Polysubstance use in adolescence and emerging adulthood: Use patterns, trajectories, and determining factors

Ziel. Ziel der Arbeit ist, einen Überblick über bisherige Forschung zum multiplen Substanzkonsum (mS) in der Adoleszenz zu schaffen, und diese durch den Blick auf deutsche Jugendliche zu ergänzen Methode. Erstens, Durchführung einer systematischen Übersichtsarbeit zu latenten Klassen von mS in der Adoleszenz (10-19 Jahre). Zweitens, latente Klassenanalyse von mS des frühen Jugendalters (N=2.490) im Mehrebenenmodell. Drittens, latente Transitionsanalyse von mS bei Auszubildenden (N=5.214). Prädiktoren von mS wurden mittels multinomialer Regressionen geprüft. Ergebnisse. Die 23 in der Übersichtsarbeit eingeschlossenen Studien fanden drei bis vier latente Klassen des Substanzkonsums (kein Konsum; nur eine Substanz (v. a. Alkohol); mS; erweiterter Konsum). Zumeist umfasste mS die Substanzen Alkohol, Tabak und Cannabis und hing mit höherem Alter, Konsum der Eltern/Peers und schwachen Schulleistungen zusammen. Im frühen Jugendalter war mS (Alkohol und Binge Drinking, Zigaretten) mit Konsum der Eltern/Peers, höherem Alter, Bullying und niedrigem sozioökonomischem Status (SES) assoziiert. Bei Auszubildenden bestand ein Zusammenhang zwischen mS (Alkohol, Zigaretten, Cannabis) und Stress. Die Transitionen zwischen den latenten Klassen waren gering (2-10 %); die Stabilität von mS lag bei 92 %. In den meisten Studien stellte mS die kleinste Klasse dar. Diskussion und Schlussfolgerung. Nur wenige Jugendliche praktizieren mS, gleichwohl bestehen erhöhte Gesundheitsrisiken, sowie Zusammenhänge mit Konsum der Eltern/Peers und niedrigem SES für diese Gruppe. Prävention sollte daher gezielt sozial Benachteiligte adressieren und dabei deren Eltern/Peers berücksichtigen. Die Befunde legen eine hohe Stabilität von mS legt nahe, weshalb gerade Entstehung und Entwicklung von mS im Jugendalter genauer beobachtet werden müssen. Überdies ist der Zusammenhang von Produkten wie E-Zigaretten mit mS bislang unklar und könnte, etwa über Gateway-Modelle, hinsichtlich seiner Bedeutung eruiert werden.Aim. This thesis aims to review existing research on polysubstance use (PU) in adolescence, and provide a closer look at PU – and predictors thereof – in German adolescents. Methods. First, a systematic review of latent classes of PU in adolescence (10-19 years) was conducted. Second, PU in early adolescence was investigated in a longitudinal sample of 2,490 students via multilevel latent class models. Third, late adolescents’ PU was examined in a longitudinal sample of 5,214 vocational students via latent transition analysis. Predictors of PU were investigated via multinomial logistic regressions. Results. The systematic review identified 23 studies that mostly found three or four latent classes of substance use (no use; single substance use (alcohol); polysubstance use; advanced use). PU commonly comprised a combination of alcohol, tobacco, and cannabis. It was univocally associated with age, parental/peer substance use, and poor academic performance. In early adolescence, PU (alcohol use and binge drinking, cigarette smoking) was associated with parental/peer substance use, age, bullying, and low socio-economic status. Among late adolescents, PU (alcohol, cannabis, cigarettes) was connected to high stress. Transition rates between latent classes were small (2% to 10%), particularly for PU, with 92% remaining in the latent class over time. In most studies, PU was the smallest latent class. Discussion and conclusion. A small proportion of adolescents practices PU. Nevertheless, it is connected to elevated health risks, low socio-economic status, and peer/parental substance use. Thus, preventive efforts should target socially disadvantaged adolescents, and include parents and peers. Longitudinal models suggest stability of PU. Therefore, the progression of PU in adolescence needs to be examined closely. Also, with an increase in the use of potentially harmful products, e.g., e-cigarettes, the impact on PU should be studied, for example by investigating gateway models

Social Distancing and Stigma: Association Between Compliance With Behavioral Recommendations, Risk Perception, and Stigmatizing Attitudes During the COVID-19 Outbreak

