Substanzkonsum von Studierenden und Einflüsse der Peergroup: über die Bedeutung von sozialen Normen für den legalen und illegalen Substanzkonsum von europäischen Studierenden

Helmer SM. Substanzkonsum von Studierenden und Einflüsse der Peergroup: über die Bedeutung von sozialen Normen für den legalen und illegalen Substanzkonsum von europäischen Studierenden. Bielefeld: Universität Bielefeld; 2015.## Background and research questions Licit and illicit substance use (i.e., using alcohol, tobacco, cannabis and other illicit drugs) is a key public health concern among university students in Europe. The delivery of normative feedback based upon the so called ‘social norms approach’ has shown promising results regarding substance use reduction. The approach stems from previous international research indicating that incorrect perceptions of high rates of peer substance use are predictive of an increased personal use. North-American ‘social norms’-intervention studies show that providing feedback on actual peer consumption rates to students leads to a reduction of social pres-sure on the individual and may consequently reduce personal substance use. To date, work on this issue has largely been restricted to the North-American college system and little is known about the peer influence on personal substance use in European, particularly in German students. Therefore, it remains unclear if social norms-interventions may be a viable method to reduce substance use in European students. The key research question of this thesis is: Are peers a relevant factor for personal substance use of European, particularly German students, and, do basic requirements for the implementation of social norms-interventions to reduce substance use exist in Europe? ## Methods Social learning theories were used to explain modifications in substance use behaviour among university students. In this regard, associations between internal and external locus of control and licit and illicit substance use were evaluated. As a basis principle of the social norms ap-proach, discrepancies between estimated peer and personal substance use behaviour were as-sessed, and associations between perceptions of peer and personal substance use among Euro-pean university students were examined. Data were collected in the context of a German multicentre cross-sectional study (Gesundheitssurvey NRW) and an EU-funded study conducted in seven European countries (Social Norms Intervention for the prevention of Polydrug usE (SNIPE)). ## Results The results of the German survey showed that licit and illicit substance use are not associated with high internal locus of control and that high social-external locus of control is associated with low illicit substance use. Considerable discrepancies were observed between personal licit and illicit substance use and perceived peer use among European students. The majority of students across all seven participating European countries thought that their peers use licit and illicit substances more frequently than themselves. In addition, higher perception of peer licit and illicit substance use was associated with higher odds for own substance use. For instance, the perception that the majority of peers had consumed illicit substances at least once in their lives was associated with an odds ratio of 1.97 (95% CI: 1.53-2.54) for own lifetime use of illicit substances. ## Conclusion Students perceive substance use of peers to be higher than their personal use. Given the association between perceptions of substance use and personal substance use, basic requirements for the implementation of social norms interventions in European student populations exist. These findings lead to the conclusion that interventions addressing perceived norms, already widely used in the North-American educational system, may be a viable method to change substance use among European students. To gain knowledge about the feasibility and efficacy of interventions based upon the social norms approach in European societies, prevention approaches which take the phenomenon of misperceived norms into consideration should be designed and tested

Health-related locus of control and health behaviour among university students in North Rhine Westphalia, Germany

Helmer SM, Krämer A, Mikolajczyk RT. Health-related locus of control and health behaviour among university students in North Rhine Westphalia, Germany. BMC Research Notes. 2012;5(1): 703

Adolescents' perceptions and user experiences with a virtual reality-based alcohol prevention tool in Germany: A focus group study

Background: Excessive alcohol consumption is a major public health problem, with substance use early in life contributing to higher levels of use later in life. Virtual reality (VR) is an innovative technology for alcohol prevention among adolescents that could solve the problem of insufficient outreach to the target group of young people. The co-created German Virtual LimitLab simulation is one of the few examples of VR-based alcohol prevention tools and consists of a virtual house party simulation. The aims of Virtual LimitLab are to increase the users' awareness of how social pressure can influence their own decision-making as well as to enable various actions and communication strategies in order to train competencies when dealing with alcohol. The present study thus aims to explore adolescents' content- and technique-specific perceptions of Virtual LimitLab in order to gain insights into user experiences and to test the prototype with the German target group. Methods: Four semi-structured focus groups with adolescents aged 15-18 years (n = 13) were conducted and analyzed using thematic analyses. A user experience questionnaire (UEQ-S) was applied in order to quantitatively assess adolescents' satisfaction with Virtual LimitLab. Results: Three main themes were identified (VR experience, content, and technical aspects). Participants positively assessed both the content and the technical aspects of Virtual LimitLab. This trend was also seen by the UEQ-S data, which yielded positive ratings for both pragmatic and hedonic quality. The broad variety of options in the simulation that allow the user to try new behaviors was perceived particularly positively. In general, Virtual LimitLab was regarded as an innovative tool that encourages adolescents to think critically about their personal alcohol consumption. Technical errors in the simulation and users' difficulties in identifying with the simulation were the main points of criticism. Conclusions: Feedback from adolescent users revealed positive and therefore promising results when using Virtual LimitLab as a gaming alcohol-prevention tool. Some technical aspects still need to be improved in order to further refine the prototype, and suggestions for expanding the content of the application have already been made

