.6, 2.6) vs. 1.6 (1.4, 2.0)).

2.5. Missing Value Imputation

The missing observations are reported in Table 1. From the original sample of 12,795 drinking occasions, less than 5% of the students failed to answer some of the questions. Missing values were replaced by means of Markov Chain Monte Carlo estimates. A multiple imputation technique (as implemented in SPSS for Windows (version 20, IBM Corp., New York, NY, USA), performed five imputed datasets) was used to deal with all missing observations on the assumption that missing observations depend only on the observed covariates included in the model (MAR = missing at random assumption).

2.6. Statistical Analysis

The inter-correlations between the situational variables and motives were relatively low (r ≤ 0.22, p < 0.01), (Pearson correlation was used and the significance level was tested using a two-tailed test).
A mixed-effects linear regression model was constructed to address our research questions, because we are working with a two-level design with drinking occasions and their particular aspects at the first level, and students and their individual characteristics at the second level: i.e., 12,795 drinking occasions at level 1 nested within 4265 individuals at level 2. The primary outcome variable is the number of SDs per occasion. Because of a skewed response distribution, the number of SDs was log-transformed to approximate a normal distribution and reduce the impact of extreme values. As independent variables, we distinguished between the contextual variables (drinking day; time of the drinking day, duration of drinking, main purpose of drinking, drinking with food, drinking location, number of people who drink together, gender of people drinking together, relationship of the people drinking together) and the individual variables (gender, age, drinking motives). Studies have suggested that students from different disciplines may differ in their frequency and quantity of alcohol consumption [31]. Since the university/faculty was related to the outcome variables of interest in this sample, it was included as a covariate. The proportion of variance explained was computed using the method proposed by Snijders and Bosker [32]. Since there are large gender differences in drinking volume, the model was separately tested for men and women.
Since the time span over which the three drinking occasions were distributed varies between the students, another model including a variable indicating the time interval over which the three drinking occasions took place (e.g., 1 month/2 month/…) was tested. Due to the fact that a substantial number of students could not recollect at which time one or more of the three most recent drinking occasions took place, this analysis includes a far less large number of students (female = 417 students with 1251 drinking occasions; male = 1023 students with 3069 drinking occasions). The purpose of testing this model was to exploring whether the frequency of drinking occasions influences the effect of contextual variables and motives on drinking. Data of this model was not shown.

3. Results

Of the total number of 12,795 drinking occasions during the previous 12 months, 13.9% occurred within the previous week; 20.6% occurred between 2 weeks and 1 month ago, 18.8% occurred more than 1 month ago, and of the remaining 46.7% of the drinking occasions the students did not remember when they had happened. Comparison of the three most recent drinking occasions revealed that there was no significant difference in the standard drinking intake between the first, the second and the third most recent occasion. However, comparing occasions for which a date was reported with those the date was not reported, we found significant difference indicating a higher consumption in occasions with date was reported (Median of alcohol consumption per occasion with date reported was 3.4 (SD = 3.1) vs. with no date reported was 2.6 (SD = 2.7)). Table 1 shows that the participants scored higher on social motives, followed by conformity, and then by coping and enhancement motives.
Table 2 shows that the mean alcohol intake per occasion is 3.0 standard drinks (SD = 2.9) with a median of 2 standard drinks (interquartile range 1–4). Most of the drinking occasions take place in the weekends, in the evening/night, when having a party, drinks with food, and at home. Additionally, students drink in mostly mixed gender groups with 4–9 friends. Students rarely drink longer than 3 h per occasion.
Table 3 shows that, at the contextual level, both male and female students consumed more alcohol per occasion when the context is characterized by long duration of drinking occasion, large number of people and the participants being casual friends or acquaintances rather than family. Among male students only, more alcohol is drunk per occasion when they drink at a specific occasion such as a wedding or a celebration (as opposed to not a special event), when not having food, and when drinking in a tavern/pavement/outside (as opposed to a discotheque/karaoke bar/others). Additionally, male students drink less alcohol when they drink in exclusively female company. Among those variables, the duration of drinking has the strongest association. On average, the alcohol intake of students who spent ≥3 h drinking on an occasion was about two times higher than that of students who spent ≤1 h drinking on an occasion.
At the individual level, all drinking motives were significantly associated with drinking among male students. Conformity motives were not significantly associated with drinking among women, while a higher score on conformity motives was associated with a significantly lower consumption among male students.
Individual characteristics explained 7% and 10% of the variance in alcohol intake per occasion among female and male students, respectively. Situational characteristics explained 11% and 23% of the variance in alcohol intake per occasion among female and male students, respectively. Together, the individual and contextual characteristics explained 16% and 27% of the variance in alcohol intake per occasion among female and male students, respectively. In a combined model, the contextual characteristics explained more variance (women 11% and men 23%) than individual characteristics (women 7%; men 10%) in alcohol intake per occasion.
Controlling for the time span over which the three drinking occasions took place did not change anything in the effect of the contextual and individual variables on the outcome (number of glasses per occasion). Additionally, it confirmed our conclusion that drinking context variables explain more variance than individual ones (data not shown).

