[Evidence-based alcohol prevention-what does effectiveness research recommend? : Results of the 2020 BZgA review of reviews on addiction prevention]. / Evidenzbasierte Alkoholprävention ­ Was empfiehlt die Wirksamkeitsforschung? : Ergebnisse der BZgA-Expertise zur Suchtprävention 2020.

BACKGROUND: A substantial group of adolescents and young adults engage in risky alcohol use and there is a need for alcohol prevention. The 2020 BZgA review of reviews on addiction prevention provides the best available scientific knowledge on effectiveness of prevention measures for young people. RESEARCH QUESTION: Which approaches show preventive effects on alcohol use in different prevention settings? METHODS: A systematic literature search in June 2017 in seven international databases resulted in 28,949 hits. Inclusion criteria were a review or meta-analysis study type, a 2012-2017 publication date, a universal or selective target group, age up to 25 years, and a target behavior of alcohol consumption. Exclusion criteria were target group people with substance use disorders and target behavior risk factors. The three authors performed a systematic content analysis of 34 alcohol-related publications and assessed their methodology using AMSTAR (A MeaSurement Tool to Assess systematic Reviews). Conclusions and recommendations were framed by consensus among all authors. RESULTS: Based on a total number of 53 conclusions on the effectiveness of alcohol prevention approaches depending on setting (family, school, college, media, health care, and community) and target group, it can be recommended - among other things - to implement family programs and parenting training, behavioral programs targeting specific personal and social skills, brief interventions with feedback, and mentoring programs. No recent reviews that investigated the effectiveness of alcohol policies at the community or national level could be identified. CONCLUSIONS: Behavioral alcohol prevention is effective. It is recommended to address specific age and target groups in different settings by using specific interventions. Consensus is needed with regard to what kind of evidence proves effectiveness of environmental prevention measures.

Cluster-randomized trial of a German leisure-based alcohol peer education measure.

Because of scarce research, the effectiveness of substance abuse prevention in leisure settings remains unclear. In this study, we evaluated the effectiveness of a peer-led educational prevention measure with adolescent groups in unstructured leisure settings, which is a component of the complex German nationwide 'Na Toll!' campaign. Using a cluster-randomized two-group post-test-only design, we tested whether the measure influenced component-specific goals, namely risk and protective factors of alcohol use such as risk perception, group communication and resistance self-efficacy. The sample consisted of 738 adolescents aged 12-20 years who were recruited at recreational locations and completed an online questionnaire 1 week after the peer education or recruitment event. Sixty-three percent of the sample participated in the 3-month follow-up assessment. Data analysis revealed post-test effects on risk perception, perceived norm of alcohol communication in the peer group and resistance self-efficacy. Follow-up effects were not observed, with the exception of a significant effect on risk perception. In conclusion, the peer-led education measure in leisure settings might have supported the adolescents in this study to perceive alcohol-related risks, to feel accepted to talk about alcohol problems with their friends and to be more assertive in resisting alcohol use in the short term.

An Internet-based ecological momentary assessment study relying on participants' own mobile phones: insights from a study with young adult smokers.

BACKGROUND: In this paper we describe a novel Internet-based cell phone-optimized assessment technique (ICAT) to conduct an ecological momentary assessment (EMA) study. Participants could access the assessment instrument via the web browsers of their mobile phones. METHODS: We report results from 92 young adult smokers (18-25 years old) who completed the baseline assessment and the first of 4 waves (3 days/wave) of EMA. Random prompts were issued via text messages sent to the participants. The participants were also instructed to self-initiate reports of smoking situations. RESULTS: Compliance with the study protocols was low. In total, the participants completed 885 assessments during the 3 days of monitoring. Only 50.2% of random prompts were responded to, and 52.4% of those were completed within the first 10 min after issuing. Furthermore, reports of smoking situations were rarely self-initiated. In a multivariate regression analysis, age (positively) and female gender (negatively) predicted the number of completed assessments. CONCLUSIONS: This study adds to the limited experiences made with ICAT in substance use research. Similar to the few prior ICAT studies, compliance was low compared to traditional EMA studies. While using ICAT is technically feasible, specific improvements should be implemented to tap ICAT's full potential in future studies.

Adolescents' protection motivation and smoking behaviour.

The protection motivation theory (PMT) is a well-known theory of behaviour change. This study tested the applicability of the sub-constructs of threat and coping appraisal in predicting adolescents' smoking-related behavioural intentions and smoking behaviour longitudinally. Adolescents (N = 494) aged 11-16 years and not currently smoking at baseline participated in the study. Predictive validity of PMT constructs was tested in a path analysis model. Self-efficacy significantly predicted behavioural intention at baseline, which significantly predicted behavioural intention at follow-up, which in turn predicted smoking behaviour at follow-up. The effect of self-efficacy on behavioural intention at follow-up was mediated by behavioural intention at baseline and the effect of self-efficacy on smoking behaviour was mediated by behavioural intention at baseline and follow-up. In conclusion, we found support for one part of the PMT, namely for the predictive validity of the coping appraisal construct self-efficacy in predicting adolescents' smoking-related behavioural intention and smoking behaviour. These results fail to support the appropriateness of the PMT's construct threat appraisal in longitudinally predicting adolescents' smoking as well as the applicability of communicating fear and negative information as preventive interventions for this target group.

Tobacco prevention and reduction with nursing students: A non-randomized controlled feasibility study.

BACKGROUND: Prevalence of tobacco use among nurses and nursing students is disproportionally high in Germany. However, from a public health perspective they are considered to be an important group for delivering smoking cessation interventions. As delivery of tobacco-related treatment depends on own smoking status, smoking prevention and cessation among the nursing professions is indicative for improving nurse and public health. OBJECTIVE: To evaluate the feasibility and effects of a comprehensive tobacco prevention and reduction program on psychosocial and environmental factors related to smoking behavior of nursing students. METHODS: Between 2014 and 2015, a non-randomized, controlled feasibility study was conducted in 12 schools of nursing with 397 nursing students in Germany. Students in the intervention group received a program (ASTRA) consisting of an introductory session, steering committee workshop, stress prevention lessons, evidence-based smoking cessation intervention, and action project. Six months after baseline assessment, change in smoking-related protective and risk factors was determined. Secondary endpoints included smoking behavior. RESULTS: The program was implemented in total in 5 of 7 intervention schools. About one third of smoking nursing students participated in a cessation intervention. The program seems to do better than a minimal intervention booklet in four primary outcomes: perceived descriptive, subjective, and injunctive norms towards smoking and nursing as well as perceived social support. As anticipated, there was no change in smoking behavior. CONCLUSIONS: The applied approach is feasible and able to improve important smoking-related norm perceptions of student nurses and perception of social support. However, additional context measures to influence the settings of nursing education currently rather supporting smoking seem to be necessary in order to promote smoking cessation among nursing students and to scale up implementation of the program.

How Do Light and Intermittent Smokers Differ from Heavy Smokers in Young Adulthood: The Role of Smoking Restraint Strategies.

Light and intermittent smoking has become a prevalent pattern of use among young adults. Little is known about which factors differentiate light and intermittent smokers (LITS) from heavy smokers (HS) in young adulthood. In this study, we compare young adult LITS with HS with regard to demographic- and smoking-related variables, self-control abilities, and concrete strategies of smoking restraint. The data were collected as part of an Ecological Momentary Assessment (EMA) study with 137 German young adult smokers (M Age = 21.1 years, 46.0% female; 76 HS [≥10 cigarettes/day] and 61 LITS [≤5 cigarettes/day]). Participants were recruited over the Internet and completed a baseline questionnaire online. Several variables differentiated LITS and HS in a multiple logistic regression analysis: LITS reported fewer smoking friends (p < .001) and a higher self-efficacy to resist smoking (p < .01). Further, LITS smoking status was associated with reporting a past quit attempt (p < .05) and the use of smoking restraint strategies (counting, limiting, and purposefully not smoking cigarettes; p < .05). Notably, nicotine dependence and trait self-control abilities did not differentiate between LITS and HS. Our results point to the role of smoking restraint strategies and self-monitoring of smoking to limit the daily number of cigarettes smoked.

Are you in or out? Recruitment of adolescent smokers into a behavioral smoking cessation intervention.

INTRODUCTION: Even though many adolescent smokers want to quit, it is difficult to recruit them into smoking cessation interventions. Little is known about which adolescent smokers are currently reached by these measures. In this study we compare participants of a group-based, cognitive behavioral smoking cessation intervention with adolescent smokers who decided against participating. METHODS: Within a non-randomized controlled trial, data of 1053 smokers (aged 11-19) from 42 German secondary schools were analyzed. Of these smokers, 272 were recruited into 47 courses of the intervention. An in-class information session, individually addressing potential participants, and incentives were used as means of recruitment. Personal predictors of participation were analyzed using regression analyses and multivariate path analyses to test for mediation. RESULTS: In the path analysis model, nicotine dependence, quit motivation, and a previous quit attempt were directly positively related to participation. Heavier smoking behavior was indirectly positively associated with participation through nicotine dependence and negatively through quit motivation, yielding an overall positive indirect effect. The positive effect of a previous quit attempt on participation was partially mediated through nicotine dependence and quit motivation. The proportion of smoking friends were indirectly positively related to participation, mediated through nicotine dependence. CONCLUSIONS: Since adolescents with heavier smoking behavior and stronger nicotine dependence are less likely to undertake a successful unassisted quit attempt, the reach of these young smokers with professional cessation interventions is desirable. Further measures to improve the recruitment of those currently not motivated to quit have to be examined in future studies.

Screening for alcohol-related problems in the general population using CAGE and DSM-IV: characteristics of congruently and incongruently identified participants.

This study examines the role of age, gender, and drinking patterns in inconsistent identification of alcohol-related problems by CAGE and DSM-IV criteria. Data come from a nationally representative sample of the noninstitutionalized German general adult population (N=8020) surveyed through self-administered questionnaires in 1997. Current drinkers who were classified positive for a DSM-IV (abuse or dependence) and/or CAGE diagnosis (n=942) were included in the descriptive analysis and multinomial logistic regression. Among current drinkers with at least one positive classification, only 31.7% were "congruently" classified; that is, they were consistently identified by corresponding CAGE and DSM-IV criteria. Analyses on item level support findings of incongruence on scale level. Overall, we found that younger age groups were more likely to meet DSM criteria without reporting CAGE items. For older age groups, the reverse seems to be true. Women were found to respond more readily to CAGE items whereas men seem to respond more readily to DSM criteria. Intensive drinking patterns more often lead to congruent classification, yet surprisingly, participants with less intensive drinking patterns were found more often to be CAGE positive than to fulfil DSM abuse criteria. Moreover, binge drinkers with alcohol-related problems were neither more likely to receive a DSM nor a CAGE diagnosis. We conclude that heightened awareness is needed when employing the studied instruments in certain groups.

Situational and mood factors associated with smoking in young adult light and heavy smokers.

INTRODUCTION AND AIMS: Antecedents of smoking have been widely researched in studies with older adults. However, less is known about the smoking patterns and antecedents of smoking in young adult smokers. DESIGN AND METHODS: In this study, we used ecological momentary assessment collected with an Internet-based survey instrument and used the participants' own mobile phones to contrast the smoking patterns of young adult light and intermittent smokers (n = 23) with heavy smokers (n = 18). Overall, 1543 smoking and non-smoking situations were analysed. By means of generalised estimating equations, we used a range of situational characteristics to predict smoking in both groups. RESULTS: Craving and smoking of others increased the odds of smoking, and smoking bans were associated with a decreased probability of smoking among both light and intermittent smokers and heavy smokers. Situational antecedents differed between both groups. Cue-associated smoking played a bigger role for light and intermittent smokers than for heavy smokers. Situational antecedents, such as craving, being at the home of others, drinking alcohol and smoking by others, were more strongly associated with the smoking of light and intermittent smokers compared with heavy smokers. DISCUSSION AND CONCLUSIONS: Smoking among young adults is associated with both internal and external situational characteristics. Compared with heavy smokers, light and intermittent smoking seems to be under more stimulus control and more characterised by social smoking. These results are consistent with several findings from previous studies and provide further information on different subgroups of smokers in early adulthood.

The role of participants' self-selected future smoking goals in adolescent smoking cessation interventions.

BACKGROUND: There is an implicit assumption that abstinence is the treatment goal of young smokers that deliberately participate in cessation interventions, but this may not always be the case. To gain information on subgroups of adolescent intervention participants, we compare participants who want to achieve smoking abstinence (Abst) with those stating a non-abstinence future smoking goal (NAbst), with regard to baseline characteristics, reasons for participation, quit motivation, retention, goal attainment, and smoking abstinence. METHODS: The sample consisted of 202 adolescent smokers (49.5% female). At baseline, 118 (58.4%) indicated abstinence as future smoking goal and 84 (41.6%) indicated non-abstinence. All participants received a behavioral smoking cessation intervention. Assessments took place before, during, and after treatment, and at 6-month follow-up. Regression analyses were conducted. RESULTS: Abst and NAbst participants reported similar baseline characteristics. Abst participants, however, were more likely to report a previous quit attempt and indicated a higher quit motivation before and during treatment. Abst participants were more likely to participate based on own initiative and NAbst participants because of participating friends. Both groups attended a similar number of intervention sessions and were equally likely to attain their self-selected smoking goal. However, more Abst participants reported a successful quit attempt during treatment and abstinence at post-treatment and follow-up. CONCLUSIONS: NAbst participants may represent a substantial subgroup in smoking cessation interventions for adolescents. Results indicate that future smoking goals can influence treatment outcomes. NAbst participants in treatment may benefit from additional information on the negative health consequences of light smoking.

Smoking cessation with teenagers: the relationship between impulsivity, emotional problems, program retention and effectiveness.

AIMS: This study examines whether individual differences in impulsivity and emotional problems in adolescent smokers are related to initial smoking characteristics of participants, acceptance, retention and outcome of a school-based smoking cessation program. DESIGN: The data was obtained from a feasibility study of a youth-specific, cognitive-behavioral and motivation enhancing program at 22 schools with 139 participating teenage smokers in Germany. A one-group-pre-posttest design was realized. MEASUREMENT: Impulsivity levels were assessed by use of the impulsivity scale of the IVE ("Inventar zur Erfassung von Impulsivität, Risikoverhalten und Empathie", Stadler, Janke, & Schmeck, 2004). To evaluate the extent of emotional problems, the corresponding 5-items scale of the SDQ-Deu ("Strength and difficulties questionnaire", Klasen et al., 2000) was applied. Smoking behavior and acceptance of the program were assessed by students' self-reports. FINDINGS: Acceptance and retention did not differ with regard to impulsivity and emotional problems, but initial smoking status did. Cessation rates varied with level of impulsivity: compared to non-impulsive participants, impulsive adolescents succeeded in quitting smoking less often. Emotional problems were not related to the rate of quitting. CONCLUSIONS: Impulsive adolescents were similarly compliant to the offered cessation intervention as less impulsive smokers. In spite of their general positive evaluation, impulsive adolescents seem to benefit less from a smoking cessation program than their non-impulsive counterparts. Specific elements supporting impulsive teenage smokers in their goal to quit should be incorporated into youth-specific cessation programs.

The role of life skills promotion in substance abuse prevention: a mediation analysis.

Research has shown that life skills programs are the most effective single activity in school-based substance abuse prevention. However, little is known about the processes through which they are effective. This study examines whether an evidence-based prevention program targeting general competence is effective through the promotion of knowledge about life skills and enhanced related behaviors. Based on a sample of 442 fifth graders participating in a quasi-experimental prevention study, as expected, mediation analyses revealed that increased knowledge about life skills paralleled an increase in students' distant attitudes toward alcohol and nicotine use. Unexpectedly, behaviors manifesting enhanced life skills were found not only among program participants who remained experimental/non-smokers or stopped smoking but also among smokers. In general, findings suggest that favorable prevention outcomes may be influenced through building knowledge about general life skills. The notion of uniform mechanisms of effectiveness in prevention programs is discussed.