A recent report of the World Health Organization (WHO) highlights the global issue of alcohol use disorder [1]. It proposed that there needs to be further governmental efforts put in place to curb the increasing prevalence of this disorder [1]. According to the existing clinical guidelines, the intake of more than 40 g/day of alcohol for males and more than 24 g/day for females is considered to be hazardous alcohol consumption [2]. Prior studies have found an association between hazardous levels of drinking and the development of multiple medical comorbidities, such as hepatic dysfunction, seizures, neuropsychiatric conditions including anxiety and depression, as well as a heightened incidence of cancer, including that of the liver and breast [1].

The problem of alcohol use disorder is especially prevalent in Vietnam. Based on the latest WHO report [3], about 1.4% Vietnamese population were alcohol drinkers with the average alcohol consumption doubling from 3.8 liters in 2005 to 6.6 liters of alcohol in 2010 [3]. However, this statistic might be an underestimate because Vietnamese people in rural areas brew their own alcohol and statistics are lacking [4]. For example, in a nationally representative survey, 80% of male respondents reported drinking alcohol in the last 12 months, of which 40% were hazardous drinkers [5]. Hence, alcohol use disorder, along with its multiple medical and psychiatric comorbidities would eventually be a major public health epidemic and problem in Vietnam along with its rapidly progressing economy. However, there are no restrictions in the alcohol-related policies, and there are no health warning labels on alcohol advertisements and containers [3]. Additionally, there is no comprehensive governmental management plan or a taskforce to deal with this issue [3].

In addition to the growing incidence of alcohol consumption among the adult population, a growing concern also pertains to how the youth population might be affected. With rapid changes in the economy, Vietnam is now more commercialized and more connected to the rest of the world via the Internet and social media. Previous studies have reported that more than 60% of the Internet users in Vietnam are in the range of 15–34 years old [6]. The increased accessibility of the Internet might mean that more youths are exposed to social networking sites. One recent paper suggested that individuals, especially youths, who are exposed to social networking sites as well as smartphone applications are more easily influenced and tend to have a higher consumption of alcoholic beverages [7]. The impact of technological advances seemed to be most influential on youths. Other recent studies have reported that the absolute amount of time youths spent on social media networks correlated with the frequency of them having alcohol or even other addictive behaviors [8]. In addition, prior studies have also looked into youths' perceptions of alcohol-related advertisement on social media sites. Huang et al. [9] also highlighted how online interpersonal relationships might predispose individuals to using alcohol. Griffiths and Casswell [10] highlighted how the Internet allows youths to create “intoxigenic social identifies” and networks that have normalized their attitudes towards drinking. Thus, the introduction of technology has led to changes in perceptions of youths towards alcohol in developing countries.

Although the evidence of alcohol use among general Vietnamese population is available [5], there has been a lack of research on the rate of alcohol use in vulnerable groups, especially the youth population. Therefore, this study investigated the prevalence of alcohol use among Vietnamese youths in the Internet setting. In addition, it is also the objective of this paper to elucidate the associated factors that might predispose youths to alcohol-related disorders, such as high levels of perceived stressors in life, or having a poor health-related quality of life.

Table 1 presents the demographic characteristics of the participants. A cumulative total of 1,080 youths were recruited via the sampling methodology. Of the youths recruited 52.8% were female, and the remaining 41.9% were male. In all, 59.5% males and 12.7% of youths declared that they were actively using alcohol. The vast majority of the participants were between 18 and 22 years of age, accounting for 54.3% of the total sample. Most of the participants (78.6%) had obtained university education. The majority of the participants were of Kinh ethnicity (95.8%), and most were single (72.6%) and were staying in a hostel (47.6%) when they were recruited. Of significance, a cumulative total of 10.7% of the participants were current smokers, and another 5.2% of the participants were water-pipe (Shisha) smokers.

Table 2 shows that a cumulative total of 32.3% of the participants were drinking alcohol, with 21.8% and 25.0% of the participants being classified as drinking hazardously and binge drinkers, respectively.

Table 3 presents the general health status of the respondents. About 17.5% of active drinkers were overweight as compared to 5.3% of those who were not drinking. There were no significant differences in the various domains of the HRQOL for most of the participants who were drinking and not drinking alcohol, with the exception that those who were actively drinking had more significant problems with their self-care. Of note, there were no statistically significant differences in the EQ-5D index, EQ-VAS, and PSS.