Introduction: Following behavioral recommendations is key to successful containment of the COVID-19 pandemic. Therefore, it is important to identify causes and patterns of non-compliance in the population to further optimize risk and health communication. Methods: A total of 157 participants [80% female; mean age = 27.82 years (SD = 11.01)] were surveyed regarding their intention to comply with behavioral recommendations issued by the German government. Latent class analysis examined patterns of compliance, and subsequent multinomial logistic regression models tested sociodemographic (age, gender, country of origin, level of education, region, and number of persons per household) and psychosocial (knowledge about preventive behaviors, risk perception, stigmatizing attitudes) predictors. Results: Three latent classes were identified: high compliance (25%) with all recommendations; public compliance (51%), with high compliance regarding public but not personal behaviors; and low compliance (24%) with most recommendations. Compared to high compliance, low compliance was associated with male gender [relative risk ratio (RRR) = 0.08 (0.01; 0.85)], younger age [RRR = 0.72 (0.57; 0.93)], and lower public stigma [RRR = 0.21 (0.05; 0.88)]. Low compliers were also younger than public compliers [RRR = 0.76 (0.59; 0.98)]. Discussion: With 25% of the sample reporting full compliance, and 51% differing in terms of public and personal compliance, these findings challenge the sustainability of strict regulatory measures. Moreover, young males were most likely to express low compliance, stressing the need for selective health promotion efforts. Finally, the positive association between public stigma and compliance points to potential othering effects of stigma during a pandemic, but further longitudinal research is required to examine its impact on health and social processes throughout the pandemic

More Than a Glance: Investigating the Differential Efficacy of Radicalizing Graphical Cues with Right-Wing Messages

In recent years, online radicalization has received increasing attention from researchers and policymakers, for instance, by analyzing online communication of radical groups and linking it to individual and collective pathways of radicalization into violent extremism. But these efforts often focus on radical individuals or groups as senders of radicalizing messages, while empirical research on the recipient is scarce. To study the impact of radicalized online content on vulnerable individuals, this study compared cognitive and affective appraisal and visual processing (via eye tracking) of three political Internet memes (empowering a right-wing group, inciting violence against out-groups, and emphasizing unity among human beings) between a right-wing group and a control group. We examined associations between socio-political attitudes, appraisal ratings, and visual attention metrics (total dwell time, number of fixations). The results show that right-wing participants perceived in-group memes (empowerment, violence) more positively and messages of overarching similarities much more negatively than controls. In addition, right-wing participants and participants in the control group with a high support for violence directed their attention towards graphical cues of violence (e.g., weapons), differentness, and right-wing groups (e.g., runes), regardless of the overall message of the meme. These findings point to selective exposure effects and have implications for the design and distribution of de-radicalizing messages and counter narratives to optimize the efficacy of prevention of online radicalization

Internalizing and externalizing symptoms in Spanish children aged 6-8: Results of a latent profile analysis

Background Internalizing and externalizing problems are widely addressed in research. However, most studies use variable-centred approaches and ignore the possible co-occurrence of both types of symptoms. This study aimed to identify homogeneous groups of children with similar psychological difficulties and strengths, using latent profile analysis as a person-centred approach. Methods The parents of 107 Spanish children aged 6 to 8 years completed the Strengths and Difficulties Questionnaire (SDQ). Results The results revealed the existence of four latent groups. The children who belonged to the high difficulties group showed the most severe symptoms in emotional problems, peer problems and hyperactivity. The children classified in the externalizing group showed high levels of hyperactivity, behavioral problems, and emotional problems. On another hand, the internalizing profile grouped children with emotional and peer problems. Finally, the well-adjusted group showed an adequate psychological adjustment in all evaluated variables. High difficulties were associated with lower educational attainment of their parents. Limitations Data were reported from a single source of information, father or mother. Also, the socio-demographic variables that were related to each one of the four profiles only considered the age and educational level of the main informant. Conclusions These data suggest that co-occurrence of symptoms is very high in young Spanish children. It is essential to carry out clinical assessments that include both types of symptoms. Considering externalization and internalization as independent and exclusive phenomena can compromise the effectiveness of psychological treatments and preventive programs

Validity and psychometric properties of the self-identification as having a mental illness scale (SELF-I) among currently untreated persons with mental health problems

Conceptualizing own symptoms as potential signs of a mental illness is an important, yet underresearched step towards appropriate help. Few validated measures address recognition and identification of own mental illness. Aim of this study is to investigate performance and correlates of the ‘Self-Identification as Having a Mental Illness’ scale (SELF-I) in a group of 229 currently untreated individuals with mental health problems, predominantly depression. Measures included: self-identification with having a mental illness (SELF-I), depressive and somatic symptom severity (PHQ-9 and PHQ-15), illness perceptions (B-IPQ-R-C), and sociodemographic variables. Principal-component analysis revealed in a unidimensional factor structure. The SELFI showed good reliability in terms of internal consistency (Cronbach’s alpha, 0.85-0.87) and retest reliability over three months (Intraclass correlation coefficient, 0.74). Associations with depressive symptoms, previous treatment experiences and self-labelling demonstrated construct and criterion validity. Low associations with somatic symptoms and with illness-perceptions as measured by the B-IPQ-R-C indicated discriminant validity. We did not observe any floor or ceiling effects. The SELF-I scale is a brief, unidimensional and reliable measure of selfidentification as having a mental illness that offers useful research perspectives

