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INTRODUCTION: In 2013, a new federal law obligated all German federal states to collect additional clinical data in population-based cancer registries as an active tool for monitoring and improving the quality of cancer care, increasing transparency and promoting health research. Now, 10 years later, the current status of the expanded cancer registration is presented, including current figures on cancer in Germany. METHODS: Reporting of cancer is mandatory for physicians, and about 5 to 10 reports from different healthcare providers are expected for each case. A uniform national dataset of about 130 items is used, and reports are usually sent electronically to the registry. We used the most recent data available from cancer registries up to the year of diagnosis in 2019. We calculated incidence rates and 5-year relative survival (5YRS) for common cancers. Data on clinical outcomes and benchmarking based on quality indicators (QIs) from guidelines were provided by the Cancer Registry Schleswig-Holstein (CR SH). RESULTS: All federal state cancer registries met most of the previously defined national eligibility criteria. Approximately 505,000 cancer cases were registered in 2019, with breast, prostate, colorectal and lung cancer being the most common cancers. The age-standardised cancer incidence has slightly decreased during the last decade. and spatial heterogeneity can be observed within Germany. 5YRS for all cancers was 67% and 63% for women and men, respectively. Therapy data for rectal cancer in 2019-2021 from the CR SH are shown as an example: 69% of the registered patients underwent surgery, mostly with curative intent (84%) and tumour-free resection (91%). Radiotherapy was given to 33% of the patients, and chemotherapy was given to 40%. Three selected QIs showed differences between involved healthcare providers. DISCUSSION: The implementation of population-based clinical cancer registration can be considered a success. Comprehensive recording of diagnosis, treatment and disease progression and the use of registry data for quality assurance, benchmarking and feedback have been implemented.
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BACKGROUND: Colorectal cancer (CRC) is one of the most common types of cancer in Western civilization and responsible for a high number of yearly deaths. Long-term outcome is influenced by many factors, potentially including socioeconomic aspects like income, education, and employment. Furthermore, annual surgical case volume plays a major role in achieving good oncological results. In our retrospective study, we evaluated the effect of socioeconomic deprivation and hospital volume on overall survival (OS) in the federal state of Saxony, Germany. METHODS: All patients with CRC who underwent surgery in Saxony, Germany between 2010 and 2020 and were living in Saxony at the time of diagnosis were included in our retrospective analysis. Uni- and multivariate analyses were conducted considering age, sex, tumor localization, UICC tumor stage, surgical approach (open/laparoscopic), number of resected lymph nodes, adjuvant chemotherapy, year of surgery, and hospital case volume. In addition, our model was adjusted for social disparity using the German Index of Socioeconomic Deprivation (GISD). RESULTS: A total of 24,085 patients were analyzed (15,883 with colon cancer and 8,202 with rectal cancer). Age, sex, UICC tumor stage and tumor localization were distributed as expected for CRC. Median overall survival time was 87.9 months for colon cancer and 110.0 months for rectal cancer. Univariate analysis revealed laparoscopic surgery (colon and rectum P < 0.001), high case volume (rectum: P = 0.002) and low levels of socioeconomic deprivation (colon and rectum P < 0.001) to be significantly associated with better survival. In multivariate analyses, the associations of laparoscopic surgery (colon: HR = 0.76, P < 0.001; rectum: HR = 0.87, P < 0.01), and mid-low to mid-high socioeconomic deprivation (colon: HR = 1.18-1.22, P < 0.001; rectum: HR = 1.18-1.36, P < 0.001-0.01) remained statistically significant. Higher hospital case volume was associated with better survival only in rectal cancer (HR = 0.89; P < 0.01). CONCLUSION: In Saxony, Germany, better long-term survival after CRC surgery was associated with low socioeconomic deprivation, laparoscopic surgery and partly with high hospital case volume. Thus, there is a need to reduce social differences in access to high-quality treatment and prevention and increase hospital patient volume.
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Neoplasias del Colon , Neoplasias Colorrectales , Laparoscopía , Neoplasias del Recto , Humanos , Neoplasias Colorrectales/patología , Estudios Retrospectivos , Neoplasias del Recto/patología , Neoplasias del Colon/cirugía , Hospitales , Factores SocioeconómicosRESUMEN
BACKGROUND: In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff. METHODS: The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory-European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished. RESULTS: Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen's kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM. CONCLUSIONS: While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005035 . Registered 03/06/2013.
