Ronald Knibbe

• Maastricht University

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, r...

Background: Cultural competence of healthcare professionals (HCPs) is recognized as a strategy to reduce cultural disparities in healthcare. However, standardised, valid and reliable instruments to assess HCPs' cultural competence are notably lacking. The present study aims to 1) identify the core components of cultural competence from a healthcar...

Overview of the study procedures for the development and psychometric evaluation of the CCCHP. (PDF)

Cross-Cultural Competence instrument for Healthcare Professionals (CCCHP-27) (English version). (PDF)

Detailed description of methods. (DOCX)

Fragebogen zur Erhebung Interkultureller Kompetenz in der Gesundheitsversorgung (CCCHP-27) [Cross-Cultural Competence instrument for Healthcare Professionals (CCCHP -27)] (original German version). (PDF)

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, co...

In many countries worldwide, heavy drinking can cause harm not only to drinkers but also to those around them. To examine the prevalence and predictors of secondhand effects of alcohol use among students in Vietnam. In this cross-sectional study, a multistage sampling strategy was used to select 6,011 students (from the first to final study year) o...

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. Arti...

To determine the effect on adolescent alcohol use of a community intervention combining intensified formal control (restricting retail supply) and informal control (restricting social supply). Intervention effects on intermediate intervention goals were investigated. Analyses for different age groups were performed. A longitudinal quasi-experimenta...

Motieven voor het drinken van alcohol zijn de redenen voor de uiteindelijke beslissing die iemand neemt om te gaan drinken en kunnen intern (vanuit de persoon zelf) of extern (door omgevingsfactoren) geïnitieerd worden. In deze studie wordt onderzocht welke motieven veranderingen in het drinkgedrag van Nederlandse jongeren voorspellen (H1) en of om...

Introduction and Aim This study examines the prevalence of and risk factors for alcohol-related harm and types of harm among medical students from Hanoi Medical University (Vietnam). Risk factors include aspects of drinking patterns and relevant socio-demographic variables. Study Design and Methods A cross-sectional study involving 1st to 6th year...

Aims: To provide a qualitative report of the process of development and implementation of a Dutch community intervention in which retail and social alcohol supply for adolescents was restricted. Insight will be provided into how relevant stakeholders evaluated their role in the process. Methods: Qualitative methods were used to analyze the document...

Introduction: In 2004 the Dutch government instituted a workplace-smoking ban. This study focuses on differences in compliance over time and between occupational sectors, and describes the background variables. Methods: Telephone interviews were conducted with company employees across industry, public and service sectors in 2004 (n=705), 2006 (n...

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 h...

Determining whether intensified inspections on alcohol retailers, combined with a policy withdrawing liquor licenses if retailers are fined twice per annum, is effective in reducing adolescents' odds to initiate weekly drinking and drunkenness. Causal pathways by which the intervention was assumed to work were tested. A longitudinal (2008, 2009, an...

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 socia...

We investigated whether the link between early pubertal timing and initiation of weekly alcohol use is mediated by changes in perceived parental alcohol-specific rule setting and changes in perceived proportion of drinkers in the peer group. Longitudinal data including 3 annual waves were used to estimate the hazard for adolescents to initiate drin...

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. A total of 360 companies had participated in the telephone survey (in October and November 2006) and were also visited by inspectors directly...

Similarity in alcohol consumption among adolescent friends could be caused by the influence of friends or by the selection of friends who consume similar levels of alcohol. This article aims to disentangle influence and selection processes while specifically examining changes over time in these processes and possible differences between reciprocal...

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 employme...

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 t...

To investigate whether differences in gender-income equity at country level explain national differences in the links between alcohol use, and the combination of motherhood and paid labour. Cross-sectional data in 16 established market economies participating in the Gender, Alcohol and Culture: An International Study (GenACIS) study. Population sur...

This study examines relations between drinking patterns, going-out behavior, and illicit substance use among Dutch adolescents ages 15 to 24 who reported alcohol use at least once per week (N = 711). Logistic regression analyses indicated that adolescents reporting heavy drinking patterns showed higher risks of lifetime and current illicit substanc...

Longitudinal full cross-lagged models are essential to test causal relationships. This study used such a model to test the predictive value of internal (enhancement and coping) and external (conformity and social) drinking motives for changes in alcohol use over time, and tested possible reversed causality (i.e. alcohol use explains later drinking...

