[Harmful health effects of flavors in e-cigarettes]. / Gesundheitsschädliche Wirkungen von Aromen in E-Zigaretten.

BACKGROUND: Almost all e-cigarettes contain flavorings that make the product more attractive. In the evaluation of e-cigarettes on health, flavors have so far played a subordinate role. METHOD: Selective literature search in PubMed, supplemented by legal regulations on the use of flavors in e-cigarettes. RESULTS: Flavors make it easier to start using e-cigarettes and have a consumption-promoting effect. Deeper inhalation increases nicotine uptake and the absorption of toxic substances from the e-cigarette liquid. For some flavors, pathological effects have been demonstrated in addition to other toxic components of the e-cigarette. To date, no toxicological analyses are available for the vast majority of flavors contained in e-cigarettes. CONCLUSIONS: The proven consumption-promoting effect and the health risks that can be extrapolated from preclinical data are significant for the political discussion of a ban on flavors for e-cigarettes, analogous to the ban on flavors in tobacco products already in force.

[Binge drinking in early adolescence : Results of the "Präventionsradar" from 2016 to 2023]. / Rauschtrinken in der frühen Adoleszenz : Ergebnisse des Präventionsradars von 2016 bis 2023.

INTRODUCTION: In Germany, no other psychotropic substance is consumed as often and in such large quantities during adolescence as alcohol. This work aims to examine trends in binge drinking in early adolescence from 2016 to 2023. METHOD: Based on seven waves of the "Präventionsradar," which is a school-based epidemiological study in lower secondary education, the lifetime as well as the 30-day prevalence of binge drinking (for girls 4, for boys 5 alcoholic drinks on one occasion) were determined for the period from 2016 to 2023 for 12- to 15-year-olds. RESULTS: The analyses were based on 44,713 questionnaires. The sex ratio was balanced (50% female), and the mean age was 13.8 years (SD = 1.02). From 2016 to 2023, lifetime prevalence of binge drinking increased significantly by 3.6 percentage points to 25.3% (95% confidence interval 24.1-26.5). The 30-day prevalence did not change statistically during the observation period and was 15.9% (95% CI 14.9-16.9) in 2023. Compared to the previous year, both lifetime prevalence (-2.5 percentage points) and 30-day prevalence of binge drinking (-3.5 percentage points) decreased significantly in the first year of the COVID-19 pandemic (2020/2021) and increased again in subsequent years. Systematic differences between the genders could not be found. DISCUSSION: The German Youth Protection Act does not allow legal access to alcohol for the age group under study. Against this background, it is worrying that every fourth adolescent already reports experiences of binge drinking. Consistent structural and behavioral prevention measures are necessary to curb the high prevalence of binge drinking in childhood and adolescence.

[Medical societies in Germany call for a ban on flavors in e-cigarettes - A Position Paper of the German Respiratory Society (DGP) in cooperation with other professional associations and organizations]. / Medizinische Fachgesellschaften fordern ein Verbot von Aromen in E-Zigaretten.

E-cigarettes are primarily used by teenagers and young adults. Flavors in e-cigarettes increase their attractiveness and encourage young people and adults to start using them. This exposes young people in particular to the risk of nicotine addiction and various toxic substances from the aerosol of e-cigarettes. There are indications that various flavors in e-cigarettes are harmful to health, although toxicological studies are still lacking for the majority of flavors. There is a need for independent scientific investigations in this area. The scientific societies involved are calling for a ban on flavors in e-cigarettes, a ban on disposable e-cigarettes, effective regulation of the sale of e-cigarettes and effective control and implementation of the provisions for the protection of minors.

[Smoking in Netflix feature films and youth protection]. / Rauchen in Netflix-Spielfilmen und Jugendschutz.