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Alcoholismo , Cuidados Posteriores , Alcoholismo/diagnóstico , Alcoholismo/terapia , Humanos , Motivación , Atención Dirigida al Paciente , Derivación y ConsultaRESUMEN
OBJECTIVES: The aim of this study was to assess penile cancer incidence, clinical characteristics, treatment options, transparency of clinical quality, and relative survival based on data from the clinical cancer registry. SUBJECTS AND METHODS: A total of 898 patients with tumours of the penis were diagnosed and analysed in the period from 2000 to 2018; they were documented in the 4 regional clinical cancer registries and summarized in the Command Office of these 4 registries. RESULTS: The standardized incidence rate increased from 0.86 in 2000 to 2.67 in 2018. Most tumours were located at the glans (42.9%) followed by the prepuce (19.5%) and corpus penis (6.9%); they were classified into pT1a/pT1b (20.0%/7.0%), pT2 (23.5%), pT3 (12.4%), and pT4 (0.8%). In only 32.0% of all documented cases, a stage-related lymphadenectomy (LND) was carried out. Negative surgical margins were found in only 70% and the Rx status in 15.1%. Primary metastasis was detected in pN1 (5.1%), pN2 (3.9%), pN3 (3.1%), and M1 status in 3.0%, respectively. The predominant therapy was surgery in 78.3%. The proportion of penile partial resections was significantly (p = 0.0045) regredient over the control period. Adjuvant chemotherapy was performed in 4.7%, adjuvant external-beam radiotherapy in 3.0%. The 5-year relative overall survival rate was 74.7% and ranged from 108.0% (stage 0) to 17.1% (stage IV). A total of 29 hospitals performed tumour operations. CONCLUSIONS: The multitude of clinical and epidemiological variables available in clinical cancer registries allows a safe assessment of tumour dynamics themselves, as well as good quality of transparency and broadly acceptable guideline adherence. Deviations from the accepted level of evidence were found in the grading definition, in the high quota of positive surgical margins, in the defensive indication position to the glans resurfacing/reconstruction and diagnostical LND. Based on these relevant findings in the database combined with the low frequency of the tumour in area/clinics/year, we recommended establishing SCCP reference clinics. This work is the first time that European standardized rate-based cancer registry data on penile cancer from Germany has been communicated.
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Neoplasias del Pene , Alemania/epidemiología , Humanos , Escisión del Ganglio Linfático , Masculino , Neoplasias del Pene/epidemiología , Neoplasias del Pene/patología , Neoplasias del Pene/terapia , Pene/patología , Pene/cirugía , Tasa de SupervivenciaAsunto(s)
COVID-19 , Neoplasias , Humanos , Neoplasias/epidemiología , Pandemias , Sistema de Registros , SARS-CoV-2RESUMEN
INTRODUCTION: The ageing of baby boomers is expected to confront addiction care with new challenges. This cohort had greater exposure to psychoactive substances in youth than earlier cohorts. In this study, we aimed to investigate whether Berlin addiction care is confronted with a sustained change in its clientele initiated by the baby boomers. METHODS: Using data from Berlin outpatient addiction care facilities, we contrasted type of primary substance use disorder and number of comorbid substance use disorders in baby boomers with an earlier and a later cohort. To isolate cohort effects, two-level random intercept regression models were applied in the overlapping age groups of the baby boomer cohort with each of the other cohorts. RESULTS: Compared with the earlier cohort, alcohol use disorder lost importance whereas illicit substance use disorder gained importance in the baby boomers. Baby boomers presented a higher number of comorbid substance use disorders than the earlier cohort. Comparing baby boomers with the later cohort, these relationships pointed in the opposite direction. DISCUSSION AND CONCLUSIONS: Outpatient addiction care faces a sustained change to more illicit and comorbid substance use disorders. With increasing life expectancy and the ageing of baby boomers marked by higher substance use than previous cohorts, older clients, who had been under-represented in outpatient addiction care, will gain relevance. Hence, addiction care has to adapt its offers to appropriately meet the changing needs of its clientele.
