The choice of indicators influences conclusions about the educational gradient of sex-specific alcohol consumption

There has been considerable public interest in reports on harmful alcohol consumption of higher educated females. This study assesses the robustness of this finding with representative German data using ten different indicators of alcohol consumption. This cross-sectional study used data of the Epidemiological Survey on Substance Abuse from 2012. 4,225 females and 3,239 males represent the German population aged 18-64. It presents ten indicators of alcohol consumption by sex and education and provides group specific means and 95 %-confidence intervals. The main results are: (1) Higher educated males and females are drinking alcohol more frequently than lower educated males and females. (2) When drinking, higher educated males and females tend to drink less alcohol than lower educated males and females. (3) Only when using an indicator for hazardous alcohol consumption with different thresholds for males and females, the results indicate a pattern that significantly exposes hazardous alcohol consumption in the group of higher educated females. Concerning the choice of indicators, this study shows that sex-specific threshold-based indicators of alcohol consumption may lead to different conclusions as the majority of other indicators

Alkohol und Familie. Teil I: Konsum der Eltern. Teil II. Konsum der Kinder

„Alkohol und Familie”. In der vorliegenden Expertise werden aktuelle Ergebnisse der wissenschaftlichen Literatur zum Thema “Alkohol und Familie” zusammengefasst. Im ersten Teil werden schwerpunktmäßig der Alkoholkonsum der Eltern und seine Auswirkungen auf die familiäre Situation dargestellt; der zweite Teil beschäftigt sich mit dem Konsum von Kindern und Jugendlichen und dem Einfluss der Eltern auf deren riskante Trinkgewohnheiten. Alkoholkonsum ist unter deutschen Erwachsenen weit verbreitet. Frauen trinken gewöhnlich weniger riskant als Männer, dennoch konsumieren 14% der Frauen Alkohol während ihrer Schwangerschaft. Dies erhöht das Risiko für Alkoholfolgeschäden beim Kind. Mehr als zwei Millionen Kinder und Jugendliche leben in Familien mit alkoholbezogenen Problemen und haben deshalb eine erhöhte Wahrscheinlichkeit, intellektuelle, emotionale oder soziale Probleme oder eine Alkoholabhängigkeit zu entwickeln. Kinder alkoholabhängiger Eltern übernehmen häufig spezifische Rollenmuster um dadurch die Herausforderungen ihres täglichen Lebens bewältigen zu können. Ein Sechstel aller deutschen Jugendlichen zwischen 12 und 17 Jahren konsumiert mindestens einmal wöchentlich Alkohol. Sie bevorzugen Bier oder Mischgetränke und trinken meist gemeinsam mit ihren Freunden auf öffentlichen Plätzen. Jugendliche trinken aufgrund von Verstärkungs-, Bewältigungs-, Konformitäts- und sozialen Motiven. Riskantes Konsumverhalten (z.B. Rauschtrinken) hat zahlreiche kurz- und langfristige Effekte auf das körperliche, psychische und soziale Wohlbefinden von Jugendlichen. Eine große Zahl von Kindern, Jugendlichen und jungen Erwachsenen werden jährlich aufgrund einer Alkoholintoxikation in einem Krankenhaus behandelt. Eltern haben einen Einfluss auf den Alkoholkonsum ihrer Kinder durch ihren Erziehungsstil, Regelsetzung, Kommunikation, Vorbild- und Monitoringverhalten. Präventionsprogramme sollten daher sowohl Jugendliche als auch Eltern ansprechen.„Alcohol in Families“. This report summarises current results of the scientific literature regarding the topic “Alcohol in Families“. The first part focuses on parental alcohol use and its effects on the family. In the second part, alcohol consumption of children and adolescents and the impact of parents on their hazardous drinking habits are discussed. Hazardous alcohol use is a widely spread phenomenon among German adults. Women usually have less risky consumption patterns than men; however, during pregnancy, 14% of women consume alcohol. This increases the risk of alcohol related harms for the child. Over two million children and adolescents live in families with alcohol-related problems and are therefore more likely to develop intellectual, emotional and social problems, or alcohol dependence. Children with alcohol dependent parents tend to adopt specific roles in order to cope with the diverse challenges of their daily life. In Germany, one out of six adolescents between 12 and 17 years of age consume alcohol at least weekly. They prefer to drink beer or mixed drinks together with their friends at public places. Adolescents use alcohol because of enhancement, coping, conformity and social motives. Hazardous alcohol use (e.g. binge drinking) has numerous short and long term effects on the physical, psychological and social well-being of adolescents. A large number of children, adolescents, and young adults are admitted to hospital due to alcohol intoxication every year. Parents have an impact on the alcohol use of their children via their parenting, rule setting, communication, role modelling, and monitoring behaviour. Prevention programs should therefore address both adolescents and their parents