BACKGROUND: With the aim of protecting minors, the World Health Organization has recommended classifying films with smoking scenes as unsuitable for children and adolescents. In recent years, films have increasingly been viewed via video streaming services - a trend which has been intensified by the COVID-19 pandemic - which poses new challenges for the protection of minors. AIM: To examine the frequency of smoking scenes in Netflix feature films and the age recommendations for Netflix productions with smoking scenes. METHOD: A total of 235 films that were made available for streaming exclusively by the Netflix platform in 2021 and 2022 were content coded in order to find out (1) how high the proportion of smoke-free films was in this film sample, (2) how often smoking scenes occurred in these films and (3) the proportion of films with smoke scenes classified as appropriate for young people in Germany and the USA. All films with an age rating of under 16 were considered suitable for children and young people. RESULTS: Smoking scenes occurred in 113 of 235 analyzed films (48.1%). Of the 113 films with smoking scenes, 57 (50.4%) in Germany and 26 films (23.0%) in the USA were classified as youth films (p<0.001). A total of 3,310 smoking scenes were registered. Of these, 39.4% (n=1,303) were in films with youth ratings in Germany, and in Netflix USA this proportion was 15.8% (n=524). DISCUSSION: Smoking scenes are a common feature in Netflix movies. Neither in the US nor in Germany does Netflix adhere to the recommendations of the WHO Framework Convention on Tobacco Control to restrict access by young people to films depicting smoking. However, the protection of minors in the US is better than in Germany, since half of the Netflix films with smoking scenes in Germany were rated as suitable for minors, in the USA less than a quarter.

[Use of tobacco cigarettes, e-cigarettes, and shishas among children and adolescents: Results of the 'Präventionsradar' from 2016 to 2023]. / Konsum von Tabakzigaretten, E-Zigaretten und Wasserpfeifen bei Kindern und Jugendlichen. Ergebnisse des Präventionsradars von 2016 bis 2023.

AIM: To measure trends in the use of various smoking products among children and adolescents from 2016 to 2023. METHOD: The data is based on seven waves of the "Präventionsradar", a school-based epidemiological study in grades 5 to 10. The primary endpoints of the study were the lifetime and monthly prevalence of the use of tobacco cigarettes, e-cigarettes, shisha and the use of at least two of these smoking products (combined use). Prevalence estimates are based on logistic regression models. RESULTS: The analysis was based on 94,127 questionnaires. The sex ratio was balanced (49% female), mean age was 13 years (SD=1.8). In 2022/2023, the lifetime prevalence of smoking tobacco cigarettes was 18.8% (95% CI 18.1-19.5), of e-cigarettes 23.5% (95% CI 22.8-24.3), of shisha 14.0% (95% CI 13.4-14.7) and combined use 19.0% (95% CI 18.3-19.7). The monthly prevalence of smoking tobacco cigarettes was 5.9% (95% CI 5.5-6.4), of e-cigarettes 7.0% (95% CI 6.5-7.4), of shisha 3.2% (95% CI 2.8-3.5) and combined use 4.8% (95% CI 4.4-5.2). The following trends in lifetime prevalence have emerged since 2016: tobacco cigarettes (-3.0 percentage points), e-cigarettes (+1.8 percentage points), shisha (-9.2 percentage points), combined use (-2.7 percentage points). In the years of the COVID-19 pandemic, youth smoking decreased and rose again post-COVID with the exception of shisha. DISCUSSION: The use of smoking products in adolescence occurs frequently. Over the observational period, a trend reversal towards e-cigarettes as the most popular product among children and young people is most likely. In addition, the combined use of several smoking products has become a common pattern of consumption. Consistent preventive measures are required in order to achieve the goal of a smoke-free society in 2040.

[Intended and unintended effects of e-cigarettes in clinical studies: a plea for (more) transparency]. / Beabsichtigte und unbeabsichtigte Wirkungen von E-Zigaretten in klinischen Studien ­ ein Plädoyer für (mehr) Transparenz.

E-cigarettes are used in clinical trials to facilitate smoking cessation. Due to the health risks associated with the use of e-cigarettes, the results of clinical trials should be fully reported, including continued exclusive use and dual use of tobacco and e-cigarettes. Nicotine cessation outcomes should be reported as the primary endpoint as well as the analysis of tobacco cessation alone. As there is currently no robust evidence that reducing cigarette consumption provides substantial health benefits, cigarette consumption reduction should not be used as a health outcome in clinical trials. Continued nicotine dependence should be included as an "adverse event" in the reporting of trial results.

[Effectiveness of a cannabis prevention program in school: results of a randomized prospective study]. / Wirksamkeit eines Cannabispräventionsprogramms in der Schule: Ergebnisse einer randomisiert-prospektiven Studie.

