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Effects of the life skills programme "Eigenstandig werden" (Becoming independent) on life skills and on identified antecedents of adolescent health risk behaviour, childhood internalizing and externalizing behaviour were tested in an elementary school setting. A quasi-experimental controlled trial with five repeated measures was conducted. Participants were 919 students from 50 elementary schools in Saxony, Germany. Outcomes were assessed by teachers' ratings. Growth-curve models revealed that the rate of decline in internalizing and externalizing behaviour was significantly higher in the intervention group--especially for students with high baseline levels of externalizing behaviour (P less than 0.01). No general programme effects on the development of skills could be found (P = 0.22). The current study provides evidence that life skills programmes in elementary school may be an effective strategy in reducing antecedents of adolescent risk-taking behaviour.

Background: Far too many people smoke in Germany, and the number of serious attempts to stop smoking has been falling for years., Methods: Smoke-free in May 2024 is a low-threshold measure to encourage people to stop smoking. Adults who "regularly" consume nicotine products as well as support persons were eligible to take part. As part of the measure, participants and supporters were offered daily support via app notifications, emails and/or WhatsApp. They were also made aware of existing stop-smoking programmes. Finally, prizes were raffled off among the successful participants., Results: A total of 6,386 individuals registered to take part. Of these, 550 individuals registered with a person of their choice to support them. Smokers were predominantly female (56.5%) and on average 42.9 (SD=13.2) years old. They came from all federal states in Germany, with a disproportionately high number from the federal states of Bremen, Schleswig-Holstein, Berlin, North Rhine-Westphalia, Hamburg and Bavaria in relation to the population distribution. Compared to a representative sample from a study by the Robert Koch Institute (2012), they reported a significantly higher subjective socio-economic status. Of the participants, 79.3% categorised their addiction as high. Regular use of more than one nicotine products occurred in 35.3% of the sample; 39.8% of the participants stated that they had not tried to stop smoking during the last 12 months., Conclusions: The number of smokers participating in the program is encouraging. In addition to an efficacy study, it should be examined in subsequent years how more males and individuals with a low subjective social status can be encouraged to initiate smoking cessation., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Acluster-randomised trial was conducted in five German federal states to evaluate the results of a school-based cannabis prevention unit. A total of 55 schools were randomly assigned to the intervention group, i.e. participation in a two-hour cannabis prevention workshop conducted by drug prevention specialists in grades 8 and 9, or to a control group with a waiting list. The knowledge, attitudes, intentions and behaviour of the young people in relation to cannabis were measured at the start of the study and six months later. 2,669 pupils(50.8% girls, average age=14.12 years) made up the sample. Effects of the intervention on the students' knowledge (adjusted regression coefficient=0.26 [0.15-0.38], p<0.001) and on the expected negative consequences of cannabis use in adolescents (adjusted regression coefficient=0.15 [0.04-0.25], p=0.006) were found. Both increased significantly more in the intervention group compared to the control group. There were no effects on other attitude-related variables, intentions or behaviour. A very short school-based workshop for grade 8 and 9 students improved their knowledge of and critical attitudes towards cannabis use, but had no effect on their future intentions and cannabis use., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: In the current debate about legalized access to cannabis for adults in Germany, there is widespread agreement about the need for increased prevention among children and young people. The aim of this work is to examine the effectiveness of a school-based cannabis prevention program on knowledge, attitudes, and behavior., Method: Cluster-randomized waiting list control group study with two study arms: "participation in the 'Der grüne Koffer' prevention program", a collection of methods for cannabis prevention, vs. "no participation" and two measurement time points before and four months after the intervention in four German states., Results: The mean age of the sample of 3976 adolescents from 280 school classes in grades 8 and 9 was 14.02 years (standard deviation = 0.89). The sex ratio was balanced (49.5% female). Cannabis-related knowledge increased significantly more in the intervention group compared to the control group from the first to the second measurement time point (adjusted beta = 0.25 [95% confidence interval: 0.14-0.37]). Attitudes toward cannabis use did not change significantly in either group. In the 8th grades of the intervention group, significantly fewer adolescents (2.9%) started experimenting with cannabis use for the first time during the observation period than in the control group (5.3%), whereas no group difference was detectable in the 9th grades (interaction grade level x group: odds ratio = 2.17 [1.13-4.15], p = 0.019)., Discussion: The evidence of an effect of participation in the "Der grüne Koffer" prevention program on knowledge and first-time use of cannabis in the 8th grade can be considered promising against the background of previous national and international studies, which could not provide evidence of effects of school-based cannabis prevention in middle and late adolescence., (© 2024. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Background: Excessive UV radiation from the sun may lead to skin cancer, the most common type of cancer in Germany. Therefore, among other things, the World Health Organization recommends seeking shade during the midday hours from a UV index of 3 (3 to 5 = "moderate"). However, this important preventive measure can only be taken if sufficient shaded areas are available. The aim of the study is to record shaded areas in kindergartens and schools nationwide., Methods: An epidemiological cross-sectional study with two samples was carried out. Management of kindergartens and schools were surveyed using online questionnaires about the provision of shading measures at their educational institution from May to August 2020 and from April to July 2021, respectively. The primary outcome was to record the presence of various structural shading measures in the outdoor area of their educational institutions. The secondary outcome was to estimate the size of the shaded exterior area., Results: From the nationwide population, 1042 kindergartens (1.9%) and 713 schools (2.3%) participated. Compared to schools, kindergartens had sun protection measures in the outdoor area significantly more often (99% vs. 82%; p < 0.001) and were able to shade a significantly larger outdoor area (43% vs. 26%; p < 0.001). Assuming a minimum required shaded outdoor area of 1 m 2 per person, 45% of the schools and 10% of the kindergartens did not have sufficient shaded outdoor areas (p < 0.001)., Conclusion: Almost every fifth school in Germany had no shaded places in the outdoor area. Against the background of climatic changes, an urgent high need for improvements seems obvious., (© 2022. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Introduction: Experimentation with e-cigarettes is rising among youth, and there are concerns that e-cigarettes could be a new risk factor for initiating substance use. This study aimed to investigate whether e-cigarette use longitudinally predicts experimentation with cannabis., Aims and Methods: During 2017-2019, a prospective cohort study with an observation period of 18 months was conducted with 3040 students from Germany who had never used cannabis (mean age = 14.8, range: 13-18 years). A multiple Poisson regression was used to investigate whether e-cigarette use was an independent predictor of future cannabis use., Results: Lifetime e-cigarette use was reported by 29.4% of the survey population (n = 894) at baseline, and 17.4% (n = 529) initiated cannabis use during the observation period. Among e-cigarette ever users, the initiation rate was 34.5% compared with 10.4% of never users. Results were robust to adjustment for age, sex, migrant status, type of school, sensation seeking, peer cannabis use, the use of alcohol and conventional cigarettes (ARR = 1.83; 95% CI: 1.48-2.25). Further analyses revealed that the association between e-cigarette use and cannabis experimentation was stronger among youth with low sensation-seeking scores (ARR = .77, CI: .61-.97) and no conventional cigarette use (ARR = .48, CI: .37-.64) at baseline., Conclusions: E-cigarette use is associated with a subsequent initiation of cannabis use. This association seems to be stronger for youth who have a lower risk for substance use in general. Future studies need to investigate whether this is only true for experimental or also more frequent cannabis use., Implications: The study indicates a prospective association between e-cigarette use and initiation of cannabis experimentation independent of other risk factors. It suggests that e-cigarette use is more strongly associated with cannabis initiation for youth with a lower propensity to use substances (low sensation-seekers and non-smokers)., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The German Medical Society for Health Promotion (ÄGGF) has developed a school-based teaching unit for students in grade 8 and higher that aims at primary and secondary prevention of unplanned pregnancies., Aims: The accompanying evaluation study analyzes the effects of the teaching unit on the students' knowledge and their experience with self-efficacy concerning unplanned pregnancies., Methods: A two-armed cluster-randomized controlled study was conducted using a ten-page anonymous questionnaire with a closed answer format before and after the intervention., Results: In the first survey, 1855 students participated; 1523 students participated in the second. Participants in the intervention group showed a greater increase in knowledge over time. Compared to the control group, they showed an increased intention to use the pill and condoms as well as a marked increase in self-efficacy in the case of an unplanned pregnancy. Furthermore, they significantly corrected their perception of the age at which same-aged boys start having sexual intercourse. All effects remained stable when covariates were controlled. The teaching units were highly accepted: more than 90% of the participants stated that they would recommend them to other students., Discussion: A school-based medical teaching unit about the prevention of unplanned teenage pregnancies was able to contribute to the improvement of students' knowledge and competency. The intervention itself was highly accepted within the target group., (© 2021. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Aim: We tested the hypothesis that waterpipe smoking increases the likelihood to try conventional and electronic cigarettes., Methods: In 2017 and 2018, 2752 German adolescents (mean age: 14.9 years), who had never tried conventional cigarettes or e-cigarettes, took part in a longitudinal survey with a 6-month observational period. Multiple regression analyses tested the association between waterpipe use at baseline and first experimentation with e-cigarettes at follow-up. The models adjusted for risk-taking propensity (sensation seeking and experimentation with alcohol and marijuana), age, sex, migration background, type of school and peer substance use., Results: Some 381 adolescents (12.5% of the survey population) reported waterpipe smoking at baseline. The overall initiation rate during the 6 months was 4.9% (n=134) for conventional cigarettes and 10.5% (n=288) for e-cigarettes. Prior waterpipe smoking significantly predicted cigarette use (adjusted relative risk (ARR)=1.81, 95% CI 1.19-2.76), as well as e-cigarette use (ARR=3.29, 95% CI 2.53-4.28). In addition, a significant interaction between waterpipe use and sensation seeking was found (ARR=0.56, 95% CI 0.33-0.95), with waterpipe use being more predictive of later e-cigarette initiation for lower sensation-seeking individuals., Discussion: Waterpipe use predicted both later cigarette and e-cigarette use independent of all other assessed risk factors, indicating that waterpipe use might be a risk factor on its own. The results suggest that the association was stronger for adolescents with a lower risk-taking propensity, which brings this group into focus for prevention efforts. However, further research is needed to understand whether these associations are causal., Competing Interests: Conflict of interest: R. Hanewinkel has nothing to disclose. Conflict of interest: M. Morgenstern has nothing to disclose. Conflict of interest: J.D. Sargent has nothing to disclose. Conflict of interest: M. Goecke has nothing to disclose. Conflict of interest: B. Isensee has nothing to disclose., (Copyright ©The authors 2021.)

This study examined the association between bullying victimization and e-cigarette use. Data from a 2019-2020 German student survey were used (N = 16,476). The target population consisted of students enrolled in grades 5-10, with a mean age of 13.1 years (SD = 1.8), and equal gender distribution (49.5% female). Mixed-effect multivariable logistic regression models were used to examine the association between bullying victimization (attacked physically, assaulted verbally, experienced relational bullying, sexual harassment, cyberbullying) and current e-cigarette use. The multivariable analysis controlled for age, sex, sensation-seeking, socioeconomic status, school performance, type of school attended, and substance use (current cigarette smoking, hookah smoking, and alcohol drinking). Overall 510 (3.7%) students reported current use of e-cigarettes. The odds for using e-cigarettes increased each step of being bullied from "never," "rarely," "sometimes," "once a week," to "several times a week" by 2.03 (95% confidence interval [CI]: 1.81, 2.29) in the unadjusted model, and by 1.46 (95% CI: 1.24, 1.71) in the covariate-adjusted model. Data indicate an empirical association between victimization and e-cigarette use among German students. Design limitations prevent the conclusion of a causal relationship, calling for well-designed longitudinal studies to investigate the temporal sequence between victimization and e-cigarette use., (© 2021 Wiley Periodicals LLC.)

In Germany, alcohol is the most popular drug among adolescents. So far, school-based alcohol prevention programs have focused on elementary school children and pupils in early adolescence. The school program "Klar bleiben" ("Keep a Clear Head") was especially designed for young people in late adolescence (10th graders) with the aim of establishing non-binge drinking as a social norm.Students in the participating classes commit themselves to abstain from binge drinking for six weeks (contract management). The class gives feedback after each week. After at least five positive feedbacks, the class is rated as successful and enters a prize draw. Elaborated teaching impulses and information resources for teachers and parents are further components of the prevention program.The evaluation of the class competition by 92 teachers can be regarded as consistently positive. The results of a cluster-randomized study showed a relative risk reduction of 10.4% in binge drinking in the last month for those adolescents who had already consumed alcohol before and belong to the intervention group. After the end of the intervention, this group of adolescents consumed an average of 0.19 fewer alcoholic beverages per drinking occasion compared to adolescents from the control group. The findings presented here are encouraging, keeping in mind that the intervention is relatively inexpensive.

Due to the prevalence and harmful consequences of alcohol consumption, universal measures for alcohol prevention are also necessary in adolescence. An example of such a universal measure, "Aktion Glasklar," has been implemented mainly in the school setting for more than 15 years. Through print media, lesson proposals, a quiz with regular prize lotteries, and a website including interactive elements, young people are informed about alcohol in an age-appropriate manner and are encouraged to reflect on alcohol critically. Parents receive suggestions on how to address alcohol consumption with their children. For adult caregivers, such as teachers or youth group leaders, Aktion Glasklar provides prepared teaching suggestions. In a cluster-randomized study, the effects of participation in an intervention on alcohol-related knowledge and the frequency of binge drinking were shown. Thus, even a low-threshold and less intensive measure may contribute to the education and reduction of risky forms of consumption in adolescence.

