Smoking in Popular Streaming Shows and Youth Protection in Germany.

Aim was to investigate the amount of smoking in popular streaming series in Germany with a focus on the comparison between series recommended for adults versus youth. The sample was drawn from the 35 highest user-rated streaming series, that released 1794 new episodes between January 1, 2017 and December 31, 2020. One-third of the episodes (N = 598) were randomly selected and analyzed for smoking content. The age ratings of these episodes ranged from 6 to 18 years, with categories of "6", "12", "16" and "18" years. Ten of the 35 shows (28.6%) were completely smoke-free, 25 shows (71.4%) had at least one episode with smoking. Of all analyzed episodes, 25.1% contained smoking (range = 1 to 36 smoking scenes; median = 4). There was a statistically significant association between episode age rating and the presence of smoking (χ2[3] = 9.1; p = 0.028; Spearman's rho = 0.11): The proportion of episodes with smoking was 0% for episodes with age ratings below 12 years, 20.4% for age ratings "12", 28.3% for age ratings "16", and 32.4% for age ratings "18". This association differed between streaming services, but all services had smoking in episodes rated for youth. Smoking is common in popular streaming series. None of the streaming services meet the recommendations of the WHO Framework Convention on Tobacco Control to reliably restrict young people's access to media content that depicts smoking.

[Smoking in Netflix feature films and youth protection]. / Rauchen in Netflix-Spielfilmen und Jugendschutz.

BACKGROUND: With the aim of protecting minors, the World Health Organization has recommended classifying films with smoking scenes as unsuitable for children and adolescents. In recent years, films have increasingly been viewed via video streaming services - a trend which has been intensified by the COVID-19 pandemic - which poses new challenges for the protection of minors. AIM: To examine the frequency of smoking scenes in Netflix feature films and the age recommendations for Netflix productions with smoking scenes. METHOD: A total of 235 films that were made available for streaming exclusively by the Netflix platform in 2021 and 2022 were content coded in order to find out (1) how high the proportion of smoke-free films was in this film sample, (2) how often smoking scenes occurred in these films and (3) the proportion of films with smoke scenes classified as appropriate for young people in Germany and the USA. All films with an age rating of under 16 were considered suitable for children and young people. RESULTS: Smoking scenes occurred in 113 of 235 analyzed films (48.1%). Of the 113 films with smoking scenes, 57 (50.4%) in Germany and 26 films (23.0%) in the USA were classified as youth films (p<0.001). A total of 3,310 smoking scenes were registered. Of these, 39.4% (n=1,303) were in films with youth ratings in Germany, and in Netflix USA this proportion was 15.8% (n=524). DISCUSSION: Smoking scenes are a common feature in Netflix movies. Neither in the US nor in Germany does Netflix adhere to the recommendations of the WHO Framework Convention on Tobacco Control to restrict access by young people to films depicting smoking. However, the protection of minors in the US is better than in Germany, since half of the Netflix films with smoking scenes in Germany were rated as suitable for minors, in the USA less than a quarter.

[Substance use and the usage of social media, computer games, and gambling among apprentices at vocational schools]. / Substanzkonsum und Nutzung von sozialen Medien, Computerspielen und Glücksspielen unter Auszubildenden an beruflichen Schulen.

BACKGROUND: The aim of the current study was to assess the prevalence of the (problematic) consumption of alcohol, tobacco, and cannabis as well as the (problematic) use of social media, e­products, computer games, and gambling among apprentices. METHOD: Cross-sectional survey of 4591 apprentices at 17 vocational schools from Bavaria, Schleswig-Holstein, and Hamburg. Data was collected using questionnaires between March 2021 and April 2022. The primary endpoints were the 30-day prevalence and the problematic consumption and usage behavior of the mentioned substances/behaviors using screening instruments. RESULTS: Among the assessed substances/behaviors, social media were used most frequently by the apprentices with a 30-day prevalence of 97.7%, followed by alcohol (64.3%) and computer games (55.8%). Cigarettes were consumed by 35.1%, e­products by 17.9%, and cannabis by 15.4% of the apprentices. Of the apprentices, 12.2% reported having gambled in the past 30 days. Rates of problematic use were 47.4% for alcohol, 18.0% for tobacco, 6.2% for e­products, and 1.6% for cannabis. Problematic use of social media was indicated by 45.0% of the apprentices, of gambling by 2.2%, and of computer games by 0.7%. DISCUSSION: These results suggest that apprentices constitute a risk group for problematic substance use, indicating increased need for intervention. In particular, secondary prevention efforts in the areas of alcohol and social media should be taken into consideration due to their widespread prevalence in the vocational school setting.