4. Discussion

Vietnamese students seem to consume less alcohol per drinking occasion than, for example, Canadian students (3.0 SDs vs. 4.4–4.5 SDs) [8,10] and probably than most students in European countries [1] or in the U.S. [33,34,35,36]. This finding is in line with another cross-countries study among students which showed that hazardous drinking is lower in Asia and Africa but higher in Australia, Europe, and North and South America [37].
The results of the present study indicate that, at the contextual level, drinking sessions lasting more than 3 h, drinking in large groups, and drinking with casual acquaintances rather than with family members, are associated with a significantly higher level of alcohol consumption. Drinking without food and drinking in a tavern/pavement/an outside location are likely to increase alcohol consumption per occasion among male students only. Findings at the contextual level are similar to those from studies among students in other countries such as in the U.S., Canada and the Netherlands, showing that students drink less when in the presence of a family member [38], that students are protected against alcohol problems when drinking with food [39], and that students drink more on occasions involving a larger group [9,10,13,16].
At the individual level, coping, social and enhancement motives are associated with a higher level of alcohol consumption among both genders, while conformity motives are associated with less alcohol consumption among male students. In this study, coping motives were most strongly positively associated with alcohol consumption of male and female students. Studies among adolescents in Switzerland, Canada, and the U.S. [40] similarly reported that enhancement and coping motives were positively related to alcohol use and to risky drinking in particular, and coping motives were additionally related to alcohol-related problems. In the present study, results at the individual level are also comparable with other studies among students/adolescents in European countries that show that coping motives are most strongly related to alcohol consumption and conformity motives are negatively related to alcohol consumption [27,28,41,42,43].
Both individual and contextual characteristics are important in explaining alcohol consumption per occasion. However, the variance explained by situational level variables is higher than that explained by individual level factors. A study among U.S. college students examined the relationship between individual and environmental variables and heavy alcohol use at the most recent drinking occasion; that study showed that environmental level characteristics explained more variance than the individual level predictors [13]. On the other hand, studies among Canadian students, in which the individual level explains 30.7% and situational level explains 25.2% of the variance, concluded that contextual level variables appear to be as important as individual level characteristics for the explanation of alcohol consumption per occasion [10]. However, it is difficult to compare our results with others because no study included drinking motives as an individual variable.
Our finding that contextual variables explain more of the variance might be an underestimation of the importance of motives. The correlation between contextual variables and motives was rather low (r < 0.22, p < 0.01). The low inter-correlations indicate little influence of motives on the selection of drinking situations. Beside that, as Cooper et al. suggest [44], we assume that the low correlation is mainly due to the measure of motives being “general”, whereas only a small number of specific drinking occasions was used to measure the contextual variables. One would expect that the response to a question like “How often do you drink to...” has a background related to a far larger number of drinking situations than the three most recent drinking occasions that we used to measure the context of the drinking situations.
Among students in Vietnam, contextual aspects explain more variance than individual characteristics in explaining alcohol consumption per occasion. In other words, the duration of a drinking session explains more of the actual consumption than the scores on social or enhancement motives. An explanation for this might be found in the Vietnamese drinking culture. Social motives and conformity motives score highest among Vietnamese students, indicating that motives aimed at adjusting to the situation, rather than motives maximizing individual benefits (enhancement; coping). This is different from most previously reported findings on motives from 13 other European countries [26,45], U.S. and Canada [35,40], where (besides social motives), enhancement motives score highest among adolescents and young persons.
In Vietnam, with the development of the economy, alcohol use has become a normal way to develop contacts, stimulate social interaction, and business discussions. In many regions in Vietnam, a frequently reported reason for drinking among Vietnamese people is peer pressure. People can only start to negotiate or work after drinking at least three “cups” of alcohol [18]. Of course, this drinking culture can also influence how young people drink. Vietnamese adolescents most often start to drink because of peer pressure, or based on imitation [46]. As a result, in contrast to other countries, in Vietnam conformity is far more important and enhancement is a less dominant drinking motive.
These findings have implications for alcohol prevention policies in Vietnam. Importantly, prevention should focus on detecting and discouraging Vietnamese students that score high on coping motives to help them reduce their alcohol consumption level. However, considering the relatively large influence of contextual variables on drinking, the main focus should be on prevention measures discouraging drinking for a long period per occasion, in taverns, at special events, in large groups, or with casual acquaintances. This implies an alcohol policy with general measures aiming to reduce both the frequency of certain drinking context and of alcohol consumption per occasion. Policies should aim to reduce the drinking duration per occasion by restricting the daily opening hours of alcohol outlets [47,48]. Additionally, shops/outlets selling alcohol should be closed during special events and have specific days of closure during public holidays. Moreover, a prevention policy should reduce the accessibility of alcohol in taverns/outside, by making a license a prerequisite for selling alcohol, even in a tavern [2,49]. Studies worldwide have shown that alcohol policies can effectively limit the availability of alcohol by restricting the opening hours of alcohol outlets/bars [50]; with government controls on the sale of alcohol [51], as well as increasing price [52] through increasing the tax on alcohol [53]. At the moment, in Vietnam a license is required only for selling spirits, but not for beer and wine [54]. Also, there is no policy related to restrictions for on/off premise sales of alcohol beverages related to hours, days, density, specific events/intoxicated persons, etc. [55]. Furthermore, there is no policy regarding the control of producing and selling home-brewed alcohol; this is a common type of alcohol in Vietnam [56] resulting in wide availability and accessibility throughout the country. The uncontrolled quality of alcohol also contributes to the low price of alcohol, increasing its availability and affordability.

