Tabak-, Alkohol- und Drogenkonsum von Jugendlichen in Deutschland

Does parental separation moderate the heritability of health risk behavior among adolescents?

Social influences on adolescents' health risk behavior are well documented, but little is known about the interaction of parental separation with genetic sensitivities. Using data from a German sample of 1762 twins, this study examines whether family living arrangements moderate the influence of genetic predispositions on health risk behavior. Derived from variance decomposition moderator models, three key findings emerge. Firstly, genetic contributions to drug use are significantly higher in single-mother families, indicating an amplified heritability potentially resulting from triggered genetic sensitivities or challenges in preventing genetic risks from unfolding. Secondly, unique environmental factors have a greater impact on drug use in single-mother families. Lastly, no heritability differences are found in smoking and excessive alcohol consumption between family types. These findings provide novel evidence of increased importance of genetic influences on drug use in single-mother families, shedding light on gene-environment interactions, and informing policy interventions that support vulnerable family arrangements.

Ansatzpunkte für die Prävention frühen jugendlichen Alkoholkonsums

Zusammenfassung. Ziele: In der vorliegenden Studie werden sowohl frühkindliche als auch elterliche Risikofaktoren, die jugendliche Trinkmotivation und die Übereinstimmung zwischen den Müttern und Jugendlichen hinsichtlich des jugendlichen Alkoholkonsums zur Ableitung von präventiven Ideen ausgewertet. Methodik: Die Daten von 239 Familien aus dem längsschnittlichen deutschen Projekt Zukunft Familie wurden vom Kindergartenalter ( M = 4.5 Jahre) bis in das Jugendalter ( M = 14 Jahre) erhoben. Mittels binär logistischer Regressionsmodelle wurden die Zusammenhänge zwischen psychischen Auffälligkeiten im Kindesalter, der soziodemographischen Situation sowie Verhaltensweisen der Eltern und dem Alkoholkonsum der Kinder zehn Jahre später analysiert. Ergebnisse: Kinder von Müttern mit einer höheren Schulbildung und aus Familien mit einem höheren sozialen Status hatten ein erhöhtes Risiko, schon vor dem gesetzlich erlaubten Mindestalter, regelmäßig Alkohol zu trinken. Bei den im Durchschnitt 4.5-jährigen Kindern erwiesen sich internalisierende Auffälligkeiten als Schutzfaktor vor einem frühzeitigen jugendlichen Konsum. Alkohol wurde im Jugendalter vor allem aus sozialen und Verstärkungsmotiven getrunken. Mütter unterschätzten signifikant den Konsum ihrer Kinder um das Vier- bis Fünffache. Schlussfolgerung: Präventionsmaßnahmen könnten den Jugendlichen Alternativen aufzeigen, um die sozialen und verstärkenden Motivationen auf risikofreien Wegen zu erreichen. Zur verbesserten Einschätzung des kindlichen Konsums, könnten Mütter in Hinweisen geschult werden, die auf einen übermäßigen Konsum hindeuten. Das erhöhte Risiko von Kindern aus Familien mit einem höheren sozialen Status könnte dabei berücksichtigt werden.

[Trends in educational inequalities in smoking among adolescents in Germany : Evidence from four population-based studies]

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.

Smoking and Passive Smoke Exposure Among Adolescents in Germany

BACKGROUND

Children and adolescents are the most important target group for smoking prevention and non-smoker protection measures (smoke-free legislation). In this article, we discuss trends over time and differences between social groups with regard to smoking and passive smoke exposure among adolescents in Germany.

METHODS

The data evaluated in this article were collected in two different study periods of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), namely, 2003-2006 and 2009-2012. Adolescents aged 11 to 17 were asked about their smoking behavior and passive smoke exposure (6812 and 5258 respondents in the two study periods, respectively). Their social status was rated with an index based on information supplied by the adolescents' parents about their level of education, occupation, and income.

RESULTS

The prevalence of smoking among adolescents fell in approximately six years from 20.4% to 12.0% (p< 0.001), and that of daily smoking from 13.3% to 5.4% (p<0.001). The percentage of non-smokers who spent time several days per week, or every day, in rooms where other persons were smoking declined from 35.1% to 18.8% (p<0.001). The lower the respondents' social status, the more likely they were to smoke daily and to have regular passive exposure to smoking.

CONCLUSION

The findings suggest that the measures implemented in recent years to protect adolescents from the health risks of active and passive smoking have been beneficial independently of the adolescents' social backgrounds.