[Smoking in Netflix feature films and youth protection]. / Rauchen in Netflix-Spielfilmen und Jugendschutz.

BACKGROUND: With the aim of protecting minors, the World Health Organization has recommended classifying films with smoking scenes as unsuitable for children and adolescents. In recent years, films have increasingly been viewed via video streaming services - a trend which has been intensified by the COVID-19 pandemic - which poses new challenges for the protection of minors. AIM: To examine the frequency of smoking scenes in Netflix feature films and the age recommendations for Netflix productions with smoking scenes. METHOD: A total of 235 films that were made available for streaming exclusively by the Netflix platform in 2021 and 2022 were content coded in order to find out (1) how high the proportion of smoke-free films was in this film sample, (2) how often smoking scenes occurred in these films and (3) the proportion of films with smoke scenes classified as appropriate for young people in Germany and the USA. All films with an age rating of under 16 were considered suitable for children and young people. RESULTS: Smoking scenes occurred in 113 of 235 analyzed films (48.1%). Of the 113 films with smoking scenes, 57 (50.4%) in Germany and 26 films (23.0%) in the USA were classified as youth films (p<0.001). A total of 3,310 smoking scenes were registered. Of these, 39.4% (n=1,303) were in films with youth ratings in Germany, and in Netflix USA this proportion was 15.8% (n=524). DISCUSSION: Smoking scenes are a common feature in Netflix movies. Neither in the US nor in Germany does Netflix adhere to the recommendations of the WHO Framework Convention on Tobacco Control to restrict access by young people to films depicting smoking. However, the protection of minors in the US is better than in Germany, since half of the Netflix films with smoking scenes in Germany were rated as suitable for minors, in the USA less than a quarter.

Use of Electronic Cigarettes as a Predictor of Cannabis Experimentation: A Longitudinal Study Among German Youth.

INTRODUCTION: Experimentation with e-cigarettes is rising among youth, and there are concerns that e-cigarettes could be a new risk factor for initiating substance use. This study aimed to investigate whether e-cigarette use longitudinally predicts experimentation with cannabis. AIMS AND METHODS: During 2017-2019, a prospective cohort study with an observation period of 18 months was conducted with 3040 students from Germany who had never used cannabis (mean age = 14.8, range: 13-18 years). A multiple Poisson regression was used to investigate whether e-cigarette use was an independent predictor of future cannabis use. RESULTS: Lifetime e-cigarette use was reported by 29.4% of the survey population (n = 894) at baseline, and 17.4% (n = 529) initiated cannabis use during the observation period. Among e-cigarette ever users, the initiation rate was 34.5% compared with 10.4% of never users. Results were robust to adjustment for age, sex, migrant status, type of school, sensation seeking, peer cannabis use, the use of alcohol and conventional cigarettes (ARR = 1.83; 95% CI: 1.48-2.25). Further analyses revealed that the association between e-cigarette use and cannabis experimentation was stronger among youth with low sensation-seeking scores (ARR = .77, CI: .61-.97) and no conventional cigarette use (ARR = .48, CI: .37-.64) at baseline. CONCLUSIONS: E-cigarette use is associated with a subsequent initiation of cannabis use. This association seems to be stronger for youth who have a lower risk for substance use in general. Future studies need to investigate whether this is only true for experimental or also more frequent cannabis use. IMPLICATIONS: The study indicates a prospective association between e-cigarette use and initiation of cannabis experimentation independent of other risk factors. It suggests that e-cigarette use is more strongly associated with cannabis initiation for youth with a lower propensity to use substances (low sensation-seekers and non-smokers).