Table 4 presents the alcohol drinking quitting pattern among the participants. The majority of the participants (60.7%) were pre-contemplative, in that they did not feel that they had an alcohol issue. Only 11.6% had contemplated their problem, and only 2.9% and 6.7% were in the preparation and action phases with regards to changing their alcohol habits. For those who were using alcohol, the preferred methodology for them to quit alcohol usage was to use a replacement liquid (8.9%). The majority also perceived that support from relatives and friends was important and helpful. Notification from mobile phone was not perceived to be very useful for this group of participants. Out of the entire sample, only 19.2% of the participants indicated that they were willing to pay a median of VND 50,000 (USD 2.24) for a smartphone application to help them.

Table 5 presents an analysis of the factors that are associated with individuals who are drinkers or drinking hazardously. Of significance, drinking alcohol was positively associated with males (odds ratio [OR] = 7.65; 95% confidence interval [CI], 5.48–10.68) and higher age (OR = 1.26; 95% CI, 1.17–1.35). Individuals who were current smokers were 5.65 times more likely to drink alcohol (OR = 5.65; 95% CI, 3.09–10.31) than non-smokers. Meanwhile, higher perceived stress score was negatively related with higher likelihood of being an alcohol drinker (OR = 0.90; 95% CI, 0.83–0.97).

Regarding hazardous drinkers, people who were male (OR = 7.52; 95% CI, 5.08–11.14), older (OR = 1.16; 95% CI, 1.09–1.24), current smokers (OR = 2.94; 95% CI, 1.81–4.79) and had ever smoked shisha (OR = 2.31; 95% CI, 1.17–4.56) were more likely to be hazardous drinkers. Meanwhile, people who were single were less likely to drink hazardously compared to those living with a spouse/partner (OR = 0.60; 95% CI, 0.41–0.88).

While there have been prior studies looking into alcohol and its associated harmful effects among the youth population in the Internet setting in Vietnam [18], this is one of the first studies to utilize e-health to determine the severity of alcohol use disorders among an Internet sample of youths and to determine associated factors that might predispose these individuals towards alcohol usage. Surveying an Internet cohort of participants would share insights into how the introduction of e-health technologies in a developing country might affect the severity of alcohol use disorders. The obtained results demonstrate that our sampled population has a relatively high level of educational attainment, with the vast majority having at least a university education. Of importance, approximately 5.2% and 10.7% of the sampled population were already using other substances, such as tobacco and water-pipe (shisha). The results also demonstrate that an alarming 21.8% and 25% of the sampled individuals were using alcohol hazardously, or were binging on alcohol as well. Those who were drinking alcohol hazardously were noted to be overweight, which might be due to the adverse caloric effects of chronic alcohol use. Of note, the majority of those sampled were ambivalent and pre-contemplative about cutting down their alcohol use. A further statistical analysis also revealed that there is a correlation between alcohol usage and other risky behaviors, such as tobacco and waterpipe usage.

Notably, our prevalence result is similar to the result of a national survey on adolescents and youths in Vietnam, which used a face-to-face approach and found that 36% of participants aged from 14–25 years had drank alcohol in the last 30 days [13]. Another study among Vietnamese medical students using the paper-pencil method showed that 57.5% of participants had drank alcohol in the previous 12 months [18]. The differences might be explained by the differences in the sample and the measurement of each study. A previous study suggested that Internet-based survey has the advantages of the anonymity of participants and convenience for researchers in storing data in electronic databases [19]. Further studies are warranted to compare the usability of Internet-based surveying and other survey methods in examining alcohol use behaviors.

