[Intended and unintended effects of e-cigarettes in clinical studies: a plea for (more) transparency]. / Beabsichtigte und unbeabsichtigte Wirkungen von E-Zigaretten in klinischen Studien ­ ein Plädoyer für (mehr) Transparenz.

E-cigarettes are used in clinical trials to facilitate smoking cessation. Due to the health risks associated with the use of e-cigarettes, the results of clinical trials should be fully reported, including continued exclusive use and dual use of tobacco and e-cigarettes. Nicotine cessation outcomes should be reported as the primary endpoint as well as the analysis of tobacco cessation alone. As there is currently no robust evidence that reducing cigarette consumption provides substantial health benefits, cigarette consumption reduction should not be used as a health outcome in clinical trials. Continued nicotine dependence should be included as an "adverse event" in the reporting of trial results.

[Medical societies in Germany call for a ban on flavors in e-cigarettes - A Position Paper of the German Respiratory Society (DGP) in cooperation with other professional associations and organizations]. / Medizinische Fachgesellschaften fordern ein Verbot von Aromen in E-Zigaretten.

E-cigarettes are primarily used by teenagers and young adults. Flavors in e-cigarettes increase their attractiveness and encourage young people and adults to start using them. This exposes young people in particular to the risk of nicotine addiction and various toxic substances from the aerosol of e-cigarettes. There are indications that various flavors in e-cigarettes are harmful to health, although toxicological studies are still lacking for the majority of flavors. There is a need for independent scientific investigations in this area. The scientific societies involved are calling for a ban on flavors in e-cigarettes, a ban on disposable e-cigarettes, effective regulation of the sale of e-cigarettes and effective control and implementation of the provisions for the protection of minors.

Associations of accelerometer-based sedentary bouts with adiposity markers among German adults - results from a cross-sectional study.

BACKGROUND: Long periods of uninterrupted sitting, i.e., sedentary bouts, and their relationship with adverse health outcomes have moved into focus of public health recommendations. However, evidence on associations between sedentary bouts and adiposity markers is limited. Our aim was to investigate associations of the daily number of sedentary bouts with waist circumference (WC) and body mass index (BMI) in a sample of middle-aged to older adults. METHODS: In this cross-sectional study, data were collected from three different studies that took place in the area of Greifswald, Northern Germany, between 2012 and 2018. In total, 460 adults from the general population aged 40 to 75 years and without known cardiovascular disease wore tri-axial accelerometers (ActiGraph Model GT3X+, Pensacola, FL) on the hip for seven consecutive days. A wear time of ≥ 10 h on ≥ 4 days was required for analyses. WC (cm) and BMI (kg m- 2) were measured in a standardized way. Separate multilevel mixed-effects linear regression analyses were used to investigate associations of sedentary bouts (1 to 10 min, >10 to 30 min, and >30 min) with WC and BMI. Models were adjusted for potential confounders including sex, age, school education, employment, current smoking, season of data collection, and composition of accelerometer-based time use. RESULTS: Participants (66% females) were on average 57.1 (standard deviation, SD 8.5) years old and 36% had a school education >10 years. The mean number of sedentary bouts per day was 95.1 (SD 25.0) for 1-to-10-minute bouts, 13.3 (SD 3.4) for >10-to-30-minute bouts and 3.5 (SD 1.9) for >30-minute bouts. Mean WC was 91.1 cm (SD 12.3) and mean BMI was 26.9 kg m- 2 (SD 3.8). The daily number of 1-to-10-minute bouts was inversely associated with BMI (b = -0.027; p = 0.047) and the daily number of >30-minute bouts was positively associated with WC (b = 0.330; p = 0.001). All other associations were not statistically significant. CONCLUSION: The findings provide some evidence on favourable associations of short sedentary bouts as well as unfavourable associations of long sedentary bouts with adiposity markers. Our results may contribute to a growing body of literature that can help to define public health recommendations for interrupting prolonged sedentary periods. TRIAL REGISTRATION: Study 1: German Clinical Trials Register (DRKS00010996); study 2: ClinicalTrials.gov (NCT02990039); study 3: ClinicalTrials.gov (NCT03539237).

Correlation of Acceleration Curves in Gravitational Direction for Different Body Segments during High-Impact Jumping Exercises.

