App-Based Coaching to Prevent Addictive Behaviors among Young Adults

Abstract: Background: Vocational students have an increased risk to engage in health-risk behaviors compared to same-aged peers. To date, evidence-based digital prevention approaches that address multiple health-risk behaviors are rare. Method: The randomized-controlled trial (RCT) “Prevention of at-risk substance and Internet use disorders among vocational students” (PARI) investigates the efficacy of an app-based prevention approach compared to a waitlist-control condition. The aim is to prevent substance-related and behavioral addictions and improve life skills. An existing app (ready4life) was adapted under consideration of focus groups with teachers, prevention experts, and students. A Delphi expert group rated the quality of the approach. The efficacy of the modified ready4life app is currently being tested in a RCT. The proactive recruitment takes place in German vocational schools. After participating in an app-based screening (T0), participants get individualized feedback and will be cluster-randomized per class to the intervention group (IG; n=1.250) or control group (CG; n=1.250). The IG chooses two out of six modules: Social competence, stress management, cannabis, tobacco, alcohol, social media/gaming. The CG receives information on how to improve health behaviors. Follow-ups are conducted after 6 months (T1) and 12 months (T2). Conclusion: This RCT provides data on a multibehavioral prevention approach for vocational students. Final results are expected in 2023

Aspects of behavioral interventions for cardiovascular risk reduction: Target behaviors, recruitment strategies and use of new communication technologies