[Smoking in Movies: Implementation Status of the World Health Organization Recommendations on the Protection of Minors]. / Rauchen in Filmen: Stand der Umsetzung der WHO-Empfehlungen zum Jugendschutz.

BACKGROUND: To reduce the exposure of young people to smoking scenes in films, the World Health Organization has recommended classifying films with smoking scenes as unsuitable for children and adolescents. AIM: To examine the question whether this recommendation is being implemented in Germany and the USA by comparing the ratings for films with and without smoking scenes in both countries. METHOD: The selection criterion for the films was the box office result in German theaters in 2019. The 50 most successful US productions and the 50 most successful productions from Germany were content analyzed. The questions raised were: (1) how high the proportion of smoke-free films was in these two film samples, and (2) how high the proportion of films with smoking scenes was that were classified as unsuitable for young people. All films with an age rating below 16 years were considered suitable for children and adolescents. RESULTS: A total of 52 of the 100 films were smokefree. The rate was 64 % for US productions, compared to 40 % for German productions (p = 0.016). According to the German Self-regulatory Organization for the Cinema (FSK) rating system, 87 % of the films were suitable for young people. Overall, the proportion of smokefree films was higher for films suitable for young people than for films not suitable for young people (56 % vs. 23 %; p = 0.025). Of the 48 films with smoking, the FSK classified 79 % as suitable for minors. With regard to the age ratings for films with smoking scenes, there was no difference between the MPAA and FSK ratings for the top 50 US productions. CONCLUSIONS: Neither the USA nor Germany has implemented the recommendation of the World Health Organization to protect young people from smoking scenes in films in a satisfactory manner. In Germany, films with smoking scenes are largely classified as suitable for minors.

Association between bullying victimization and e-cigarette use among German students.

This study examined the association between bullying victimization and e-cigarette use. Data from a 2019-2020 German student survey were used (N = 16,476). The target population consisted of students enrolled in grades 5-10, with a mean age of 13.1 years (SD = 1.8), and equal gender distribution (49.5% female). Mixed-effect multivariable logistic regression models were used to examine the association between bullying victimization (attacked physically, assaulted verbally, experienced relational bullying, sexual harassment, cyberbullying) and current e-cigarette use. The multivariable analysis controlled for age, sex, sensation-seeking, socioeconomic status, school performance, type of school attended, and substance use (current cigarette smoking, hookah smoking, and alcohol drinking). Overall 510 (3.7%) students reported current use of e-cigarettes. The odds for using e-cigarettes increased each step of being bullied from "never," "rarely," "sometimes," "once a week," to "several times a week" by 2.03 (95% confidence interval [CI]: 1.81, 2.29) in the unadjusted model, and by 1.46 (95% CI: 1.24, 1.71) in the covariate-adjusted model. Data indicate an empirical association between victimization and e-cigarette use among German students. Design limitations prevent the conclusion of a causal relationship, calling for well-designed longitudinal studies to investigate the temporal sequence between victimization and e-cigarette use.

[Predictors and Effects of Cannabis-Related Legal Investigations]. / Prädiktoren und Auswirkungen von Ermittlungsverfahren wegen Cannabis.

BACKGROUND AND OBJECTIVE: In 2018, 218,660 cases of cannabis-related legal investigations were registered by the German police. In the present study, predictors and effects of cannabis-related legal investigations are investigated. METHODS: Retrospective cohort study with 10,432 subjects between 15 and 46 years of age (M=22.2 years, SD=4.8) of which 54.6% were male. The sample recruitment took place in 2018 over social media. The online questionnaire included potential predictors and as outcome measures mental health, social status, unemployment, income, and problematic cannabis and alcohol use. RESULTS: A total of 9,246 subjects (88.6%) had consumed cannabis in their lifetime. A cannabis-related legal investigation had been initiated against 1,736 subjects (18.8%). These individuals were more likely to be male, older, less likely to achieve A-levels, scored higher on sensation seeking, were more likely to report ADHD, started cannabis use earlier, and had higher levels of all cannabis use variables. No significant associations were found between cannabis-related legal investigations and the level of income, unemployment, mental health or subjective social status. Of the never or former consumers, 63.4 and 44.8%, respectively, reported that fear to get into trouble with the law was a reason for non-use. CONCLUSION: There was no evidence that cannabis-related legal investigations had any impact on the current life or health situation. Fears of getting into trouble with the law were particularly relevant for people who had never used, or were currently not using cannabis.