[Health status of people with a migrant background and impact of socio-economic factors: First results of the German Health Interview and Examination Survey for Adults (DEGS1)]

People with a migrant background (PMB) have specific health-related risk factors and resources compared to the non-migrant population (NMP). The analysis focuses on the relationship between migrant background and health and health-related behavior. Moreover, the study analyses whether socio-economic status (SES) contributes to the explanation of differences between PMB and the NMP. The research is based on the German Health Interview and Examination Survey for Adults (DEGS1) (2008-2012, n = 8151). The population for cross-sectional analyses contains 1107 PMB (weighted 19.8 %). The research question is addressed on the basis of nine exemplary health outcomes. All analyses are gender specific and make a distinction between first and second generation PMB. Logistic regression is calculated adjusting for age and SES. The results reveal clear gender-specific patterns: For women, differences are statistically significant mainly for first generation PMB. Compared to the NMP their self-assessed health status is lower, they are less physically active, consume less alcohol, feel less informed about cancer screening programs and make less use of preventive health services. However, daily smoking is more prevalent in second generation women. For men, differences are statistically significant for first and second generation PMB. Men with a migrant background show more symptoms of depression, consume less alcohol and feel less informed about cancer screening programs. After adjusting for SES the impact of migrant background on health status and health-related behavior largely remains stable. The study shows that the DEGS1 data offers valuable results and new insights into the health status of people with a migrant background. The use of this data for further research requires a differentiated approach to the concept of migrant background and a careful interpretation of results.

Education Against Tobacco (EAT): a quasi-experimental prospective evaluation of a multinational medical-student-delivered smoking prevention programme for secondary schools in Germany

OBJECTIVES

To evaluate the multinational medical-student-delivered tobacco prevention programme for secondary schools for its effectiveness to reduce the smoking prevalence among adolescents aged 11-15 years in Germany at half year follow-up.

SETTING

We used a prospective quasi-experimental study design with measurements at baseline (t1) and 6 months postintervention (t2) to investigate an intervention in 8 German secondary schools. The participants were split into intervention and control classes in the same schools and grades.

PARTICIPANTS

A total of 1474 eligible participants of both genders at the age of 11-15 years were involved within the survey for baseline assessment of which 1200 completed the questionnaire at 6-month follow-up (=longitudinal sample). The schools participated voluntarily. The inclusion criteria were age (10-15 years), grade (6-8) and school type (regular secondary schools).

INTERVENTION

Two 60 min school-based modules delivered by medical students.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary end point was the difference from t1 to t2 of the smoking prevalence in the control group versus the difference from t1 to t2 in the intervention group (difference of differences approach). The percentage of former smokers and new smokers in the two groups were studied as secondary outcome measures.

RESULTS

In the control group, the percentage of students who claimed to be smokers doubled from 4.2% (t1) to 8.1% (t2), whereas it remained almost the same in the intervention group (7.1% (t1) to 7.4% (t2); p=0.01). The likelihood of quitting smoking was almost six times higher in the intervention group (total of 67 smokers at t1; 27 (4.6%) and 7 (1.1%) in the control group; OR 5.63; 95% CI 2.01 to 15.79; p<0.01). However, no primary preventive effect was found.

CONCLUSIONS

We report a significant secondary preventive (smoking cessation) effect at 6-month follow-up. Long-term evaluation is planned.

Insomnia complaints and substance use in German adolescents: did we underestimate the role of coffee consumption? Results of the KiGGS study

The purpose of the study was to study the associations of tobacco, alcohol, marijuana, and coffee use and insomnia complaints (IC) in adolescents with special consideration of the influence of coffee consumption on these relationships. 7698 Subjects aged 11-17 years were investigated in a cross-sectional study within the German Health Interview and Examination Survey for Children and Adolescents. Self-report questionnaires were distributed to the participants. Hierarchical regression analyses were performed to assess possible effects of coffee consumption on the association of tobacco, alcohol, and marijuana use with IC. Common risk factors for insomnia were included in the adjusted analyses. Tobacco, alcohol, marijuana and coffee use displayed significant bivariate associations with IC. After adjusting the first three substances for coffee consumption, their associations with IC were reduced considerably. After additionally adjusting for other potential confounders (age, gender, socio-economic status, externalizing and internalizing psychiatric problems, media use, bodyweight, medical condition), frequent coffee consumption, high alcohol intake and frequent smoking contributed to the prediction of IC in male subjects while frequent coffee consumption and high alcohol intake predicted the occurrence of IC in females. Coffee consumption could be an important risk factor for IC in adolescents and it significantly affects the association of smoking, alcohol, and marijuana with IC. Future research that includes long-term studies about psychoactive substance use (PSU) and sleep should also consider coffee consumption. Parents, educators, clinicians, and researchers should be aware of the potentially hazardous influence of PSU, especially coffee, alcohol and tobacco, on sleep in young individuals.