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Crecimiento Demográfico , Trastornos Relacionados con Sustancias , Adolescente , Berlin/epidemiología , Estudios de Cohortes , Humanos , Pacientes Ambulatorios , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapiaRESUMEN
BACKGROUND: Previous studies on lifestyle risk factors mainly focused on age- or gender-specific differences. However, lifestyle risk factors also vary across regions. Aim of the present study was to examine the extent to which prevalence rates of SNAP (smoking, nutrition, alcohol consumption, physical activity) vary between East and West Germany or North and South Germany. METHODS: Data came from the population-representative 2015 Epidemiological Survey of Substance Abuse (ESA) comprising 9204 subjects aged 18 to 64 years. To assess an east-west or south-north gradient, two binary logistic regression models were carried out for each SNAP factor. RESULTS: The logistic regression models revealed statistically significant differences with higher rates of at-risk alcohol consumption and lower rates of unhealthy nutrition in East Germany compared to West Germany. Significant differences between North and South Germany were found for at-risk alcohol consumption with higher rates of at-risk alcohol consumption in South Germany. Daily smoking and low physical activity were equally distributed across regions. CONCLUSIONS: The implementation of measures reducing at-risk alcohol consumption in Germany should take the identified east-west and south-north gradient into account. Since the prevalence of unhealthy nutrition was generally high, prevention and intervention measures should focus on Germany as a whole instead of specific regions.
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Consumo de Bebidas Alcohólicas/epidemiología , Dieta/estadística & datos numéricos , Ejercicio Físico , Fumar/epidemiología , Adolescente , Adulto , Estudios Transversales , Femenino , Alemania/epidemiología , Alemania Oriental/epidemiología , Alemania Occidental/epidemiología , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Placement matching guidelines are promising means to optimize patient-centered care and to match patients' treatment needs. Despite considerable research regarding placement matching approaches to optimize alcohol abuse treatment, findings are inconclusive. OBJECTIVES: To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usual referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under- or overmatched. METHODS: Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment. SETTING: Four German psychiatric clinics offering a 7-21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence. PARTICIPANTS: From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127). INTERVENTION: The PCPM were applied to patients of the IG by feeding back a recommendation to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request. MEASUREMENTS: The MATE, the Client Socio-Demographic and Service Receipt Inventory--European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models. RESULTS: In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio [IRR] 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients. CONCLUSIONS: While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.
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Alcoholismo/rehabilitación , Evaluación de Necesidades , Atención Dirigida al Paciente , Derivación y Consulta , Cuidados Posteriores , Consumo de Bebidas Alcohólicas/psicología , Femenino , Alemania , Investigación sobre Servicios de Salud , Hospitalización/economía , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana EdadAsunto(s)
Consumo de Bebidas Alcohólicas/tendencias , Autoinforme , Clase Social , Adolescente , Adulto , Factores de Edad , Estudios de Cohortes , Femenino , Alemania , Humanos , Masculino , Prevalencia , Adulto JovenRESUMEN
AIM: Estimates of e-cigarette consumption in Germany vary considerably. The use of e-cigarettes for tobacco cessation is critically discussed. Based on current data, the distribution of the consumption of e-cigarettes and their use in the adult general population of Germany will be presented. METHODS: The 2015 Epidemiological Survey of Substance Abuse, a nationwide survey of 18 to 64 year-old people in Germany (n=9,204, response rate: 52,2%), was used as data basis. RESULTS: E-cigarettes were known to most of the respondents (85,3%, 43,5 Mio.), whereas only 2,9% (1,5 Mio.) used e-cigarettes in the last 30 days. Higher risk of consuming e-cigarettes was seen in younger people (OR=0,95, 95%-KI=(0,93; 0,97)), men (OR=1,45, 95%-KI=(1,02; 2,07)) and smokers (OR=12,53, 95%-KI=(8,71; 18,03)). About a third of smokers and ex-smokers of conventional cigarettes (36,6%) who consumed e-cigarettes used these for tobacco cessation of which one fifth (21,3%) was able to quit smoking. CONCLUSION: E-cigarette users seem to be more likely to be male, younger and smokers of conventional cigarettes. In addition to curiosity, the change in smoking behavior is an important motive for consumption. The results indicate that the use of e-cigarettes can contribute to tobacco cessation, the majority of users, however, continue to consume conventional and/or e-cigarettes.