[Alcohol use before the age of 14: marker variable or independent risk factor?] / Alkoholkonsum vor dem 14. Lebensjahr: Markiervariable oder unabhängiger Risikofaktor?

BACKGROUND: Even if the legal age for alcoholic beverages in Germany is 16 or 18, the majority of young people have tried alcohol before this age. Parents are a frequent source of supply, especially for small amounts of alcohol ("sipping"). AIM OF THE WORK: To investigate whether trying small amounts of alcohol is an independent predictor for binge drinking initiation. MATERIAL AND METHODS: A longitudinal analysis was carried out with 2566 students from 6th to 8th grade from thirteen German federal states (survey period 2018 to 2020). Inclusion criteria were an age of 13 years or younger and had never drunk a full drink of alcohol. The main study parameter was the first binge drinking event within 12 months. RESULTS: Of the respondents, 35.9% stated that they had already tried alcohol but had not yet drunk a whole drink, while 64.1% had not yet had any experience with alcohol. After 12 months, those who had tried alcohol stated more often that they had already practiced binge drinking. This relationship persisted even after all study variables associated with binge drinking were controlled including age, type of school, sensation seeking, smoking, consumption of energy drinks and coffee, media time, sleep duration, hyperactivity, and behavior problems (adjusted odds ratio = 2.33; 95% CI 1.64-3.31). DISCUSSION: There was an independent association between prematurely trying alcohol and the onset of binge drinking. The findings are in line with those of other studies that question the practice of early alcohol exposure. However, further studies are necessary to establish a causal relationship.

[Risk factors for risky cannabis use : A retrospective cohort study of 7671 cannabis users]. / Risikofaktoren für einen riskanten Cannabiskonsum : Eine retrospektive Kohortenstudie mit 7671 Cannabisnutzern.

BACKGROUND: Cannabis use is widespread in Germany. So far little is known about which factors are predictive for the development of risky cannabis use. METHODS: A retrospective cohort study was conducted. Via social networks 7671 cannabis users (mean age = 21.8 years, standard deviation (SD) = 4.5 years) were recruited (59.3% male). The end point of the online study was risky cannabis use, which was assumed with a cut-off >3 of the Severity of Dependence Scale (SDS). Predictors were gender, age, migration status, sensation seeking, a diagnosis of attention deficit hyperactivity disorder (ADHD), the age of first use and the prevalence of cannabis use in school time. In addition, characteristics of the parental home were surveyed, such as socioeconomic status, parenting style, the relationship with the parents, and mental health of the parents. RESULTS: Risky cannabis use was reported by 29.7% of the sample. The following risk factors predicted risky cannabis use: male gender (adjusted risk ratio, ARR: 1.25), higher age (ARR: 1.01), migration status (ARR: 1.13), higher sensation seeking (ARR: 1.08), earlier onset of cannabis use (ARR: 0.94), more frequent cannabis use among peers during school time (ARR: 1.21), unstable relationship with parents (ARR: 0.97), and lower parental mental health (father: ARR: 0.98; mother: ARR: 0.96). No associations could be found for a diagnosis of ADHD, parental socioeconomic status and parenting style. CONCLUSION: Potentially influenceable risk factors for risky cannabis use are relationship quality in the parental home and early onset of cannabis use.

Energy drink consumption among German adolescents: Prevalence, correlates, and predictors of initiation.