This paper examines (i) gender and country differences in negative consequences related to drinking; (ii) relative rates of different consequences; and (iii) country-level predictors of consequences. Multi-level analyses used survey data from the Gender, Alcohol, and Culture: An International Study (GENACIS) collaboration. Measures included 17 nega...

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...

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). Data fro...

The present study examines whether depressed mood and external control mediate or moderate the relationship between the number of social roles and alcohol use. The analysis was based on a national representative sample of 25- to 45-year-old male and female drinkers in Switzerland. The influence of depressed mood and external control on the relation...

We examined the hypothesis that best friends and members from a broader peer group would not differ in the amount of influence they have on young adults' alcohol consumption and that what counts would be the mere presence of drinking peers in a given context—irrespective of the type of relationship such peers would have with the target young adult....

To investigate time-trend changes in the frequency of drunkenness among European and North American adolescents. Cross-sectional surveys in the 1997/1998 and 2005/2006 Health Behaviour in School-Aged Children Study (HBSC). High schools in 23 countries. A sample of 77 586 adolescents aged 15 years was analyzed by means of hierarchical linear modelin...

Purpose Assess whether family environmental factors affected changes in fruit and snack consumption among 12- to 14-year-old adolescents participating in a Dutch healthy diet promotion program. Design Data were derived from pretest and posttest questionnaires completed by adolescents in 10 schools in the intervention arm of the program trial and q...

Background: A widely held assumption is that one way in which people can cope with stress is by drinking alcohol. Aims: To investigate to what extent drinking motives moderate the possible effect of stress on alcohol use and its related problems, that is, circumstances under which stress is more likely to lead to alcohol use and its related problem...

Prevention programs in adolescence are particularly effective if they target homogeneous risk groups of adolescents who share a combination of particular needs and problems. The present work aims to identify and classify risky single-occasion drinking (RSOD) adolescents according to their motivation to engage in drinking. An easy-to-use coding proc...

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...

We examined the hypothesis that best friends and members from a broader peer group would not differ in the amount of influence they have on young adults’ alcohol consumption and that what counts would be the mere presence of drinking peers in a given contextFirrespective of the type of relationship such peers would have with the target young adult....

This paper examines the drinking behaviour of young adults aged 24–32 who were married or were cohabiting. Data on this subject were available from surveys in 10 European countries. These were carried out under the auspices of the major investigation entitled ‘Gender, Alcohol and Culture: An International Study (GENACIS)’. In general married people...

Aim. A cross‐national comparison of perceived availability of alcoholic beverages and cannabis, and of the influence of availability on consumption of and problems due to alcohol and cannabis. Method. National surveys of school‐going adolescents (14–18 years) in France and the Netherlands were used. The questionnaire was comparable for all measures...

Aim. This research compares retrieval strategies and cultural differences in answering survey questions using protocol analysis on four alcohol use items: frequency of drinking, quantity of drinking, frequency of drunkenness, and the context of drinking in the last 12 months. Data. The data came from a project to improve the comparability of health...

Rather than using the traditional, costly method of personal interviews in a general population sample, substance-use prevalence rates can be derived more conveniently from data collected among members of an online access panel. To examine the utility of this method, we compared the outcomes of an online survey with those obtained with the computer...

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 e...

The paper examines how family members in 18 countries attempt to influence each other to drink less. Data come from the GENACIS (Gender, Alcohol and Culture: an International Study) dataset. Countries included were Argentina, Costa Rica, Czech Republic, Denmark, Finland, Germany, Hungary, Iceland, India, Japan, Nigeria, Norway, Spain, Sri Lanka, Sw...

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 structur...

A number of studies have shown that pressure from others is an important element in decision making concerning entering treatment and that the pressure most often comes from one's partner. Is has also been found that, besides actual drinking habits, togetherness of drinking, i.e. proportion of drinking occasions spent together with partner, is reve...

The focus of this paper is on informal control of drinking, indicated by criticism of people in the social network on someone's alcohol consumption. It studies country and gender differences in the extent drinkers suffering from typical symptoms of heavy or prolonged alcohol use report informal control from others (reactive informal control), and c...

The role of best friends and peer group members in young adults’ alcohol use We examined the hypothesis that best friends and members from a broader peer group would not differ in the amount of influence they have on young adults’ alcohol consumption, and that what counts would be the mere presence of drinking peers in a given context - irrespecti...

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 effecti...

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. 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...