Osteoporosis is a common disease of old age. However, in many cases, it can be very well prevented and counteracted with physical activity, especially high-impact exercises. Wearables have the potential to provide data that can help with continuous monitoring of patients during therapy phases or preventive exercise programs in everyday life. This study aimed to determine the accuracy and reliability of measured acceleration data at different body positions compared to accelerations at the pelvis during different jumping exercises. Accelerations at the hips have been investigated in previous studies with regard to osteoporosis prevention. Data were collected using an IMU-based motion capture system (Xsens) consisting of 17 sensors. Forty-nine subjects were included in this study. The analysis shows the correlation between impacts and the corresponding drop height, which are dependent on the respective exercise. Very high correlations (0.83-0.94) were found between accelerations at the pelvis and the other measured segments at the upper body. The foot sensors provided very weak correlations (0.20-0.27). Accelerations measured at the pelvis during jumping exercises can be tracked very well on the upper body and upper extremities, including locations where smart devices are typically worn, which gives possibilities for remote and continuous monitoring of programs.

[Fit for Two - A Study of Sedentary Behavior and Physical Activity During Pregnancy]. / Fit für Zwei ­ Eine Studie zu sitzendem Verhalten und körperlicher Aktivität in der Schwangerschaft.

BACKGROUND: In the pilot study sedentary behavior and physical activity were measured in pregnant women using an accelerometer. METHODS: A total of 32 pregnant women were enrolled in the study; eleven of them were included in the first trimester. The defined wearing periods for the accelerometer in the first, second and third trimester were weeks 9-12, 23-26, and 36-39, respectively. A self-administered survey was carried out after a 7-day measurement. RESULTS: The pregnant women were on average 30 years old, 50% were nulliparous, and 68.8% had a high school diploma. The accelerometer was worn on average of 13 hours per day. Sedentary behavior was recorded more than half of the wearing time for all trimesters. The proportion of time spent in moderate-to-vigorous activity was highest at 4.7% in the second trimester, compared to 2.5% in the first and 3.8% in the third. A proportion of women, ranging from 32% in the first, 54% in the second, and 58% in the third trimester did reach the levels of PA recommended by the guidelines. Nulliparous women in the second and third trimester spent twice as much time in moderate-to-vigorous activities compared to multiparous women. CONCLUSION: Pregnant women spent more than half of the monitored day in sedentary behaviors. Half of them did meet the recommendations for physical activity in the second and third trimester. The results show that sedentary behavior and physical activity should be considered more in clinical practice and research to motivate pregnant women to adopt a physically active lifestyle.

S3 Guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" - Short Version.

INTRODUCTION: In addition to the prevention of tobacco consumption, the establishment and assurance of high-quality treatment for harmful use and dependence on tobacco products remains an important health-related task in Germany. Regular updating of the Association of the Scientific Medical Societies (AWMF) S3 guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" (Tobacco Guideline) offers a sustainable and reputable source of knowledge on smoking cessation. METHODS: Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology (DGPPN) and the German Society for Addiction Research and Addiction Therapy (DG-Sucht), the Tobacco Guideline was revised in 2019-2020 by 63 experts, who were involved in the development process of the text, in 11 working groups. Undue influence of conflicts of interest on the guideline could be minimized through careful conflict of interest management. Delegates from 50 professional societies discussed the 80 guideline recommendations and voted online. RESULTS: In addition to recommendations for screening and diagnostics, the Tobacco Guideline takes a positive stance towards the use of low-threshold counseling and support services. If, due to the severity of the tobacco-related disorder, brief counseling, telephone counseling, or internet- or smartphone-based methods are not sufficiently effective, individual or group behavioral therapy, possibly in combination with medication, is indicated. If nicotine replacement therapy is not effective, varenicline or bupropion should be offered. Alternative strategies with a lower level of recommendation are hypnotherapy, mindfulness-based treatments, or medication with cytisine. In adolescents and pregnant women, the use of medication should be limited to well-specified exceptions and nicotine replacement. The mean agreement with the recommendations reached a value of 98%. A general overview of the treatment recommendations of the Tobacco Guideline is provided by three clinical algorithms.

The effect of a video-supported assessment to increase the accuracy of self-reported physical activity.