5. Study Limitations

The present study required students to recall the three most recent drinking occasions, which is likely to lead to recall bias. The finding that, for those drinking occasions for which students could not specify how long ago they had occurred, the consumption was significantly lower than for those occasions that students could (still) remember how long ago they occurred, is an indication that there is some recall bias. Additionally, the study tested the model with only 2 individual variables (drinking motives and age) and 10 situational variables. The situational variables focused upon aspects of the direct drinking context. A limitation was not only unable to include other aspects of drinking context which may possibly influence drinking such as loudness of music and crowdedness [15,16,17] but also did not include other environmental aspects such as aspects of neighborhoods in which the drinking took placed (e.g., urban vs. sub-urban or rural). It is possible that the results may be different if other individual characteristics possibly determining consumption, had been included, e.g., expectancies, school results. Yet, the fact that motives have been shown to mediate other individual characteristics [22,23,24,25] may mean that, even when including other individual characteristics, the balance between the amount of variance explained by contextual respectively, individual characteristics might not change a lot. However, it should be mentioned that drinking motives vary from day to day as a function of mood [57]. Therefore, examining the association of daily drinking motives at the drinking occasion level may explain an additional part of variance in alcohol intake.
Furthermore, in our study, motives and context were measured on a different level. When motives are measured within a situation, this might change the amount of variance explained by both context and motives. Longitudinal studies with many more than three drinking occasions are required to further elucidate the interaction between motives and contextual variables. In addition, the generalizability of the results is limited since the study included Vietnam only.

6. Conclusions

The results of this study contribute to the empirical evidence on alcohol intake among students, suggesting that drinking context more strongly predict alcohol consumption than drinking motives. Prevention programs should incorporate these findings within a Vietnamese cultural context by looking at both the individual level variables (people in whom coping motives are dominant) and contextual level factors (e.g., restricting alcohol availability, and its accessibility and affordability should receive attention).

Acknowledgments

This research was supported by the project “Strengthening Teaching and Research Capacity of Preventive Medicine in Vietnam”, the project in cooperation with Hanoi Medical University and seven other public schools in Vietnam; and the collaborative project between the Government of the Netherlands and Vietnam’s Ministry of Health Project: “Developing Centers of Excellent in Training and Consulting among eight Medical Universities in Vietnam”.