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Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar , Trastornos Relacionados con Sustancias , Adolescente , Adulto , Anciano , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: Lifestyle risk factors, such as drinking or unhealthy diet, can expotentiate detrimental health effects. Therefore, it is important to investigate multiple lifestyle risk factors instead of single ones. The study aims at: (1) identifying patterns of lifestyle risk factors within the adult general population in Germany and (2) examining associations between the extracted patterns and external factors. DESIGN: Cross-sectional study. SETTING: General German adult population (aged 18-64 years). PARTICIPANTS: Participants of the 2015 Epidemiological Survey of Substance Abuse (n=9204). PRIMARY OUTCOME MEASURES: Lifestyle risk factors (daily smoking, at-risk alcohol consumption, unhealthy diet, low physical activity, weekly use of pharmaceuticals, as well as consumption of cannabis and other illicit drugs). RESULTS: A latent class analysis was applied to identify patterns of lifestyle risk factors, and a multinomial logistic regression was carried out to examine associations between the extracted classes and external factors. A total of four classes were extracted which can be described as healthy lifestyle (58.5%), drinking lifestyle (24.4%), smoking lifestyle (15.4%) and a cumulate risk factors lifestyle (1.7%). Individuals who were male, at younger age and single as well as individuals with various mental health problems were more likely to show multiple lifestyle risk factors. CONCLUSIONS: Healthcare professionals should be aware of correlations between different lifestyle risk factors as well as between lifestyle risk groups and mental health. Health promotion strategies should further focus especially on younger and single men.
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Estilo de Vida , Trastornos Mentales/epidemiología , Adolescente , Adulto , Factores de Edad , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Estudios Transversales , Dieta , Divorcio , Escolaridad , Femenino , Alemania/epidemiología , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Mal Uso de Medicamentos de Venta con Receta/efectos adversos , Mal Uso de Medicamentos de Venta con Receta/estadística & datos numéricos , Factores de Riesgo , Conducta Sedentaria , Factores Sexuales , Persona Soltera , Fumar/efectos adversos , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The perception that ecigarettes are less harmful than traditional tobacco products can influence the consumption of ecigarettes. OBJECTIVES: Three questions were examined: (1) How do different population groups perceive health risks of ecigarettes? (2) Do sociodemographic variables explain differences in the risk assessment of ecigarettes? (3) Does the perception of health risks predict the use of ecigarettes for smoking cessation? METHODS: Data came from the 2015 Epidemiological Survey of Substance Abuse (ESA) with a sample size of nâ¯= 9204 participants, aged 18 to 64 years (response rate 52.2%). Data were collected by telephone, online, or by written questionnaires. Assessments of risk perception of ecigarettes and conventional cigarettes (more harmful, just as harmful, less harmful, do not know) were compared. Descriptive statistics and logistic regressions were performed. RESULTS: Individuals with lower education rated ecigarettes as more harmful. Older people and women perceived ecigarettes as just as harmful. Smokers considered ecigarettes to be more harmful than or just as harmful as conventional tobacco products. The likelihood of using ecigarettes for smoking cessation was higher if people thought they were less harmful than conventional cigarettes. CONCLUSIONS: Only one-third of the population knows that ecigarettes are less harmful to health than conventional cigarettes. The perception of health risks is related to the usage of ecigarettes for smoking cessation.