Self-reported physical activity differs from activity levels measured by device. We tested the effect of a video that visualizes the intensity levels of physical activity to increase the agreement between self-reported and accelerometer-based moderate-to-vigorous physical activity (MVPA) within a single-blinded, randomized study. Participants (N = 378, 40-75 years) wore an accelerometer for seven days. Prior to the collection of self-reported data by the IPAQ-SF, participants were randomly assigned (1:1) to a control group (CG) or a video group (VG). The outcome was the absolute difference between self-reported and accelerometer-based time spent in MVPA (Δ MVPAIPAQ-Accelerometry ). To examine the agreement, we used Spearman correlation coefficients and Bland-Altman analysis. To test the video effect, we used Wilcoxon signed-rank test, Bayes factor, and simultaneous-quantile regression. In total, 302 participants fulfilled the accelerometer wear time criteria (≥10 hours/day; ≥6 days) and completed self-reports within three days after the wearing period. The median of Δ MVPAIPAQ-Accelerometry was -9.0 min/day (IQR: -32.0 to 66.6) for CG and -11.5 min/day (IQR: -29.9 to 14.3) for VG. Wilcoxon signed-rank test revealed no differences in Δ MVPAIPAQ-Accelerometry between study groups whereas Bayes factor indicated insensitivity of the data. Simultaneous-quantile regression revealed no relationship between video presentation and Δ MVPAIPAQ-Accelerometry in the 25th percentile. In the 50th (b = -12.4 [95% CI = -23.2 to -1.5] and 75th percentile (b = -45.7 [95% CI = -70.5 to -20.9]), Δ MVPAIPAQ-Accelerometry was negatively associated with video presentation. To conclude, video-supported assessment may increase the accuracy of self-reported MVPA among individuals who slightly underestimated and those who overestimated their MVPA.

Brief alcohol intervention at a municipal registry office: reach and retention.

BACKGROUND: The aim was to investigate the suitability of a municipal registry office for alcohol screening and brief intervention. We analyzed whether trial participation and retention differ by alcohol- and health-related, demographic and socio-economic participant characteristics. METHODS: Over 3 months, all 18- to 64-year-old visitors of a registry office were systematically screened. Persons with alcohol consumption in the past 12 months (N = 1646) were randomized to brief alcohol intervention (BAI) or assessment only. BAI was delivered by computer-generated individualized feedback letters at baseline, 3 and 6 months. Logistic and ordered logistic regression models were used to investigate whether the odds of trial participation and retention depended on participant characteristics. Models were rerun separately for low-risk and at-risk drinkers with Alcohol Use Disorder Identification Test-Consumption scores ≥4/≥5 for women/men indicating at-risk drinking. RESULTS: The trial participation rate was 67% with higher odds of participation in younger adults (P < 0.001). Retention rates at 3 and 6 months were 85% and 81%, respectively. Higher retention was associated with older age, higher level of school education and non-smoking (all p-values ≤0.05). Low-risk drinkers were more likely to participate in the trial (P < 0.01) and in post-baseline assessments (P < 0.05) than at-risk drinkers. CONCLUSION: Our data suggest that registry offices could be a suitable setting to reach people from the general population for BAI. Especially the understudied group of low-risk drinkers was well reached through BAI and showed high adherence. BAI that addresses alcohol consumers beyond those at risk may be well accepted in proactively recruited people from the general population.

Do sociodemographic variables and cardiometabolic risk factors moderate the mere-measurement effect on physical activity and sedentary time?

BACKGROUND: Participation in an assessment may change health behavior. This "mere-measurement effect" may be used for prevention purposes. However, little is known about whether individuals' characteristics moderate the effect. The objective was to explore whether changes of physical activity (PA) and sedentary time (ST) after a cardiovascular assessment depend on sociodemographic variables and cardiometabolic risk factors. METHODS: A sample of n = 175 adults aged 40 to 65 received baseline assessment including self-administered PA and ST questionnaires and standardized measurement of blood pressure, waist circumference, and blood parameters. After 5 weeks, participants again reported PA and ST without any prior treatment or intervention. Linear regression models were used to analyze the dependence of five-week changes in PA and ST on baseline sociodemographic and cardiometabolic variables. RESULTS: Men increased transport-related PA more than women (b = 9.3 MET-hours/week, P = .031). Men with higher triglycerides increased transport-related PA less than men with lower triglycerides (b = - 5.6 MET-hours/week, P = .043). Men with higher systolic blood pressure reduced ST more than those with lower systolic blood pressure (b = - 35.7 min/week, P = .028). However, this linear association ceased to exist at a level of approximately 145 mmHg (b of squared association = 1.0, P = .080). A similar relationship was found for glycated hemoglobin and ST. CONCLUSIONS: The findings suggest that sex and cardiometabolic risk factors moderate mere-measurement effects on PA and ST. Researchers and practitioners using mere measurement for prevention purposes may address PA and ST according to these individual characteristics. TRIAL REGISTRATION: ClinicalTrials.govNCT02990039. Registered 7 December 2016. Retrospectively registered.