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.

Smoking in Popular Streaming Shows and Youth Protection in Germany.

Aim was to investigate the amount of smoking in popular streaming series in Germany with a focus on the comparison between series recommended for adults versus youth. The sample was drawn from the 35 highest user-rated streaming series, that released 1794 new episodes between January 1, 2017 and December 31, 2020. One-third of the episodes (N = 598) were randomly selected and analyzed for smoking content. The age ratings of these episodes ranged from 6 to 18 years, with categories of "6", "12", "16" and "18" years. Ten of the 35 shows (28.6%) were completely smoke-free, 25 shows (71.4%) had at least one episode with smoking. Of all analyzed episodes, 25.1% contained smoking (range = 1 to 36 smoking scenes; median = 4). There was a statistically significant association between episode age rating and the presence of smoking (χ2[3] = 9.1; p = 0.028; Spearman's rho = 0.11): The proportion of episodes with smoking was 0% for episodes with age ratings below 12 years, 20.4% for age ratings "12", 28.3% for age ratings "16", and 32.4% for age ratings "18". This association differed between streaming services, but all services had smoking in episodes rated for youth. Smoking is common in popular streaming series. None of the streaming services meet the recommendations of the WHO Framework Convention on Tobacco Control to reliably restrict young people's access to media content that depicts smoking.

Regional socioeconomic deprivation in Germany and nicotine use among children and adolescents.

To assess the association of regional socioeconomic deprivation and nicotine use, survey data from 17,877 pupils aged 9-17 years were analysed. Lifetime use of combustible, e-cigarettes, and both products were the outcome variables. The German Index of Socioeconomic Deprivation was the exposure variable. Logistic regression models controlling for age, gender, school type, and sensation seeking were used to examine associations between regional socioeconomic deprivation and nicotine use. Ever use of combustible cigarettes was 17.8%, of e-cigarettes 19.6%, and of both products 13.4%. Compared to the most affluent area, the adjusted odds ratio of combustible cigarette use in the most deprived area was 2.24 (95% CI: 1.67-3.00), of e-cigarette use 1.56 (95% CI: 1.20-2.03), and of poly use 1.91 (95% CI: 1.36-2.69). Nicotine use among young people across ages and especially in socioeconomic-deprived areas was widespread. Nicotine control measures are urgently needed to reduce smoking and vaping in German adolescents.

[Use of tobacco cigarettes, e-cigarettes, and shishas among children and adolescents: Results of the 'Präventionsradar' from 2016 to 2023]. / Konsum von Tabakzigaretten, E-Zigaretten und Wasserpfeifen bei Kindern und Jugendlichen. Ergebnisse des Präventionsradars von 2016 bis 2023.

AIM: To measure trends in the use of various smoking products among children and adolescents from 2016 to 2023. METHOD: The data is based on seven waves of the "Präventionsradar", a school-based epidemiological study in grades 5 to 10. The primary endpoints of the study were the lifetime and monthly prevalence of the use of tobacco cigarettes, e-cigarettes, shisha and the use of at least two of these smoking products (combined use). Prevalence estimates are based on logistic regression models. RESULTS: The analysis was based on 94,127 questionnaires. The sex ratio was balanced (49% female), mean age was 13 years (SD=1.8). In 2022/2023, the lifetime prevalence of smoking tobacco cigarettes was 18.8% (95% CI 18.1-19.5), of e-cigarettes 23.5% (95% CI 22.8-24.3), of shisha 14.0% (95% CI 13.4-14.7) and combined use 19.0% (95% CI 18.3-19.7). The monthly prevalence of smoking tobacco cigarettes was 5.9% (95% CI 5.5-6.4), of e-cigarettes 7.0% (95% CI 6.5-7.4), of shisha 3.2% (95% CI 2.8-3.5) and combined use 4.8% (95% CI 4.4-5.2). The following trends in lifetime prevalence have emerged since 2016: tobacco cigarettes (-3.0 percentage points), e-cigarettes (+1.8 percentage points), shisha (-9.2 percentage points), combined use (-2.7 percentage points). In the years of the COVID-19 pandemic, youth smoking decreased and rose again post-COVID with the exception of shisha. DISCUSSION: The use of smoking products in adolescence occurs frequently. Over the observational period, a trend reversal towards e-cigarettes as the most popular product among children and young people is most likely. In addition, the combined use of several smoking products has become a common pattern of consumption. Consistent preventive measures are required in order to achieve the goal of a smoke-free society in 2040.

