Anneke Bühler

Prevention of familial transmission of depression: EFFEKT-E, a selective program for emotionally burdened families

AimParental depression is a strong risk factor for depression in children and is associated with offspring’s behavioral problems. Therefore, prevention measures should aim to reduce the transmission of risk to children of depressed mothers. In this paper, description and evaluation results are reported for EFFEKT-E (Entwicklungsförderung in Familien: Eltern- und Kinder-Training in emotional belasteten Familien), a prevention program to be used in the setting of mother–child rehabilitation clinics. EFFEKT-E is a family-oriented program including parent training and social skills training for pre-school children.Subjects and methodsThe evaluation study contained 375 mothers and their children. The program was evaluated in a quasi-experimental pre-post-follow-up design using instruments on parenting behavior and children’s emotional and behavioral problems.ResultsEvaluation showed satisfying out reach and implementation of the program. Compared to a treatment-as-usual condition, EFFEKT-E children exhibited less emotional disruption and hyperactivity. Mother’s sense of parental competence was promoted, problematic parenting behavior decreased.ConclusionEFFEKT-E is an evidence-based selective program which has the potential to prevent intergenerational transmission of depression.

An Internet-based ecological momentary assessment study relying on participants' own mobile phones: insights from a study with young adult smokers.

Background: In this paper we describe a novel Internet-based cell phone-optimized assessment technique (ICAT) to conduct an ecological momentary assessment (EMA) study. Participants could access the assessment instrument via the web browsers of their mobile phones. Methods: We report results from 92 young adult smokers (18-25 years old) who completed the baseline assessment and the first of 4 waves (3 days/wave) of EMA. Random prompts were issued via text messages sent to the participants. The participants were also instructed to self-initiate reports of smoking situations. Results: Compliance with the study protocols was low. In total, the participants completed 885 assessments during the 3 days of monitoring. Only 50.2% of random prompts were responded to, and 52.4% of those were completed within the first 10 min after issuing. Furthermore, reports of smoking situations were rarely self-initiated. In a multivariate regression analysis, age (positively) and female gender (negatively) predicted the number of completed assessments. Conclusions: This study adds to the limited experiences made with ICAT in substance use research. Similar to the few prior ICAT studies, compliance was low compared to traditional EMA studies. While using ICAT is technically feasible, specific improvements should be implemented to tap ICATs full potential in future studies.

Prevention of teenage smoking through negative information giving, a cluster randomized controlled trial

Aims: The objective of this study was to evaluate the preventive effect of a clinic-based, emotionally arousing, negative information giving intervention on adolescents’ protective and risk factors of smoking. Methods: Data of 563 students (18 schools) from a cluster randomized controlled trial conducted in Heidelberg, Germany (2010–2011) were analysed. The intervention included a presentation about the risks of smoking, a live video session of a pulmonary endoscopy and a testimonial interview with a lung cancer patient. A prevention booklet served as the control condition. Students’ reaction to the intervention was assessed after 2 weeks, risk and protective factors of smoking and smoking status were assessed after 2.5 months. Findings: The clinic intervention received significantly better ratings of credibility, personal relevance and emotional arousal than the booklet. Differences between clinic and booklet groups failed to reach significance on smoking-related threat appraisal, coping appraisal, protection motivation, behavioural intention and smoking status. Conclusions: Although the clinic intervention generated a significant immediate reaction, there were no significant preventive effects at follow-up. These results are in line with previous research and add further evidence for the ineffectiveness of emotionally arousing negative information giving in smoking prevention with adolescents.

Prevention of familial transmission of depression through a family‐oriented programme targeting parenting as well as the child's social competence

Purpose – The purpose of this article is to evaluate the prevention programme EFFEKT‐E that was designed for preschool children of depressive mothers and contains an intervention for children and for mothers.Design/methodology/approach – Research was carried out in mother‐child clinics in Germany. In total, 220 strained mothers, who were screened for elevated levels of depressive symptoms, were enrolled in the control and 186 in the training group. For evaluation, mothers rated emotional disturbance and social competence of the child as outcome measures before and after the training. Changes in parenting behaviour, perceived parental competence and parenting stress were also assessed.Findings – An effect on emotional disturbance of the child emerged (d=0.52) in the training group. Perceived parental competence increased (d=0.72) and parental stress decreased (d=0.23) significantly under training. EFFEKT‐E has proven to be a valuable programme for preventing depression in offspring of mothers who feel depr...