Introduction: A "smoke-free" society is assumed if less than 5 % of a population smoke. We predict when this goal could be reached in Germany. To reduce the proportion of smokers in the population, the World Health Organization recommends a bundle of measures (MPOWER) that should minimize both the supply of and the demand for tobacco. The current level of implementation of these recommendations in Germany is presented., Methods: A total of 21 representative cross-sectional surveys of the Drug Affinity Study and the Epidemiological Survey of Substance Abuse since 2000/2001 with adolescents and adults show the smoking behavior of the population until 2018. Per capita consumption of factory-built and self-made cigarettes during the same period is used as an objective data basis. Regression analyses are used to model the date at which less than 5 % of the German population smoke. A selective literature review is carried out to describe the implementation of the MPOWER program., Results: Before 2000 there was no trend in Germany towards non-smoking. After the implementation of various preventive measures such as price increases for tobacco products and the introduction of non-smoking protection laws, the spread of smoking among the population has steadily decreased since 2000. By 2018, the 5 % prevalence target among adolescents had almost been reached, as the relative proportion of adolescents who smoked fell by 20.9 percentage points to 6.6 %. The relative proportion of smoking in adult women fell by 12.1 percentage points to 18.5 %, the relative proportion of smoking in men by 14.8 percentage points to 24.2 %. Assuming a linear trend, the prevalence target of less than 5 % smoking adults can be reached by around 2043. Of the six recommended measures of the MPOWER program, Germany is currently only implementing the monitoring of tobacco consumption in society without compromises., Discussion: After various tobacco prevention measures were implemented, a trend towards non-smoking began in Germany. The continual price increase recommended by the World Health Organization, the further restriction of availability, the ban on all tobacco advertising and promotion, the support of smoking cessation as well as the education of the population appear to be necessary to reinforce this trend and to achieve the health policy goal of a smoke-free society in 2040., Competing Interests: RH, BI und MM beteiligen sich an der Implementation des gemeinnützigen, schulbasierten Präventionsprogramms „Be Smart – Don’t Start“. FJW hat keine Interessenkonflikte., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim:  Description of adolescent e-cigarette use over time., Method:  In 2017 and 2019, 261 adolescents from North Rhine-Westphalia who had used e-cigarettes at least once a month (mean age: 14.9 years; 33.5 % female) took part in a questionnaire study., Results:  In 2017, 84 adolescents (32.2 %) reported exclusive e-cigarette use (single users), 177 adolescents were classified as dual users (67.8 %) because they consumed a tobacco product (conventional cigarette and/or hookah) in addition to e-cigarettes. During the observation period of 18 months, 83 adolescents (31.8 %) quit nicotine products altogether. Dual users quit nicotine less often than single users (N = 39 or 22.0 % vs. N = 44 or 52.4 %, p < 0.001). Seven single users (8.3 %) did not change their behavior, 11 began to use tobacco exclusively (13.1 %), another 22 (26.2 %) started dual use. Seventy-eight dual users (44.1 %) did not change their behavior, 57 (32.1 %) switched to tobacco use only, 3 dual users (1.7 %) stopped tobacco use, but continued to use e-cigarettes. Taken together, at the end of the study, 10 (5.6 %) of the remaining 178 adolescents consumed only e-cigarettes, while 168 (94.4 %) smoked tobacco or were dual-users., Conclusions:  More than two thirds of all young e-cigarette users and more than three quarters of dual users also used nicotine products 18 months later. The remaining consumers showed a less frequent stay or switch to single use, instead a more frequent use of tobacco or dual use., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim:  To describe the smoking behavior of adolescents from England and Germany over a period of 15 years., Methods:  Eleven repeated cross-sectional surveys involving a total of 107,485 persons aged 11 to 15 years were carried out between 2001 and 2016 in England and Germany. The following data were assessed: a) the relative proportion of young people who ever smoked a conventional tobacco product, and b) the relative proportion of adolescents, who were current smokers, i. e. teenagers who smoked "occasionally" or "constantly" or "regularly"., Results:  In the observational period, there was a significant stronger reduction in the proportion of young people who ever smoked in Germany (from 52 % to 10 %) compared to England (from 44 % to 19 %). In the same period, the proportion of young people who smoked currently dropped by 16 percentage points to 3 % in Germany and by 12 percentage points to 7 % in England (no significant difference)., Conclusions:  Data indicate a stronger trend towards never smoking in Germany compared to England, and a similar falling trend on "current" smoking in both countries. Causal conclusions are not possible due to the study design., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Prediction of binge drinking in young adults: a cohort study over nine years Abstract., Objective: Which person characteristics and environmental factors predict binge drinking at age 21?, Method: A longitudinal observational study with a nine-year follow-up. A total of 5,176 adolescents from the German states Schleswig-Holstein and Saxony-Anhalt were surveyed in 2006 with paper-pencil questionnaires (mean age 12.6 years, SD = 0.6). A follow-up assessment was conducted in the year 2015. Baseline predictors were age, gender, school type, school performance, parenting style, early experience with alcohol, alcohol use of parents, alcohol use of friends, and sensation seeking. Primary outcome in 2015 was binge drinking at least once a month (six or more alcoholic drinks during one drinking occasion)., Results: A subsample of 1,087 (20.9 %) of the former students could be surveyed nine years after baseline (mean age 21.6 years, SD = 0.8). One out of four (25.4 %) reported binge drinking at least once in a month. A multiple regression model revealed three significant predictors of binge drinking: male gender, early experience with alcohol and frequency of parental alcohol use at baseline., Conclusions: Perceived frequency of parental alcohol use might be an important risk factor for children's alcohol use in early adulthood. Parents need to reflect their role as alcohol-specific socialization agents.

The competition for smoke-free classes, the "Be Smart - Don't Start" program has been implemented in Germany since 1997. Using contract management techniques, school classes participating in the competition commit themselves to abstain from smoking for six months. Classes report on a regular basis whether they have stayed smoke-free or not. After the end of the competition period, successful classes participate in a prize draw. The competition aimes to influence social norms.Over the past 20 years, the competition has become a major school-based intervention to prevent smoking in Germany. Several studies addressed process and outcome evaluation, cost-benefit efficacy and iatrogenic effects. Following the evidence so far, the intervention is feasible for implementation in school routines, evokes positive feedback in teachers and students, and reveals a positive cost-benefit ratio. Findings from controlled studies imply that negative side-effects are unlikely to occur and that participation in the competition affects the progression of smoking positively at least in the short term.

Background: Physical activity (PA) is one of the most important health behaviors that may be modified by each individual. To foster PA in adolescents, a school-based intervention was evaluated., Methods: A cluster-randomized controlled trial with preassessment in 2014 and follow-up assessment in 2015 included 29 schools with 1020 students (47.6% girls, mean age = 13.69 years). Intervention students received pedometers and monitored their steps for 12 weeks. Classes with the most steps were awarded. Primary outcomes included moderate-to-vigorous PA, out-of-school sports activities, active transport assessed through questionnaires, as well as cardiorespiratory fitness measured using the 20-m shuttle-run test and anthropometric data (weight, height, body fat, and waist circumference) assessed by study staff., Results: Significant interaction terms between group and time were found for all 3 indicators of PA; intervention students showed a higher increase of PA than control students. The same pattern was shown for cardiorespiratory fitness, but the effect missed significance. A more favorable development for the intervention students was shown for body fat and waist-to-height ratio, while there was no effect on body mass index percentile., Conclusions: An easy way to administer school-based PA program may enhance students' leisure-time PA even 1 year after the intervention has ended., (© 2018, American School Health Association.)

Background: Existing research shows significant effects of pedometer interventions on students' physical activity (PA). The current study investigates motivational aspects of quantitative increases in PA in the course of a school-based pedometer intervention for adolescents using qualitative data analysis. In addition, critical issues regarding pedometer use in adolescence were examined., Method: Data were obtained in the "läuft." evaluation trial. Students of the intervention group received pedometers and took part in class competitions over a time period of 12 weeks. Qualitative data were collected through focus groups (n = 34) with students of the intervention group as well as through in-depth interviews with teachers (n = 33) who implemented the intervention. A grounded theory approach was used to analyze qualitative data., Results: Five major motivational aspects for subsequent increases in PA were examined among students participating in the "läuft." PA program issues: (1) affordance of the pedometer, (2) awareness of the own PA, (3) self-determination with regard to time and type of PA, (4) individual goal setting, and (5) social comparison and competition., Conclusions: Findings provide a deeper understanding of which aspects of pedometer interventions might be especially important in adolescence and help design effective future interventions for the promotion of PA.