Gender and Emotional Representation Matter : Own Illness Beliefs and Their Relationship to Obesity

Background: Current treatments of obesity often fail to consider gender and psychological aspects, which are essential for weight loss and weight maintenance. The aim of our study was to analyze subjective illness representations (SIRs) of adults with obesity according to the Common-Sense Self-Regulation Model (CSM) by assessing their associations with weight-related variables and gender. Methods: Data was collected via online self-assessment between April 2017 and March 2018. SIRs were operationalized by the revised Illness Perception Questionnaire (IPQ-R) and illness outcomes according to the CSM were defined as BMI, eating behaviour, physical wellbeing, bodyweight satisfaction, and shape concerns. The sample consisted of 427 adults (M = 42.2 years, SD = 10.9; 82% female) with obesity (BMI: M = 42.3 kg/m2, SD = 9.0). Student's t-tests and multiple hierarchical regression analyses were conducted with the control variables (age and BMI) and subjective illness representations and gender as independent variables. Results: The explanation of outcome variances was moderate to high (21-43%) except for restraint eating behaviour (10%). Subjective illness representations showed several significant associations with weight-related variables, especially timeline and emotional representations. Female gender was significantly associated with more restraint eating behaviour [F(1, 400) = 4.19, p < 0.001] and females had unfavourable values of the weight-related variables as well as a more cyclic [t(425) = 3.68, p < 0.001], and more emotional representation [t(100) = 5.17, p < 0.001] of their obesity. Conclusion: The results of this study indicate that gender and subjective illness representations, especially the emotional representation, play an important role for weight-related variables. Therefore, the assessment of SIRs may constitute an economic tool to identify specific individual deficits of self-regulation

Does Weight-Cycling Influence Illness Beliefs in Obesity? : A Gender-Sensitive Approach

Obesity is classified as a chronic disease. Women and men seem to face different obstacles in their attempts to overcome one of the most challenging tasks in the treatment of this disease, namely, weight reduction maintenance. The Common-Sense-Model (CSM) is mainly used to improve the understanding of self-regulation and health behaviour in chronic diseases but has yet to be explored for obesity. This paper applies the CSM to obesity, focussing on the construct of illness representations, which is the basis of health behaviour according to the CSM. A sample of n = 356 women and n = 77 men with obesity was investigated to assess the extent that illness representations in obesity are shaped by experiences of weight-cycling and the extent that gender influences their quality. Our results show that the representations of timeline and consequences as well as the emotional representation are particularly influenced by weight-cycling, especially in men. On average, women showed more maladaptive illness representations than men. These findings not only contribute to a better applicability of the CSM in obesity, but also emphasize the importance of gender in obesity research and interventions

Food Addiction and Its Relationship to Weight- and Addiction-Related Psychological Parameters in Individuals With Overweight and Obesity