Are you in or out? Recruitment of adolescent smokers into a behavioral smoking cessation intervention.

Even though many adolescent smokers want to quit, it is difficult to recruit them into smoking cessation interventions. Little is known about which adolescent smokers are currently reached by these measures. In this study we compare participants of a group-based, cognitive behavioral smoking cessation intervention with adolescent smokers who decided against participating. Within a non-randomized controlled trial, data of 1053 smokers (age 11–19) from 42 German secondary schools were analyzed. Of these smokers, 272 were recruited into 47 courses of the intervention. An in-class information session, individually addressing potential participants, and incentives were used as means of recruitment. Personal predictors of participation were analyzed using regression analyses and multivariate path analyses to test for mediation. In the path analysis model, nicotine dependence, quit motivation, and a previous quit attempt were directly positively related to participation. Heavier smoking behavior was indirectly positively associated with participation through nicotine dependence and negatively through quit motivation, yielding an overall positive indirect effect. The positive effect of a previous quit attempt on participation was partially mediated through nicotine dependence and quit motivation. The proportion of smoking friends were indirectly positively related to participation, mediated through nicotine dependence. Since adolescents with heavier smoking behavior and stronger nicotine dependence are less likely to undertake a successful unassisted quit attempt, the reach of these young smokers with professional cessation interventions is desirable. Further measures to improve the recruitment of those currently not motivated to quit have to be examined in future studies.

The role of participants' self-selected future smoking goals in adolescent smoking cessation interventions

BACKGROUND There is an implicit assumption that abstinence is the treatment goal of young smokers that deliberately participate in cessation interventions, but this may not always be the case. To gain information on subgroups of adolescent intervention participants, we compare participants who want to achieve smoking abstinence (Abst) with those stating a non-abstinence future smoking goal (NAbst), with regard to baseline characteristics, reasons for participation, quit motivation, retention, goal attainment, and smoking abstinence. METHODS The sample consisted of 202 adolescent smokers (49.5% female). At baseline, 118 (58.4%) indicated abstinence as future smoking goal and 84 (41.6%) indicated non-abstinence. All participants received a behavioral smoking cessation intervention. Assessments took place before, during, and after treatment, and at 6-month follow-up. Regression analyses were conducted. RESULTS Abst and NAbst participants reported similar baseline characteristics. Abst participants, however, were more likely to report a previous quit attempt and indicated a higher quit motivation before and during treatment. Abst participants were more likely to participate based on own initiative and NAbst participants because of participating friends. Both groups attended a similar number of intervention sessions and were equally likely to attain their self-selected smoking goal. However, more Abst participants reported a successful quit attempt during treatment and abstinence at post-treatment and follow-up. CONCLUSIONS NAbst participants may represent a substantial subgroup in smoking cessation interventions for adolescents. Results indicate that future smoking goals can influence treatment outcomes. NAbst participants in treatment may benefit from additional information on the negative health consequences of light smoking.

