[The Course of E-Cigarette Use in Adolescence: A Cohort Study over 18 Months]. / Der Verlauf des E-Zigarettenkonsums im Jugendalter: Eine Kohortenstudie über 18 Monate.

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.

[E-Cigarette Use and Later Use of Conventional Cigarettes - Results of a Prospective Observational Study over 2 Years]. / E-Zigarettenkonsum und späterer Konsum konventioneller Zigaretten.

AIM: The aim was to investigate whether e-cigarette use predicts later experimentation with conventional cigarettes. METHODS: During the 2016/2017 school year, 2,388 children and adolescents from Baden-Württemberg, Mecklenburg-Western Pomerania, North Rhine-Westphalia, Rhineland-Palatinate, Schleswig-Holstein and Saxony who had never smoked conventional cigarettes before took part in a survey over a 2-year period (mean age 11.8 years, SD = 1.21; 49.6 % female). RESULTS: At baseline, 85 pupils (3.6 %) reported that they had already tried e-cigarettes at least once. By the end of the observational period, 430 of the sample had tried conventional cigarettes (18.0 %). After statistical control for age, sex, migration background, type of school, socioeconomic status, sensation-seeking, alcohol use, and school performance, the adjusted relative risk of experimentation with conventional cigarettes was 85 % higher (adjusted relative risk = 1.85, 95 % CI [1.34 - 2.56]) for pupils who had used e-cigarettes at baseline. Further analyses revealed that the risk was higher among adolescents with low sensation-seeking scores. CONCLUSION: Among young never-smokers, experimentation with conventional cigarettes is more common in those who used e-cigarettes before than among those who have not tried e-cigarettes before. This effect seems to be stronger among adolescents who, in general, have a lower risk of starting to smoke.

[Smoking in Adolescence in England and Germany, 2001 - 2016]. / Rauchen im Jugendalter in England und Deutschland, 2001 ­â€Š2016.

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.

[Smoking in German Movies]. / Rauchen in deutschen Filmen.

AIM: To study the frequency of smoking in movies nominated for the German movie award during 2016 - 2018; testing the association between movies depicting smoking and their age rating. METHODS: All movies (n = 61) nominated for the German movie awards ("Lolas") between 2016 and 2018 were content coded according to whether or not they portrayed smoking. The age rating of the movies according to the Voluntary Self Regulation Body of the Movie Industry (FSK) was also recorded. RESULTS: 53 of 61 movies (87 %) portrayed smoking. There was no association between smoking in movies and FSK age rating (p = 0.166). Smoking was shown in all 16 movies with no age restrictions (FSK-0). CONCLUSIONS: Smoking was depicted quite often in movies nominated for the German movie award. Increasing the FSK age rating for films that portray smoking would decrease the exposure of smoking in films to youth and would be in line with recommendations of the World Health Organization.

[Prevalence and Correlates of Substance Use in 5,688 Vocational School Students]. / Verbreitung und Korrelate des Substanzkonsums unter 5,688 Auszubildenden an beruflichen Schulen.

OBJECTIVE: The aim of this study was to investigate the prevalence of substance use of German apprentices in vocational schools, considering socio-demographic characteristics and vocational field. METHODS: Cross-sectional study of 5,688 first year apprentices. These were 5,001 apprentices from 34 schools of the "Dual System" and 687 students from 15 vocational schools of the social and health sector. Sociodemographic characteristics and prevalence of tobacco, alcohol, cannabis, other illegal drugs, and pharmaceuticals were assessed. There was also a screening for problematic alcohol and cannabis use. The paper-pencil survey was conducted by trained research staff in 7 German federal states from September to December 2012. RESULTS: Half of the apprentices (49.9%) used tobacco in the 30 days prior to questioning, 40.7% reported daily smoking. Alcohol use in the past 30 days was reported by 68.9%, 45.0% of the sample had a positive screening result for problematic alcohol use. Prevalence rates for the use of cannabis and other illegal drugs in the last 30 days were 7.5% and 2.6%, taking pharmaceuticals was reported by 20.7%. Significant correlates of substance use were gender and socio-economic status. Differences between vocational clusters were also found, with higher average rates in service-based and commercial-technical professions. However, these differences could mostly be explained by sociodemographic differences in the composition of the vocational clusters. CONCLUSIONS: Use of psychotropic substances is a widespread activity in German apprentices. Prevalence rates are higher than in the same age total population. The highest proportion of variance was explained by differences in gender and socio-economic status.

