Barbara Isensee

The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update.

The objectives of the community-based Early Developmental Stages of Psychopathology (EDSP) Study are described along with a detailed account of the overall design, special design features, sample characteristics and instruments used. The EDSP employed a prospective-longitudinal design to study substance use and other mental disorders in a representative population sample of 3,021 subjects aged 14–24 years (birth cohorts 1970–1981) at ‘baseline’ – the outset of the study. Two follow-up investigations were conducted after the baseline investigation covering an overall period of 3–4 years. Special design features are the linkage with a family supplement (EDSP-FS) as well as neurobiological laboratory studies of high-risk subjects.

Parental alcohol use disorders and alcohol use and disorders in offspring: a community study

BACKGROUND We examined the association between parental alcohol use disorders and patterns of alcohol consumption and DSM-IV alcohol use disorders in their offspring in a community-based sample of young adults. METHODS Data are based on baseline and 4-year follow-up data of 2427 respondents aged 14-24 at baseline. Alcohol use and disorders in respondents were assessed using the Munich-Composite-international-Diagnostic-Interview with DSM-IV algorithms. Diagnostic information about parents was collected by family history information from the respondents, and by direct interview with one parent (cohort aged 14 to 17 years only). RESULTS Although the association between maternal and paternal alcohol use disorders and non-problematical drinking in offspring was minimal, there was a strong effect for the transition to hazardous use and for alcohol abuse and dependence; the effect of parental concordance for transition into hazardous use was particularly striking. Maternal history was associated with a higher probability of progression from occasional to regular use, whereas paternal history was associated with progression from regular to hazardous use. Parental alcoholism increased the risk for first onset of hazardous use and alcohol dependence between the ages of 14-17, and for an earlier onset of the alcohol outcomes in offspring. The impact of parental alcohol use disorders was comparable for male and female offspring. CONCLUSIONS Parental alcoholism predicts escalation of alcohol use, development of alcohol use disorders and onset of alcohol outcomes in offspring.

Sedentary behavior and indicators of mental health in school-aged children and adolescents: A systematic review.

OBJECTIVE The presented systematic review aims at giving a comprehensive overview of studies assessing the relationship between sedentary behavior and indicators of mental health in school-aged children and adolescents. METHODS Six online databases (MEDLINE, EMBASE, PsycINFO, PsycARTICLES, CINAHL and SPORTDiscus) as well as personal libraries and reference lists of existing literature were searched for eligible studies. RESULTS Ninety-one studies met all inclusion criteria. There was strong evidence that high levels of screen time were associated with more hyperactivity/inattention problems and internalizing problems as well as with less psychological well-being and perceived quality of life. Concerning depressive symptoms, self-esteem, eating disorder symptoms, and anxiety symptoms, no clear conclusion could be drawn. But, taking quality assessment into account, self-esteem was negatively associated with sedentary behavior, i.e. high levels of time engaging in screen-based sedentary behavior were linked to lower scores in self-esteem. CONCLUSIONS Overall, the association between sedentary behavior and mental health indicators was rather indeterminate. Future studies of high quality and with an objective measure of sedentary behavior will be necessary to further examine this association as well as to investigate longitudinal relationships and the direction of causality. Furthermore, more studies are needed to identify moderating and mediating variables.

Five in a row—reactions of smokers to tobacco tax increases: population-based cross-sectional studies in Germany 2001–2006

Objective: To assess reactions of smokers to five waves of tobacco tax increases in Germany. Design: A 10-wave cross-sectional study, with assessments before and after the tax increases. Setting: General population of Germany. Participants and methods: 10 representative samples from the general population with a total number of 27 608 people aged ⩾14 years, including 8548 smokers (31% of the total sample), were interviewed. Outcome measures: Reflection on smoking behaviour, and smoking behaviour (quitting, reducing, switching to a cheaper brand or no change) before and after tobacco tax increases. Results: Before the tax increases, one third to more than half of the smokers reflected on their smoking behaviour, 9.7–13.9% intended to quit, 23.4–34.7% intended to reduce smoking and 10.8–16.4% intended to switch to cheaper tobacco products, whereas 36.1–52.1% did not intend any change at all. After the tax increases, one fourth to more than one third reported to have reflected on their smoking behaviour, 4.0–7.9% quit smoking owing to the increase, 11.5–16.6% reduced consumption and 11.0–19.9% switched to cheaper products. Significant associations were found between the height of the price increase and the intentions and reactions of smokers. Conclusions: Price increases lead to a substantial reflection on smoking and intended and realised behaviour changes such as reduced consumption and switching to cheaper tobacco products. These effects are more pronounced the more the price rises. Therefore, taxation policy will lead to quitting and reducing smoking. However, complementary measures should also be taken to prevent smokers switching to cheaper tobacco products, which would reduce the effectiveness of taxation policy.