Author Contributions

Pham Bich Diep, Ronald A. Knibbe, and Nanne De Vries designed the study. Pham Bich Diep collected data and wrote the first draft. All data was analyzed by Pham Bich Diep with the instruction and supervision from Frans E. S. Tan. All authors contributed ideas to improve the subsequent drafts. All authors substantially contributed to and have approved the final manuscript.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Hibell, B.; Guttormsson, U.; Ahlström, S.; Balakireva, O.; Bjarnason, T.; Kokkevi, A.; Kraus, L. The 2011 ESPAD Report—Substance Use among Students in 36 European Countries; The Swedish Council for Information on Alcohol and Other Drugs (CAN): Stockholm, Sweden, 2012. [Google Scholar]
  2. Room, R.; Babor, T.; Rehm, J. Alcohol and public health. Lancet 2005, 365, 519–530. [Google Scholar] [CrossRef]
  3. Parker, L. Alcohol consumption behaviours and attitudes in Vietnam: An exploratory analysis. In Proceedings of the International Non-Profit and Social Marketing Conference (INSM), Brisbance, Australia, 15–16 July 2010; pp. 143–147.
  4. Diep, P.B.; Clough, A.R.; Nguyen, H.V.; Kim, G.B.; Buettner, P.G. Alcohol consumption and alcohol-related problems among Vietnamese medical students. Drug Alcohol Rev. 2010, 29, 219–226. [Google Scholar]
  5. Diep, P.B.; Knibbe, R.A.; Giang, K.B.; De Vries, N. Alcohol-related harm among university students in Hanoi, Vietnam. Glob. Health Action 2013, 6, 1–10. [Google Scholar] [CrossRef] [PubMed]
  6. Clapp, J.D.; Segars, L.; Voas, R. A conceptual model of the alcohol environment of college students. J. Hum. Behav. Soc. Environ. 2002, 5, 73–90. [Google Scholar] [CrossRef]
  7. Kairouz, S.; Gliksman, L.; Demers, A.; Adlaf, E.M. For all these reasons, I do...drink: A multilevel analysis of contextual reasons for drinking among Canadian undergraduates. J. Stud. Alcohol 2002, 63, 600–608. [Google Scholar] [CrossRef] [PubMed]
  8. Wells, S.; Mihic, L.; Tremblay, P.F.; Graham, K.; Demers, A. Where, with whom, and how much alcohol is consumed on drinking events involving aggression? Event-level associations in a Canadian national survey of university students. Alcohol Clin. Exp. Res. 2008, 32, 522–533. [Google Scholar] [CrossRef] [PubMed]
  9. Knibbe, R.A.; Oostveen, T.; van de Goor, I. Young people’s alcohol consumption in public drinking places: Reasoned behaviour or related to the situation? Br. J. Addict. 1991, 86, 1425–1433. [Google Scholar] [CrossRef] [PubMed]
  10. Demers, A.; Kairouz, S.; Adlaf, E.M.; Gliksman, L.; Newton-Taylor, B.; Marchand, A. Multilevel analysis of situational drinking among Canadian undergraduates. Soc. Sci. Med. 2002, 55, 415–424. [Google Scholar] [CrossRef]
  11. Clapp, J.D.; Lange, J.; Min, J.W.; Shillington, A.; Johnson, M.; Voas, R. Two studies examining environmental predictors of heavy drinking by college students. Prev. Sci. 2003, 4, 99–108. [Google Scholar] [CrossRef] [PubMed]
  12. Harford, T.C.; Wechsler, H.; Seibring, M. Attendance and alcohol use at parties and bars in college: A national survey of current drinkers. J. Stud. Alcohol 2002, 63, 726–733. [Google Scholar] [CrossRef] [PubMed]
  13. Clapp, J.D.; Min, J.W.; Shillington, A.M.; Reed, M.B.; Croff, J.K. Person and environment predictors of blood alcohol concentrations: A multi-level study of college parties. Alcohol Clin. Exp. Res. 2008, 32, 100–107. [Google Scholar] [CrossRef] [PubMed]
  14. Kypri, K.; Paschall, M.J.; Langley, J.D.; Baxter, J.; Bourdeau, B. The role of drinking locations in university student drinking: Findings from a national web-based survey. Drug Alcohol Depend. 2010, 111, 38–43. [Google Scholar] [CrossRef] [PubMed]