Adolescents' perceptions and user experiences with a virtual reality-based alcohol prevention tool in Germany: A focus group study

BackgroundExcessive alcohol consumption is a major public health problem, with substance use early in life contributing to higher levels of use later in life. Virtual reality (VR) is an innovative technology for alcohol prevention among adolescents that could solve the problem of insufficient outreach to the target group of young people. The co-created German Virtual LimitLab simulation is one of the few examples of VR-based alcohol prevention tools and consists of a virtual house party simulation. The aims of Virtual LimitLab are to increase the users' awareness of how social pressure can influence their own decision-making as well as to enable various actions and communication strategies in order to train competencies when dealing with alcohol. The present study thus aims to explore adolescents' content- and technique-specific perceptions of Virtual LimitLab in order to gain insights into user experiences and to test the prototype with the German target group.MethodsFour semi-structured focus groups with adolescents aged 15–18 years (n = 13) were conducted and analyzed using thematic analyses. A user experience questionnaire (UEQ–S) was applied in order to quantitatively assess adolescents' satisfaction with Virtual LimitLab.ResultsThree main themes were identified (VR experience, content, and technical aspects). Participants positively assessed both the content and the technical aspects of Virtual LimitLab. This trend was also seen by the UEQ–S data, which yielded positive ratings for both pragmatic and hedonic quality. The broad variety of options in the simulation that allow the user to try new behaviors was perceived particularly positively. In general, Virtual LimitLab was regarded as an innovative tool that encourages adolescents to think critically about their personal alcohol consumption. Technical errors in the simulation and users' difficulties in identifying with the simulation were the main points of criticism.ConclusionsFeedback from adolescent users revealed positive and therefore promising results when using Virtual LimitLab as a gaming alcohol-prevention tool. Some technical aspects still need to be improved in order to further refine the prototype, and suggestions for expanding the content of the application have already been made

Schulische Alkoholprävention mittels Virtual Reality

Risky alcohol consumption among adolescents continues to be of high public health relevance in Germany. Therefore, preventive measures should promote the skills of adolescents to deal with alcohol and peer pressure. Interactive and gender-sensitive primary prevention programs in schools have a great potential to reach the target group and to increase the effectiveness of interventions. Digital tools such as virtual simulations may help with this process. Virtual reality (VR) enables the experience of risk situations in a safe environment. Internationally, there are currently two VR alcohol prevention programs for adolescents. Their co-creation with the target group was a core element, and comprehensive research on the usability and subjective effectiveness has already been published. Conventional effectiveness evaluations such as randomized controlled trials, however, have limitations with interactive formats. Alternative and complementary evaluation approaches are needed in the future. Furthermore, the potential of tailoring VR to recipients has to be examined. In this context, a gender-sensitive design is both an opportunity and a challenge. Further research is needed to study possibilities to use VR in alcohol prevention in adolescents in Germany

Effects of blended learning training for oncology physicians to advise their patients about complementary and integrative therapies: results from the multicenter cluster-randomized KOKON-KTO trial

Background: Many oncology physicians are confronted with the topic of complementary and integrative medicine (CIM) by cancer patients. This study examined whether a blended learning (e-learning and a workshop) to train oncology physicians in providing advice on CIM therapies to their cancer patients, in addition to distributing an information leaflet about reputable CIM websites, had different effects on physician-reported outcomes in regard to consultations compared with only distributing the leaflet. Methods: In a multicenter, cluster-randomized trial, 48 oncology physicians were randomly allocated to an intervention group (CIM consultation and an information leaflet) or a control group (information leaflet only). After the training, the oncology physicians conducted 297 consultations with their cancer patients. Measurements were assessed at oncology physician, physician-patient-interaction (measured by external reviewers), and patient levels. This analysis focused on the physician outcomes of stress reaction and perceived consultation skill competency. In addition, qualitative interviews were conducted with a subsample of oncology physicians who experienced both, the intervention and control condition. Results: The oncology physicians in the intervention group showed a lower stress reaction in all measured dimensions after CIM consultations than those in the control group. There was no significant difference between oncology physicians in the intervention and control groups regarding the perceived consultation skill competency (overburden: intervention 1.4 [95% CI: 0.7;2.1]; control 2.1 [95% CI: 1.4;2.7], tension: 1.3 [95% CI: 0.7;2.0] vs. 1.9 [95% CI: 1.3;2.5], and discomfort with consultation situations: 1.0 [95% CI: 0.4;1.7]; vs. 1.7 [95% CI: 1.2;2.3]). The qualitative data showed that only providing the leaflet seemed impersonal to oncology physicians, while the training made them feel well prepared to conduct a full conversation about CIM and provide the information leaflet. Conclusions: In our exploratory study providing structured CIM consultations showed positive effects on the perceived stress of oncology physicians, and the training was subjectively experienced as an approach that improved physician preparation for advising cancer patients about CIM, however no effects regarding perceived consultation skill competency were found