Our results are consistent with those of a previous study by Kaljee et al. [20]. Their findings showed that approximately 29.2% of their sampled population had had alcohol use disorder, and females were more likely to have indulged in binge drinking and were more likely to have suffered from intoxication within a 6-month period [20]. Their initial study already highlighted that, since 2005, there has been an increasing trend of youths consuming alcohol at a younger age. At the same time, there is perhaps a multitude of factors that might predispose youths in Vietnam towards increased consumption of alcohol. One of the main factors might be the changes in the economy in Vietnam, with more commercialization and globalization taking place. In addition to the changes in the economy, there are other factors, such as attainment of better and higher education as well as an increase in technological access. Previous studies have examined the impact of social media on alcohol consumption in adolescents and young adults [21]. These studies have highlighted the close relationship and association between the exposure youths and young adults get from social networking and Internet sites and the amount of alcohol they eventually consume [21]. Health behavior theories, such as the social learning theory, could potentially account for the changes in youths and young adult's behavior. More recent studies have highlighted that besides conventional methodologies of marketing and promoting alcohol consumption, the Internet, and various digital media and social network sites are increasingly being used to promote the use of alcohol [7]. Although we have not managed to elucidate the extent to which youths and adolescents in our sample used the Internet and social networking sites, it is inevitable that along with the introduction of the Internet in Vietnam, youths and adolescents are at risk of greater exposure. Another issue pertains to the alcohol control policies that are currently in place in Vietnam. Prior research has demonstrated that the amount that youths and young adults are drinking is highly dependent on environmental factors [22], in particular, the availability of alcohol and the density of drinking places [22]. Alcohol control policies have been shown to be effective in controlling the prevalence of alcohol-use disorders [23]. Vietnam, to our knowledge, does not have a concrete alcohol control policy that is comparable to other countries, such as restrictions on the timing of alcohol sale and the sites at which alcohol can be consumed.

Our current research highlighted that there are no significant differences in the various domains of physical health among those who use alcohol as compared to those who do not use alcohol, with the exception that those who use alcohol hazardously tend to be overweight. Excessive alcoholic consumption and its detrimental impact on college students have previously been extensively studied [24]. While prior research suggested that the most common consequences are overdoses and memory blackouts, it is expected that there might be metabolic and physical changes over time for those who consume alcohol hazardously. This is in view of the fact that an average drink would provide a significant amount of calories [25]. Lastly, our results also highlighted an association between the use of tobacco and shisha and alcohol use disorder. Our findings agree with prior research findings, which suggest that there are significant correlations between water-pipe smoking, drug usage, and alcohol and tobacco usage [26]. Other risky behaviors, such as water-pipe smoking as well as tobacco use, might be gateways towards predisposing youths to alcohol use and dependence.

Our findings also demonstrate that the majority of our online sample of youths are in the pre-contemplative and contemplative stages of change, and these findings agree with those of prior studies [27]. One of the key findings in our study pertains to how participants perceive the effectiveness of having a smartphone-based application to help them with their alcohol use disorder. The vast majority of the participants felt that notification was a useful reminder, which agrees with our previous study of a new alcohol tracker application amongst a Canadian cohort of university students [28]. Various other studies have demonstrated how mobile phones are useful in helping reduce unhealthy use of alcohol and facilitate the delivery of psychological interventions, such as commitment and acceptance therapy in motivating change [29,30]. There remains a lack of examination of the existing applications in Vietnamese application stores, and future research ought to examine their evidence base so that there could be a repository of applications that could be recommended by clinicians to individuals.

The strength of our current research is that we managed to recruit a large sample of participants and therefore managed to determine the severity of alcohol use disorder amongst the sample recruited. Our current study also demonstrated the utility of e-health and its potential in the assessment of individuals for various disorders, as established by prior research. The significant advantage of using technology in assessing the severity of a particular condition in the general population is that it is much faster in the acquisition of data than conventional sampling mechanisms, and it is relatively more cost-effective as well.

There were several limitations in our current study. Although we managed to recruit a substantial number of individuals to determine the overall prevalence of hazardous drinking, the prevalence data could have limited generalization to the entire Vietnamese population, given that individuals in rural areas of Vietnam were not included. In addition, as the mechanism of recruitment was via the Internet, we were not able to measure the amount of alcohol-use disorders among individuals of similar ages who did not have access to the Internet. While we have shown that access to the Internet might have changed individuals' perceptions and caused them to drink more, we have not, in our questionnaire, asked specifically about their degree and amount of Internet usage.

In conclusion, this is perhaps one of the first studies to make use of e-health to determine the severity of alcohol use disorder amongst an online sample of participants as well as the factors that might predispose individuals to use alcohol. Our findings may be instrumental in providing guidance to existing governmental policies as well as guiding future ehealth interventions in this area in Vietnam.