BACKGROUND: Energy drinks (EDs) have become popular worldwide. Despite growing concerns about negative health effects of ED, they are increasingly popular among adolescents, yet little is known about the context and patterns of ED use in adolescents. OBJECTIVE: This study examined the prevalence and correlates of ED use as well as initiation rates and predictors among German adolescents over a one-year period. DESIGN: A school-based longitudinal study of 6902 adolescents ages 9-19 years was conducted in 44 schools in six Federal states of Germany in 2016-2018. Demographics, ED use, drug use behavior, advertising exposure, intrapersonal, interpersonal, and community factors were assessed. RESULTS: Lifetime ED use was reported by 61.7% of the participants, while 21.4% reported past 30-day use. In two multilevel models, lifetime and past 30-day ED use were positively associated with male sex, older age, drug use, poor dietary habits, higher BMI, sensation seeking, worse school performance, and more frequent ad exposure (p < .01). One quarter of the non-users initiated ED use in 12 months. ED initiation was positively associated with male sex (AOR, 1.50 [95% CI, 1.11-2.03]), greater sensation seeking traits (AOR, 1.25 [95% CI, 1.08-1.43]), more frequent ED ad exposure (AOR, 1.31 [95% CI, 1.12-1.53]), and curiosity about trying EDs (AOR, 2.31 [95% CI, 1.74-3.07]), while inversely associated with better school performance (AOR, 0.84, [95% CI, 0.73-0.97]) and attending a gymnasium-type school (AOR, 0.69 [95% CI, 0.50-0.96]). CONCLUSIONS: ED consumption is common among German adolescents. The association between EDs and negative health and lifestyle outcomes and risky behaviors is concerning. Parents, school officials, and healthcare providers should be aware of signs and consequences of excessive ED consumption and limit their use by adolescents. Adopting policies that limit the direct marketing to minors under the age of 18 years can be also beneficial in curbing this epidemic.

[Prediction of binge drinking in young adults: a cohort study over nine years]. / Vorhersage des Rauschtrinkens im jungen Erwachsenenalter: Eine Kohortenstudie über 9 Jahre.

Prediction of binge drinking in young adults: a cohort study over nine years Abstract. OBJECTIVE: Which person characteristics and environmental factors predict binge drinking at age 21? METHOD: A longitudinal observational study with a nine-year follow-up. A total of 5,176 adolescents from the German states Schleswig-Holstein and Saxony-Anhalt were surveyed in 2006 with paper-pencil questionnaires (mean age 12.6 years, SD = 0.6). A follow-up assessment was conducted in the year 2015. Baseline predictors were age, gender, school type, school performance, parenting style, early experience with alcohol, alcohol use of parents, alcohol use of friends, and sensation seeking. Primary outcome in 2015 was binge drinking at least once a month (six or more alcoholic drinks during one drinking occasion). RESULTS: A subsample of 1,087 (20.9 %) of the former students could be surveyed nine years after baseline (mean age 21.6 years, SD = 0.8). One out of four (25.4 %) reported binge drinking at least once in a month. A multiple regression model revealed three significant predictors of binge drinking: male gender, early experience with alcohol and frequency of parental alcohol use at baseline. CONCLUSIONS: Perceived frequency of parental alcohol use might be an important risk factor for children's alcohol use in early adulthood. Parents need to reflect their role as alcohol-specific socialization agents.

Did limits on payments for tobacco placements in US movies affect how movies are made?

OBJECTIVE: To compare how smoking was depicted in Hollywood movies before and after an intervention limiting paid product placement for cigarette brands. DESIGN: Correlational analysis. SETTING/PARTICIPANTS: Top box office hits released in the USA primarily between 1988 and 2011 (n=2134). INTERVENTION: The Master Settlement Agreement (MSA), implemented in 1998. MAIN OUTCOME MEASURES: This study analyses trends for whether or not movies depicted smoking, and among movies with smoking, counts for character smoking scenes and average smoking scene duration. RESULTS: There was no detectable trend for any measure prior to the MSA. In 1999, 79% of movies contained smoking, and movies with smoking contained 8 scenes of character smoking, with the average duration of a character smoking scene being 81 s. After the MSA, there were significant negative post-MSA changes (p<0.05) for linear trends in proportion of movies with any smoking (which declined to 41% by 2011) and, in movies with smoking, counts of character smoking scenes (which declined to 4 by 2011). Between 1999 and 2000, there was an immediate and dramatic drop in average length of a character smoking scene, which decreased to 19 s, and remained there for the duration of the study. The probability that the drop of -62.5 (95% CI -55.1 to -70.0) seconds was due to chance was p<10-16. CONCLUSIONS: This study's correlational data suggest that restricting payments for tobacco product placement coincided with profound changes in the duration of smoking depictions in movies.