Psychometric properties of the Autonomy over Tobacco Scale in German.

BACKGROUND/AIMS: We investigated the psychometric properties of a German translation of the 12-item Autonomy over Tobacco Scale (AUTOS) among 1,195 eighth-grade students. METHODS: Data for this study were collected as part of the fourth wave of data collection of the Smokefree Class Competition intervention in the Saxony-Anhalt region of Germany. Students from the control arm of the Smokefree Class Competition study who indicated that they had ever smoked 'at least a few puffs' on a cigarette were classified as ever-smokers. They self-completed questionnaires distributed by teachers. RESULTS: AUTOS scores ranged from 0 to 36 with a distribution highly skewed toward lower-response categories. Inter-item correlations ranged from 0.65 to 0.89 (mean = 0.79, SD = 0.06). Composite reliability for the AUTOS was high (Ω = 0.96) and 3 lower-order factors were also reliable (withdrawal: 0.89, psychological dependence: 0.91, cue-induced cravings: 0.87). Concurrent validity was supported by strong relationships between the AUTOS and both lifetime cigarette consumption and current smoking frequency. Youths were 18 times more likely to be current smokers (95% CI = 11.9-27.2, p < 0.001) if they endorsed any AUTOS item. CONCLUSION: The German AUTOS is reliable and valid, and the results are consistent with the English AUTOS for use with adolescents.

[Smoking in movies and established smoking in adolescence]. / Rauchen in Filmen und Etablierung des Rauchens im Jugendalter.

AIM: The aim of this study was to examine whether smoking in movies can predict established smoking in adolescence. METHODS: A longitudinal study was conducted over a period of 13 months with 4112 German students. Adolescents' exposure to smoking in movies was assessed by asking each student to indicate which film he or she had seen from a unique list of 50 movies, which was randomly selected for each individual survey from a sample of 398 popular contemporary movies. We calculated exposure to movie smoking for each respondent by summing the number of smoking occurrences for each movie that the respondent reported seeing. RESULTS: At follow-up, a total of 272 young people had smoked more than 100 cigarettes during their lifetime. While 2.1% of the young people with the lowest exposure to movie smoking initiated established smoking, 13.4% of the group with the highest exposure to movie smoking initiated established smoking. The adjusted relative risk of initiation of established smoking was 2.05 times higher in the group with the highest movie smoking exposure compared to the group with the lowest exposure (95% confidence interval: 1.25-3.35). CONCLUSION: Our data indicate that smoking in movies can be regarded as an independent risk factor for the initiation of established smoking in adolescence.

Influencing antecedents of adolescent risk-taking behaviour in elementary school: results of a 4-year quasi-experimental controlled trial.

Effects of the life skills programme 'Eigenständig 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 < 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.

[The impact of smoking in movies on children and adolescents. A systematic review]. / Der Einfluss des Rauchens in Filmen auf Kinder und Jugendliche. Eine systematische Ubersichtsarbeit.

In accordance with the conclusion of the US National Cancer Institute to consider smoking in films, in addition to other factors, as one risk factor for the initiation of smoking among children and adolescents, the World Health Organization has invited its member states to implement rules for limiting smoking depictions in films. Results of methodically high-value longitudinal and experimental studies which provide empirical evidence for the association between smoking depictions in films and smoking among children and adolescents are presented. Interpretation of this association as causal according to Hill criteria is discussed. In this systematic review, future personal and structural preventive interventions to address this problem in Germany are presented and discussed. Of special importance is the enhancement of both parental competence in media education as well as media literacy in children and adolescents. Rating films depicting smoking as approved for adults only could yield the largest effect, since it leads to an enduring reduction of exposure.

[Revenue for the German federal budget from cigarette smoking by persons younger than 18 years]. / Einnahmen des Bundeshaushalts aus dem Zigarettenkonsum Minderjähriger.

