[The alcohol prevention program "HaLT-Hart am LimiT" : Conceptual development in connection with funding from the German Prevention Act]. / Das Alkoholpräventionsprogramm "HaLT ­ Hart am LimiT" : Konzeptionelle Weiterentwicklung in Verbindung mit einer Förderung über das Präventionsgesetz.

The program "HaLT - Hart am LimiT" is a national community-based alcohol prevention program for children and adolescents. It responds to harmful alcohol consumption with early intervention (reactive module) and builds strategic prevention networks on a community level (proactive module). It was initiated in 2003 by the Villa Schöpflin gGmbH. HaLT was one of the first programs funded by the German Prevention Act (PrävG), which came into force in 2015. Since March 2018, the program has been developed further and the respective innovations are described in a framework concept. This article presents the program, its network, and the updated concept.There are 152 HaLT sites in Germany; primarily, the covered regions are counties and (district-free) cities. One aim of the further development is to modularize the program prevention measures for funding and to implement a specific quality management (QM) concept. Additionally, there is a development with regard to new topics and target groups, including young people who consume alcohol and illegal drugs and young adults between 18 and 21 years old. Another example is a classroom workshop in secondary schools that addresses the prevention of fetal alcohol spectrum disorder (FASD).In July 2019, the first stage of funding for the HaLT reactive module started. In January 2020, the second stage of funding started, which accepted applications for QM measures and community-based alcohol prevention. The new framework concept is already being implemented in practice, including the qualification of professionals within the network of HaLT and new prevention measures for the target group of 18- to 21- year-olds in the reactive and proactive modules.

Cross-sectional relationship of perceived familial protective factors with depressive symptoms in vulnerable youth.

BACKGROUND: There are multiple negative consequences associated with heavy episodic drinking and close associations between substance abuse and depression, alcohol-intoxicated adolescents (AIA) represent a vulnerable group. We aim to add to the current literature by investigating the cross-sectional relationship of perceived familial protective factors with depressive symptoms in AIA in hospitals, with respect to sex. Depression is among the 10 leading causes of disabilities during childhood and adolescence, with girls being more vulnerable than boys. Considerable evidence reveals a strong association between depression and alcohol abuse. The family provides the possibility to positively influence depressive symptoms. METHODS: We present cross-sectional data of a German multisite, epidemiological cohort study on AIA. By using youth's self-reports, we assessed sociodemographic data, as well as data on perceived familial protective factors and depressive symptoms using items of the Communities that Care Youth Survey instrument. We performed descriptive and multigroup analyses to evaluate the measurement invariance of the used instruments. Moreover, to investigate the relationships between the constructs, we used structural equation modelling. RESULTS: The study sample comprised 342 AIA, with a mean age of 15.5 years (SD = 1.2; 48.1% girls). The final structural equation model achieved an acceptable model fit of χ2 (69, 342) = 110.056; p = .001; TLI = 0.97; CFI = 0.98; RMSEA = 0.046; SRMR = 0.042, and the rewards for prosocial involvement in the family context correlated significantly negatively with present depressive symptoms, (ß = - 0.540, p <  0.001). The effects were stronger in boys (ß = - 0.576, p <  0.001) than in girls (ß = - 0.519, p <  0.001). CONCLUSION: In vulnerable youth in Germany, depressive symptoms are correlated to good experiences within the family. Future research should assess whether interventions that enhance parental support reduce the risk of depressive symptoms in AIA. Our findings highlight the need for family-based prevention programmes, particularly for AIA with an increased risk of depression.

Familial risk and protective factors in alcohol intoxicated adolescents: psychometric evaluation of the family domain of the Communities That Care Youth Survey (CTC) and a new short version of the Childhood Trauma Questionnaire (CTQ).

BACKGROUND: Alcohol intoxicated adolescents (AIA) in emergency department are an important target group for prevention and valid information on their familial risk and protective factors (RPF) is crucial for implementing customized family-based counseling in hospitals. We therefore, examined the psychometric characteristics of scales which assess familial RPF. METHODS: We used seven family scales from the Communities That Care Youth Survey Instrument (CTC-F7); four assess risk factors: family conflicts, poor family management, parental attitudes favorable towards drug use/antisocial behavior; three assess protective factors: family attachment, opportunities and rewards for prosocial involvement. To assess physical and emotional abuse and emotional neglect, we created a new scale composed of six items from the Childhood Trauma Questionnaire (CTQ-6). We tested these eight scales on 342 AIA aged 13-17. Based on the classical test theory we calculated descriptive item and scale statistics and internal consistency. We assessed construct validity by confirmatory factor analysis with Maximum Likelihood (ML) estimation in a sample with imputed missing values (EM-Algorithm). To check robustness, we repeated the analyses with complete cases, with multiple imputed data, and with methods suitable for categorical data. We used SPSS 21, AMOS 21 and R (randomForrest and lavaan package). RESULTS: Three of seven CTC-F scales showed poor psychometric properties in the descriptive analysis. A ML-confirmatory model with five latent factors fitted the remaining CTC-F scales best (CTC-F5). The latent structure of the CTQ-6 is characterized by three first-order factors (physical abuse, emotional abuse, emotional neglect) and one second-order factor. The global goodness-of-fit indices for the CTC-F5 and the CTQ-6 demonstrated acceptable fit (for both models: TLI and CFI>0.97, RMSEA<0.05). The confirmatory evaluation based on complete cases (n=266), on multiple imputed data, and with alternative estimation methods produces global and local model-fit indices that are comparable to those from the main analysis. The final subscales CTC-F5 and CTQ-6 show acceptable to good internal consistency (α>0.7). CONCLUSIONS: The final CTC-F5 and the newly developed CTQ-6 demonstrate acceptable to good psychometric properties for the AIA sample. The CTC-F5 and the CTQ-6 facilitate a psychometrically sound assessment of familial RPF for this vulnerable and important target group for prevention.

Developmental Hazards Among Young Alcohol Intoxicated Patients.

PURPOSE: The rising numbers of alcohol intoxicated adolescents (AIA) treated in emergency care units in several European countries have drawn attention to this target group for prevention. To our knowledge, this is the first study to assess a broad array of developmental hazards and their stability in AIA and to compare their distribution with representative samples (RS). METHODS: A multisite cohort study of AIA aged 13-17 years assessed, in the hospital (t0) and 6 months later (t1), (family) violence, cannabis and alcohol use, school problems, delinquency, homelessness, depression, and suicidality, using items from representative German surveys: Children and Adolescent Health Survey (KiGGS), Childhood Trauma Questionnaire and Communities That Care Youth Survey. We calculated the differences between AIA and RS and corresponding 95% confidence intervals. For AIA respondents who completed t0 and t1 information, we calculated prevalence/persistence/incidence of developmental hazards and corresponding 95% confidence interval. RESULTS: A total of 342 AIA participated at t0, 228 at t1 (67%). AIA had a significantly higher burden of concomitant risks regarding physical and emotional family abuse, (sexual) victimization, cannabis use, binge drinking, school expulsion, police arrest, gang membership, and being violent. Six months after hospitalization, emotional family abuse (34.1%), cannabis use (23.5%), depression (14.8%), and being violent (13.2%) were especially prevalent. CONCLUSIONS: Developmental hazards are up to six times more prevalent in AIA than in RS. Therefore, when assessing the risk profile of AIA, it is important to consider developmental hazards as well as detrimental alcohol use.