Exposure to Gambling Advertisements and Gambling Behavior in Young People.

A cross-sectional survey of 4617 adolescents and young adults from 38 schools in two German states was conducted in 2014 to assess the association between gambling advertisements and gambling behavior. Exposure to ten gambling advertisements was measured with masked ad images; students indicated contact frequency and brand recall. Main outcomes were several gambling behaviors including probable pathological gambling assessed with the South Oaks Gambling Screen (SOGS ≥ 5). A total of 65.4 % of the students reported gambling at least once in their life; 42.2 % gambled in the last 12 months; 6.9 % gambled in the last week, and 2.8 % reported probable pathological gambling. The average frequency that one of the selected ads had been seen at least once was 29.5 %, the average brand recall rate was 9.4 %. After adjustment for confounding, multilevel mixed-effects logistic regressions revealed that high gambling ad exposure was positively related to all assessed gambling outcomes, with the strongest association for weekly gambling. Future studies need to clarify the temporal sequence and specificity of these associations.

[Use of Psychotropic Substances and Satisfaction with Vocational Education]. / Konsum psychotroper Substanzen und Ausbildungszufriedenheit.

Objective: The aim of this study was to investigate if there is an independent association between substance use and satisfaction in vocational education. Methods: A cross-sectional study of 5 688 first-year apprentices from 49 vocational schools, mean age 19.4 years (SD=3.9 years) was undertaken. Data were analysed using multilevel linear regression analysis. Predictors were use of tobacco, alcohol, cannabis and pharmaceuticals as well as personal characteristics (sex, age, migration background, educational level, financial status, chronic diseases, psychological distress, physical activity, media use, personality) and vocational/firm characteristics (firm size, number of apprentices, perceived quality of mentoring, amount of pay, vocational field, working conditions, over- and underload, housing situation, number of previous apprenticeships, first choice). Vocational satisfaction was used as primary outcome. Results: Satisfaction was most strongly associated with perceived quality of mentoring, judgement that the chosen education was first choice and working climate in the training company. In addition, only problematic alcohol use remained significant in the multivariate analysis. There was no association in the adjusted model between vocational satisfaction and daily tobacco use or problematic use of cannabis and pharmaceuticals. Conclusions: Results suggest that problematic alcohol use could be an independent risk factor for problems in vocational education.

Content Themes of Alcohol Advertising in U.S. Television-Latent Class Analysis.

BACKGROUND: There is little alcohol research that reports on the thematic contents of contemporary alcohol advertisements in U.S. television. Studies of alcohol ads from 2 decades ago did not identify "Partying" as a social theme. Aim of this study was to describe and classify alcohol advertisements aired in national television in terms of contents, airing times, and channel placements and to identify different marketing strategies of alcohol brands. METHODS: Content analysis of all ads from the top 20 U.S. beer and spirit brands aired between July 2009 and June 2011. These were 581 unique alcohol ads accounting for 272,828 (78%) national television airings. Ads were coded according to predefined definitions of 13 content areas. A latent class analysis (LCA) was conducted to define content cluster themes and determine alcoholic brands that were more likely to exploit these themes. RESULTS: About half of the advertisements (46%) were aired between 3 am and 8 pm, and the majority were placed either in Entertainment (40%) and Sports (38%) channels. Beer ads comprised 64% of the sample, with significant variation in airing times and channels between types of products and brands. LCA revealed 5 content classes that exploited the "Partying," "Quality," "Sports," "Manly," and "Relax" themes. The partying class, indicative of ad messages surrounding partying, love, and sex, was the dominant theme comprising 42% of all advertisements. Ads for alcopops, flavored spirits, and liqueur were more likely to belong to the party class, but there were also some beer brands (Corona, Heineken) where more than 67% of ads exploited this theme. CONCLUSIONS: This is the first analysis to identify a partying theme to contemporary alcohol advertising. Future analyses can now determine whether exposure to that or other themes predicts alcohol misuse among youth audiences.