Evidence underlines the importance of drinking patterns and individual characteristics in experiencing adverse alcohol-related consequences; however, little research has been conducted to explore who does and who does not experience consequences with similar drinking patterns. Using data from seven European countries, this study assesses the associ...

The present study investigates the direct and indirect links (through alcohol use) between adolescents' drinking motives and violent behaviors (i.e. bullying and fighting). Structural equation models were estimated based on a national representative sample of 5419 8th to 10th graders in Switzerland (mean age 15.0, SD=.86). Results demonstrate that...

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, model...

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=1...

De zorgbehoeften van langdurig verslaafden en het zorgaanbod zijn moeilijk op elkaar af te stemmen. Terwijl het juist bij dit soort moeilijk bereikbare groepen belangrijk is om aandacht te besteden aan de ervaren zorgbehoefte en aan problemen die de zorg voor hen ontoegankelijk of onaantrekkelijk maken. De auteurs beschrijven een Richtlijn Cliëntpr...

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 o...

Our main goal was to establish whether French and Dutch adolescents differ in rates of substance-related adverse events (e.g. fights, robbery), problems with peers or socializing agents even when controlling for pattern of substance use. For problems with peers and socializing agents due to alcohol we hypothesized that, because of stronger informal...

The purpose of this study was to test whether the link between alcohol expectancies and alcohol use (drinking frequency, usual quantity, five-plus drinking) is mediated by drinking motives. Linear structural equation models were estimated based on a nationally representative sample of 5,616 8th, 9th, and 10th graders in Switzerland (51% female; mea...

The aim was to review the empirical research carried out over the last 15 years on the characteristics of young people (10- to 25-year olds) who have specific motives for drinking. In a computer-assisted search of relevant literature, 82 studies were identified. Concerning demographic factors, a developmental trend was found - from general, undiffe...

This study explored the suitability of the Alcohol Use Disorder Identification Test (AUDIT) for cross-national comparable estimates of problem drinking in general populations. On the item level the focus is on responsiveness to cross-national and gender differences. For the set of items the focus is on intercorrelations between items, indicating to...

First, this paper investigates (i) gender differences in associations of social stratification, family roles, and heavy drinking, and (ii) country differences in these associations. Second, it seeks to explain country differences in the associations of social stratification and family roles with alcohol consumption by societal level variables. Surv...

To investigate among adolescents whether (i) drinking motives are related to beverage preference; (ii) beverage preference is related to alcohol use (drinking levels and risky drinking occasions); (iii) the association between beverage preference and alcohol use is moderated or mediated by drinking motives. Data from a national representative sampl...

Aim: To investigate whether France and the Netherlands differ in how peer-group substance use and deviancy are related to alcohol intoxication and to the use of cannabis and other illegal drugs. The associations between substance use and peer group and deviant behaviours were expected to be stronger in France. Method: School surveys (age range: 14-...

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 re...

Ondanks de zorg over geweld bij het uitgaan is hier in Nederland nog weinig onderzoek naar gedaan. In onderstaande bijdrage geven de auteurs een eerste schatting van de mate waarin drankgebruik de kans beïnvloedt dat men slachtoffer of dader is van geweld in een publieke ruimte, en welke andere factoren daarbij een rol spelen. In 2004 werd hiernaar...

Local and regional policymakers, care providers and prevention workers involved in addiction and addiction care need timely and reliable information. As few data on substance use are available at a local or regional level, an integrated local or regional monitoring system for alcohol and drugs (MAD) was developed. The MAD consists of four modules:...

This paper has two aims: (1) to replicate the four-dimensional structure of the Drinking Motive Questionnaire Revised (DMQ-R) in a national representative sample from Switzerland, and (2) to validate the relevance of distinguishing drinking motives by inspecting the relations with expected consequences, alcohol use, and alcohol-related and other pr...

The Alcohol Expectancy Challenge (EC) is a promising program for changing alcohol expectancies and reducing alcohol consumption in "heavy drinking" young men in a bar-lab setting. In this study the EC was adapted for use in mixed-gender groups in a holiday setting and its feasibility tested in camping resorts in the Netherlands where a lot of binge...

Die Beziehung zwischen Substanzkonsum, Peergruppe und Devianz im Jugendalter Fragestellung: Ziel der Studie ist zu untersuchen, inwieweit sich Frankreich und die Niederlande im Zusammenhang zwischen Substanzkonsum der Peergruppe bzw. Devianz und dem eigenen Substanzkonsum im Jugendalter unterscheiden. Angenommen wird, dass die Beziehungen in Frankr...