The impact of school nonresponse on substance use prevalence estimates - Germany as a case study

BACKGROUND

The European School Survey Project on Alcohol and Other Drugs (ESPAD) is a survey study that collects comparable data on substance use of students aged 15-16 years old in European countries. The present study aims at investigating the impact of school refusal to participate in ESPAD on substance use prevalence estimates.

METHODS

Data came from the 2007 German ESPAD study; the sample consisted of 12,246 students in 552 schools within seven German federal states. A simulation approach was used in order to study the effects of systematic exclusion of participating schools on prevalence estimates of key ESPAD outcomes including the use of tobacco, alcohol, cannabis, and other illegal drugs.

RESULTS

The systematic exclusion of schools based on city-, school-, and class size, school environment, and schools' substance use policies resulted in significant changes in prevalence estimates in 23 of 25 examined combinations of selection criterion and outcome. Yet, these effects were small, with differences remaining below three percentage points around the original estimates.

CONCLUSIONS

This simulation approach suggests that nonparticipation of schools in surveys on students' substance use in Germany does not largely affect the validity of resulting prevalence estimates. Even a reduced number of schools may be sufficient to gain valid prevalence figures.

Are you in or out? Recruitment of adolescent smokers into a behavioral smoking cessation intervention

Even though many adolescent smokers want to quit, it is difficult to recruit them into smoking cessation interventions. Little is known about which adolescent smokers are currently reached by these measures. In this study we compare participants of a group-based, cognitive behavioral smoking cessation intervention with adolescent smokers who decided against participating.

Within a non-randomized controlled trial, data of 1053 smokers (age 11–19) from 42 German secondary schools were analyzed. Of these smokers, 272 were recruited into 47 courses of the intervention. An in-class information session, individually addressing potential participants, and incentives were used as means of recruitment. Personal predictors of participation were analyzed using regression analyses and multivariate path analyses to test for mediation. In the path analysis model, nicotine dependence, quit motivation, and a previous quit attempt were directly positively related to participation. Heavier smoking behavior was indirectly positively associated with participation through nicotine dependence and negatively through quit motivation, yielding an overall positive indirect effect. The positive effect of a previous quit attempt on participation was partially mediated through nicotine dependence and quit motivation. The proportion of smoking friends were indirectly positively related to participation, mediated through nicotine dependence.

Since adolescents with heavier smoking behavior and stronger nicotine dependence are less likely to undertake a successful unassisted quit attempt, the reach of these young smokers with professional cessation interventions is desirable. Further measures to improve the recruitment of those currently not motivated to quit have to be examined in future studies.

Education Against Tobacco (EAT): a quasi-experimental prospective evaluation of a programme for preventing smoking in secondary schools delivered by medical students: a study protocol

INTRODUCTION

A survey conducted by the German Federal Centre for Health Education in 2012 showed that 35.2% of all young adults (18-25 years) and 12.0% of all adolescents (12-17 years) in Germany are regular cigarette smokers. Most smoked their first cigarette in early adolescence. We recently reported a significantly positive short-term effect of a physician-delivered school-based smoking prevention programme on the smoking behaviour of schoolchildren in Germany. However, physician-based programmes are usually very expensive. Therefore, we will evaluate and optimise Education against Tobacco (EAT), a widespread, low-cost programme delivered by about 400 medical students from 16 universities in Germany.

METHODS AND ANALYSIS

A prospective quasi-experimental study design with two measurements at baseline (t1) and 6 months post-intervention (t2) to investigate an intervention in 10-15-year-olds in grades 6-8 at German secondary schools. The intervention programme consists of two 60-min school-based medical-student-delivered modules with (module 1) and without the involvement of patients with tobacco-related diseases and control groups (no intervention). The study questionnaire measuring smoking status (water pipe and cigarette smoking), smoking-related cognitions, and gender, social and cultural aspects was designed and pre-tested in advance. The primary end point is the prevalence of smokers and non-smokers in the two study arms at 6 months after the intervention. The percentage of former smokers and new smokers in the two groups and the measures of smoking behaviour will be studied as secondary outcome measures.