Parental depression and depression in offspring : evidence for familial characteristics and subtypes?

The objectives of this paper were twofold. First, to evaluate in a community sample the age of onset of major depression in adolescents and young adults with and without parental major depression. Second, to examine whether specific clinical characteristics of major depression in adolescents and young adults are associated with elevated rates of major depression among parents. Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study (EDSP), a prospective-longitudinal community study of adolescents and young adults. Results are based on 470 subjects who completed the follow-up, for whom diagnostic information for both parents was available, and who reported at least one episode of major depression according to DSM-IV-criteria through second follow-up. Diagnostic assessment in respondents was accomplished by using the standardized Munich-Composite International Diagnostic Interview (M-CIDI). Information on major depression in parents was collected as family history information from the respondents, and additionally from M-CIDI diagnostic interviews with parents of the younger cohort. Both recurrence and impairment as clinical characteristics of major depression in adolescents and young adults were associated with elevated rates of major depression among parents. Age of onset as well as overall higher impairment as clinical characteristics of major depression in youth were associated with elevated rates of parental major depression in the univariate, but not in the multiple, analyses. Our findings suggest that clinical features of major depression may indicate familial subtypes of the disorder, most evident for recurrence and impairment.

Risk factors for e-cigarette, conventional cigarette, and dual use in German adolescents: A cohort study

OBJECTIVE Little is known about risk factors that are associated with e-cigarette use in adolescents. METHODS Multilevel mixed-effects regressions were performed to assess the relationship between factors that might be associated with e-cigarette, conventional cigarette and dual use in a cohort of 2693 German adolescents (mean age=12.5 years; SD=0.6). Risk factors were assessed in October 2010 and life time e-cigarette and conventional cigarette use were assessed 26 months later. RESULTS Use of e-cigarettes as well as use of conventional cigarette and dual use were associated with higher sensation seeking scores, and higher odds of having friends and parents who smoke conventional cigarettes, with conventional cigarette use additionally with male gender, being older, having higher odds of siblings who smoke conventional cigarettes, and less likely for adolescents who attend a Gymnasium, secondary school with a strong emphasis on academic learning. The use of conventional cigarettes at baseline did not predict e-cigarette use at follow-up. Lifetime prevalence of e-cigarette use was 4.7%, of conventional cigarette use 18.4%. A quarter of e-cigarette users (23.8%) never smoked a conventional cigarette. DISCUSSION Data indicate that e-cigarette and conventional cigarette use share many but not all risk factors. E-cigarettes could counteract the process of denormalization of smoking.

Meta-Analysis on the Effects of the Smoke-Free Class Competition on Smoking Prevention in Adolescents

Background: The ‘Smoke-Free Class competition’ (SFC) is a school-based smoking prevention programme including commitment not to smoke, contract management and prizes as rewards broadly implemented in Europe. Objectives: To meta-analyse (randomised) controlled trials on the effects of SFC on current smoking at latest follow-up in adolescents. Methods: A systematic review of articles using MEDLINE and the Cochrane Library was conducted. The study selection included randomised controlled trials and controlled trials with follow-up assessment that investigated the efficacy of SFC on current smoking in students participating in SFC compared to non-participating students. Independent extraction of articles was performed by both authors. Results: Of 24 records identified, five fulfilled the inclusion criteria. These studies were conducted in three European countries (Finland, The Netherlands and Germany) and recruited 16,302 students altogether. A random effects meta-analysis of these five studies revealed a pooled risk ratio of 0.86 (95% CI 0.79–0.94; z = 3.44, p = 0.001) on current smoking at follow-up by participation in the competition. Conclusion: SFC appears to be an effective tool in school-based smoking prevention.

Effects of a school-based prevention programme on smoking in early adolescence: a 6-month follow-up of the 'Eigenstandig werden' cluster randomised trial.

