Effectiveness of an app-based intervention to reduce substance use, gambling, and digital media use in vocational school students: study protocol for a randomized controlled trial

Background: Substance-related and addictive disorders are among the most common mental disorders in adolescence and young adulthood. Vocational school students are a risk group for problematic substance use and addictive behavior. However, the availability of evidence-based prevention concepts and programs is underdeveloped in the vocational school setting. Methods/design: A two-arm cluster randomized waitlist-controlled trial will be conducted to evaluate the effectiveness of an app-based intervention to decrease substance use, gambling, and digital media use in vocational school students in Germany. Vocational students will participate in an app-based intervention that is designed to support voluntary commitment to abstain from or reduce substance or digital media use over a period of 2 weeks. The "education-as-usual" control arm will have access to the intervention after data collection is completed. One of the primary outcome measures will be the use of alcohol, nicotine, and digital media 30 days after the intervention. Several secondary outcome measures will also be included, such as cannabis consumption, gambling, symptoms of stress, physical activity, mindfulness, well-being, impulsivity and sensation seeking, and readiness to change. A total of 4500 vocational students from 225 classes will be recruited and randomized across three German federal states. Discussion: This study protocol describes the design of an RCT testing the effectiveness of an app-based intervention to reduce addictive behaviors in vocational school students. It is expected that this approach will be feasible for and effective in the vocational school setting and that the study provides comprehensive information on the key factors involved in temporary abstaining or reducing substance or digital media use. Trial registration: German Clinical Trials Register DRKS00023788. Registered on 20 January 2021

Nichtraucherschutz und Tabakentwöhnung: Ein Thema für Mitarbeitende in Einrichtungen der deutschen Kinder- und Jugendpsychiatrie?

Fragestellung: Mitarbeitende in kinder- und jugendpsychiatrischen (KJP) Einrichtungen stehen im Spannungsverhältnis zwischen der Durchsetzung von Rauchverboten für Patient_innen und dem eigenen Rauchverhalten. Bisher fehlen Daten, ob und wo Mitarbeitende rauchen und welche Entwöhnungsangebote KJP-Einrichtungen ihnen anbieten. Methodik: In einer Onlinestudie beantworteten n = 78 leitende Mitarbeitende deutscher KJP-Einrichtungen (41.9 % aller Angeschriebenen) Fragen zu stationsübergreifenden sowie stationsspezifischen Nichtraucherschutzmaßnahmen sowie zu Tabakentwöhnungsmaßnahmen. Ergebnisse: Umfassende Rauchverbote werden selten umgesetzt (< 20 % der Einrichtungen). Mitarbeitende dürfen vorrangig im Außengelände rauchen (z. B. in Raucherzonen: 69 bis 78 % je nach Stationstyp). Entwöhnungsangebote für Mitarbeitende bietet nur jede zweite KJP an (47 %). Schlussfolgerungen: Die Daten weisen auf zukünftige Handlungsfelder der Tabakkontrolle in der KJP-Pflege hin: transparente Regeln, Weiterbildungen und Ausbau betrieblicher Entwöhnungsangebote.Objective: Whereas, on the one hand, employees in child and adolescent psychiatric institutions (CAP) have to enforce smoking bans among patients, on the other hand, they have a high likelihood of being smokers themselves. Little data are available on the enforcement of smoking regulations and what cessation support is offered by CAP institutions. Method: In an online survey, n = 78 senior staff members or directors of German CAP institutions (41.9 % of all addressed CAP institutions) responded to questions on smoking regulations, exceptions, and cessation support for employees. Results: The enforcement of comprehensive smoking bans is rarely reported (<20 % of CAP institutions). Employees are exempted or allowed to smoke mostly outside of the building (e. g., in designated smoking areas: 69-78 % depending on ward type). Cessation support was offered by less than half of the CAP institutions (47%). Conclusions: The data presented point toward future areas for tobacco control in CAP care, including transparent regulations, staff training, and dissemination of support for occupational smoking cessation

Predictors and outcomes in primary depression care (POKAL) – a research training group develops an innovative approach to collaborative care

BACKGROUND: The interdisciplinary research training group (POKAL) aims to improve care for patients with depression and multimorbidity in primary care. POKAL includes nine projects within the framework of the Chronic Care Model (CCM). In addition, POKAL will train young (mental) health professionals in research competences within primary care settings. POKAL will address specific challenges in diagnosis (reliability of diagnosis, ignoring suicidal risks), in treatment (insufficient patient involvement, highly fragmented care and inappropriate long-time anti-depressive medication) and in implementation of innovations (insufficient guideline adherence, use of irrelevant patient outcomes, ignoring relevant context factors) in primary depression care. METHODS: In 2021 POKAL started with a first group of 16 trainees in general practice (GPs), pharmacy, psychology, public health, informatics, etc. The program is scheduled for at least 6 years, so a second group of trainees starting in 2024 will also have three years of research-time. Experienced principal investigators (PIs) supervise all trainees in their specific projects. All projects refer to the CCM and focus on the diagnostic, therapeutic, and implementation challenges. RESULTS: The first cohort of the POKAL research training group will develop and test new depression-specific diagnostics (hermeneutical strategies, predicting models, screening for suicidal ideation), treatment (primary-care based psycho-education, modulating factors in depression monitoring, strategies of de-prescribing) and implementation in primary care (guideline implementation, use of patient-assessed data, identification of relevant context factors). Based on those results the second cohort of trainees and their PIs will run two major trials to proof innovations in primary care-based a) diagnostics and b) treatment for depression. CONCLUSION: The research and training programme POKAL aims to provide appropriate approaches for depression diagnosis and treatment in primary care