  15. Van de Goor, L.A.; Knibbe, R.A.; Drop, M.J. Adolescent drinking behavior: An observational study of the influence of situational factors on adolescent drinking rates. J. Stud. Alcohol 1990, 51, 548–555. [Google Scholar] [CrossRef] [PubMed]
  16. Knibbe, R.A.; van de Goor, L.A.; Drop, M.J. Contextual influences on young people’s drinking rates in public drinking places: An observational study. Addict. Res. Theory 1993, 1, 269–278. [Google Scholar] [CrossRef]
  17. Hughes, K.; Quigg, Z.; Eckley, L.; Bellis, M.; Jones, L.; Calafat, A.; Kosir, M.; van Hasselt, N. Environmental factors in drinking venues and alcohol-related harm: The evidence base for European intervention. Addiction 2011, 106, 37–46. [Google Scholar] [CrossRef] [PubMed]
  18. Cuong, D.V.; Hanh, V.T.M. Assessment of Situation of Alcohol and Beer Abuse in Vietnam: Vietnam-Sweden Health Cooperation Program—Health Policy Component; Health Strategy and Policy Institute Medical Publishing House: Hanoi, Vietnam, 2007; pp. 10–30. [Google Scholar]
  19. Cox, W.M.; Klinger, E. A motivational model of alcohol use. J. Abnorm. Psychol. 1988, 97, 168–180. [Google Scholar] [CrossRef] [PubMed]
  20. Cox, W.M.; Klinger, E. Incentive Motivation, Affective Change, and Alcohol Use: A Model; Gardner Press: New York, NY, USA, 1990. [Google Scholar]
  21. Kuntsche, E. Tell Me... Why Do You Drink? A Study of Drinking Motives in Adolescence; Swiss Institute for the Prevention of Alcohol and Drug Problems: Lausanne, Switzerland, 2007. [Google Scholar]
  22. Catanzaro, S.J.; Laurent, J. Perceived family support, negative mood regulation expectancies, coping, and adolescent alcohol use: Evidence of mediation and moderation effects. Addict. Behav. 2004, 29, 1779–1797. [Google Scholar] [CrossRef] [PubMed]
  23. Kuntsche, E.; Knibbe, R.; Engels, R.; Gmel, G. Drinking motives as mediator of the link between alcohol experiences and alcohol use among adolescents. J. Stud. Alcohol Drug 2007, 68, 76–85. [Google Scholar] [CrossRef]
  24. Hasking, P.; Lyvers, M.; Carlopio, C. The relationship between coping strategies, alcohol expectancies, drinking motives and drinking behaviour. Addict. Behav. 2011, 36, 479–487. [Google Scholar] [CrossRef] [PubMed]
  25. Van Tyne, K.; Zamboanga, B.L.; Ham, L.S.; Olthuis, J.V.; Pole, N. Drinking motives as mediators of the associations between alcohol expectancies and risky drinking behaviors among high school students. Cogn. Ther. Res. 2012, 36, 756–767. [Google Scholar] [CrossRef]
  26. Kuntsche, E.; Gabhainn, S.N.; Roberts, C.; Windlin, B.; Vieno, A.; Bendtsen, P.; Hublet, A.; Tynjälä, J.; Välimaa, R.; Dankulincová, Z.; et al. Drinking motives and links to alcohol use in 13 European countries. J. Stud. Alcohol Drug 2014, 75, 428–437. [Google Scholar] [CrossRef]
  27. Cooper, M.L.; Frone, M.R.; Russell, M.; Mudar, P. Drinking to regulate positive and negative emotions: A motivational model of alcohol use. J. Pers. Soc. Psychol. 1995, 69, 990–1005. [Google Scholar] [CrossRef] [PubMed]
  28. Nemeth, Z.; Urban, R.; Kuntsche, E.; San Pedro, E.M.; Roales Nieto, J.G.; Farkas, J.; Futaki, L.; Kun, B.; Mervo, B.; Olah, A.; et al. Drinking motives among Spanish and Hungarian young adults: A cross-national study. Alcohol Alcoholism 2011, 46, 261–269. [Google Scholar] [CrossRef] [PubMed]
  29. Paschall, M.J.; Saltz, R.F. Relationships between college settings and student alcohol use before, during and after events: A multi-level study. Drug Alcohol Rev. 2007, 26, 635–644. [Google Scholar] [CrossRef] [PubMed]