Background and Aims: It is assumed that a relevant subgroup of individuals experiences an addiction-like eating behaviour (Food Addiction), characterized by an impaired control over eating behaviour, emotional eating and food craving. Individuals experiencing Food Addiction partially share common symptomatology with Binge-Eating-Disorder and Bulimia Nervosa. The aim of this study was to investigate the prevalence of Food Addiction, general psychopathology, and associations with weight- and addiction-related constructs in individuals with overweight and obesity, who did not suffer from Binge-Eating-Disorder or Bulimia Nervosa. Methods: N=213 (67.1% female; MBMI=33.35kg/m2, SDBMI=3.79kg/m2) participants who were included in a weight loss program (I-GENDO project) reported BMI and completed questionnaires before the start of the treatment. Food Addiction severity, depressive symptoms, alcohol use disorder, internet use disorder, psychological distress, impulsivity personality trait, impulsive and emotional eating behaviour, food related inhibitory control, weight bias internalization, and self-efficacy were assessed. Results: The prevalence of Food Addiction was 15% with higher, although not statistically significant, prevalence in female (18.2%) compared to male (8.6%) participants. Food Addiction was associated with higher BMI at baseline assessment, low self-esteem, impulsive and emotional eating behaviour, weight bias internalization, and deficits in food-related inhibitory control. In addition, correlations were found between Food Addiction and severity of depressive symptoms, internet use disorder, and psychological distress. Conclusion: A relevant subgroup of participants experiences Food Addiction even when controlling for Binge-Eating-Disorder and Bulimia Nervosa. Future studies are warranted that investigate whether Food Addiction affects treatment success

Subjektive Krankheitsrepräsentationen sind relevant für Outcomes der Adipositasbehandlung

Adipositas wird von der WHO als chronische Erkrankung beschrieben; Gewichtsreduktionsprogramme sind langfristig häufig nicht erfolgreich. Das Common-Sense-Modell (CSM) der Selbstregulation nach Leventhal nimmt an, dass kognitive und affektive subjektive Repräsentationen von chronischen Gesundheitszuständen das Selbstregulationsverhalten der Betroffenen und darüber den Krankheitsverlauf beeinflussen. Es scheint somit geeignet, um relevante Einflüsse auf Faktoren der Entstehung und Aufrechterhaltung der Adipositas zu identifizieren und neue Ansatzpunkte der Behandlung abzuleiten. Bislang wurden vor allem Ursachenrepräsentationen untersucht. Das CSM postuliert jedoch weitere kognitive (z. B. über Verlauf, Kontrollierbarkeit und Verständnis) sowie emotionale Repräsentationen, die bislang weitestgehend unberücksichtigt blieben

Differential effects of the individualized gender-sensitive mHealth intervention I-GENDO on eating styles in individuals with overweight and obesity : a randomized controlled trial

Background: Addressing cognitive behavioral factors is associated with a favorable development of eating styles (i.e., increased levels of restrained eating, decreased levels of external and emotional eating) in individuals with overweight and obesity. Research suggests that the use of digital interventions that consider gender aspects regarding prevalence, comorbidities, and weight-related behaviors could enhance existing treatment options. This randomized controlled trial aimed to evaluate the effectiveness of the self-guided gender-sensitive mobile health intervention I-GENDO on restrained, emotional and external eating, body mass index, and physical activity at the end of the intervention, and at a 9- and 15-month follow-up. Methods: Two hundred thirteen individuals (67% female, body mass index: 33.35 ± 3.79 kg/m2) were randomly assigned to the intervention or control group. Multilevel models were calculated to investigate differences between groups. I-GENDO offered interactive modules addressing psychological content associated with obesity. Users were able to self-tailor intervention content based on their individual needs and life realities. Results: Restrained eating was higher in the intervention group after the intervention (95% CI: 0.20, 0.36) and at 9-months (95% CI: 0.07, 0.24). At 9-months, emotional eating among women was lower in the intervention group compared to the control group (95% CI: -0.44, -0,19). In the intervention group, external eating was lower after the intervention, which remained significant for women at 9 (95% CI: -0.40, -0.19) and 15-months (95% CI: -0.34, -0.13). Body mass index of men in the intervention group was 1.44 lower at 15-months than in the control group. No significant effects on physical activity were found. Conclusions: The I-GENDO intervention was effective in changing restrained eating of both women and men in the long-term, suggesting that a self-guided, gender-sensitive approach is promising. However, the differential effects on the outcome measures indicate that more research is warranted to examine distinct gender-sensitive mechanisms of digital psychological interventions (i.e., dose–response relationship, blended counselling). Trial registration: ClinicalTrials.gov identifier: NCT04080193, 06–09-2019

