The average age of smoking onset in Germany--trends and correlates.

OBJECTIVES: Germany is rated among the countries with the highest prevalence of tobacco use in Europe. This paper analyzes whether the age of smoking onset has decreased in recent years. METHODS: Multivariable event data analyses were performed on the basis of the representative national cross-sectional study "Drug Affinity among Young People in the Federal Republic of Germany 2004". The survey involved a total net sample of 3032 individuals aged 12 to 25. RESULTS: Socioeconomic groups starting to smoke at significantly earlier age include those from the economically deprived areas in eastern Germany, low educational achievers and subjects in households with adult smokers. CONCLUSIONS: The average age of smoking onset has decreased further in the 1978-1992 birth cohorts.

School-based interventions to prevent overweight and obesity in prepubertal children: process and 4-years outcome evaluation of the Kiel Obesity Prevention Study (KOPS).

AIM: To evaluate the feasibility and 4-year outcome of school-based health promotion on overweight among 6-10-year-old children. METHODS: Four-year follow-up data of 344 children participating in health promotion (I) as part of the Kiel Obesity Prevention Study (KOPS) at age 6 years, compared with 4-year changes in 1420 non-intervention children (NI). Nutritional knowledge was assessed before and 3 months after intervention in 1996 and 2004. Outcome was characterized compared to reference values for (i) BMI, (ii) triceps skinfold (TSF) and (iii) waist circumference (WC). RESULTS: Process evaluation showed an increase in knowledge after intervention. However, the prevalence of children with good nutritional knowledge before intervention doubled from 1996 to 2004 but similar intervention-induced increases in knowledge (+50%) were observed. When compared with NI I increased remission of overweight with no significant effect on incidence. The effect was most pronounced in girls. The effect was affected by definition of overweight: when compared with parameters of fat mass (TSF and WC), BMI was showing a stronger effect (remission in girls (Delta I - NI): BMI: +13.4%, TSF: +18.7%, WC: +20.7%). CONCLUSIONS: School-based health promotion has sustainable effects on nutritional knowledge and remission of overweight being most pronounced in girls. The effect of intervention was most pronounced using TSF and WC as criteria of overweight.

Four-year follow-up of school-based intervention on overweight children: the KOPS study.

OBJECTIVE: To evaluate the 4-year outcome of a school-based health promotion on weight status as part of the Kiel Obesity Prevention Study (KOPS). RESEARCH METHODS AND PROCEDURES: Within a cluster-sampled quasi-randomized controlled trial, 1764 children at 6 and 10 years of age were assessed between 1996 and 2005 in 32 primary schools in Kiel, North Germany. Six nutrition units followed by 20-minute running games were performed within the first year at school. Prevalence, incidence, and remission of overweight were main outcome measures. RESULTS: The 4-year change in BMI was +11.6%, with increases in prevalence of overweight and obesity from 5.2% to 11.1% and 3.9% to 5.1%, respectively. Cumulative 4-year incidence of overweight and obesity was 9.2% and 3.1%, respectively. Intervention had no effect on mean BMI. The effect on prevalence was significant in children from families with high socioeconomic status [odds ratio (OR), 0.35; 95% confidence interval (CI), 0.14 to 0.91] and marginally significant in children of normal-weight mothers (OR, 0.57; 95% CI, 0.33 to 1.00). Cumulative 4-year incidence of overweight was lower only in intervention children from families with high socioeconomic status (OR, 0.26; 95% CI, 0.07 to 0.87). Remission of overweight was most pronounced in children of normal-weight mothers (OR, 5.43; 95% CI, 1.28 to 23.01). Prevalence of underweight was unchanged. The intervention had minor but favorable effects on lifestyle. DISCUSSION: A school-based health promotion has sustainable effects on remission and incidence of overweight; it was most pronounced in children of normal-weight mothers and children from families with high socioeconomic status. There was no effect on obesity. The data argue in favor of additional measures of prevention.

School- and family-based interventions to prevent overweight in children.

There have been only a few controlled studies on the prevention of overweight and obesity in children and adolescents. These studies differ in relation to strategy, setting, duration, focus, variables of outcome and statistical power, and therefore do not allow general conclusions to be made about the value of preventive measures. All school-based interventions aimed at the prevention of overweight and obesity show some improvement of health knowledge and health-related behaviours. Short-term effects on nutritional state seem to be more pronounced in girls than in boys. School-based interventions can reduce the incidence of overweight. There is evidence that families of intermediate and high socio-economic status as well as intact families benefit more from treatment than families sharing other characteristics. Selected prevention in obese children is most successful when children are treated together with their parents. However, there are social barriers limiting the success of family-based interventions. Although some positive effects have been reported, simple interventions in a single area (e.g. a school health education programme) are unlikely to work on their own. The development of effective preventive interventions probably requires strategies that affect multiple settings simultaneously. At present there is no concerted action, rather many strategies in health promotion that are followed in isolation. Faced with the epidemic of overweight there is a need for national campaigns and action plans on childhood overweight and obesity. It is tempting to speculate that this strategy will also increase the value of isolated approaches (e.g. in schools and families).