Background: Cardiovascular disease (CVD) remains the major cause of mortality and morbidity worldwide and produces large productivity loss. The majority of CVD mortality could be prevented with changes in modifiable risk factors including tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol. Successful behavioral prevention of CVD requires the identification of relevant target behaviors and reach of populations at risk. Presenteeism i.e. attending work while ill is discussed as a work-related risk factor for CVD. However, little is known about the interplay of presenteeism with established health risk behaviors. The first aim of this dissertation was to examine the association of presenteeism with health behaviors (study 1). The second aim was to examine factors that can enhance the public health impact of CVD prevention efforts. Therefore, the effect of recruitment strategy used on reach (study 2) and of communication channel used on intervention usage (study 3) was examined. Methods: Study 1 comprised data from 710 Australian employees aged 18 years and older who completed an online-survey. Linear regression analysis was used to examine the association of health behaviors (physical activity, work and non-work-related sitting time, sleep duration and sleep quality) with presenteeism. For study 2 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) and job centers (n = 1,049), and mail invitations from a health insurance company (n = 894). Recruitment strategies were compared regarding three aspects of reach: (1) participation rate, (2) participants’ characteristics i.e. socio-demographics, self-reported health and CVD risk factors, and (3) predictors of program participation. Study 3 compromised 16,948 users (aged 18 years and older) of the feely available physical activity promotion program 10,000 Steps. Users were grouped based on which platform (website, app) they logged their physical activity: Web-only, App-only, or Web-and-app. Groups were compared on socio-demographics, engagement parameters and logged physical activity. Non-usage attrition i.e. discontinued program usage over the first three months was examined using Kaplan-Meier survival curves. A Cox regression model was used to determine predictors of non-usage attrition. Results: Analyses from study 1 revealed that presenteeism was associated with poor sleep quality and suboptimal sleep duration after controlling for socio-demographics, work and health-related variables. Engaging in three health risk behaviors was associated with higher presenteeism compared with engaging in none or one. Study 2 showed screening participation rates of 56.0%, 32.8%, 23.5% for general practices, job centers and the health insurance company, respectively. Participation rate for the CEP among eligible individuals was 80.3%, 65.5%, and 96.1%, respectively. Job center clients showed the lowest socio-economic status and the most adverse CVD risk pattern. Whereas being female predicted screening participation across all strategies, higher age predicted screening participation only within individuals recruited via the health insurance company. Within general practices and job centers CEP participants were less likely to be smokers than non-participants. Study 3 revealed that engagement with the program was highest for Web-and-app users. Cox regression showed that user group predicted non-usage attrition: Web-and-app users (hazard ratio = 0.86; P < .001) and App-only users (hazard ratio = 0.63; P < .001) showed a reduced attrition risk compared to Web-only users. Further, older age, being male, being non-Australian, higher program engagement and higher number of steps logged were associated with reduced non-usage attrition risk. Conclusion: The results of this dissertation have three implications for designing CVD behavioral interventions with a high public health impact. First, employees suffering from presenteeism may require interventions addressing health risk behaviors including suboptimal sleep behaviors. Second, implementing prevention efforts in job centers may be especially useful to reduce health inequalities induced by social gradient. Third, the population impact of web-based interventions may be increased when using mobile delivery channels.Hintergrund: Der Großteil der kardiovaskulären Mortalität könnte durch Veränderungen von Risikofaktoren wie Rauchen, Körperliche Inaktivität, ungesunde Ernährung und riskantem Alkoholkonsum verhindert werden. Erfolgreiche Verhaltensprävention von kardiovaskulären Erkrankungen erfordert (1) die Identifikation von relevanten Zielverhaltensweisen, und (2) die Erreichung von Risikopopulationen. Präsentismus, das Aufsuchen des Arbeitsplatzes trotz Krankheit, wird als arbeitsbezogener Risikofaktor für kardiovaskuläre Erkrankungen diskutiert. Bisher existiert aber wenig Wissen über das Zusammenspiel von Präsentismus mit bereits bekannten gesundheitsriskanten Verhaltensweisen. Die vorliegende Dissertation hatte das Ziel den Zusammenhang von Gesundheitsverhaltensweisen und Präsentismus zu untersuchen (Studie 1). Weiterhin sollten Faktoren untersucht werden, die den Public-Health-Impact von kardiovaskulären Präventionsangeboten erhöhen können. Hierfür wurde der Einfluss der Rekrutierungsstrategie auf die Erreichung (Studie 2) sowie des Kommunikationskanals auf die Interventionsnutzung untersucht (Studie 3). Methode: Studie 1 beinhalteten 710 australische