  30. Cooper, M.L. Motivations for alcohol use among adolescents: Development and validation of a four-factor model. Psychol. Assess. 1994, 6, 117–128. [Google Scholar] [CrossRef]
  31. Wicki, M.; Kuntsche, E.; Gmel, G. Drinking at European universities? A review of students’ alcohol use. Addict. Behav. 2010, 35, 913–924. [Google Scholar] [CrossRef] [PubMed]
  32. Snijders, T.A.B.; Bosker, R.J. Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modeling; Sage Publishers: London, UK, 2012. [Google Scholar]
  33. Pedersen, E.R.; LaBrie, J. Drinking game participation among college students: Gender and ethnic implications. Addict. Behav. 2006, 31, 2105–2115. [Google Scholar] [CrossRef] [PubMed]
  34. Abar, C.; Abar, B.; Turrisi, R. The impact of parental modeling and permissibility on alcohol use and experienced negative drinking consequences in college. Addict. Behav. 2009, 34, 542–547. [Google Scholar] [CrossRef] [PubMed]
  35. Merrill, J.E.; Wardell, J.D.; Read, J.P. Drinking motives in the prospective prediction of unique alcohol-related consequences in college students. J. Stud. Alcohol Drug. 2014, 75, 93–102. [Google Scholar] [CrossRef]
  36. Lecci, L.; MacLean, M.G.; Croteau, N. Personal goals as predictors of college student drinking motives, alcohol use and related problems. J. Stud. Alcohol 2002, 63, 620–630. [Google Scholar] [CrossRef] [PubMed]
  37. Karam, E.; Kypri, K.; Salamoun, M. Alcohol use among college students: An international perspective. Curr. Opin. Psychiat. 2007, 20, 213–221. [Google Scholar] [CrossRef] [PubMed]
  38. Lange, J.E.; Clapp, J.D.; Turrisi, R.; Reavy, R.; Jaccard, J.; Johnson, M.B.; Voas, R.B.; Larimer, M. College binge drinking: What is it? Who does it? Alcohol Clin. Exp. Res. 2002, 26, 723–730. [Google Scholar] [CrossRef] [PubMed]
  39. Clapp, J.D.; Shillington, A.M.; Segars, L.B. Deconstructing contexts of binge drinking among college students. Am. J. Drug Alcohol Abuse 2000, 26, 139–154. [Google Scholar] [CrossRef] [PubMed]
  40. Kuntsche, E.; Stewart, S.; Cooper, M. How stable is the motive-alcohol use link? A cross-national validation of the drinking motives questionnaire revised among adolescents from Switzerland, Canada, and the United States. J. Stud. Alcohol Drug. 2008, 69, 388–396. [Google Scholar] [CrossRef]
  41. Kuntsche, E.; Knibbe, R.; Gmel, G.; Engels, R. Replication and validation of the Drinking Motive Questionnaire Revised (DMQ-R, Cooper, 1994) among adolescents in Switzerland. Eur. Addict Res. 2006, 12, 161–168. [Google Scholar] [CrossRef] [PubMed]
  42. Schelleman-Offermans, K.; Kuntsche, E.; Knibbe, R.A. Associations between drinking motives and changes in adolescents’ alcohol consumption: A full cross-lagged panel study. Addiction 2011, 106, 1270–1278. [Google Scholar] [CrossRef] [PubMed]
  43. Pengpid, S.; Peltzer, K. Alcohol use and associated factors among adolescent students in Thailand. West Indian Med. J. 2012, 61, 890–896. [Google Scholar] [PubMed]
  44. Cooper, M.L.; Kuntsche, E.; Levitt, A.; Barber, L.L.; Wolf, S. Motivational models of substance use: A review of theory and research on motives for using alcohol, marijuana, and tobacco. Oxford Handb. Online 2015. [Google Scholar] [CrossRef]
  45. Kuntsche, E.; Knibbe, R.; Gmel, G.; Engels, R. Why do young people drink? A review of drinking motives. Clin. Psychol. Rev. 2005, 25, 841–861. [Google Scholar] [CrossRef] [PubMed]
  46. Kaljee, L.M.; Genberg, B.L.; Minh, T.T.; Tho, L.H.; Thoa, L.T.; Stanton, B. Alcohol use and HIV risk behaviors among rural adolescents in Khanh Hoa province, Vietnam. Health Educ. Res. 2005, 20, 71–80. [Google Scholar] [CrossRef] [PubMed]