OBJECTIVES: The purpose of this study was to estimate the tax value of tobacco products consumed by persons younger than 18 years in 2007. METHODS: Tax, population, and consumption data were used to compute an estimate of the tax value of tobacco products consumed by minors. RESULTS: Youth smoking generated an estimated 193 Million Euro in federal tax revenue in one year. CONCLUSIONS: The revenues from cigarettes smoked by youth should be used to finance youth-specific prevention programmes.

[Acceptance of a total smoking ban in schools: students' attitudes]. / Akzeptanz eines totalen Rauchverbots an Schulen: Einstellungen der Schülerinnen und Schüler.

AIM: The purpose of this study was to measure students' attitudes towards a total smoking ban in schools and towards impositions in cases of violation. METHOD: Cross-sectional survey of 1 738 students of 12 public schools in Schleswig-Holstein (grades 7-13, age 11-20 years). Data were collected by means of written questionnaires administered during class time. The following variables were assessed: attitude towards smoking ban, attitude towards impositions, age, sex, citizenship, perceived school climate, current smoking, lifetime smoking; for smokers, and additionally, the "Heaviness of Smoking Index". RESULTS: 76.5% of all students agreed with a total smoking ban, 66.4% agreed with the punishment of violations. Higher acceptance rates were found among girls, young students (11-15 years of age), for never-smokers, and for students who feel comfortable at school. Acceptance of the smoking ban is closely related to current smoking status: 93% of the non-smoking students, but only 14% of the daily smoking students agreed with the regulations. Refusal of the ban increased with increasing physical dependence. CONCLUSIONS: The intensification of the smoking ban in public schools meets approval by the majority of students. Smoking students should be more strongly involved in the implementation process, e.g., by supplemental cessation programmes.

["Be smart--don't start". Results of a non-smoking competition in Germany 1997-2007]. / "Be smart--don't start". Ergebnisse des Nichtraucherwettbewerbs in Deutschland 1997-2007.

PURPOSE: The purpose of this article is to describe the diffusion and evaluation of the smoking prevention programme "Be Smart--Don't Start", the German "Smoke Free Class Competition". METHOD: The diffusion is described by means of numbers of participating classes and a representative population-based interview of 3,600 12-19-year-olds, which was conducted in 2005. Two controlled and two randomised controlled studies carried out in three countries (Germany, Finland and the Netherlands) with a total number of 12,812 adolescents (N of the intervention group: 8,086; N of the control group: 4,726) have been realised to evaluate the intervention. RESULTS: In 2005 20% of all 12-15 year-olds and 9% of all 16-19-year-olds living in Germany had participated in the programme. From baseline to follow-up test 12-24 months later smoking increased by 21.78 per cent points in the control group, compared to an increase of 16.02 per cent points in the intervention group. At follow-up 27.57% of the pupils from the intervention group, and 35.91% of the pupils from the control group are actual smokers (odds ratio=0.65, 95% confidence interval: 0.57-0.74). CONCLUSIONS: Participating rate in the competition is high. The results indicate that the competition might have a short-term effect and be able to delay the onset of smoking.

[Motivational interviewing of unemployed acceptance and effects of counselling to improve health-related behaviour]. / Motivierende Gesprächsführung mit Arbeitslosen Akzeptanz und Ergebnisse einer Beratung zur Verbesserung gesundheitsrelevanter Verhaltensweisen.

PURPOSE: Conception, implementation and evaluation of a risk-reducing and health-promoting brief intervention addressed to unemployed. METHOD: Control-group-study with repeated measurement. 131 unemployed took part in the intervention group and 95 persons were matched according to age and sex and served as a reference group. The intervention group were recruited via flyers, press articles and several institutions, the reference group via the journal of a health insurance company. The reference group received a questionnaire twice assessing the same health-related variables as the intervention group. INTERVENTION: In the intervention group, life style-related variables - eating habits, exercising, smoking, alcohol consumption - were assessed via questionnaire. In a one-hour counselling session based on Motivational Interviewing, participants received an individual feedback on their results of the questionnaire, including a comparison against standards and a review of their personal risks and negative consequences as well as advice and recommendations, while the decision for or against a behaviour change was left to the participant. RESULTS: 85.2 % of the participants of the intervention reported that the counselling met their expectations, and 86.2 % would recommend the intervention to a friend. Statistically significant effects for the intervention group compared to the control group from pre- to post-measurement could be shown for alcohol consumption, eating habits, and exercise (p

[Evaluation of the 2003 tobacco tax increase in Germany]. / Evaluation der Tabaksteuererhöhung vom 1. Januar 2003.