ETHICS AND DISSEMINATION

In accordance with Good Epidemiologic Practice (GEP) guidelines, the study protocol was submitted for approval by the responsible ethics committee, which decided that the study does not need ethical approval (Goethe University, Frankfurt-Main, Germany). Findings will be disseminated in peer-reviewed journals, at conferences, within our scientific advisory board and through medical students within the EAT project.

Be smart against cancer! A school-based program covering cancer-related risk behavior

Background

Several studies suggest that most school-age children are poorly informed about cancer risk factors. This study examines the effectiveness of the ‘Be smart against cancer’ (BSAC) program in promoting cancer awareness and intentions to engage in health-promoting behavior.

Methods

235 seventh-grade students were randomized to either the intervention (N = 152) or the wait-control group (N = 83). The intervention included the modules: “What is cancer?,” “Sun protection,” “Non smoking,” and “Physical activity, Healthy nutrition, and Limited alcohol consumption.” Outcomes measured at baseline and at the end of the one week BSAC program included knowledge of cancer and its behavioral risk factors, health-promoting intentions, and reported risk behavior.

Results

BSAC was effective in increasing knowledge about cancer and risk factors for cancer (p < .001), as well as in increasing intentions to engage in health-promoting behavior (p < .001), independent of a student’s risk profile. Knowledge did not serve as a mediator for intention building.

Conclusions

The BSAC is an effective school-based program for raising awareness of cancer, associated risk factors and intentions to engage in cancer-preventive behavior. The results indicate that the effectiveness of BSAC is independent of a student’s risk profile. Therefore, it holds considerable promise as a broadly applicable program to raise cancer awareness and promote healthy behavior intentions.

The development of the MeDALL Core Questionnaires for a harmonized follow-up assessment of eleven European birth cohorts on asthma and allergies

BACKGROUND

Numerous birth cohorts have been initiated in the world over the past 30 years using heterogeneous methods to assess the incidence, course and risk factors of asthma and allergies. The aim of the present work is to provide the stepwise proceedings of the development and current version of the harmonized MeDALL-Core Questionnaire (MeDALL-CQ) used prospectively in 11 European birth cohorts.

METHODS

The harmonization of questions was accomplished in 4 steps: (i) collection of variables from 14 birth cohorts, (ii) consensus on questionnaire items, (iii) translation and back-translation of the harmonized English MeDALL-CQ into 8 other languages and (iv) implementation of the harmonized follow-up.

RESULTS

Three harmonized MeDALL-CQs (2 for parents of children aged 4-9 and 14-18, 1 for adolescents aged 14-18) were developed and used for a harmonized follow-up assessment of 11 European birth cohorts on asthma and allergies with over 13,000 children.

CONCLUSIONS

The harmonized MeDALL follow-up produced more comparable data across different cohorts and countries in Europe and will offer the possibility to verify results of former cohort analyses. Thus, MeDALL can become the starting point to stringently plan, conduct and support future common asthma and allergy research initiatives in Europe.

Adolescents' use of alcohol, tobacco and illicit drugs in relation to prenatal alcohol exposure: modifications by gender and ethnicity

AIMS

The study aimed to investigate (a) the association between low to moderate prenatal alcohol exposure (PAE) and the use of alcohol, tobacco and illicit drugs in adolescence and (b) whether the associations are modified by gender and ethnicity.

METHODS

The subjects of the study were 5922 children and adolescents, aged from 11 to 17 years, enrolled in the cross-sectional German Health Interview and Examination Survey for Children and Adolescents (the KiGGS study). Information on PAE is based on parental self-report questionnaires. Use of alcohol, tobacco and illicit drugs was assessed through self-report questionnaires for adolescents.

RESULTS

Low to moderate PAE was associated with an increased risk of drinking alcohol (adjusted odds ratio (OR) 1.73, 95% confidence interval (CI) 1.34, 2.18) and also of illicit drug use (adjusted OR 1.62, 95% CI 1.23, 2.14). The associations between PAE and the use of alcohol, tobacco and illicit drugs differed according to gender and ethnicity. Gender-stratified analyses resulted in adverse effects of PAE on drinking alcohol, smoking and illicit drug use in females; however, in German males, the associations disappeared. Stronger associations between PAE and the outcome measures were found in non-Germans.

CONCLUSIONS

Our findings indicate that low to moderate levels of maternal alcohol intake during pregnancy are a risk factor for use of alcohol, tobacco and illicit drugs by the offspring, with stronger associations in females and non-Germans.