Comparison of tobacco and alcohol use in films produced in Europe, Latin America, and the United States.

BACKGROUND: Studies that have evaluated tobacco and alcohol portrayals in films have mainly focused on US films. Our aim is to describe tobacco and alcohol portrayals in nationally produced films from six European and two Latin American countries, and compare them with US produced films. METHODS: A sample of 337 nationally produced and 502 US produced films, consisting of top grossing films from 2004 to 2009 in each country, was content coded for presence of tobacco or alcohol and seconds of tobacco or alcohol use. Logistic and linear regression models were estimated for all films and youth-rated films (Ages 0-14) to assess cross country differences in tobacco and alcohol content, with US films as the reference category. RESULTS: Domestically produced films from several countries were more likely than US films to contain any tobacco use both overall (Iceland (OR = 9.29, CI: 1.22-70.89), Italy (OR = 3.58, CI: 1.72-7.43), Argentina (OR = 5.06, CI: 2.13-12.03), Mexico (OR = 4.87, CI: 2.17-10.90)) and for youth-rated films (Germany (OR = 2.24, CI: 1.21-4.16), Iceland (OR = 13.79, CI: 1.80-105.5), Italy (OR = 5.31, CI: 2.54-11.1), and Argentina (OR = 6.9, CI: 0.88-1.34)). Models for alcohol showed few differences compared to US, regardless of rating. Linear regression models for seconds of use in films with tobacco indicated that only Argentine films had more seconds of smoking than US films, regardless of the rating category. For films with alcohol use, Mexican films had higher seconds of alcohol use than US films. CONCLUSIONS: Smoking was more commonly depicted in films produced outside the US, however there were few differences in the means for smoking screen time in films that contained smoking. This may be partly explained by the prohibition of tobacco product placement in the US. Countries should consider banning paid placement of both products and eliminating subsidies for films with content that promotes tobacco and alcohol use.

Long-term effects of a lifestyle modification program for men with obesity delivered in German football clubs.

This study examined the long-term effects of a lifestyle modification program delivered at German Bundesliga football clubs. Weekly 90-minute group sessions over 12 weeks combined health education and physical activity and were delivered by coaches affiliated with the football clubs. A total of 371 men (mean age 49.7 years [SD = 7.6]) attended 41 classes at 19 clubs in 2017 and 2018 and participated in the long-term follow-up. Primary outcome was weight-loss at follow-up with a mean observation period of 20.4 months after baseline. Measures were taken partly by research staff and partly by participants themselves. At baseline, the men had a mean weight of 111.3 kg (SD = 16.9). Three months after baseline (posttest), the men had lost a mean of 6.3 kg (95% CI: 5.7-6.9). From posttest to follow-up, growth curve model showed men lost an average of 0.8 kg (95% CI: 0.2-1.4). Weight regain from posttest to follow-up of at least 3% was observed in 75 participants (20.2%) and was associated with less improvement in vegetable consumption in an adjusted logistic regression model. The data suggest that participation in a male-only lifestyle modification program offered by German football clubs may lead to sustained weight loss, but lack of a randomized control group and drop-outs prevent generalization of the results.

Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial.

BACKGROUND: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app ("Meine Zeit ohne") has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. OBJECTIVE: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants' characteristics, and (3) to study how variations in app use were related to participants' baseline characteristics. METHODS: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection ("congruent use": eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. RESULTS: The intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. CONCLUSIONS: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users' characteristics. TRIAL REGISTRATION: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-022-06231-x.