Do accelerometer-based physical activity patterns differentially affect cardiorespiratory fitness? A growth mixture modeling approach.

Findings on the association between cardiorespiratory fitness (CRF) and moderate-to-vigorous physical activity (MVPA) may be distorted if patterns of accumulated MVPA over a week exist but are ignored. Our aim was to identify MVPA patterns and to associate them to CRF. Two hundred twenty-four 40-75-year-old adults wore accelerometers for 7 days. CRF was measured by peak oxygen uptake (V'O2,peak) assessed on a cycle ergometer via standardized cardiopulmonary exercise testing. Growth mixture modeling indicated four MVPA patterns: "low/stable" (57%, Mean MVPA time (M) = 21 min day-1), "medium/stable" (20%, M = 46 min day-1), "medium/weekend high" (14%, M = 47 min day-1), and "high/weekend low" (9%, M = 71 min day-1). V'O2,peak was higher for persons with "high/weekend low" and "medium/weekend high" patterns compared to "low/stable" and "medium/stable" (p values < 0.001). The same total amount of MVPA may have greater benefit if performed on fewer days during the week but with a longer duration than if performed every day but with a lower duration.

[Utilization of Gynaecological Cancer Screening by Women 20 to 35 Years of Age Receiving Unemployment Benefits Under Social Security Code II]. / Die Inanspruchnahme gynäkologischer Krebsfrüherkennungsuntersuchungen bei 20- bis 35-jährigen Frauen mit Bezug sozialer Transferleistungen nach Sozialgesetzbuch II.

The aim of the study was to analyze associations between utilization of gynaecological cancer screening (GCS) and the number of months during which state unemployment benefits (Social Security Code II) were drawn by women aged 20 to 35 years. The sample included 223 women with complete interview data (participation rate: 69%). The findings show that more women drawing unemployment benefits for a short-term (<12 months) utilized GCS compared to those receiving long-term benefits (>36 months).

Association between the use of free-of-charge intrauterine devices and a history of induced abortion: a retrospective study.

BACKGROUND: To determine whether use of intrauterine device (IUD) is influenced by a history of induced abortion and the type of contraceptives used until costs are covered. METHODS: We analyzed data from 301 female residents in Mecklenburg-West Pomerania, an economically challenged community. The women, aged between 20 and 35 years, were entitled to receive unemployment benefits, and had access to free-of-charge oral contraceptives, ring or IUD. Cross-sectional data were analyzed using logistic regression. RESULTS: There were 112 (37.2%) women with a history of induced abortion, and 46 (15.3%) reported exclusively using less effective contraceptives (e.g. condoms). In a univariate logistic regression, use of an IUD was associated with a history of having had an induced abortion. Furthermore, uptake of an IUD was associated with women who had, until costs were covered, exclusively choice to use less effective contraceptives (OR = 3.281, 95% CI: 1.717; 6.273). Both associations remained significant in a multivariate model. CONCLUSIONS: Free contraceptives provided to women receiving unemployment benefits may increase the use of IUDs, especially among those with a history of an induced abortion and those using less effective contraceptives.

Feasibility and Acceptability of an Intervention Providing Computer-Generated Tailored Feedback to Target Alcohol Consumption and Depressive Symptoms in Proactively Recruited Health Care Patients and Reactively Recruited Media Volunteers: Results of a Pilot Study.