The Use of Alcohol, Tobacco, Illegal Drugs and Medicines : An Estimate of Consumption and Substance-Related Disorders in Germany

Background: Prevalence estimates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications and of substance-related disorders enable an assessment of the effects of substance use on health and society.Methods: The data used for this study were derived from the 2018 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA). The sample of the German adult population comprised 9267 persons aged 18 to 64 (response rate, 42%). Population estimates were obtained by extrapolation to a total resident population of 51 544 494 people.Results: In the 30 days prior to the survey, 71.6% of the respondents (corresponding to 36.9 million persons in the population) had consumed alcohol, and 28.0% (14.4 million) had consumed tobacco. 4.0% reported having used e-cigarettes, and 0.8% reported having used heat-not-burn products. Among illegal drugs, cannabis was the most commonly used, with a 12-month prevalence of 7.1% (3.7 million), followed by amphetamines (1.2%: 619 000). The prevalence of the use of analgesics without a prescription (31.4%) was markedly higher than that of the use of prescribed analgesics (17.5%, 26.0 million); however, analgesics were taken daily less commonly than other types of medication. 13.5% of the sample (7.0 million) had at least one dependence diagnosis (12-month prevalence).Conclusion: Substance use and the consumption of psychoactive medications are widespread in the German population. Substance-related disorders are a major burden to society, with legal substances causing greater burden than illegal substances.Gebrauch von Alkohol, Tabak, illegalen Drogen und Medikamenten: Schätzungen zu Konsum und substanzbezogenen Störungen in DeutschlandHintergrund: Schätzungen des Gebrauchs von Tabak, Alkohol, illegalen Drogen und psychoaktiven Medikamenten sowie von substanzbezogenen Störungen ermöglichen es, soziale und gesundheitliche Folgen des Substanzkonsums beurteilen zu können.Methode: Datengrundlage ist der Epidemiologische Suchtsurvey (ESA) 2018. Die Stichprobe aus der deutschen Erwachsenenbevölkerung umfasste n = 9 267 Personen im Alter von 18 bis 64 Jahren (Antwortrate 42 %). Die Prävalenzschätzungen wurden ausgehend von 51 544 494 Personen auf die Wohnbevölkerung hochgerechnet.Ergebnisse: In den letzten 30 Tagen vor der Befragung hatten 71,6 % der Befragten (36,9 Millionen [Mio.]) Alkohol und 28,0 % (14,4 Mio.) Tabak konsumiert. Den Gebrauch von E-Zigaretten berichteten 4,0 % und 0,8 % nutzten „heat-not-burn“-Produkte. Unter den illegalen Drogen wurde Cannabis (12-Monats-Prävalenz) mit 7,1 % (3,7 Mio. Personen) am häufigsten konsumiert, gefolgt von Amphetaminen (1,2 %; 619 000). Die Gebrauchsprävalenz nichtverordneter Analgetika (31,4 %) war deutlich höher als die vom Arzt verordneter Analgetika (17,5 %, gesamt 26,0 Mio.), sie wurden im Vergleich zu anderen Medikamenten jedoch seltener täglich genutzt. Mindestens eine Abhängigkeitsdiagnose (12-Monats-Prävalenz) wiesen 13,5 % der Stichprobe auf (7,0 Mio.).Schlussfolgerung: Substanzkonsum und der Gebrauch von psychoaktiven Medikamenten sind in der deutschen Allgemeinbevölkerung weit verbreitet. Substanzbezogene Störungen stellen eine erhebliche Belastung für die Gesellschaft dar, wobei die Belastung durch den Konsum legaler Substanzen die Belastung durch illegale Substanzen übersteigt

Short-term effectiveness of the national German quitline for smoking cessation: results of a randomized controlled trial

Abstract Background The objective of the present study was to examine the short-term effectiveness of the national German quitline for smoking cessation. Methods A parallel-group, two-arm, superiority, randomized controlled trial with data collection at baseline and post-intervention (three months from baseline) was conducted. Individuals were randomized to either the intervention group, receiving up to six telephone counselling calls, or the control group, receiving an active control intervention (self-help brochure). The primary outcome was the seven-day point prevalence abstinence at post-assessment. Secondary outcomes included changes in smoking-related cognitions and coping strategies from pre- to post-assessment, the perceived effectiveness of intervention components, and the satisfaction with the intervention. Results A total of n = 905 adult daily smokers were assigned to either the intervention group (n = 477) or the control group (n = 428). Intention-to-treat analyses demonstrated that individuals allocated to the telephone counselling condition were more likely to achieve seven-day point prevalence abstinence at post-assessment compared to those allocated to the self-help brochure condition (41.1% vs. 23.1%; OR = 2.3, 95% CI [1.7, 3.1]). Participants who received the allocated intervention in both study groups displayed significant improvements in smoking-related cognitions and coping strategies with the intervention group showing greater enhancements than the control group. This pattern was also found regarding the perceived effectiveness of intervention components and the satisfaction with the intervention. Conclusion The present study provides first empirical evidence on the short-term effectiveness of the national German quitline for smoking cessation, highlighting its potential as an effective public health intervention to reduce the burden of disease associated with smoking. Trial registration This study is registered in the German Clinical Trials Register (DRKS00025343). Date of registration: 2021/06/07