  47. Norstrom, T.; Skog, O.J. Saturday opening of alcohol retail shops in Sweden: An impact analysis. J. Stud. Alcohol 2003, 64, 393–401. [Google Scholar] [CrossRef] [PubMed]
  48. Chikritzhs, T.; Stockwell, T. The impact of later trading hours for Australian public houses (hotels) on levels of violence. J. Stud. Alcohol 2002, 63, 591–599. [Google Scholar] [CrossRef] [PubMed]
  49. Gruenewald, P.J. Regulating availability: How access to alcohol affects drinking and problems in youth and adults. Alcohol Res. Health 2011, 34, 248–256. [Google Scholar] [PubMed]
  50. Popova, S.; Giesbrecht, N.; Bekmuradov, D.; Patra, J. Hours and days of sale and density of alcohol outlets: Impacts on alcohol consumption and damage: A systematic review. Alcohol Alcohol. 2009, 44, 500–516. [Google Scholar] [CrossRef] [PubMed]
  51. Holder, H.; Agardh, E.; Högberg, P.; Miller, T.; Norström, T.; Österberg, E.; Ramstedt, M.; Rossow, I.; Stockwell, T. Alcohol Monopoly and Public Health: Potential Effects of Privatization of the Swedish Alcohol Retail Monopoly; Swedish National Institute of Public Health: Stockholm, Sweden, 2008. [Google Scholar]
  52. Jackson, C.A.; Henderson, M.; Frank, J.W.; Haw, S.J. An overview of prevention of multiple risk behaviour in adolescence and young adulthood. J. Public Health 2012, 34, 31–40. [Google Scholar] [CrossRef] [PubMed]
  53. Kuo, M.; Heeb, J.L.; Gmel, G.; Rehm, J. Does price matter? The effect of decreased price on spirits consumption in Switzerland. Alcohol Clin. Exp. Res. 2003, 27, 720–725. [Google Scholar] [CrossRef] [PubMed]
  54. World Health Organization. Global Status Report: Alcohol Policy; Department of Mental Health and Substance Abuse, WHO: Geneva, Switzerland, 2004. [Google Scholar]
  55. World Health Organization. Global Status Report on Alcohol and Health; WHO: Geneva, Switzerland, 2014. [Google Scholar]
  56. Lachenmeier, D.W.; Anh, P.T.; Popova, S.; Rehm, J. The quality of alcohol products in Vietnam and its implications for public health. Int. J. Environ. Res. Public Health 2009, 6, 2090–2101. [Google Scholar] [CrossRef] [PubMed]
  57. Arbeau, K.J.; Kuiken, D.; Wild, T.C. Drinking to enhance and to cope: A daily process study of motive specificity. Addict. Behav. 2011, 36, 1174–1183. [Google Scholar] [CrossRef] [PubMed]
Table
Table 1. Demographic and individual characteristics of drinkers (n = 4265).
Table 1. Demographic and individual characteristics of drinkers (n = 4265).
Individual Variablesn = 4265%
University
Medical 142233.3
Technology152235.7
Economics132131.0
Province
Hanoi120228.2
BMT107325.2
HCM102123.9
Hue96922.7
Gender
Male255659.9
Female167539.3
Missing340.8
Drinking motivesMedian(IQR)
Average score of Social3.2(2.4, 3.8)
Average score of Conformity1.8(1.4, 2.4)
Average score of Coping1.4(1.0, 1.8)
Average score of Enhancement1.4(1.0, 2.0)
Age (years)Mean = 20.7SD = 1.7
Table
Table 2. Situational characteristics of 12,795 drinking occasions among 12 universities/faculties in four provinces in Vietnam.
Table 2. Situational characteristics of 12,795 drinking occasions among 12 universities/faculties in four provinces in Vietnam.
Situational Variablesn (%)Situational Variablesn (%)
Drinking day Location of drinking
Working day3591 (28.1) Home6328 (50.0)
Weekend5075 (39.7) Restaurant3522 (27.8)
Holidays3996 (31.2) Tavern/pavement/outside2274 (18.0)
Missing value133 (1.0) Discotheque/karaoke bar/others536 (4.2)
Time of drinking day Missing value135 (1.1)
Morning/lunch2119 (16.7)Number of group members
Afternoon1605 (12.7) 0170 (1.3)
Evening/midnight8962 (70.6) 1–33089 (24.1)
Missing value109 (0.9) 4–96011 (47.0)