BACKGROUND: A pre-post pilot study was conducted to test the feasibility, acceptability, and potential effectiveness of a fully automatized computer-based intervention targeting hazardous drinking and depressiveness in proactively recruited health care patients (HCPs). To address the importance of the sample selection when testing interventions, HCPs were compared to media recruited volunteers (MVs). METHOD: In a multicenter screening program 2,773 HCPs were screened for hazardous drinking and depressive symptoms. MVs were recruited via media solicitation. Over a period of 6 months, study participants received 6 individualized counseling letters and weekly short messages. Pre-post data were analyzed for 30 participants (15 HCPs, 15 MVs). Intervention acceptability was assessed in post-intervention interviews conducted with 32 study participants. RESULTS: MVs showed higher problem severity and motivation to change than HCPs. Over the course of the intervention both subsamples reduced regular binge drinking (HCPs: p = 0.016; MVs: p = 0.031) and depressiveness (HCPs: p = 0.020; MVs: p < 0.001). MVs further reduced average daily alcohol consumption (p = 0.034). The intervention received positive ratings from both subsamples, the alcohol module was rated more favorably by MVs than by HCPs (p = 0.012). Subsamples further differed in terms of intervention usage (p = 0.013). CONCLUSION: The intervention was technically and logistically feasible, well accepted, and may have the potential to reduce hazardous drinking and depressive symptoms in different populations. Subsamples differed in terms of problem severity, motivation to change, intervention usage, pre-post changes, and attitudes toward the intervention, showing that intervention development should involve the intended target populations to avoid biased conclusions on intervention effectiveness and acceptability.

Effect of blood pressure and total cholesterol measurement on risk prediction using the Systematic COronary Risk Evaluation (SCORE).

BACKGROUND: To compare the reproducibility in total cholesterol (TC), systolic blood pressure (BP), and the resulting Systematic COronary Risk Evaluation (SCORE) obtained by an in-office cardio-preventive screening program (SP) and a subsequent program performed in a clinical trial examination center (EP). METHODS: A total of 307 individuals (60.3% female, mean age = 52.8 years) participated. According to TC and BP measurements at the SP and EP, three variables were created: the SCORESP = single BP reading at the SP, the SCOREEP/BP-first = first BP reading at the EP, and the SCOREEP/BP-mean = mean second/third BP reading at the EP. Differences in TC and BP were analyzed. Associations between age, sex and mean differences between the SCORESP and the SCOREEP/BP-first (M1) and the SCOREEP/BP-mean (M2) were analyzed using multivariable linear and quantile regression. RESULTS: TC and BP values from the SP were significantly higher than those from the EP. Among individuals with a decreased SCORE value at the EP (compared to the SP), younger age was associated with a higher improvement in risk estimation compared with older age. Female sex was associated with higher risk improvement in the SCORE between the SP and the EP compared with male sex. Associations between both demographics and M1 (M2) achieved statistical significance at the 75.0th (50th) percentile. CONCLUSIONS: The reproducibility of results in cardiovascular risk prediction seems to be influenced by the accuracy of BP measurement. It seems that younger individuals and females are more likely to benefit from accuracy compared with older individuals and males.

Patterns of accelerometer-based sedentary behavior and their association with cardiorespiratory fitness in adults.

We aimed to identify patterns of sedentary behavior (SB) and examined whether cardiorespiratory fitness differs between classes with distinct patterns of SB. One hundred and seventy participants (57% women, mean age = 56.4 years) received accelerometry monitoring for 7 days. Prior to accelerometry assessment, cardiorespiratory fitness was assessed by peak oxygen uptake (VO2peak ). VO2peak was directly measured during a symptom-limited cardiopulmonary exercise testing on a cycle ergometer. Patterns in accelerometer data were classified based on time spent in SB per day using growth mixture modeling. Model-implied class-specific VO2peak means were compared using adjusted equality test of means. Growth mixture modeling revealed four patterns of SB: "High, stable" (n = 120, M = 724.9 min/d), "Low, increase" (n = 14, M = 622.2 min/d), "Low, decrease" (n = 11, M = 540.2 min/d), and "High, decrease" (n = 25, M = 694.8 min/d). Persons in class "High, stable" had significantly lower VO2peak values (M = 25.0 mL/kg/min, SD = 0.6) compared to persons in class "Low, increase" (M = 30.5 mL/kg/min, SD = 3.6; P = 0.001), in class "Low, decrease" (M = 30.1 mL/kg/min, SD = 5.0; P = 0.009), and in class "High, decrease" (M = 29.6 mL/kg/min, SD = 5.9; P = 0.032). No differences among the other classes were found. We identified four classes of individuals with distinct patterns of SB and showed that VO2peak partially differs between classes. Especially, individuals with stable high SB levels throughout the week might be addressed in public health recommendations and interventions.