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Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Alemania , Conocimientos, Actitudes y Práctica en Salud , Humanos , Persona de Mediana Edad , Percepción , Encuestas y Cuestionarios , Adulto JovenRESUMEN
AIMS: Shared decision making (SDM) is increasingly demanded in medical decision making. SDM acknowledges patients' role preferences in decision making processes. There has been limited research on SDM and role preferences in substance use disorders; results are promising. Aim of this study was to investigate role preferences of patients with alcohol use disorders (AUD), and to identify predictors of these preferences. METHOD: Cross-sectional data collected from June 2013 to May 2014 in four detoxification wards in Germany during a randomised controlled trial (RCT, Registration Code 01GY1114) was analysed. Of the 250 patients with AUD who were included in the RCT, data from 242 patients [65% male; mean ageâ¯=â¯45.2â¯years (sdâ¯=â¯10.3)] were analysed. Participants' role preferences were assessed with the Control Preference Scale. Potential correlates were drawn from instruments used in the RCT; multinomial logistic regression was used. RESULTS: 90% (nâ¯=â¯217) of the AUD patients preferred an active or shared role in decision-making, 10% (nâ¯=â¯25) preferred a passive role. Patients' desire for help was associated with their role preference (ORâ¯=â¯3.087, pâ¯=â¯.05). The model's goodness of fit was Nagelkerke's R2â¯=â¯0.153 [χ2 (24)â¯=â¯25.206, pâ¯=â¯.395]. CONCLUSIONS: Patients' preference for an active role in decision-making underscores the importance of involving patients in their treatment planning. Patients' desire for help seems to be an important determinant of paternalistic decision making. However, further research is needed to determine whether patients' role preferences are related to their behavior during their treatment referral and recovery.
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Alcoholismo/rehabilitación , Participación del Paciente , Prioridad del Paciente , Adulto , Anciano , Estudios Transversales , Toma de Decisiones , Femenino , Alemania , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
AIMS: To estimate temporal trends in adolescents' current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence. DESIGN AND SETTING: Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]. PARTICIPANTS: A total of 223 814 male and 211 712 female 15-16-year-old students. MEASUREMENTS: Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi-level mixed-effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion. FINDINGS: Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time. CONCLUSIONS: Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence.
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Conducta del Adolescente , Consumo Excesivo de Bebidas Alcohólicas/tendencias , Fumar Cigarrillos/tendencias , Uso de la Marihuana/tendencias , Consumo de Alcohol en Menores/tendencias , Adolescente , Peninsula Balcánica/epidemiología , Consumo Excesivo de Bebidas Alcohólicas/epidemiología , Fumar Cigarrillos/epidemiología , Europa (Continente)/epidemiología , Europa Oriental/epidemiología , Femenino , Humanos , Masculino , Uso de la Marihuana/epidemiología , Consumo de Alcohol en Menores/estadística & datos numéricosRESUMEN
BACKGROUND: The abuse of new psychoactive substances (NPS) and methamphetamine has severe adverse effects. Here we provide the first report of regional patterns in NPS and methamphetamine consumption in Germany, on the basis of epidemiologic data from six federal states (Bavaria, Hamburg, Hesse, North Rhine-Westphalia, Saxony, and Thuringia). METHODS: Data were derived from the 2015 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey) and supplemented with additional cases from the federal states that were studied. The numbers of persons included in the representative samples of persons aged 18 to 64 in each state were 1916 (Bavaria), 1125 (Hamburg), 1151 (Hesse), 2008 (North Rhine-Westphalia), 1897 (Saxony), and 1543 (Thuringia). Potential risk factors for the lifetime prevalence of consumption were studied by logistic regression. RESULTS: The lifetime prevalence of methamphetamine consumption in the individual states ranged from 0.3% (North Rhine-Westphalia) to 2.0% (Saxony). Thuringia and Saxony displayed values that were significantly higher than average. For NPS, the figures ranged from 2.2% (Bavaria) to 3.9% (Hamburg), but multivariate analysis revealed no statistically significant differences between the states. Higher age and higher educational level were associated with lower consumption of NPS and methamphetamine, while smoking and cannabis use were each associated with higher consumption. CONCLUSION: NPS consumption is equally widespread in all of the federal states studied. Methamphetamine is rarely consumed; its consumption appears to be higher in Saxony and Thuringia. The risk factor analysis reported here should be interpreted cautiously in view of the low case numbers with respect to consumption.