Effects of training oncology physicians advising patients on complementary and integrative therapies on patient‐reported outcomes: A multicenter, cluster‐randomized trial

Background: Many patients with cancer do not disclose complementary medicine use but want their physician's advice on this matter. This study evaluated whether using blended learning (e-learning plus a workshop) to train oncology physicians in providing advice on complementary and integrative medicine (CIM) therapies to their patients with cancer, in addition to distributing an information leaflet on reputable CIM websites, had different effects on patient-reported outcomes for the consultation than only distributing the leaflet. Methods: In this multicenter, cluster-randomized trial, patients from private practices/hospital departments, recruited by 48 oncology physicians randomly allocated to an intervention group (CIM consultation plus information leaflet) or a control group (information leaflet), received CIM information. Patient-reported outcomes included satisfaction (Patient Satisfaction With Information on Cancer Treatment), readiness to make a decision (Preparation for Decision Making), and physician-patient communication (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and Communication 26 [EORTC QLQ-COMU26]) for the consultation. Qualitative interviews were conducted with a physician subsample. Results: A total of 291 patients (128 in the intervention group and 169 in the control group) advised by 41 physicians participated. Patients in the intervention group rated physician-patient communication higher on all EORTC QLQ-COMU26 scales (mean total score, 84.3 [95% CI, 79.5-89.2] vs 73.6 [95% CI, 69.3-78.0]; P = .002), were more satisfied with the advice (mean, 4.2 [95% CI, 4.0-4.4] vs 3.7 [95% CI, 3.5-3.8]; P < .001), and were readier to make a decision (mean, 63.5 [95% CI, 57.4-69.6] vs 53.2 [95% CI, 47.8-58.7]; P = .016) than the control group. Physicians who reported patients in both settings seemed satisfied with the advice given. Conclusions: This study evaluated a novel education intervention for training oncology physicians in providing CIM advice in routine care. Providing structured CIM consultations had positive effects on patient satisfaction, readiness to make decisions, and physician-patient communication

Coronary artery disease in patients hospitalized for peripheral artery disease: a nationwide analysis of 1.8 million patients

Purpose: Coronary artery disease (CAD) and peripheral artery disease (PAD) are highly prevalent in society. This nationwide analysis aimed to evaluate the trends of in-hospital treatment of patients admitted due to PAD with and without concomitant CAD, to determine the prevalence and risk factors of concomitant CAD in patients with PAD. Methods: Using data from the German Federal Statistical Office, we included all admissions for PAD (with and without concomitant CAD) in Germany between 2009 and 2018. Baseline patient characteristics, outcomes and comorbidities were analyzed. Elixhauser comorbidity groups and the linear van Walraven comorbidity score (vWs) were calculated to assess the comorbidity burden. Results: Of all 1,793,517 patients hospitalized for PAD, a total of 21.8% (390,259) had concomitant CAD, increasing from 18.6% in 2009 to 24.4% in 2018. Patients with accompanying CAD showed higher in-hospital mortality (3.7 vs. 2.6%), more major amputations (9.0 vs. 7.7%) and more comorbidities (Elixhauser score: 4.2 vs. 3.2 and vWs: 9.1 vs. 6.1), resulting in higher costs (median: EUR 4541 vs. EUR 4268 per case). More advanced stages of PAD were associated with multi-vessel CAD (10% of all patients with PAD Fontaine IV showed 3-vessel CAD) and the prevalence of multi-vessel CAD increased predominantly in patients with advanced PAD. Conclusion: One in four patients hospitalized for PAD had concomitant CAD, showing an increase over time with an additional medical and economic burden for hospitals compared with patients without CAD