The relation of self-esteem and illegal drug usage in high school students

BACKGROUND

Adolescence is the period of stress and strain. Researchers have shown that adolescents without strong social supports would have tendency towards smoking and drug abuse.

OBJECTIVES

This study aimed to evaluate the relationship between low self-esteem and illegal drug abuse.

MATERIALS AND METHODS

Participants were 943 grades nine to 12 high school students, from Sarakhs during 2010 - 2011. Adolescents participated in the study, completed two self-report questionnaires. The first questionnaire included questions about individual and family information, smoking and illegal drug abuse history, and the second was the Rosenberg's self-esteem scale.

RESULTS

53.8% of participants were male (507 individuals). The mean Rosenberg self-esteem score was 19.8 + 5.2, and the most frequent obtained scores were from 22 to 30. The difference of Rosenberg self-esteem score test between students who did not use any substance and those who had a history of smoking or drug abuse like heroin, pills, alcohols, betel nut (Nas) and other drugs (such as Pan and Hookah) was significant (P < 0.001). But this difference was not significant for marijuana (hashish) and opium. The difference of mean self-esteem scores between adolescents who lived with both or one of the parents, and those who did not live with any of parents, was significant (P = 0.04). There was also a significant association between the number of children in the family and self-esteem score.

CONCLUSIONS

The current study showed significant association between the Rosenberg self-esteem test results and smoking, and illegal drug abuse like heroin, pills, alcohol, Nas, and other substances. Therefore, increasing self-esteem is essential for preventing the adolescents' emotional and behavioral disorders. This fact could guide us to the new approaches for smoking and drug-abuse prevention in adolescents.

Educational differences in smoking among adolescents in Germany: what is the role of parental and adolescent education levels and intergenerational educational mobility?

Background: Adolescence is the period in which smoking onset usually occurs and the course for future socioeconomic status (SES) is set. However, because of the transitional nature of adolescence, it is questionable whether health inequalities are best measured by indicators of parental SES or rather by indicators of the adolescents’ own developing SES. We examine the independent effects of parental and adolescent education and intergenerational educational mobility on adolescent smoking behaviour while controlling for differences in parental and close friends’ smoking behaviour. Methods: The study is based on data from a subsample (12–17 years, n = 5,053) of the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Participants reported their education level as well as their personal and close friends’ smoking behaviour. Information on parental education and smoking behaviour was obtained via parent interviews. Adolescent and parental education data were dichotomized (low/high), leading to four categories of intergenerational educational mobility: stable high, potentially upwardly mobile, potentially downwardly mobile, and stable low. Results: After adjustment for parental and close friends’ smoking behaviour, adolescent smoking habits were strongly related to their personal education level, but not that of their parents. Among boys, both stable low and downwardly mobile adolescents had a 2.7-fold increased risk of being a smoker compared with peers with a stable high education. Among girls, only those with a stable low education had a 2.2-fold increased risk of smoking. Among both genders, educational upward mobility was associated with significantly lower smoking rates compared with peers with a stable low education (boys: OR 0.32; 95% CI 0.20–0.53; girls: OR 0.52; 95% CI 0.37–0.73). Conclusions: Our results show that the risk of an adolescent smoking is influenced by their own education level rather than that of their parents. Educational upward mobility seems to be protective against becoming a smoker in youth. Boys who experience downward mobility tend to have a significantly higher inclination to smoke than their peers with a stable high education. These findings illustrate the potential public health benefits of investments in education and help identify high-risk groups for smoking onset.

Prevalence and gender patterns of mental health problems in German youth with experience of violence: the KiGGS study

BACKGROUND

Research examining mental health in violence-affected youth in representative samples is rare. Using data from the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) this study reports on gender-specific prevalence rates and associations of a broad range of internalizing and externalizing mental health problems: emotional problems, conduct problems, ADHD, disordered eating, somatic pain and substance use in youth variously affected by violence. While internalizing is generally more common in girls and externalizing in boys, observations of prior non-normative studies suggest reverse associations once an individual is affected by violence. The occurrence of such "gender cross-over effects" is therefore examined in a representative sample.

METHODS

The sample consisted of 6,813 adolescents aged 11 to 17 from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS): Applying multivariate logistic regression analyses, associations between each type of violence history and mental health indicator were determined for perpetrators, victims, and perpetrating victims of youth violence. Moderating effects of gender were examined by using product term interaction.