Drinking duration more than 103389 (26.5)
<1 h3658 (28.9) Missing value136 (1.1)
1–2 h4472 (35.3)Gender of group members
2–3 h3294 (26.0) Female only640 (5.0)
More than 3 h1241 (9.7) Male only3742 (29.2)
Missing value130 (1.0) Mixed gender8117 (63.4)
Main purpose of drinking Missing value296 (2.3)
Party5634 (44.6)Relationship of group member
Meeting with friends4508 (35.7) Family/relative relationship2265 (18.1)
Wedding/celebration1452 (11.5) Friend relationship8959 (70.0)
Special event1041 (8.1) Casual relationship1262 (10.1)
Missing value160 (1.3) Missing value309 (2.4)
Drinking with food (even snack)Outcome variables
Yes12298 (96.1) Standard drinks per occasionMean (SD) = 3.0 (2.9)
No254 (2.0) Standard drinks per occasionMedian (IQR) = 2 (1, 4)
Missing value 243 (1.9) Missing value619 (4.8)
Table
Table 3. Multilevel estimates for alcohol intake per occasion.
Table 3. Multilevel estimates for alcohol intake per occasion.
VariablesStandard Beta Coefficient
Male StudentsFemale Students
Constant = 0.66Constant = −0.28
Control variablesUniversity (reference, Economics)
Medical−0.09 **−0.13 **
Technology0.060.00
Province (reference, Hue)
Hanoi−0.12 ***−0.1 *
BMT0.030.06
HCM−0.10 **0.06
Situational variablesDrinking day (reference, vacations)
Week day0.03−0.03
Weekend0.020.08
Time of drinking day (reference, evening/midnight)
Morning/lunch−0.03−0.02
Afternoon−0.00−0.02
Drinking duration (reference over 3 h)
<1 h−0.81 ***−0.59 ***
1–2 h−0.46 ***−0.38 ***
2–3 h−0.21 ***−0.19 ***
Main purpose of drinking (reference, wedding or celebration)
Party−0.020.00
Meeting with friends−0.030.02
Not special event−0.17 ***−0.08
Drinking with food (even snack) (reference, have food)
No0.2 ***0.06
Location (reference, discotheque/karaoke bar/others)
Home0.030.05
Restaurant0.060.04
Tavern/pavement/outside0.01 **0.07
Number of group members (reference, more than 10 people)
00.03−0.01
1–3−0.13 ***−0.04
4–9−0.06 ***−0.04 *
Drinking company (reference, mixed gender)
Female only−0.16 **0.04
Male only0.02−0.01
Relationship (reference, casual relationship)
Family member/relative−0.17 ***−0.13 **
Friend relationship0.04−0.03
Occasion (reference, third most recent occasion)
First recent occasion−0.01−0.01
Second recent occasion−0.02−0.00
Individual variablesAge0.016 *0.02
Drinking motives
Social0.10 ***0.09 ***
Enhancement 0.05 **0.08 **
Coping0.13 ***0.13 ***
Conformity−0.04 *0.00
StatisticsR square explained by individual variables0.100.07
R square explained by situational variables0.230.11
R square explained by both individual and situational variables0.270.16
* p < 0.05; ** p < 0.01; *** p < 0.001.

Share and Cite

MDPI and ACS Style

Diep, P.B.; Tan, F.E.S.; Knibbe, R.A.; De Vries, N. A Multilevel Study of Students in Vietnam: Drinking Motives and Drinking Context as Predictors of Alcohol Consumption. Int. J. Environ. Res. Public Health 2016, 13, 710. https://doi.org/10.3390/ijerph13070710

AMA Style

Diep PB, Tan FES, Knibbe RA, De Vries N. A Multilevel Study of Students in Vietnam: Drinking Motives and Drinking Context as Predictors of Alcohol Consumption. International Journal of Environmental Research and Public Health. 2016; 13(7):710. https://doi.org/10.3390/ijerph13070710

Chicago/Turabian Style

Diep, Pham Bich, Frans E. S. Tan, Ronald A. Knibbe, and Nanne De Vries. 2016. "A Multilevel Study of Students in Vietnam: Drinking Motives and Drinking Context as Predictors of Alcohol Consumption" International Journal of Environmental Research and Public Health 13, no. 7: 710. https://doi.org/10.3390/ijerph13070710

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop