Contextual effects of community capacity as a predictor for adolescent alcohol, tobacco, and illicit drug use: A multi-level analysis.

Adolescent substance use is a major public health issue that can result in enduring physical, psychological, and social consequences. This study seeks to examine the relationship between community capacity for prevention and the 4-week prevalence rate of substance use, including tobacco, alcohol, other drugs, and binge-drinking, among students in Germany ranging from grades 5 to 11. This study employed a cross-sectional design and used baseline data from 28 communities participating in the CTC-EFF study. The sample consisted of 7210 students who were surveyed about their substance use behavior. Additionally, 158 local key informants were surveyed on ten capacity domains, which included commitment, knowledge and skills, resources, leadership, inclusiveness, prevention collaboration, sectoral-collaboration, cohesion, problem-solving skills, and needs orientation. Furthermore, a total capacity score was calculated as the mean of the ten capacity domains. To examine the associations between community capacity and substance use behavior, logistic multi-level models were utilized. The analysis shows a negative association between community capacity (total score) and any substance use (OR = 0.28, 95% CI 0.12-0.56). Specifically, higher levels of total community capacity are associated with lower odds of alcohol use (OR = 0.30, 95% CI 0.13-0.80), tobacco use (OR = 0.09, 95% CI 0.01-0.60), and binge-drinking (OR = 0.67, 95% CI (0.46-0.99). Further analyses of distinct community capacity domains indicate that higher levels of sectoral-collaboration (OR = 0.62, 95% CI 0.37-0.97), knowledge and skills (OR = 0.74, 95% CI 0.40-0.79), resources (OR = 0.52, 95% CI 0.36-0.76), and problem-solving skills (OR = 0.71, 95% CI 0.36-0.89) are associated with lower odds of any substance use. The study findings suggest that community capacity is associated with substance use behavior, emphasizing the importance of capacity building in interventions targeting the reduction of substance use among adolescents.

Community capacity for prevention and health promotion: a scoping review on underlying domains and assessment methods.

BACKGROUND: Building community capacity is an essential health promotion approach, which refers to the characteristics of communities that affect their ability to identify and address social and public health problems. Despite general agreement about certain capacity domains and frameworks, there is no comprehensive and consistent assessment of community capacity. Therefore, the aim of this scoping review is to identify the domains and methods used to assess community capacity related to community-based prevention and health promotion. METHODS: A scoping search was performed on 06/02/2022 via PubMed, Web of Science, and Science Direct, with supplemental searches via Google Scholar. The review included studies published in English from 1990 to 2022 that explicitly described how community capacity was assessed in health promotion and prevention interventions. Furthermore, studies had to meet at least two of the three following criteria for capacity assessment: a theoretical foundation, a participatory approach, or a field test of the assessment tool. RESULTS: From 4779 records, 38 studies were included after applying exclusion criteria. Nineteen studies used mixed, eleven qualitative and eight quantitative methods to assess community capacity. The various domains used to assess community capacity were identified and reassembled into nine comprehensive domains: community participation, knowledge and skills, resources, leadership, community power, sense of community, collaboration, critical awareness and problem-solving, and community structure. The review also identified four sub-domains, which include commitment, communication, shared values and goals, and sustainability. DISCUSSION: This scoping review provides an overview of the domains and methods used to assess community capacity, which can facilitate the development of a comprehensive approach to capacity assessment in future research.

[Evidence-based prevention for child and adolescent mental health: the "Communities That Care" (CTC) approach for Germany]. / Evidenzbasierte Prävention für die psychische Gesundheit von Kindern und Jugendlichen: Der Ansatz "Communities That Care" (CTC) für Deutschland.

Intersectoral collaboration, evidence base, and sustainable implementation are central challenges in community health promotion. The international prevention system Communities That Care (CTC) addresses these challenges. CTC aims to prevent alcohol and drug abuse, violence, delinquency, school dropout, and depressive symptoms among adolescents with a systemic multi-level strategy. The evidence-based and cost-effective prevention system developed in the USA was adapted to Germany; at present, a replication study evaluates the cost-effectiveness.CTC is based on empirical theory and follows a five-phase process model. Essential for acceptance and evidence-based implementation is the formation of an intersectoral coalition, whose members receive advisory support and training over several years. The actors are empowered to use a system change model at the municipal level and to implement it in the long term. The aim is to select evidence-based measures in a data-driven and needs-oriented manner and to implement them in consideration of the local contextual conditions in order to reduce risk factors, promote protective factors, and thus improve the health of adolescents. Validated instruments such as the CTC Children and Youth Survey and a registry with evidence-based prevention programs ("Grüne Liste Prävention") support the process.As a systemic intervention, CTC integrates existing local structures and agencies and involves them in the entire process through new decision-making and development bodies. In this way, the potential in the municipality is used and, as much as possible, resources are bundled, strengths are developed, and transparency is created.

[The Impact of Treatment Volumes of Psychiatric Clinics on the Risk for Applying Seclusion or Restraint]. / Der Einfluss des Behandlungsvolumens psychiatrischer Kliniken auf das Risiko der Anwendung besonderer Sicherungsmaßnahmen.

AIM: To determine the effect of treatment volumes on the frequency and duration of special safety measures (SSM) such as seclusion or restraint. METHOD: Register Data of the Lower Saxony Ministry of Social Affairs, Health and Equal Opportunities is analysed for the number of cases hospitalised under State Mental Health Act, the proportion of cases experiencing SSM, and the frequency and cumulative duration of SSM per case. RESULTS AND DISCUSSION: The larger the treatment volume of cases that are hospitalised under State Mental Health Act, the smaller the proportion of cases experiencing SSM. This result is robust, even if statistical outliers are exempted from analyses. CONCLUSIONS: In light of indications that also in mental health care treatment volumes may be related to the desired treatment outcome, discussion is need about the tension between hospital care that is provide.

Long-Term Effects of Integrated Strategies of Community Health Promotion on Diabetes Mellitus Mortality: a Natural Policy Experiment Based on Aggregated Longitudinal Secondary Data.

Integrated strategies of community health promotion (ISCHP) are based on intersectoral collaborations using the Health in All Policies approach to address determinants of health. While effects on health determinants have been shown, evidence on the effectiveness of ISCHP on health outcomes is scarce. The aim of this study is to assess the long-term effects of ISCHP on diabetes mellitus mortality (DMM) in German communities. A nonrandomized evaluation based on secondary county-level official data (1998-2016) was performed. In April 2019, 149 communities in Germany with ISCHP out of 401 were identified. Communities with < 5 measurements of DMM, starting before 1999 or after 2015, were excluded. Analyses included 65 communities with ISCHP (IG) and 124 without ISCHP (CG). ISCHP ran for a mean of 5.6 years. Fixed effects (FE) models were used to estimate effects of ISCHP and duration on DMM taking into account the time-varying average age. The FE estimator for DMM is b = - 2.48 (95% CI - 3.45 to - 1.51) for IG vs. CG and b = - 0.30 (95% CI - 0.46 to - 0.14) for ISCHP duration (0-16 years). In the first year of an ISCHP, a reduction of the annual DMM of 0.3 per 100,000 population (1%), and in the 16th year of 4.8 (14%) was achieved. This study provides preliminary evidence of the effectiveness of ISCHP in Germany. Limitations include inaccuracies to classify IG and CG and possible selection bias. Longitudinal county-level data may be an efficient data source to evaluate complex interventions, thereby contributing to further strengthen evidence-based integrated health promotion.

Study protocol: a non-randomised community trial to evaluate the effectiveness of the communities that care prevention system in Germany.