RESULTS

Victim status was associated primarily with internalizing problems, while perpetrators were more prone to externalizing problems. Perpetrating victims stood out with respect to the number and strength of risk associations with all investigated mental health indicators. However, the risk profiles of all violence-affected youth included both internalizing and externalizing mental health problems. Gender cross-over effects were found for girls and boys: despite lower overall prevalence, girls affected by violence were at far higher risk for conduct problems and illicit drug use; by contrast, somatic pain, although generally lower in males, was positively associated with perpetrator status and perpetrating victim status in boys. All violence-affected youth exhibited significantly higher rates of cumulative mental health problems.

CONCLUSIONS

The results highlight the importance of violence for the mental health of youth. They reveal a particular vulnerability as a function of gender. Implications for policy making, clinical practice and research are discussed.

Brain development during adolescence: neuroscientific insights into this developmental period

BACKGROUND

Adolescence is the phase of life between late childhood and adulthood. Typically, adolescents seek diversion, new experiences, and strong emotions, sometimes putting their health at serious risk. In Germany, for example, 62% of all deaths among persons aged 15 to 20 are due to traumatic injuries. Neuroscientific explanations have been proposed for typical adolescent behavior; with these explanations in mind, one can derive appropriate ways of dealing with adolescents.

METHOD

We selectively review pertinent articles retrieved from the PubMed database about the structural and functional development of the brain in adolescence.

RESULTS

New findings in developmental psychology and neuroscience reveal that a fundamental reorganization of the brain takes place in adolescence. In postnatal brain development, the maximum density of gray matter is reached first in the primary sensorimotor cortex, and the prefrontal cortex matures last. Subcortical brain areas, especially the limbic system and the reward system, develop earlier, so that there is an imbalance during adolescence between the more mature subcortical areas and less mature prefrontal areas. This may account for typical adolescent behavior patterns, including risk-taking.

CONCLUSION

The high plasticity of the adolescent brain permits environmental influences to exert particularly strong effects on cortical circuitry. While this makes intellectual and emotional development possible, it also opens the door to potentially harmful influences.

[Gender (role) aspects in doctor-patient communication]

Aspects of gender and gender roles are important factors influencing the interactions between physicians and their patients. On the one hand, gender roles have an impact on the behavior of the patients, such as in health care utilization or use of preventive examinations. On the other hand, gender issues influence doctors' actions with respect to communication, diagnosis, and treatment. Here, a gender bias may lead to misdiagnosis and inadequate treatment. In this paper certain pertinent aspects of gender roles in the doctor-patient relationship are discussed and illustrated by empirical findings.

Stand der Forschung zum Zusammenhang von Gesundheit und Bildung

Zusammenfassung. Die Diskussion um den Zusammenhang von Gesundheit und Bildung konzentriert sich in Deutschland bislang vor allem auf die Frage, welchen Einfluss Bildung auf Gesundheit hat. Für die Gesundheitsförderung und Prävention, insbesondere in Bildungs- und Erziehungssettings, ist jedoch ebenfalls von Bedeutung, ob ein und welcher Einfluss von Gesundheit auf Bildung ausgeht. Ziel des vorliegenden Beitrages ist es daher, einen Überblick über die internationale Befundlage zum Einfluss von Gesundheit auf Bildung zu geben. Entsprechend des nationalen Gesundheitsziels „gesund aufwachsen” werden dabei die Themenbereiche Ernährung, Bewegung und psychische Gesundheit fokussiert. Über eine systematische Datenbankrecherche ließen sich insgesamt 39 Längsschnittstudien identifizieren. Die Befundlage weist darauf hin, dass Übergewicht, Adipositas, mangelnde körperliche Aktivität und psychische Probleme einen negativen Einfluss auf die Schulleistung (Schulnoten), die Schulanwesenheit, den Schulabschluss sowie auch die Aufnahme und den Abschluss eines Studiums haben können. Dabei ließen sich eine Reihe von bedeutsamen Drittvariablen identifizieren (z.B. Sozialstatus, Ausmaß an Stigmatisierung). Die Ergebnisse liefern Hinweise für eine empirische Bestätigung der Annahmen des Ansatzes der guten gesunden Schule und geben überdies Anregungen für die Implementation und Evaluation von Maßnahmen der schulischen Gesundheitsförderung.

Clustering of lifestyle factors and association with overweight in adolescents of the Kiel Obesity Prevention Study

OBJECTIVE

To identify lifestyle clusters in adolescents and to characterize their association with overweight and obesity.

DESIGN

Cross-sectional and longitudinal data of the Kiel Obesity Prevention Study.

SETTING

Schools in Kiel, Germany.