Do smoking, nutrition, alcohol use, and physical activity vary between regions in Germany? - results of a cross-sectional study

Background Previous studies on lifestyle risk factors mainly focused on age- or gender-specific differences. However, lifestyle risk factors also vary across regions. Aim of the present study was to examine the extent to which prevalence rates of SNAP (smoking, nutrition, alcohol consumption, physical activity) vary between East and West Germany or North and South Germany. Methods Data came from the population-representative 2015 Epidemiological Survey of Substance Abuse (ESA) comprising 9204 subjects aged 18 to 64 years. To assess an east-west or south-north gradient, two binary logistic regression models were carried out for each SNAP factor. Results The logistic regression models revealed statistically significant differences with higher rates of at-risk alcohol consumption and lower rates of unhealthy nutrition in East Germany compared to West Germany. Significant differences between North and South Germany were found for at-risk alcohol consumption with higher rates of at-risk alcohol consumption in South Germany. Daily smoking and low physical activity were equally distributed across regions. Conclusions The implementation of measures reducing at-risk alcohol consumption in Germany should take the identified east-west and south-north gradient into account. Since the prevalence of unhealthy nutrition was generally high, prevention and intervention measures should focus on Germany as a whole instead of specific regions

Nichtraucherschutz und Tabakentwöhnung

Fragestellung: Mitarbeitende in kinder- und jugendpsychiatrischen (KJP) Einrichtungen stehen im Spannungsverhältnis zwischen der Durchsetzung von Rauchverboten für Patientinnen und Patienten und dem eigenen Rauchverhalten. Bisher fehlen Daten, ob und wo Mitarbeitende rauchen und welche Entwöhnungsangebote KJP-Einrichtungen ihnen anbieten. Methodik: In einer Onlinestudie beantworteten n = 78 leitende Mitarbeitende deutscher KJP-Einrichtungen (41.9 % aller Angeschriebenen) Fragen zu stationsübergreifenden sowie stationsspezifischen Nichtraucherschutzmaßnahmen sowie zu Tabakentwöhnungsmaßnahmen. Ergebnisse: Umfassende Rauchverbote werden selten umgesetzt (&amp;lt; 20 % der Einrichtungen). Mitarbeitende dürfen vorrangig im Außengelände rauchen (z. B. in Raucherzonen: 69 bis 78 % je nach Stationstyp). Entwöhnungsangebote für Mitarbeitende bietet nur jede zweite KJP an (47 %). Schlussfolgerungen: Die Daten weisen auf zukünftige Handlungsfelder der Tabakkontrolle in der KJP-Pflege hin: transparente Regeln, Weiterbildungen und Ausbau betrieblicher Entwöhnungsangebote

Effects of an App-Based Intervention Program to Reduce Substance Use, Gambling, and Digital Media Use in Adolescents and Young Adults: A Multicenter, Cluster-Randomized Controlled Trial in Vocational Schools in Germany

Vocational students are a risk group for problematic substance use and addictive behaviors. The study aim was to evaluate the effects of an app-based intervention on tobacco, e-cigarettes, alcohol, and cannabis use as well as gambling and digital media-related behaviors in the vocational school setting. A total of 277 classes with 4591 students (mean age 19.2 years) were consecutively recruited and randomized into an intervention (IG) or waitlist control group (CG). Students from IG classes received access to an app, which encouraged a voluntary commitment to reduce or completely abstain from the use of a specific substance, gambling, or media-related habit for 2 weeks. Substance use, gambling, and digital media use were assessed before and after the intervention in both groups with a mean of 7.7 weeks between assessments. Multi-level logistic regression models were used to test group differences. Intention-to-treat-results indicated that students from IG classes had a significantly larger improvement on a general adverse health behavior measure compared to CG (OR = 1.24, p = 0.010). This difference was mainly due to a significantly higher reduction of students&rsquo; social media use in the IG (OR = 1.31, p &lt; 0.001). Results indicate that the app &ldquo;Meine Zeit ohne&rdquo; is feasible for the target group and seems to have a small but measurable impact on students&rsquo; health behavior

Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial

BackgroundDuring adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (“Meine Zeit ohne”) has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. ObjectiveThe aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants’ characteristics, and (3) to study how variations in app use were related to participants’ baseline characteristics. MethodsLog data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (“congruent use”: eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. ResultsThe intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. ConclusionsThe domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users’ characteristics. Trial RegistrationGerman Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID)RR2-10.1186/s13063-022-06231-