The effects of causal and self-efficacy beliefs on help-seeking for people with depressive complaints: a quasi-experimental online study

BackgroundOnly approximately a third of people with depressive symptoms seek professional health care. Furthermore, people labelled as mentally ill may experience stigmatisation, which can impede help-seeking behaviour.AimTo examine the effects of three vignette-based interventions endorsing biopsychosocial causal beliefs and strengthening self-efficacy on help-seeking intention and behaviour, as well as the predictive values of these variables and previous treatment experience.MethodA quasi-experimental online study utilising a fractioned factorial design was carried out. People were screened for depressive symptoms and their current treatment status. After baseline assessment, they were randomly allocated into one of 24 groups receiving a combination of interventional messages. Actual help-seeking behaviour was measured at follow-ups 3 and 6 months after baseline.ResultsAltogether, N = 1,368 participants were included in the final analyses and N = 983 provided data on their help-seeking behaviour within 3 to 6 months after the baseline assessment. The intention to seek help from a general practitioner or a mental health professional was significantly influenced by the interventions. However, help-seeking behaviour was not influenced by the interventions. On a conceptual level, biopsychosocial causal beliefs (β = 0.09–0.23) and self-efficacy to seek help (β = 0.16–0.25) predicted help-seeking intention. There was a negative interaction effect of both self-efficacy beliefs on intention and behaviour, which changed depending on depression severity. In all models, the intention was the main predictor of actual behaviour. Treatment experience predicted both help-seeking intention and behaviour.ConclusionBiopsychosocial causal beliefs and self-efficacy have a direct effect on help-seeking intention. Interventions should include information on how to actually seek help as a means to strengthen self-efficacy beliefs and simulate previous treatment experience. Further research is needed to investigate the respective interaction effects on intention and behaviour.Clinical Trial Registrationhttps://drks.de/search/de/trial/DRKS00023557, German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021

Baseline study for improving diagnostic stewardship at secondary health care facilities in Nigeria

Background: Blood culture diagnostics are critical tools for sepsis management and antimicrobial resistance (AMR) surveillance. A baseline study was conducted to assess reported sepsis case finding, blood culture diagnostics, antimicrobial susceptibility testing (AST) and antimicrobial use at secondary health care facilities to inform the development of diagnostic stewardship improvement strategies in Nigeria. Methods: A cross-sectional online survey was conducted among 25 public secondary health care facilities in Abuja, Federal Capital Territory (FCT) and Lagos State in Nigeria to evaluate the capacity for pathogen identification and AST. Data were then prospectively extracted on all patients with reported suspected sepsis from electronic medical records from selected departments at two facilities in the Federal Capital Territory from October 2020 to May 2021 to further assess practices concerning sepsis case-finding, clinical examination findings, samples requested, and laboratory test results. Data were descriptively analysed, and a multivariate logistic regression analysis was conducted to determine factors associated with blood culture requests. Results: In the online survey, 32% (8/25) of facilities reported performing blood cultures. Only one had access to a clinical microbiologist, and 28% (7/25) and 4% (1/25) used standard bacterial organisms for quality control of media and quality control strains for AST, respectively. At the two facilities where data abstraction was performed, the incidence of suspected sepsis cases reported was 7.1% (2924/41066). A majority of these patients came from the paediatrics department and were outpatients, and the median age was two years. Most did not have vital signs and major foci of infection documented. Blood cultures were only requested for 2.7% (80/2924) of patients, of which twelve were positive for bacteria, mainly Staphylococcus aureus. No clinical breakpoints were used for AST. Inpatients (adjusted odds ratio [aOR]: 7.5, 95% CI: 4.6–12.3) and patients from the urban health care facility (aOR:16.9, 95% CI: 8.1–41.4) were significantly more likely to have a blood culture requested. Conclusion: Low blood culture utilisation remains a key challenge in Nigeria. This has implications for patient care, AMR surveillance and antibiotic use. Diagnostic stewardship strategies should focus on improving access to clinical microbiology expertise, practical guidance on sepsis case finding and improving blood culture utilisation and diagnostics.Peer Reviewe