SUBJECTS AND METHODS

Cross-sectional data of 1894 adolescents aged 14 years and 4-year longitudinal data of a subsample of 389 children aged 10 and 14 years. Self-reported data of physical activity, modes of commuting to school, media time, nutrition, alcohol consumption and smoking were used to identify lifestyle clusters with two-step cluster analysis. Obesity indices (height, weight, waist circumference and fat mass (FM)) were measured.

RESULTS

Three lifestyle clusters were identified: a 'low activity and low-risk behaviour' cluster (cluster 1: n 740, 39·1 %); a 'high media time and high-risk behaviour' cluster (cluster 2: n 498, 26·3 %); and a 'high activity and medium-risk behaviour' cluster (cluster 3: n 656, 34·6 %). Strictly speaking, none of these clusters was considered to be markedly healthy. The prevalence of overweight and obesity tended to be lower in cluster 3 (15·9 %) than in clusters 1 (20·4 %) and 2 (20·5 %; P = 0·053). Longitudinally, 4-year changes in FM were found to be lowest in cluster 2, but the 4-year incidence rate of obesity was lowest in cluster 3.

CONCLUSIONS

Explicit healthy lifestyles do not exist, but an active lifestyle reduces the incidence of obesity. In adolescents, health promotion should take into account the diversity of lifestyles and address specific lifestyle clusters.

The 'Eigenstandig werden' prevention trial: a cluster randomised controlled study on a school-based life skills programme to prevent substance use onset

Objective To implement and evaluate 'Eigenständig werden 5+6' ('Becoming Independent 5+6'), a school-based curriculum for grades 5 and 6 developed on the basis of evidence-based criteria for effective drug prevention curricula in schools. Evaluation of the programme includes efficacy, feasibility and practicability in daily school routine. Methods and results The intervention 'Eigenständig werden 5+6' consists of 14 teaching units evenly distributed over grades 5 and 6 which are interactively delivered, and a parent component. Programme effects are studied in a four wave cluster randomised controlled trial with two arms, an intervention and a control group. Self-completed questionnaires from students and teachers are collected by trained research staff. 45 schools, 172 classes and 3444 students with a mean age of 10.37 years (SD=0.59) and 47.9% girls from four federal states in Germany were assessed at baseline. 1685 students in 81 classes were assigned to intervention classes, 1759 students in 91 classes to the control arm. No differences between conditions were found for age, gender, immigration background, socioeconomic status, substance use or life skills at baseline. Exceptions were higher self-efficacy (t(3438)=2.34, p=0.02, d=0.08) and empathy (t(3302)=2.4, p=0.02, d=0.09) in the control group, whereas class climate seemed better in the intervention group (t(3037)=2.01, p=0.05, d=0.07), but effect sizes state marginal differences. Conclusion Baseline data suggest that the initial conditions are favourable for testing programme efficacy since distribution of baseline levels of the outcomes did not differ in the intervention and control groups, except for negligible differences between self-efficacy and empathy, which were higher in the control group, and class climate, which was higher in the intervention group. Trial registration number Current Controlled Trials ISRCTN99442407.

Health-related behaviour, knowledge, attitudes, communication and social status in school children in Eastern Germany

Enhancing health literacy is a keystone in health promotion. Yet, most studies on health literacy are limited to functional literacy levels. Furthermore, little evidence is available from children. Based on Nutbeam's outcome model for health promotion, this study aims (i) to elaborate a set of short scales to measure important health literacy domains in children and (ii) to analyse their associations among each other, with health behaviour as an intermediate health outcome, subjective health, social status and gender. The sample comprised 852 school children in fifth grade, aged 9-13 years, in Western Pomerania, Germany. Items were taken from the child's questionnaire to form short scales for health-related knowledge, attitudes, communication and behaviour. The internal consistencies of the communication and attitude scales were 0.73 and 0.57, respectively. Unidimensional scalability of the knowledge and behaviour scales was supported by item response models. Associations between health scales were modest. In regression analyses, social status and gender predicted only health knowledge and communication but not health behaviours, attitudes and self-efficacy. Health knowledge was not associated with any other scale. Our results suggest that targeting one specific component of health literacy in children is likely to exert only small effects on health status and health behaviour.

Prevalence of modifiable cardiovascular risk factors in German adolescents

BACKGROUND

The distribution and clustering of cardiovascular risk factors among German adolescents is only poorly understood.

OBJECTIVES

To describe the prevalence of major modifiable cardiovascular disease (CVD) risk factors and the clustering of risk factors in German adolescents aged 11-17 years.

DESIGN

Cross-sectional study.