Welche Lebensfertigkeiten fördert ein suchtpräventives Lebenskompetenzprogramm

Zusammenfassung. Lebenskompetenzprogramme (LKP) zahlen zu den effektivsten Einzelbausteinen der schulischen Suchtpravention. Trotz vieler Evaluationsstudien liegen kaum Uberprufungen des Interventionsmodells vor. Dies ergabe aber evidenz-basierte Hinweise auf die Verbesserung der Masnahmen. In der vorliegenden quasi-experimentellen Interventionsstudie wurde der Ansatz verfolgt, LKP verhaltensbezogener zu evaluieren und zunachst zu uberprufen, ob die trainierten Fertigkeiten bei den Programmteilnehmern tatsachlich Anwendung finden. Dazu wurden an einer Stichprobe mit 753 Funftklasslern und einer randomisierten Teilstichprobe mit 52 Schulern der Einfluss eines suchtpraventiven Lebenskompetenzprogramms auf die von der WHO (1994) definierten Lebensfertigkeiten langsschnittlich mittels quantitativer und qualitativer Erhebungsverfahren untersucht. Die teilnehmenden Schuler und Schulerinnen des LKP verzeichneten gegenuber einer Kontrollgruppe einen Zuwachs an Wissen uber Lebensfertigkeiten (z.B. Problemlosestrat...

Tobacco prevention and reduction with nursing students: A non-randomized controlled feasibility study.

BACKGROUND Prevalence of tobacco use among nurses and nursing students is disproportionally high in Germany. However, from a public health perspective they are considered to be an important group for delivering smoking cessation interventions. As delivery of tobacco-related treatment depends on own smoking status, smoking prevention and cessation among the nursing professions is indicative for improving nurse and public health. OBJECTIVE To evaluate the feasibility and effects of a comprehensive tobacco prevention and reduction program on psychosocial and environmental factors related to smoking behavior of nursing students. METHODS Between 2014 and 2015, a non-randomized, controlled feasibility study was conducted in 12 schools of nursing with 397 nursing students in Germany. Students in the intervention group received a program (ASTRA) consisting of an introductory session, steering committee workshop, stress prevention lessons, evidence-based smoking cessation intervention, and action project. Six months after baseline assessment, change in smoking-related protective and risk factors was determined. Secondary endpoints included smoking behavior. RESULTS The program was implemented in total in 5 of 7 intervention schools. About one third of smoking nursing students participated in a cessation intervention. The program seems to do better than a minimal intervention booklet in four primary outcomes: perceived descriptive, subjective, and injunctive norms towards smoking and nursing as well as perceived social support. As anticipated, there was no change in smoking behavior. CONCLUSIONS The applied approach is feasible and able to improve important smoking-related norm perceptions of student nurses and perception of social support. However, additional context measures to influence the settings of nursing education currently rather supporting smoking seem to be necessary in order to promote smoking cessation among nursing students and to scale up implementation of the program.

Cluster-randomized trial of a German leisure-based alcohol peer education measure

Because of scarce research, the effectiveness of substance abuse prevention in leisure settings remains unclear. In this study, we evaluated the effectiveness of a peer-led educational prevention measure with adolescent groups in unstructured leisure settings, which is a component of the complex German nationwide ‘Na Toll!’ campaign. Using a cluster-randomized two-group post-test-only design, we tested whether the measure influenced component-specific goals, namely risk and protective factors of alcohol use such as risk perception, group communication and resistance self-efficacy. The sample consisted of 738 adolescents aged 12–20 years who were recruited at recreational locations and completed an online questionnaire 1 week after the peer education or recruitment event. Sixty-three percent of the sample participated in the 3-month follow-up assessment. Data analysis revealed post-test effects on risk perception, perceived norm of alcohol communication in the peer group and resistance self-efficacy. Follow-up effects were not observed, with the exception of a significant effect on risk perception. In conclusion, the peer-led education measure in leisure settings might have supported the adolescents in this study to perceive alcohol-related risks, to feel accepted to talk about alcohol problems with their friends and to be more assertive in resisting alcohol use in the short term.

EFFEKT-E: Wirksamkeit eines Präventionsprogramms für Kinder emotional belasteter Mütter

The aim of this study was to develop an effective selective preventive programme for the risk group of children of depressed mothers. A universal parent and child training concept was adapted to the target group and to mother-child rehabilitation clinic conditions. A quasi-experimental design was implemented with 13 clinics. Evaluation of the results reveals that EFFEKT-E is an accepted, feasible selective programme which has the potential to enhance maternal competence and prevent childrens emotional disruption.