Implementation, acceptance, and effects of the increase in tobacco tax were examined. For this purpose representative samples were assessed before and after the increase of tobacco tax. Furthermore, official data on tax receipts were analyzed. The increase of tobacco tax was passed only partly to the consumer. 57 smokers (4.0%) stopped smoking because of the increase, and 11.9% reduced the amount of cigarettes consumed. The average number of cigarettes consumed was decreased by 0.06% (price elasticity of -0.01). On the basis of the official data, a relative decrease of 5.8% of cigarettes was observed (price elasticity of -1.04 for cigarettes from vending machines). The rather slight increase of price caused smokers to reflect on their smoking behavior. The amount of cigarettes used changed in the official data and in the subsample of younger subjects.

[Development, implementation and evaluation of a program for the cessation of smoking for adolescents and young adult smokers]. / Entwicklung, Implementation und Evaluation eines Programms zur Entwöhnung vom Rauchen für jugendliche und junge erwachsene Raucher.

AIM: Assessment of the smoking cessation programme "Just be smoke free". METHOD: Follow-up data assessment of the participants who registered for the programme between April 2002 and March 2003. INTERVENTION: "Just be smoke free" is a smoking cessation programme targeting adolescents and young adults. Target groups are not only smokers, but also non- and ex-smokers. Moreover the project takes into account the different stages smokers undergo with regard to their motivation to stop smoking. Smokers who are not prepared to quit smoking are offered an individualised "smoker's profile" in order to sensitise them to their smoking behaviour, motives and risk situations. Smokers who are prepared to give up, are provided with a self-help cessation manual. As an incentive, on four occasions per year, participants can win cash prizes of up to 1,000 Euro. RESULTS: From April 2002 to March 2003, 1,417 smokers registered for the programme, of which 1,265 wanted to quit and 152 were interested in a "smoker's profile". The mean age of the participants was 21.5 years and 56.7 % were female. In addition, 2,132 used the internet page for the programme. 408 smokers took part in the follow-up measurement (retention rate 32.3 %). Of these, 46.1 % (N = 188) reported to have ceased to smoke. In a projected analysis considering those who did not take part in the follow-up measurement as smokers - the quit rate was 14.9 %. CONCLUSIONS: A large number of smoking adolescents and young adults were covered by the programme. The quit rate can be considered as good, also in comparison to international smoking cessation studies.

[Diffusion of the non-smoking campaign "Be Smart-Don't Start" between 1997 and 2003 in Germany]. / Dissemination der Nichtraucherkampagne "Be Smart-Don't Start" in den Jahren 1997 bis 2003 in Deutschland.

BACKGROUND: In Germany there is a high prevalence of smoking especially among young people. A comprehensive tobacco control programme combining several single measures is necessary. One of these measures should be health education programmes, including programmes for primary prevention of smoking. One recently developed primary smoking prevention programme is the competition "Be Smart - Don't Start". This programme has been implemented in Germany since the school year 1997/1998. The aim of this study is to describe the diffusion of the programme between 1997 and 2003. METHODS: The diffusion of the programme over a six-year period in Germany is described. School classes were clustered according to grade and region (German "Bundesländer"). The estimated number of participating pupils is compared to population data. RESULTS: Between 1997 and 2003 the number of participating classes has grown by the factor 18.2: from 462 school classes in the school year 1997/1998 to 8,402 school classes in the school year 2002/2003. In the school year 2002/2003, 218,452 pupils participated in the competition, which equals 5.64 % of the total population of the 11- to 14-year olds. The number of pupils participating in the programme varies to a high degree in Germany. Between 1.07 % and 12.2 % of the target group is reached via the programme. In some grades and regions of Germany up to 19 % of the target group participate in the competition. CONCLUSION: The competition "Be Smart - Don't Start" has been successfully implemented in Germany. To our present knowledge the programme is the biggest primary smoking prevention programme in Germany.