METHODS

The German Health Interview and Examination Survey for Children and Adolescents was conducted between 2003 and 2006. The prevalence of major CVD risk factors (smoking, obesity, physical inactivity, hypertension, dyslipidaemia and diabetes) and their clustering among 6813 11-17 year old adolescents was calculated according to age and sex. Associations with sociodemographic variables were investigated in multivariate logistic regression analysis.

RESULTS

The prevalence of all risk factors apart from diabetes and obesity increased significantly across age groups. At the age of 17 years smoking and physical inactivity were the most frequent risk factors. In addition to age, most consistent and strongest associations were observed between socioeconomic status and CVD risk factors. Although the age of 11 years the majority of boys and girls were free of CVD risk factors, at age 17 years more than three-quarters were exposed to at least one risk factor.

CONCLUSION

Results indicate that the prevalence of CVD risk factors is increasing rapidly across age groups from 11 to 17 years. In late adolescence the majority of boys and girls are exposed to one or more CVD risk factor. Preventive actions will have to be expanded substantially to reduce the future burden of CVD.

Smoking and metabolic control in adolescents with type 1 diabetes

OBJECTIVE

To relate self-reported smoking frequency to metabolic control and other cardiovascular risk factors in adolescents with type 1 diabetes.

STUDY DESIGN

In the multicenter Diabetes Patienten Verlaufsdokumentationssystem database from Germany and Austria, anonymized records on 27 561 patients < 20 years of age with documented smoking status were available for analysis.

RESULTS

Self-reported smoking was negligible in patients younger than 11 years (0.1%), increasing to 5% in 11- to 15-year-old patients, and 28.4% in the 15- to 20-year-old age group. Multivariate analysis with adjustment for age, diabetes duration, sex, insulin therapy, and center differences, revealed that smokers had higher HbA1c-levels compared with non-smokers (9.1% vs 8.0%, P < .0001). Diastolic blood pressure was higher (68.2 vs 67.6 mm Hg, P < .0001), and the lipid profile was unfavorable in patients who smoke: Triglycerides and total cholesterol were higher and high-density lipoprotein-cholesterol was lower (all P < .0001).

CONCLUSIONS

Smokers display significantly worse metabolic control and a higher cardiovascular risk profile. Although not attested in trials, we state that education about smoking, smoking prevention, and psychological help for smoking cessation should be an integral part of comprehensive pediatric care for adolescent patients with type 1 diabetes.

Smoking and passive smoking exposure in young people: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

INTRODUCTION

This study analyzes the prevalence and associated factors for smoking and passive smoking among young people.

METHODS

The data are derived from a subsample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), carried out by the Robert Koch Institute between May 2003 and May 2006 (n = 6813, age = 11 to 17 years). This analysis considers current smoking status ("yes" or "no") and exposure to passive smoke ("several times a week or daily" versus "once a week or less frequently"). Social and educational status, parental smoking, and smoking status of friends were considered as associated factors.

RESULTS

In the 11 to 17 year old group, 20.5% of boys and 20.3% of girls smoked. Of those who did not smoke, 40% reported passive smoking exposure daily or several times a week. Important associated factors for smoking are educational status, parental smoking, and in particular the smoking status of friends. For passive smoking exposure, parental smoking status was of paramount significance.

DISCUSSION

These results show that adolescents are an important target group for anti-smoking interventions and that the main settings for these interventions are the school, the family, and the peer group.

Der Kinder- und Jugendgesundheitssurvey (KiGGS): Ein Überblick über Planung, Durchführung und Ergebnisse unter Berücksichtigung von Aspekten eines Qualitätsmanagements

The aim of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was to improve the information available on the health of the up-and- coming generation in Germany and to fill gaps in knowledge. This was to be done using a nationwide representative investigation and survey of children and adolescents aged 0 to 17. From May 2003 to May 2006, 17,641 girls and boys took part in the study at 167 locations in Germany; along with their parents' input they provided a unique pool of information. From the point of view of quality management, there is a description of the planning, structures, efficient use of funding, implementation and planned evaluation of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). In this description, the quality achieved is evaluated by comparing what was actually achieved with the targets set. In this manner, a comprehensive overview can be provided of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS): what it concerns, its modular structure, the co-operation partners involved, institutions financing it, regulatory processes accompanying it and strategies for evaluation. At the same time, it is shown how the individual publications in the journal for public health, health research and health protection (Bundesgesundheitsblatt) special issue no. 5/6 2007 connect to one another and to the issue as a whole.