BACKGROUND: The Communities That Care (CTC) prevention planning and implementation system trains communities throughout a five-phase cycle to (1) build capacity for prevention, (2) adopt science-based prevention, (3) assess the prevention needs of adolescents living in the community, (4) select, and (5) implement evidence-based programs according to their needs. After CTC proved to be effective and cost-effective in the U.S., it is being used by an increasing number of communities in Germany. The aim of this study is to evaluate the effectiveness and cost-effectiveness of CTC in Germany. METHODS: Communities in CTC-phases 1 to 3 (n = 21) and individually-matched comparison communities (n = 21) were recruited for a non-randomised trial. To assess long-term outcomes, (1) a cohort of 5th Grade students will be surveyed biennially concerning behaviours (antisocial behaviour and substance use) and well-being as well as risk and protective factors. Additionally, (2) biennial cross-sectional surveys will be conducted in 6th, 8th, 10th, and 11th Grade in each community. To assess short-term outcomes, a cohort of ten key informants per community will be surveyed biennially concerning adoption of science-based prevention, collaboration, community support and community norms. (4) In a cross-sectional design, all ongoing prevention programs and activities in the communities will be assessed biennially and data will be collected about costs, implementation and other characteristics of the programs and activities. (5) To monitor the CTC implementation, the members of the local CTC-boards will be surveyed annually (cross-sectional design) about team functioning and coalition capacity. Data analysis will include general and generalised mixed models to assess the average treatment effect of CTC. Mediation analyses will be performed to test the logical model, e.g., adoption of science-based prevention as a mediator for the effectiveness of the CTC approach. DISCUSSION: This is the first controlled study to evaluate the effectiveness of a comprehensive community prevention approach in Germany. Evaluating the effectiveness of CTC in Germany is an important prerequisite for further diffusion of the CTC approach. TRIAL REGISTRATION: This study was registered with German Clinical Trial Register: DRKS00022819 on Aug 18, 2021.

[Gender-Specific Utilization of Outpatient Medical and Preventive Programs in a Rural Area]. / Geschlechtsspezifische Inanspruchnahme von ambulanten medizinischen und präventiven Leistungen in einem ländlichen Raum.

AIM: The aim of this study was to provide representative results on gender-specific utilization of outpatient medical and preventive care in a peripheral rural area. METHODS: 1,246 adult inhabitants were interviewed in the Rural Health Study 2008. Answers to the utilization of outpatient care and behavioral health preventive programs were analyzed by bivariate analyses and by multiple regression analyses. RESULTS: Bivariate analyses show gender-specific differences in the utilization of the services of not only urologists and gynecologists but also of general practitioners, dentists, oculists, radiologists and preventive programs for weight reduction, healthy nutrition, back gymnastics and stress handling. Multivariate models show that women compared with men independent of age, social status and health status have higher opportunities to utilize outpatient care (OR 1,81; 95%-CI 1,11-2,94) and behavioral health preventive programs (OR 2,46; 95%-CI 1,62-3,74). CONCLUSION: The results of the present study confirm existing results on higher utilization of health services by women independent of their health status. Although regional studies never can be transmitted directly to other regions, we assume that as long as no other regional studies are available, these results could be extrapolated to other peripheral regions in Germany.

Health and lifestyle in rural northeast Germany: the findings of a Rural Health Study from 1973, 1994, and 2008.

BACKGROUND: Secular trends in health-related behavior, the frequency of illness, and life satisfaction in rural areas are inadequately documented. Such information is essential for the planning of health-care policy. METHODS: In 1973 and 1994, surveys were performed on the health and lifestyle of all adult inhabitants of 14 selected rural communities in the northern part of the former East Germany. The inhabitants were surveyed again in 2008, and the findings of the surveys were compared. RESULTS: Both the number of respondents and the response rate of the officially registered population in the 14 rural communities declined over the years, from 3603 (83%) in 1973 to 2155 (68%) in 1994 and 1246 (37%) in 2008. In 1973, 3.2% of the women and 2.7% of the men responding to the survey reported that they had diabetes mellitus. For arterial hypertension, the corresponding figures in 1973 were 21.7% and 11.4%; for chronic heart diseases, 16.7% and 12.8%. In 2008, most of the prevalence figures for these conditions were higher: for diabetes, 12.4% and 12.8%; for arterial hypertension, 34.7% and 33.9%; for chronic heart diseases, 12.3% and 15.0%. Men became less likely to report being in good or very good health (decline from 51.1% to 45.0%), while women became more likely to report being in good health (rise from 36.7% to 49.3%). Women generally had a more healthful lifestyle than men. CONCLUSION: Over the long term, there have been both improvements, particularly in lifestyle, and turns for the worse, e.g., in life satisfaction. While the latter might be due to the increasing marginalization of rural eastern Germany, we interpret the observed improvements as benefits of modernization.