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Trastornos Relacionados con Anfetaminas/epidemiología , Estimulantes del Sistema Nervioso Central/efectos adversos , Consumidores de Drogas/estadística & datos numéricos , Metanfetamina/efectos adversos , Detección de Abuso de Sustancias/estadística & datos numéricos , Adulto , Estimulantes del Sistema Nervioso Central/administración & dosificación , Femenino , Alemania/epidemiología , Humanos , Modelos Logísticos , Masculino , Metanfetamina/administración & dosificación , Persona de Mediana Edad , Prevalencia , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND AND AIMS: Several indicators suggest that the extent and trends of alcohol-related mortality differ between East and West Germany. Regional drinking patterns and differences in health-care systems are assumed to affect the risk of dying from an alcohol-induced disease. The study addresses two questions: (1) what are the unbiased and independent age, period and cohort effects on alcohol-related mortality trends in Germany; and (2) do these trends differ between East and West Germany? METHODS: Data on alcohol-related mortality for East and West Germany came from the national causes of death register for the years 1980-2014. Analyses included all deaths fully attributable to alcohol based on the International Classification of Diseases (ICD-9 and ICD-10). Gender-stratified age-period-cohort analyses were conducted using the intrinsic estimator model. RESULTS: Age effects showed a concave pattern with a peak at ages 55-64 years in both regions. Incidence rate ratios (IRR) in East Germany were highest in the years 1990-1994 (men and women: IRR = 1.52) and declined thereafter. In West Germany, IRR were lowest in 1980-1984 (men: IRR = 0.81, women: IRR = 0.75) and stabilized at approximately 1.10 since 1995-1999. Cohort effects showed continuously lower IRR for those born after 1955-1959 in the East and those born after 1945-1949 in the West. Patterns for males and females were comparable. CONCLUSIONS: The results suggest that alcohol-related mortality showed different trends in East and West Germany, which can be explained partly by different drinking patterns before and changes in the health-care system after the reunification.
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Trastornos Relacionados con Alcohol/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Alemania Oriental/epidemiología , Alemania Occidental/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Adulto JovenRESUMEN
BACKGROUND: E-cigarettes are considerably safer regarding health issues than conventional cigarettes, but there is uncertainty concerning its use for smoking cessation. OBJECTIVES: How and to what extent are Ecigarettes used by smokers willing to quit? Are Ecigarettes a useful intervention for smokers attending a group intervention for smoking cessation? MATERIALS AND METHODS: One year after attending a group intervention for smoking cessation in Germany, 637 attendants were assessed by telephone. The interview topics were the use of Ecigarettes and tobacco abstinence. RESULTS: Of the attendants that could be interviewed, 12.6% had used Ecigarettes during or after the smoking cessation intervention. At the beginning of the intervention these smokers smoked significantly more cigarettes and were more addicted to cigarettes than the other attendants. After one year significantly less Ecigarette users were abstinent compared to participants that used nicotine replacement therapy or no additional smoking cessation aids. CONCLUSIONS: The application of Ecigarettes is counterproductive for smokers looking for help in an abstinence oriented smoking cessation group. The lack of distinct, easy to follow instructions on the use of Ecigarettes as a cessation tool may impair the process of cessation. Without good guidance smokers may get distracted in their motivation and willingness to stop smoking.
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Terapia Conductista/métodos , Sistemas Electrónicos de Liberación de Nicotina , Psicoterapia de Grupo/métodos , Cese del Hábito de Fumar/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Dispositivos para Dejar de Fumar Tabaco , Adulto JovenRESUMEN
BACKGROUND: In Germany, smoking prevalence among adolescents has significantly declined since the early 2000s. However, data show that adolescent smoking rates considerably differ between different types of secondary schools. The aim of our study was to examine how educational inequalities in adolescent smoking behaviour have developed over time. METHODS: Data were used from four population-based studies (each consisting of repeated cross-sectional surveys from 2001-2015): the representative surveys of the Federal Centre for Health Education, the German Health Interview and Examination Survey for Children and Adolescents, the Health Behaviour in School-aged Children Study, and the European School Survey Project on Alcohol and Other Drugs. Each study comprised different age groups (within the age range of 11-17 years) and used different smoking measures. Adolescents' educational status was based on the attended type of secondary school. Absolute and relative educational inequalities were presented as prevalence differences and prevalence ratios, respectively. RESULTS: Despite methodical differences, all four studies similarly reveal that adolescent smoking rates have significantly declined in all educational groups. However, lower smoking rates among secondary school students attending higher educational tracks could be observed. While absolute educational inequalities tended to decrease over time, relative inequalities between educational groups remained rather stable or even increased. DISCUSSION: Declining adolescent smoking rates suggest that smoking may have lost some of its attractiveness for young people. Our findings further emphasize the importance of tobacco control measures such as raising cigarette taxes, smoking bans, and increasing minimum legal age for tobacco purchase. As relative educational inequalities in adolescent smoking rates did not diminish over time, setting- and target group-specific interventions should focus more on students in middle and lower secondary school tracks.