This article reviews evidence of adolescent and young adult drinking motives and their relation to possible consequences over the last 15 years. To this end, a computer-assisted search of relevant articles was conducted. Results revealed that most young people reported drinking for social motives, some indicated enhancement motives, and only a few...

To study the functionality of alcohol expectancies in predicting drinking behaviour in existing peer groups of young adults in a 'naturalistic' 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 b...

Friends are presumed to exert a substantial influence on young people's drinking patterns. The current study focused on the effects of the best friend's drinking behaviour on the alcohol consumption of 12-14-year-old adolescents. Furthermore, we hypothesized friendship characteristics (i.e., reciprocity and sociometric status differences) to modera...

In The Netherlands, a substantial part of the population of chronic hard drug users and alcoholics is reached by offering low-threshold services addressing basic needs such as shelter, health care and methadone substitution. It is known, however, that the needs of this category of addicts are more differentiated than can be demonstrated in the cont...

Gender differences in drinking patterns in nine European countries (the Czech Republic, Finland, France, Germany, Italy, The Netherlands, Scotland, Sweden, and Switzerland) were examined using data from surveys conducted in the late 1980s and early 1990s. Drinking patterns were analyzed with regard to sociodemographic variables such as age, educati...

The comparability of general population studies on alcohol from nine European countries is evaluated from three points of view: (1) methodologic aspects influencing alcohol estimates, (2) variation between countries in coverage of sales estimates of alcohol consumption, and (3) associations between type of question used to measure alcohol consumpti...

Background: Middle-class people generally have healthier diets than lower-class people. Considerations that underlie choices of foodstuffs may explain this class difference in eating habits. Qualitative studies on food beliefs show that lower-class mothers consider health less frequently in their choice of food, while they take the preferences of f...

The associations between alcohol consumption and intimate relationships in adolescence were examined. Data from a longitudinal study of 1,063 adolescents were used to investigate whether (a) alcohol use was a precursor of partnership and (b) adolescents tended to change their drinking habits once they became involved in a steady relationship. Young...

This paper aims to examine the functions of adolescent drinking by (a) comparing drinking patterns in Mediterranean and Northern European countries, and (b) examination of the beneficial aspects of drinking and pub-going in a Dutch survey. Data from cross-sectional European surveys in 1988 (Eurobarometer) and 1995 (ESPAD-study) and a Dutch cohort s...

To examine the consistency and/or variability of gender differences in drinking behavior cross-culturally. Women's and men's responses in 16 general population surveys from 10 countries, analyzed by members of the International Research Group on Gender and Alcohol. Comparable measures of drinking, versus abstention, typical drinking frequencies and...

This paper describes educational differences in the extent and manner in which mothers teach their children to eat foods they dislike. A survey among 849 mothers, who cared for children aged between 4 and 14 years in the Netherlands, Belgium and Germany showed that higher-educated mothers employed healthier and more consistent food rules than lower...

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...

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. Data were analysed from a three-wave 5-year longitudinal survey among 1063 secondary schoolchildren (12-18-year-olds) in The Netherlands. The survey questionnaire contained...

This study examined whether factors other than severity of alcohol-related problems add to the explanation of seeking help for drinking problems. 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...

Many studies have dealt with the relative impact of parents and peers on adolescent substance use. However, only a few studies have explored the role of adolescents themselves in social relationships. Homogeneity in behavioral patterns within friendships can also be generated by selective association. Acknowledgment of selection processes might she...

A normative aspect of late adolescents' drinking is related to the context of use: about 80% of young people's consumption takes places in pubs and discos. In this respect, drinking exclusively at home could be perceived as deviant. In the current study, we explored the possibility that in particular among late adolescents who only drink at their h...

To assess the possible effects of changes in marital status, employment status and having children at home on alcohol consumption and the frequency of heavy drinking. With role theory as a starting point it was expected that a shift into more social roles would decrease consumption and heavy drinking while the shift away from social roles would be...

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 an...

This paper is based on the session entitled “Measuring Drinking Context” that was held on May 12, 1997 at the International Workshop on Consumption Measures and Models for Use in Policy Development and Evaluation, Bethesda, MD. The session chair was Ronald Knibbe; presenters were Deborah Dawson, Tim Stockwell, Paul Gruenewald, and Eric Single; and...

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-...

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 stu...

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...