Objectives To test the effects of a school-based prevention programme on students’ smoking-related behaviour, attitudes and knowledge 6 months after implementation over 2 school-years has ended. Design Two-arm prospective cluster randomised controlled trial with a follow-up survey 6 months after end of programme implementation, that is, 26 months after baseline. Setting 45 public secondary schools from four federal states in Germany (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein). Participants A total of 3444 students from 172 classes with a mean age of 10.37 years (SD=0.59) and 47.9% girls at baseline. Analysis sample with follow-up up data merged to baseline data comprises 2513 datasets (73%). Intervention ‘Eigenständig werden 5+6’, a school-based prevention programme for grades 5 and 6 to enhance substance-specific and general life skills, consisting of 14 units (à 90 min) and two workshops (4–6 h) being taught over a time period of 2 school-years by trained teachers. Outcome measures Lifetime and current smoking, incidence of smoking in baseline never smokers, smoking-related knowledge, attitudes, perceived norms of smoking and self-efficacy to refuse cigarette offers were assessed in students. Results 6 months after the end of programme implementation, students of intervention classes showed significantly lower rates for lifetime smoking (adjusted OR=0.63; 95% CI 0.41 to 0.96; p=0.026) and incidence of smoking (adjusted OR=0.66; 95% CI 0.43 to 1.00; p=0.047), a higher increase of smoking-related knowledge (adjusted β=9.38; 95% CI 6.73 to 12.04; p<0.001) and a greater change in attitudes towards a more critical perception of risks and disadvantages of smoking (adjusted β=0.10; 95% CI 0.03 to 0.16; p=0.002). No group differences were found for current smoking, perceived norms of smoking and self-efficacy to refuse cigarette offers. Conclusions Participation in the school-based prevention programme ‘Eigenständig werden 5+6’ may have small effects on smoking behaviour and attitudes and a moderate effect on smoking-related knowledge. Trial registration Current Controlled Trials ISRCTN99442407

The 'Eigenständig werden' prevention trial: a cluster randomised controlled study on a school-based life skills programme to prevent substance use onset

Objective To implement and evaluate ‘Eigenständig werden 5+6’ (‘Becoming Independent 5+6’), a school-based curriculum for grades 5 and 6 developed on the basis of evidence-based criteria for effective drug prevention curricula in schools. Evaluation of the programme includes efficacy, feasibility and practicability in daily school routine. Methods and results The intervention ‘Eigenständig werden 5+6’ consists of 14 teaching units evenly distributed over grades 5 and 6 which are interactively delivered, and a parent component. Programme effects are studied in a four wave cluster randomised controlled trial with two arms, an intervention and a control group. Self-completed questionnaires from students and teachers are collected by trained research staff. 45 schools, 172 classes and 3444 students with a mean age of 10.37 years (SD=0.59) and 47.9% girls from four federal states in Germany were assessed at baseline. 1685 students in 81 classes were assigned to intervention classes, 1759 students in 91 classes to the control arm. No differences between conditions were found for age, gender, immigration background, socioeconomic status, substance use or life skills at baseline. Exceptions were higher self-efficacy (t(3438)=2.34, p=0.02, d=0.08) and empathy (t(3302)=2.4, p=0.02, d=0.09) in the control group, whereas class climate seemed better in the intervention group (t(3037)=2.01, p=0.05, d=0.07), but effect sizes state marginal differences. Conclusion Baseline data suggest that the initial conditions are favourable for testing programme efficacy since distribution of baseline levels of the outcomes did not differ in the intervention and control groups, except for negligible differences between self-efficacy and empathy, which were higher in the control group, and class climate, which was higher in the intervention group. Trial registration number Current Controlled Trials ISRCTN99442407.

Multiple substance use patterns in adolescents—A multilevel latent class analysis

BACKGROUND Multiple substance use among adolescents is associated with a number of negative consequences. Therefore, we aim to investigate multiple substance use patterns among young adolescents and identify possible multilevel predictors. METHODS We analyzed a longitudinal sample of 2490 German students (51% male; Mage=13.32, SD=0.57) at 45 schools in four German states (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein), who completed two assessments in fall, 2010 and fall, 2013. We conducted multilevel latent class analysis for follow-up data on a variety of outcomes, and tested our final 3-class-model for possible baseline predictors. Follow-up substance use measures included lifetime use, current use, and amount of substance for cigarettes and alcohol. Baseline covariates comprised age, gender, socio-economic status, bullying, victimization, peer and parental use, type of school, and health certification of school. RESULTS We identified three latent classes: non-users (n=1541; 61.9%), experimenters (n=722; 29.0%), and multiusers (n=227; 9.1%). Experimental consumption was predicted by higher baseline age (OR=1.71; 1.31-2.24), paternal drinking (OR=2.89; 1.23-6.79), and school type (OR=2.57; 1.83-3.61), while multiuse was predicted by peer smoking (OR=2.94; 1.80-4.80) and drinking (OR=2.13; 1.32-3.44), maternal drinking (OR=6.26; 2.02-19.43), bullying (OR=1.69; 1.15-2.48), higher age (OR=1.92; 1.40-2.62), and school type (OR=4.76; 2.75-8.24) compared to the non-users class. CONCLUSIONS Prevention and further research on multiple substance use need to concentrate on social influence models and behavior-related interventions, especially at schools without a college-preparatory track.