Appsolutely secure? Psychometric properties of the German version of an app information privacy concerns measure during COVID-19

Introduction Privacy concerns are an important barrier to adoption and continued use of digital technologies, particularly in the health sector. With the introduction of mobile health applications (mHealth apps), the construct of app information privacy concerns has received increased attention. However, few validated measures exist to capture said concerns in population samples, although they can help to improve public health efforts. Methods Using a cross-sectional survey of German adults (mean age = 35.62; 63.5% female), this study examined psychometric properties of the app information privacy concerns scale (AIPC). Analyses comprised confirmatory factor analysis, factorial validity (exploratory factor analysis), internal consistency, convergent validity (i.e., correlations with privacy victimhood, and app privacy concerns), and discriminant validity (i.e., daily app use, adoption intentions, and attitudes toward COVID-19 contact tracing app use). Results The analysis did not support the proposed three-factor structure of the AIPC (i.e., anxiety, personal attitude, and requirements). Instead, a four-factor model was preferable that differentiated requirements regarding disclosure policies, and personal control. In addition, factors mirroring anxiety and personal attitude were extracted, but shared a significant overlap. However, these factors showed good reliability, convergent and discriminant validity. Discussion The findings underline the role of app information privacy concerns as a significant barrier to mHealth app use. In this context, anxiety and personal attitudes seemed particularly relevant, which has implications for health communication. Moreover, the observed differentiation of external (disclosure) and internal (control) requirements aligns with health behavior change models and thus is a promising area for future research

Storms, Fires, and Bombs: Analyzing the Impact of Warning Message and Receiver Characteristics on Risk Perception in Different Hazards

Abstract In crisis communication, warning messages are key to prevent or mitigate damage by informing the public about impending risks and hazards. The present study explored the influence of hazard type, trait anxiety, and warning message on different components of risk perception. A survey examined 614 German participants (18–96 years, M = 31.64, 63.0% female) using a pre–post comparison. Participants were randomly allocated to one of five hazards (severe weather, act of violence, breakdown of emergency number, discovery of a World War II bomb, or major fire) for which they received a warning message. Four components of risk perception (perceived severity, anticipatory worry, anticipated emotions, and perceived likelihood) were measured before and after the receipt. Also, trait anxiety was assessed. Analyses of covariance of risk perception were calculated, examining the effect of warning message, trait anxiety, and hazard type while controlling for age, gender, and previous hazard experience. Results showed main effects of hazard type and trait anxiety on every component of risk perception, except for perceived likelihood. The receipt of a warning message led to a significant decrease in anticipated negative emotions. However, changes across components of risk perception, as well as hazards, were inconsistent, as perceived severity decreased while perceived likelihood and anticipatory worry increased. In addition, three interactional effects were found (perceived severity × hazard type, perceived severity × trait anxiety, and anticipated emotions × hazard type). The findings point toward differences in the processing of warning messages yet underline the importance of hazard type, as well as characteristics of the recipient

How is the way we spend our time related to psychological wellbeing? A cross-sectional analysis of time-use patterns in the general population and their associations with wellbeing and life satisfaction

Background!#!Time-use surveys can closely monitor daily activities, times of stress and relaxation, and examine predictors and trajectories with regard to health. However, previous studies have often neglected the complex interaction of daily activities when looking at health outcomes.!##!Methods!#!Using latent profile analysis, this study examined patterns of self-reported daily time use (0-12h hours) for nine types of behaviour (work, errands, housework, childcare, care of persons in need, education, repairs and gardening, physical activity, and hobbies/leisure-time activities) in the 2018 wave of the German Socio-Economic Panel (N = 30,152; 51.9% female; M = 46.87 years). Sociodemographic variables, affective wellbeing, general and domain-specific life satisfaction, and self-rated health were inspected as predictors via multinomial logistic regression models.!##!Results!#!Six latent profiles emerged: full-time work (47.2%), leisure (33.8%), childcare (8.9%), education (7.0%), part-time work & care (2.6%), and care (0.5%). Overall, the care and part-time work & care profiles showed the lowest wellbeing scores, lower subjective health, and life satisfaction. Women were more likely to be members of the care and childcare profiles. Men were more likely to belong to the full-time work profile, and they reported significantly higher wellbeing than women.!##!Conclusions!#!The analysis revealed distinct patterns of time use and a burden on women, given their investment in care and childcare. Part-time work, and care seemed particularly demanding, and thus, are important areas for prevention, for instance, regarding mental health problems. However, time use was assessed via self-reports, therefore future studies could implement objective measures like digital trackers to validate findings