Regional Socioeconomic Deprivation in Germany and Adherence to the 24-h Movement Guidelines among Children and Adolescents.

To examine the relationship between regional socioeconomic deprivation and adherence to the 24-h movement guidelines among children and adolescents, a cross-sectional study was conducted. A total of 17,433 students aged 9-17 participated in a survey in winter 2021/2022. Daily screen time (ST), moderate-to-vigorous physical activity (MVPA), and sleep behavior were outcome variables. The German Index of Socioeconomic Deprivation (GISD), a regional socioeconomic objective measure, was the exposure variable. Associations between GISD and health behaviors were examined using regression models. Models were adjusted for age, gender, school type, and individual self-reported socioeconomic status (SES). The proportions of meeting the MVPA, ST, and sleep duration guidelines were 14%, 22%, and 34%, respectively. A total of 2.3% met all guidelines. Students from the most deprived communities were half as likely to meet all three guidelines compared to students from the most affluent regions (OR = 0.49 [0.28; -0.03], p = 0.010). There was a consistent relationship between GISD and lower levels of adherence to screen time guidelines (most deprived compared to most affluent: OR = 0.49 [0.38; 0.64], p < 0.001). There was no association between GISD and adherence to sleep time guidelines. We found mixed results for the association between GISD and MVPA. Regional SES appears to be an important factor associated with screen time. Screen time should be limited through intervention programs, especially in disadvantaged areas. Parents should be made aware of their children's increased media consumption. Recommendations for screen time should be clearly communicated, as should the health disadvantages of increased media consumption in childhood and adolescence.

[Smoking in Netflix feature films and youth protection]. / Rauchen in Netflix-Spielfilmen und Jugendschutz.

BACKGROUND: With the aim of protecting minors, the World Health Organization has recommended classifying films with smoking scenes as unsuitable for children and adolescents. In recent years, films have increasingly been viewed via video streaming services - a trend which has been intensified by the COVID-19 pandemic - which poses new challenges for the protection of minors. AIM: To examine the frequency of smoking scenes in Netflix feature films and the age recommendations for Netflix productions with smoking scenes. METHOD: A total of 235 films that were made available for streaming exclusively by the Netflix platform in 2021 and 2022 were content coded in order to find out (1) how high the proportion of smoke-free films was in this film sample, (2) how often smoking scenes occurred in these films and (3) the proportion of films with smoke scenes classified as appropriate for young people in Germany and the USA. All films with an age rating of under 16 were considered suitable for children and young people. RESULTS: Smoking scenes occurred in 113 of 235 analyzed films (48.1%). Of the 113 films with smoking scenes, 57 (50.4%) in Germany and 26 films (23.0%) in the USA were classified as youth films (p<0.001). A total of 3,310 smoking scenes were registered. Of these, 39.4% (n=1,303) were in films with youth ratings in Germany, and in Netflix USA this proportion was 15.8% (n=524). DISCUSSION: Smoking scenes are a common feature in Netflix movies. Neither in the US nor in Germany does Netflix adhere to the recommendations of the WHO Framework Convention on Tobacco Control to restrict access by young people to films depicting smoking. However, the protection of minors in the US is better than in Germany, since half of the Netflix films with smoking scenes in Germany were rated as suitable for minors, in the USA less than a quarter.

Impact of the COVID-19 pandemic on young people with and without pre-existing mental health problems.