A cognitive behavioural mHealth intervention for families in the postpartum period to enhance weight management, mental well-being and resilience : a study protocol for a randomised controlled trial (I‑PREGNO) : [version 1; peer review: awaiting peer review]

Introduction: The postpartum period goes along with an increased risk of unhealthy weight gain and numerous physical and psychological challenges, which are associated with mental well-being and resilience. Given the individual circumstances and the accompanying time constraints, evidence-based mHealth interventions may be useful for flexible, spot-on complementary care. Thus, the mHealth app I-PREGNO aims to enhance mental well-being and resilience by offering cognitive-behavioural and behaviour change skills training to prevent unhealthy weight development in this vulnerable life episode. In a randomised controlled trial, we will examine its effectiveness and acceptance. Protocol: Parents of infants between 0 and 12 months will be randomised to the intervention or control group. Both groups will take part in a baseline survey (t0) and further assessments after 12 weeks (intervention duration, t1), and 6 months (t2). The intervention group will use the self-guided mHealth app after t0 and both groups will get unlimited access after t2. The primary outcomes will be i) weight (difference of weight in kg after the intervention and pre-pregnancy); ii) mental well-being assessed through the Edinburgh-Postnatal-Depression-Scale and Parenting Stress Index; iii) resilience assessed through the General Self-Efficacy Scale and Difficulties in Emotion Regulation Scale. Secondary outcomes will be sociodemographic variables, eating behaviour, physical activity, relationship experiences, childhood trauma, postpartum bonding, regulatory disorders, and app usability. Gender differences between mothers and fathers will be considered. Conclusion: Positive effects on weight development in the postpartum period, mental well-being, and resilience due to the I-PREGNO intervention will support parental health in the critical postpartum phase. The study results will contribute to the growing field of evidence-based, highly scalable, low-cost, geographically independent, just-in-time mobile support for a target group that is restricted in time and resources. Trial registration: The trial has been registered at the German Clinical Trials Register (DRKS00031067) in January 2023 prospectively

I-PREGNO – prevention of unhealthy weight gain and psychosocial stress in families during pregnancy and postpartum using an mHealth enhanced intervention: a study protocol of two cluster randomized controlled trials

Background The transition to parenthood represents a critical life period with psychosocial, and behavioral changes and challenges for parents. This often increases stress and leads to unhealthy weight gain in families, especially in psychosocially burdened families. Although universal and selective prevention programs are offered to families, specific support often fails to reach psychosocially burdened families. Digital technologies are a chance to overcome this problem by enabling a low-threshold access for parents in need. However, there is currently a lack of smartphone-based interventions that are tailored to the needs of psychosocially burdened families. Aims The research project I-PREGNO aims to develop and evaluate a self-guided, smartphone-based intervention in combination with face-to-face counseling delivered by healthcare professionals for the prevention of unhealthy weight gain and psychosocial problems. The intervention is specifically tailored to the needs of psychosocially burdened families during the pregnancy and postpartum period. Methods In two cluster randomized controlled trials in Germany and Austria (N = 400) psychosocially burdened families will be recruited and randomized to i) treatment as usual (TAU), or ii) I-PREGNO intervention (self-guided I-PREGNO app with counseling sessions) and TAU. We expect higher acceptance and better outcomes on parental weight gain and psychosocial stress in the intervention group. Discussion The intervention offers a low cost and low-threshold intervention and considers the life situation of psychosocially burdened families who are a neglected group in traditional prevention programs. After positive evaluation, the intervention may easily be implemented in existing perinatal care structures in European countries such as Germany and Austria. Trial registration Both trials were registered prospectively at the German Clinical Trials Register (Germany: DRKS00029673; Austria: DRKS00029934) in July and August 2022