A cross-sectional analysis of the associations between leisure-time sedentary behaviors and clustered cardiometabolic risk.

BACKGROUND: The aim of this study was to conduct a comprehensive investigation of the association between different types of leisure-time sedentary behavior (watching television, using a computer, reading and socializing) and clustered cardiometabolic risk in apparently healthy adults aged 40 to 65 years. METHODS: One hundred seventy-three participants from the general population (64% women; mean age = 54.4 years) consented to attend a cardiovascular examination program and to complete a questionnaire on leisure-time sedentary behaviors. Waist circumference, blood pressure, glucose, triglycerides, and high-density lipoprotein cholesterol of non-fasting blood samples were assessed, and a clustered cardiometabolic risk score [CMRS] was calculated. Data were collected between February and July 2015. Associations between leisure-time sedentary behaviors and CMRS were analyzed using linear and quantile regression, adjusted for socio-demographic variables and other types of leisure-time sedentary behavior (model 1) and additionally, adjusted for leisure-time physical activity and traveling in motor vehicles (model 2). RESULTS: Linear regression revealed that there was a positive association between watching television and CMRS (model 1: b = 0.27 [CI: 0.03; 0.52]; model 2: b = 0.30 [CI: 0.05; 0.56]). In addition, quantile regression analysis revealed that using a computer was negatively associated with the 50th (model 1: b = - 0.43 [CI: -0.79; - 0.07]) and the 75th percentiles (model 1: b = - 0.71 [CI: -1.27; - 0.14]) of CMRS. Reading and socializing were not associated with CMRS. CONCLUSIONS: Watching television was positively associated with a clustered cardiometabolic risk score, while time spent using a computer revealed inconsistent findings. Our results give reason to consider different types of behaviors in which individuals are sedentary and the associations between these behaviors and cardiometabolic risk, supporting the need for behavior-specific assessments as well as public health recommendations to maintain or enhance adults' health. TRIAL REGISTRATION: Clinical trial registration number: NCT02990039 , Retrospectively registered (December 12, 2016).

[The use of free-of-charge prescription contraceptives among women : Results of a pilot project in the German federal state of Mecklenburg-Western Pomerania]. / Inanspruchnahme kostenfreier verschreibungspflichtiger Verhütungsmittel durch Frauen : Ergebnisse eines Modellprojekts in Mecklenburg-Vorpommern.

BACKGROUND: There is a connection between the receipt of unemployment benefits and the failure to use contraceptives in Germany. This study aims to understand the use of contraceptives among women entitled to unemployment benefits under the Sozialgesetzbuch II or XII (SGB II or SGB XII), prior and during an offer of contraceptives free of charge (CFOC). METHODS: The criteria for the use of CFOC (pill, intrauterine device, or ring) over a 12-month period were: age between 20 and 35 years, resident in predefined urban or rural postal codes in the German federal state of Mecklenburg-Western Pomerania, and participation in a self-administered survey. Data about participants' age, education, number of children, relationship status, period of payment according to SGB II or SGB XII, the use and barriers to use of contraceptives during every occurrence of sexual intercourse, as well as the kind of contraceptives used. RESULTS: From a total of 418 women: 40.9% were single-mothers, 39.0% did not graduate school, 21.1% were childless, and 57.9% had received unemployment benefits for at least three years. Further, 21.1% rated their type of contraceptive as "less safe" or "unsafe." The most commonly cited reasons for nonregular use of contraceptives were: they are too expensive or their use is forgotten. A change in contraceptives was made by 30.9% due to the offer of CFOC. The change was associated with the number of children and the exclusive use of less safe contraceptives. DISCUSSION: CFOC seems to be attractive, especially for women with children and those who receive long-term unemployment benefits. Changing demands concerning the safety of birth control during the lives of women should be considered in the discussion about common rules for the access to CFOC.

Reach of Individuals at Risk for Cardiovascular Disease by Proactive Recruitment Strategies in General Practices, Job Centers, and Health Insurance.

PURPOSE: Reach of individuals at risk for cardiovascular disease (CVD) constitutes a major determinant of the population impact of preventive effort. This study compares three proactive recruitment strategies regarding their reach of individuals with CVD risk factors. METHOD: Individuals aged 40-65 years were invited to a two-stage cardio-preventive program including an on-site health screening and a cardiovascular examination program (CEP) using face-to-face recruitment in general practices (n = 671), job centers (n = 1049), and mail invitations from health insurance (n = 894). The recruitment strategies were compared regarding the following: (1) participation rate; (2) participants' characteristics, i.e., socio-demographics, self-reported health, and CVD risk factors (smoking, physical activity, fruit/vegetable consumption, body mass index, blood pressure, high-density lipoprotein, triglycerides, and glycated hemoglobin); and (3) participation factors, i.e., differences between participants and non-participants. RESULTS: Screening participation rates were 56.0, 32.8, and 23.5 % for the general practices, the job centers, and the health insurance, respectively. Among eligible individuals for the CEP, respectively, 80.3, 65.5, and 96.1 % participated in the CEP. Job center clients showed the lowest socio-economic status and the most adverse CVD risk pattern. Being female predicted screening participation across all strategies (OR = 1.45, 95 % CI 1.07-1.98; OR = 1.34, 95 % CI 1.04-1.74; OR = 1.62, 95 % CI 1.16-2.27). Age predicted screening participation only within health insurance (OR = 1.04, 95 % CI 1.01-1.06). Within the general practices and the job centers, CEP participants were less likely to be smokers than non-participants (OR = 0.49, 95 % CI 0.26-0.94; OR = 0.42, 95 % CI 0.20-0.89). CONCLUSION: The recruitment in general practices yielded the highest reach. However, job centers may be useful to reduce health inequalities induced by social gradient.

Factors associated with secondhand smoke exposure prevalence and secondhand smoke level of children living with parental smokers: a cross sectional study.

Factors that might account for the probability of children being exposed to secondhand smoke compared to those who are unexposed and characteristics associated with the urinary cotinine level (UCL) of those who are exposed were investigated. All households in a German region with a child aged 3 years or younger (n = 3,570) were invited to participate in a study that tested the efficacy of an intervention for reducing secondhand smoke exposure. In 1,282 households, at least one parent reported daily smoking. Among these, 915 (71.3%) participated in the study. For data analyses, we used a two-part model. Characteristics of the households associated with SHSE of the youngest child were analyzed, as well as characteristics associated with UCL among those exposed. Exposure to secondhand smoke was defined using a UCL ≥ 10 ng/ml. Secondhand smoke exposure was detected in 57.1% of the samples. Nursery attendance was associated with secondhand smoke exposure, in addition to the number of smokers living in the household, extent of home smoking ban and parental education. Among children exposed, nursery attendance, season of urine collection and age of the child were associated with UCL. Consideration of seasonal smoking behavior and a child's age at the time of intervention may increase attention to the adverse health effects of secondhand smoke exposure.

Reducing tobacco smoke exposure in children aged below 4 years - a randomized controlled trial.

OBJECTIVE: To explore the reach of a German population-based household sample using proactive recruitment and to test the efficacy of a behavioral change counseling intervention including feedback about children's urine cotinine level (CUCL). METHODS: A randomized controlled trial (2008-2010) was conducted in households with at least one child aged below 4years and at least one current smoker. The study area comprised of 3570 households. A screening assessment was provided in 2641 households; 1282 included one current smoker and 852 completed the study protocol. The intervention group (IG; n=428) received feedback about CUCL and up to two counseling sessions. The control group (CG; n=424) received a leaflet. Assessments were provided at baseline and 12-month follow-up. Heckman's selection model analysis was used to consider the detection limit of cotinine in urine (10ng/ml). RESULTS: CUCL below the detection limit in the IG was found in 43.2% at baseline and 44.6% at follow-up and in 44.8% of the CG at baseline and 47.2% at follow-up. The CUCL difference between follow-up and baseline was smaller in the CG than in the IG. The effect was not significant. CONCLUSIONS: Data revealed a high reach of the target population but failed to identify an intervention effect. Clinical Trial Registration www.clinicaltrials.gov (NCT00647413).