The objective was to examine pandemic-related changes in depression and anxiety symptoms in adolescents and young adults in Germany considering pre-existing depression and anxiety problems. In this cross-sectional study, 11,523 adolescents and young adults aged 14-21 years who perceived an impact of the Coronavirus disease (COVID-19) pandemic on their mental health reported the frequencies of depression and anxiety symptoms retrospectively for different pre-pandemic and pandemic phases. Data were collected using web-based questionnaires between January 5th and February 20th, 2022. Depression and anxiety were assessed with a modified version of the Patient Health Questionnaire (PHQ-4). Scale-fit cut-offs were used to identify pre-existing elevated depression and anxiety scores. Multilevel mixed linear models were conducted to assess changes in depression and anxiety symptoms from 2019 to 2021 and compare for age, gender and pre-pandemic mental health problems. Among young people who were experiencing mental health changes as a result of the pandemic, the frequency of depression and anxiety symptoms increased during the COVID-19 pandemic. This association was moderated by age, gender, and pre-existing elevated depression/anxiety scores. For young people without elevated pre-pandemic depression/anxiety, the scores increased strongly over time, with 61% reporting elevated depression symptoms and 44% reporting elevated anxiety symptoms in 2021. In contrast, self-perceived change was minimal for adolescents and young adults with elevated pre-pandemic depression and anxiety. Among young people whose mental health has been affected by the COVID-19 pandemic, the group without pre-pandemic mental health conditions reported greater deterioration than those with elevated pre-pandemic depression and anxiety scores. Thus, adolescents and young adults without pre-existing depression and anxiety problems who perceived a change in general mental health due to the pandemic reported an alarming increase in symptoms of depression and anxiety during the COVID-19 pandemic period.

[Electronic cigarettes: harm reduction or harm prolongation?] / Elektronische Zigaretten ­ Schadensminimierung oder Schadensverlängerung?

This paper deals with the question of whether electronic cigarettes (e-cigarettes) can minimize the proven harm of smoking tobacco or may lead to a long-term harm. While the British Royal College of Physicians recommends smokers to use e-cigarettes as a substitute for tobacco products, the German Society for Pneumology and Respiratory Medicine advises smokers against using e-cigarettes. The harm reduction strategy is based on three hypotheses. Hypothesis 1: It is assumed that e-cigarettes cause less damage to health than tobacco cigarettes. Hypothesis 2: It is postulated that smokers are motivated to switch from conventional cigarettes to e-cigarettes. Hypothesis 3: It is assumed that e-cigarettes are an effective means for quitting smoking with few side effects. Although the long-term health consequences of e-cigarette use remain unknown, there is increasing evidence that e-cigarettes are toxic, harmful to cardiovascular system, respiratory health and potentially carcinogenic. Population-representative epidemiological surveys have shown that three-quarters of all current e-cigarette users in Germany smoke tobacco at the same time. In a few randomized clinical trials, e-cigarettes showed higher success rates compared to nicotine replacement products. As over-the-counter consumer products, a large number of studies have found no advantage for e-cigarettes under real conditions. In addition, e-cigarettes prolong nicotine dependence compared to nicotine replacement products. According to the current state of knowledge, the hypotheses behind the harm minimization strategy using e-cigarettes must be regarded as refuted. It therefore appears ethically problematic when doctors recommend e-cigarettes to their patients as a substitute for smoking.

Mental Health and Physical Complaints of German Children and Adolescents before and during the COVID-19 Pandemic: A Repeated Cross-Sectional Study.

The potential impact of the COVID-19 pandemic on young people's mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schools in Germany. Assessments took place from November to February each year. Two data collections were conducted before the COVID-19 pandemic in 2018-2019 and in 2019-2020. Collections during the pandemic took place in 2020-2021 and 2021-2022. A total of 63,249 data observations were included in the analyses. Multilevel analyses were used to examine temporal trends in mean emotional problems (e.g., often unhappy, downhearted), hyperactivity-inattention (e.g., constantly fidgeting or squirming), conduct problems (e.g., fights with other children), and physical complaints. Models were adjusted for age, gender, school type, socioeconomic status, and sensation seeking. During the COVID-19 pandemic, children and adolescents in Germany experienced an increase in emotional problems from the pre-pandemic cohort 2019-2020 to the pandemic cohort 2021-2022 (ß = 0.56, 95% CI (0.51-0.62)) and, over the course of the pandemic, reported elevated levels of physical complaints (ß = 0.19, 95% CI (0.16-0.21)). Findings of increased emotional problems and physical complaints after the two years of the pandemic support the ongoing demand for low-threshold health promotion and prevention and the need for further monitoring of young people's health in Germany.