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Escolaridad , Prevención del Hábito de Fumar/tendencias , Fumar/tendencias , Factores Socioeconómicos , Adolescente , Niño , Estudios Transversales , Femenino , Alemania , Educación en Salud/tendencias , Encuestas Epidemiológicas , Humanos , Masculino , Fumar/epidemiologíaRESUMEN
OBJECTIVE: This study aimed to (a) investigate the relationship between drinking location and adolescent alcohol use, (b) analyze the association of drinking culture indicators with alcohol use, and (c) explore interaction effects of drinking location and drinking culture indicators. METHOD: Analyses were based on the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD). The analytical sample consisted of 15- to 16-year-old students (N = 36,366; 51.6% female) from 11 countries. Alcohol volume and perceived drunkenness were used as outcomes. Drinking location was used as predictor variable. Per capita consumption and restrictions on public drinking were used as country-level predictors. Sex-stratified generalized linear models with cluster robust standard errors were applied. RESULTS: Compared with drinking outdoors, the reported alcohol volume was lower when drinking at home and higher when drinking in multiple locations or at someone else's home. Drunkenness was highest among boys drinking at someone else's home and, compared with drinking outdoors, lower among girls drinking on premise. Per capita consumption was positively associated with alcohol volume. Among girls, the association between per capita consumption and both outcomes was stronger when drinking in multiple locations than when drinking outdoors. A ban on public drinking showed a negative effect on drinking volume and drunkenness among girls. CONCLUSIONS: The role of different drinking locations in alcohol use as well as sex differences should be considered in prevention and intervention of adolescent heavy drinking. Setting-specific prevention and intervention measures are of greater importance in medium- or high-consumption societies.
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Consumo de Alcohol en Menores/estadística & datos numéricos , Adolescente , Intoxicación Alcohólica/epidemiología , Europa (Continente) , Femenino , Humanos , Masculino , Caracteres Sexuales , Estudiantes/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
INTRODUCTION AND AIMS: This study estimates cross-country variation in socioeconomic disparities in adolescent alcohol use and identifies country-level characteristics associated with these disparities. DESIGN AND METHODS: The association between socioeconomic status (family wealth and parental education) and alcohol use (lifetime use and episodic heavy drinking) of 15- to 16-year-olds from 32 European countries was investigated. Country-level characteristics were national income, income inequality and per capita alcohol consumption. Multilevel modelling was applied. RESULTS: Across countries, lifetime use was lower in wealthy than in less wealthy families (odds ratio [OR](girls) = 0.95, OR(boys) = 0.94). The risk of episodic heavy drinking, in contrast, was higher for children from wealthier families (OR(girls) = 1.04, OR(boys) = 1.08) and lower when parents were highly educated (ORs = 0.95-0.98). Socioeconomic disparities varied substantially between countries. National wealth and income inequality were associated with cross-country variation of disparities in lifetime use in few comparisons, such that among girls, the (negative) effect of family wealth was greatest in countries with unequally distributed income (OR = 0.86). Among boys, the (negative) effect of family wealth was greatest in low-income countries (OR = 1.00), and the (positive) effect of mothers' education was greatest in countries with high income inequality (OR = 1.11). DISCUSSION AND CONCLUSIONS: Socioeconomic disparities in adolescent alcohol use vary across European countries. Broad country-level indicators can explain this variation only to a limited extent, but results point towards slightly greater socioeconomic disparities in drinking in countries of low national income and countries with a high income inequality. [Gomes de Matos E, Kraus L, Hannemann T-V, Soellner R, Piontek D. Cross-cultural variation in the association between family's socioeconomic status and adolescent alcohol use.