Arbeitnehmer im Alter von mindestens 18 Jahren, welche an einer internet-basierten Befragung teilnahmen. Mittels linearer Regression wurde der Zusammenhang zwischen Gesundheitsverhaltensweisen (Bewegung, arbeits- und nichtarbeitsbezogene Sitzzeit, Schlafdauer und Schlafqualität) und Präsentismus untersucht. Für Studie 2 wurden Individuen zwischen 40 und 65 Jahren zu einem zweistufigen kardio-präventiven Untersuchungsprogram eingeladen, welches eine Gesundheitsbefragung vor Ort und ein kardiovaskuläres Untersuchungsprogram (CEP) beinhaltete. Die Rekrutierung erfolge durch persönliche Ansprache der Individuen in Allgemeinarztpraxen (n = 671) und Job Centern (n = 1049), und durch Briefe einer Krankenversicherung an ihre Versicherten (n = 894). Die Rekrutierungsstrategien wurden hinsichtlich (1) Teilnahmerate, (2) Eigenschaften der Teilnehmer d.h. Soziodemographie, subjektiver Gesundheitszustand und kardiovaskuläre Risikofaktoren, und (3) Prädiktoren der Programteilnahme verglichen. Studie 3 beinhaltete 16948 Nutzer (18 Jahre und älter) des frei verfügbaren Programms 10,000 Steps zur Förderung von Bewegung. Die Nutzer wurden anhand der Plattform (10,000 Steps Internetseite = Web, 10,000 Steps iOS App = App) gruppiert, welche Sie zum einloggen Ihrer körperlichen Aktivität nutzten: Nur-Web, Nur-App, oder Web-und-App. Die Gruppen wurden hinsichtlich Soziodemographie, Nutzungsparameter und geloggter körperlicher Aktivität verglichen. Attrition, das Einstellen der Programnutzung, über die ersten drei Monate wurde mittels Kaplan-Meier-Überlebenskurven analysiert. Ein Cox-Regressionsmodell wurde genutzt um Prädiktoren von Attrition zu bestimmen. Ergebnisse: Analysen aus Studie 1 ergaben signifikante Assoziationen von Präsentismus mit geringer Schlafqualität und suboptimaler Schlafdauer nach Kontrolle für soziodemografische, arbeitsbezogene und gesundheitsbezogene Variablen. Das Ausüben von drei gesundheitsriskanten Verhaltensweisen war, verglichen mit dem Ausüben von keinem oder einem gesundheitsriskanten Verhalten, mit erhöhtem Präsentismus assoziiert. In Studie 2 betrugen die Teilnahmeraten für Arztpraxen, Job Center und Krankenversicherung jeweils 56,0%, 32,8% und 23,5%. Jeweils 80,3%, 65,5%, und 96,1% der Eligiblen nahmen am CEP teil. Klienten des Job Centers wiesen den geringsten sozio-ökonomischen Status und das höchste kardiovaskuläre Risiko auf. Während Frauen über alle Rekrutierungsstrategien häufiger am Screening teilnahmen als Männer, war höheres Alter nur innerhalb der Krankenversicherungsstichprobe ein Prädiktor für die Screeningteilnahme. Nichtraucher nahmen innerhalb der Arztpraxen und Job Center häufiger am CEP teil als Raucher. Studie 3 ergab die höchste Nutzung des Programms für die Web-und-App-Gruppe. Die Cox-Regression ergab, dass die Nutzergruppe Attrition vorhersagt: Web-und-App-Nutzer (hazard ratio = 0.86; P < .001) und Nur-App-Nutzer (hazard ratio = 0.63; P < .001) hatten ein reduziertes Attritionrisiko verglichen mit Nur-Web-Nutzern. Darüber hinaus wiesen Ältere, Männer, Nicht-Australier, Individuen mit einer höheren Nutzung und einer höheren Anzahl an geloggten Schritten ein reduziertes Attritionrisiko auf. Schlussfolgerung: Die Ergebnisse der vorliegenden Dissertation haben drei Implikationen für die Entwicklung von kardiopräventiven Verhaltensinterventionen mit hohem Public-Health-Impact. (1) Interventionen für Arbeitnehmer mit Präsentismus sollten Gesundheitsverhaltensweisen einschließlich Schlaf adressieren. (2) Die Implementierung von Präventionsangeboten in Job Centern erscheint besonders nützlich zur Reduktion von Gesundheitsunterschieden, welche durch den sozialen Gradienten induziert werden. (3) Der Public-Health-Impact von internet-basierten Interventionen könnte durch den Einsatz von mobilen Kommunikationskanälen verbessert werden

App-Based Coaching to Prevent Addictive Behaviors among Young Adults

Background: Vocational students have an increased risk to engage in health-risk behaviors compared to same-aged peers. To date, evidence-based digital prevention approaches that address multiple health-risk behaviors are rare. Method: The randomized-controlled trial (RCT) 'Prevention of at-risk substance and Internet use disorders among vocational students' (PARI) investigates the efficacy of an app-based prevention approach compared to a waitlist-control condition. The aim is to prevent substance-related and behavioral addictions and improve life skills. An existing app (ready4life) was adapted under consideration of focus groups with teachers, prevention experts, and students. A Delphi expert group rated the quality of the approach. The efficacy of the modified ready4life app is currently being tested in a RCT. The proactive recruitment takes place in German vocational schools. After participating in an app-based screening (T0), participants get individualized feedback and will be cluster-randomized per class to the intervention group (IG; n=1.250) or control group (CG; n=1.250). The IG chooses two out of six modules: Social competence, stress management, cannabis, tobacco, alcohol, social media/gaming. The CG receives information on how to improve health behaviors. Follow-ups are conducted after 6 months (T1) and 12 months (T2). Conclusion: This RCT provides data on a multibehavioral prevention approach for vocational students. Final results are expected in 2023

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies