Contextual effects of community capacity as a predictor for adolescent alcohol, tobacco, and illicit drug use: A multi-level analysis.

Adolescent substance use is a major public health issue that can result in enduring physical, psychological, and social consequences. This study seeks to examine the relationship between community capacity for prevention and the 4-week prevalence rate of substance use, including tobacco, alcohol, other drugs, and binge-drinking, among students in Germany ranging from grades 5 to 11. This study employed a cross-sectional design and used baseline data from 28 communities participating in the CTC-EFF study. The sample consisted of 7210 students who were surveyed about their substance use behavior. Additionally, 158 local key informants were surveyed on ten capacity domains, which included commitment, knowledge and skills, resources, leadership, inclusiveness, prevention collaboration, sectoral-collaboration, cohesion, problem-solving skills, and needs orientation. Furthermore, a total capacity score was calculated as the mean of the ten capacity domains. To examine the associations between community capacity and substance use behavior, logistic multi-level models were utilized. The analysis shows a negative association between community capacity (total score) and any substance use (OR = 0.28, 95% CI 0.12-0.56). Specifically, higher levels of total community capacity are associated with lower odds of alcohol use (OR = 0.30, 95% CI 0.13-0.80), tobacco use (OR = 0.09, 95% CI 0.01-0.60), and binge-drinking (OR = 0.67, 95% CI (0.46-0.99). Further analyses of distinct community capacity domains indicate that higher levels of sectoral-collaboration (OR = 0.62, 95% CI 0.37-0.97), knowledge and skills (OR = 0.74, 95% CI 0.40-0.79), resources (OR = 0.52, 95% CI 0.36-0.76), and problem-solving skills (OR = 0.71, 95% CI 0.36-0.89) are associated with lower odds of any substance use. The study findings suggest that community capacity is associated with substance use behavior, emphasizing the importance of capacity building in interventions targeting the reduction of substance use among adolescents.

The effectiveness of workplace interventions for the prevention of alcohol use: A meta-analysis.

BACKGROUND AND AIMS: Previous research has pointed to the potential of workplace interventions addressing alcohol consumption. However, there is still no systematic overview of the effects of these interventions. Therefore, we aimed to quantify the effectiveness of workplace interventions addressing alcohol use by conducting a meta-analysis. METHODS: A systematic literature search for randomized controlled trials of workplace alcohol interventions published between 1995 and 2020 was conducted in five databases. Studies were included if they were performed in the workplace and reported universal or selective interventions aiming for alcohol use reduction. Primary outcomes were any measures of alcohol use. Standardized mean effect sizes were used to calculate the meta-analytic random-effects-model. Additional analyses were carried out to identify potential moderators and to examine the amount of heterogeneity and publication bias. RESULTS: Twenty studies with 4484 participants were integrated into the meta-analysis. Results revealed a significant overall mean effect indicating a reduction of alcohol use in favor of the treatment group (d = -0.16, 95% CI = [-0.2715; -0.0511]). Heterogeneity within the data structure was found to be moderate to substantial (I2 = 75.9%, Q-test P < 0.001, τ2 = 0.0375). Additional moderator analyses only showed a significant effect for length of measurement period (P = 0.049). CONCLUSIONS: Alcohol-related prevention programs conducted in the workplace have a statistically significant and favorable effect on alcohol consumption. Although the overall mean effect is considered to be small, it underlines the effectiveness of workplace interventions targeting a reduction in alcohol use.

Improving alcohol health literacy and reducing alcohol consumption: recommendations for Germany.

BACKGROUND: Although the detrimental health effects of alcohol are well established, consumption levels are high in many high-income countries such as Germany. Improving alcohol health literacy presents an integrated approach to alcohol prevention and an important complement to alcohol policy. Our aim was to identify and prioritize measures to enhance alcohol health literacy and hence to reduce alcohol consumption, using Germany as an example. METHODS: A series of recommendations for improving alcohol health literacy were derived from a review of the literature and subsequently rated by five experts. Recommendations were rated according to their likely impact on enhancing (a) alcohol health literacy and (b) reducing alcohol consumption. Inter-rater agreement was assessed using a two-way intra-class correlation coefficient (ICC). RESULTS: Eleven recommendations were established for three areas of action: (1) education and information, (2) health care system, and (3) alcohol control policy. Education and information measures were rated high to increase alcohol health literacy but low to their impact on alcohol consumption, while this pattern was reversed for alcohol control policies. The ratings showed good agreement (ICC: 0.85-0.88). CONCLUSIONS: Improving alcohol health literacy and reducing alcohol consumption should be considered complementary and become part of a comprehensive alcohol strategy to curb the health, social, and economic burden of alcohol.

Cultural Bias in Parent Reports: The Role of Socialization Goals When Parents Report on Their Child's Problem Behavior.

It has been called into question whether widely used screening instruments for child mental health can provide comparable results across countries and cultures. Socialization goals can influence whether and to what extent a parent considers a behavior to be problematic and thus might influence parental reports on their child's behavior. We tested comparability of parental reports between native German (N = 116) and Turkish origin (N = 77) parents in Germany in an online study using a vignette approach. Parents were asked to rate the perceived problem severity of the same behavior depicted in the vignettes. We expected and found that parents of Turkish origin in Germany rate the externalizing problem behaviour depicted in the vignettes as more problematic compared to native German parents. The effect was fully mediated by parental approval of the socialization goals obedience and collectivism. We also controlled for social desirability responding and an extreme response style.

Changes in Alcoholic Beverage Choice and Risky Drinking among Adolescents in Europe 1999-2019.

This paper explores trends in beverage preference in adolescents, identifies related regional differences, and examines cluster differences in key drinking measures. Data were obtained from the European School Survey Project on Alcohol and Other Drugs (ESPAD), covering 24 European countries between 1999 and 2019. Trends in the distribution of alcoholic beverages on the participants' most recent drinking occasion were analysed by sex and country using fractional multinomial logit regression. Clusters of countries based on trends and predicted beverage proportions were compared regarding the prevalence of drinkers, mean alcohol volume and prevalence of heavy drinking. Four distinct clusters each among girls and boys emerged. Among girls, there was not one type of beverage that was preferred across clusters, but the proportion of cider/alcopops strongly increased over time in most clusters. Among boys, the proportion of beer decreased, but was dominant across time in all clusters. Only northern European countries formed a geographically defined region with the highest prevalence of heavy drinking and average alcohol volume in both genders. Adolescent beverage preferences are associated with mean alcohol volume and heavy drinking at a country-level. Future approaches to drinking cultures need to take subpopulations such as adolescents into account.

Study protocol: a non-randomised community trial to evaluate the effectiveness of the communities that care prevention system in Germany.

BACKGROUND: The Communities That Care (CTC) prevention planning and implementation system trains communities throughout a five-phase cycle to (1) build capacity for prevention, (2) adopt science-based prevention, (3) assess the prevention needs of adolescents living in the community, (4) select, and (5) implement evidence-based programs according to their needs. After CTC proved to be effective and cost-effective in the U.S., it is being used by an increasing number of communities in Germany. The aim of this study is to evaluate the effectiveness and cost-effectiveness of CTC in Germany. METHODS: Communities in CTC-phases 1 to 3 (n = 21) and individually-matched comparison communities (n = 21) were recruited for a non-randomised trial. To assess long-term outcomes, (1) a cohort of 5th Grade students will be surveyed biennially concerning behaviours (antisocial behaviour and substance use) and well-being as well as risk and protective factors. Additionally, (2) biennial cross-sectional surveys will be conducted in 6th, 8th, 10th, and 11th Grade in each community. To assess short-term outcomes, a cohort of ten key informants per community will be surveyed biennially concerning adoption of science-based prevention, collaboration, community support and community norms. (4) In a cross-sectional design, all ongoing prevention programs and activities in the communities will be assessed biennially and data will be collected about costs, implementation and other characteristics of the programs and activities. (5) To monitor the CTC implementation, the members of the local CTC-boards will be surveyed annually (cross-sectional design) about team functioning and coalition capacity. Data analysis will include general and generalised mixed models to assess the average treatment effect of CTC. Mediation analyses will be performed to test the logical model, e.g., adoption of science-based prevention as a mediator for the effectiveness of the CTC approach. DISCUSSION: This is the first controlled study to evaluate the effectiveness of a comprehensive community prevention approach in Germany. Evaluating the effectiveness of CTC in Germany is an important prerequisite for further diffusion of the CTC approach. TRIAL REGISTRATION: This study was registered with German Clinical Trial Register: DRKS00022819 on Aug 18, 2021.

Trends in alcohol consumption among adolescents in Europe: Do changes occur in concert?

OBJECTIVE: The present paper extends the scope of testing Skog's theory on the 'collectivity of drinking culture' to adolescent alcohol use in 26 European countries. The aim was to 1) examine whether changes in adolescent alcohol use are consistent across different consumption levels, and 2) explore whether trends in heavy and light drinkers diverged or converged. METHOD: Data came from six waves of the cross-sectional European School Survey Project on Alcohol and other Drugs (ESPAD) between 1999 and 2019. The sample consisted of n = 452,935 students aged 15-16 years. Trends in alcohol volume across consumption levels including abstainers were estimated by quantile regression models (50th, 80th, 90th and 95th percentile). Countries were classified according to trends showing (soft/hard) collectivity or (soft/hard) polarisation. Trends in heavy drinkers were compared with the population trend. RESULTS: Trends in alcohol consumption at different levels across 26 European countries in the period 1999-2019 were not homogeneous. Collective changes were found in 15 (14 soft/1 hard), and polarised trends in 11 countries (5 soft/6 hard). Collectivity was generally associated with a declining trend. In 18 countries, trends in heavy and light drinkers diverged. CONCLUSION: Accepting some variation in the strength of changes across consumption levels, changes in many European countries occurred in the same direction. Yet, diverging trends at different consumption levels in most countries indicate a less beneficial change in heavy compared with light drinkers, implying that in addition to universal population-level strategies, intervention strategies targeting specific risk groups are needed to prevent alcohol-related harm.

Web-Based Intervention and Email-Counseling for Problem Gamblers: Results of a Randomized Controlled Trial.

Web-based interventions have the potential to reduce the treatment gap for problem gambling. In the past years, several web-based help options were made available to the public. However, only few studies were conducted to test their effects. This study investigated the efficacy of two interventions for problem gamblers provided online by the German Federal Center for Health Education (BZgA). The first intervention is the guided program "Check Out" (CO), the second is email counselling (EC). A web-based randomized controlled trial with follow-up surveys after 3, 6 and 12 months was conducted. Participants were allocated to CO, to EC or to a waitlist (WL). Outcomes were the degree of problem gambling according to the Problem Gambling Severity Index, the number of days gambled in past 30 days, the highest stake during the past 30 days and the subjective well-being (WHO-5). 167 individuals were included in the trial. In comparison to the WL at the 3 months follow-up, participants of CO showed significant improvements with moderate to strong effect sizes in all outcomes. Strongest effects were found in the problem gambling severity (d = 0.91; p = 0.023), followed by the well-being (d = 0.70; p = 0.011), the gambling days (d = 0.59; p = 0.001) and the highest stake (d = 0.55; p = 0.012). Improvements were sustained until last follow-up. Compared to the WL, users of EC had beneficiary results in the problem gambling severity (d = 0.74; p = 0.022). No significant effect differences were found between CO and EC. However, according to process evaluation, users of CO reported a significantly stronger working alliance than users of EC (d = 0.70; p = 0.019) and used the intervention considerably longer (d = 0.84; p = 0.004). CO helps treatment-seeking individuals to sustainably reduce their gambling behavior and to increase their general well-being. Compared to EC, CO seems a better support option, since its effects include a wider range of outcomes. Possible reasons are the more engaging program structure and elements of CO, as well as the closer interaction between client and counselor.

Correction to: Web-Based Intervention and Email­Counseling for Problem Gamblers: Results of a Randomized Controlled Trial.

The article "Web-Based Intervention and Email-Counseling for Problem Gamblers: Results of a Randomized Controlled Trial" was written by Benjamin Jonas, Fabian Leuschner, Anna Eiling, Christine Schoelen, Renate Soellner and Peter Tossmann.

Measuring children's emotional and behavioural problems: are SDQ parent reports from native and immigrant parents comparable?

BACKGROUND: The number of immigrants worldwide is growing and migration might be a risk factor for the mental health of children. A reliable instrument is needed to measure immigrants' childrens mental health. The aim of the study was to test the measurement invariance of the parent version of the Strengths and Difficulties Questionnaire (SDQ) between German native, Turkish origin and Russian origin immigrant parents in Germany. The SDQ is one of the most frequently used screening instruments for mental health disorders in children. METHODS: Differential Item Functioning (DIF) was tested in samples matched by socio-economic status, age and gender of the child. A logistic regression/item response theory hybrid method and a multiple indicators- multiple causes model (MIMIC) was used to test for DIF. Multi Group Confirmatory Factor analysis (MGCFA) was used to test for configural invariance. Parent reports of 10610 German native, 534 Russian origin and 668 Turkish origin parents of children aged 3-17 years were analysed. RESULTS: DIF items were found in both groups and with both methods. We did not find an adequate fit of the original five factor model of the SDQ for the Turkish origin group, but for the Russian origin group. An analysis of functional equivalence indicated that the SDQ is equally useful for the screening of mental health disorders in all three groups. CONCLUSION: Using the SDQ in order to compare the parent reports of native and immigrant parents should be done cautiously. Thus, the use of the SDQ in epidemiological studies and for prevention planning is questionable. However, the SDQ turns out to be a valid instrument for screening purposes in parents of native and immigrant children.

Do Women With High eHealth Literacy Profit More From a Decision Aid on Mammography Screening? Testing the Moderation Effect of the eHEALS in a Randomized Controlled Trial.

Background: Our decision aid on mammography screening developed according to the criteria of the International Patient Decision Aids Standards Collaboration increases knowledge compared to usual care. However, it remains unclear whether this decision aid is more effective in women with higher eHealth literacy. Our objective was to test whether the positive effect of the decision aid on knowledge is moderated by eHealth literacy. Methods: A total of 1,206 women aged 50 from Westphalia-Lippe, Germany, participated (response rate of 16.3%) in our study and were randomized to usual care (i.e., the standard information brochure sent with the programme's invitation letter) or the decision aid. eHealth literacy was assessed at baseline with the Electronic Health Literacy Scale (eHEALS); knowledge was assessed at baseline and post-intervention. First, we compared the 2-factor model of the German eHEALS (information-seeking and information-appraisal) found in previous research and the 3-factor model we hypothesized for decision aid use to the originally proposed 1-factor model. Second, we modeled the measurement model according to the superior factor model found in step one and tested whether the eHEALS moderated the effect of the decision aid on knowledge. Results: The 3-factor model of the eHEALS had a better model fit than the 1-factor or 2-factor model. Both information-seeking, information-appraisal, and information-use had no effect on knowledge post-intervention. All three interactions of the decision aid with information-seeking, information-appraisal, and information-use were not significant. Equally, neither education nor its interaction with the decision aid had an effect on knowledge post-intervention. Conclusion: The decision aid developed in this project increases knowledge irrespective of level of eHealth literacy. This means that not only women with high eHealth literacy profit from the decision aid but that the decision aid has been successfully conceptualized as a comprehensible information tool that can be used by women of varying eHealth literacy levels. Trial registration: German Clinical Trials Register DRKS00005176 (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005176).

Telephone-Based Cognitive Behavioral Intervention Improves Dementia Caregivers' Quality of Life.

The present study examined the effects of a telephone-based cognitive behavioral intervention on dementia caregivers' quality of life (QoL). A total of 273 caregivers were randomly assigned to an intervention or control group. The intervention comprised 12 telephone sessions of individual cognitive behavioral therapy (CBT) over 6 months. At baseline, postintervention, and 6-month follow-up, QoL was assessed with the World Health Organization QoL-BREF, which measures perceived QoL for the domains physical health, psychological health, social relationships, and environment as well as overall QoL and satisfaction with general health. Intention-to-treat analyses using latent change models were performed. At postintervention, intervention group participants reported better overall QoL and satisfaction with general health as well as better physical and psychological health compared to control group participants. Together with existing evidence, the results suggest that the telephone CBT intervention does not only reduce impairments but also fosters improvements in health-related QoL.

Intervention Helps Family Caregivers of People With Dementia Attain Own Therapy Goals.

INTRODUCTION: Caregiver intervention studies typically assess whether participants attain general goals (eg, improved mental/physical health) but not their own individual goals. We used goal attainment scaling to evaluate whether participants of a telephone intervention based on cognitive behavioral therapy (CBT) attained their personal goals. We also evaluated treatment compliance and implementation. METHODS: A sample of 139 family caregivers of people with dementia received 12 telephone sessions over 6 months. Participants personal goals were specified during the first and second sessions. Participants and therapists assessed goal attainment at the end of the intervention. RESULTS: Nearly all participants reported meaningful improvements with regard to their personal goals. Specifically, 20.9% exceeded, 56.4% completely attained, and 21.8% partially attained at least one of their personal goals. There was high agreement between self- and therapist ratings. Treatment compliance and implementation were highly satisfactory. CONCLUSIONS: The CBT telephone intervention successfully helped participants attain their personal goals.

Exploring the Association Between Health Literacy and Psychological Well-Being Among Industry Managers in Germany.

OBJECTIVE: Industry managers are typically exposed to high work demands but have received limited attention by research, particularly concerning the issue of health literacy and how this relates to their psychological well-being. The aim of this study was to explore the association between health literacy and psychological well-being among managers in Germany. METHODS: An online survey of a sample of 126 commercial industry managers was conducted. Effects of health literacy on psychological well-being (WHO-5 index) were investigated using path analysis. RESULTS: The findings show a quarter of managers were classified as having poor well-being. Health literacy, namely the facets self-regulation (ß = 0.40, P < 0.001), self-perception (ß = 0.26, P < 0.001), self-control (ß = 0.25, P < 0.01), and proactive approach to health (ß = 0.09, P < 0.05), were positively associated with psychological well-being. CONCLUSION: The study indicates that higher health literacy is associated with decreased risk of poor well-being.

The Tele.TAnDem Intervention: Telephone-based CBT for Family Caregivers of People With Dementia.

Background and Objectives: This study evaluated the effectiveness of a telephone-based cognitive-behavioral therapy for family caregivers of people with dementia in existing health care provision structures. Research Design and Methods: Two hundred seventy-three family caregivers of people with dementia were randomly assigned to receive the intervention or usual care. Usual care included unrestricted access to community resources. Intervention group participants received twelve 50-min sessions of individual cognitive-behavioral therapy by trained psychotherapists within 6 months. Symptoms of depression, emotional well-being, physical health symptoms, burden of care, coping with the care situation and challenging behavior were assessed after the intervention ended and at a 6-month follow-up. Intention-to-treat analyses using latent change models were applied. Results: Intention-to-treat analyses showed improved emotional well-being (γ = 9.59, p = .001), fewer symptoms of depression (γ = -0.23, p = .043), fewer physical health symptoms (γ = -0.25, p = .019), improved coping with the care situation (γ = 0.25, p = .005) and the behavior of the care recipient (γ = 0.23, p = .034) compared with usual care. Effects for coping (γ = 0.28, p = .006 and γ = 0.39, p < .001, respectively) and emotional well-being (γ = 7.61, p = .007) were also found at follow-up. Discussion and Implications: The CBT-based telephone intervention increased mental and physical health as well as coping abilities of family caregivers of people with dementia. The intervention can be delivered by qualified CBT therapists after an 8-h training session in existing health care provision structures.

Is Drinking Contagious? An Analysis of the Collectivity of Drinking Behavior Theory Within a Multilevel Framework.

AIMS: To analyze the effect of behavioral contagion regarding problematic adolescent alcohol use among countries with varying prevalence of problematic drinking. METHODS: Nested data from 48,215 12 to 16-year olds from seventh to ninth grade of 25 European countries (48.5% male, M = 13.83 years) were studied using hierarchical general linear modeling sequences. Finally, an intercept-as-outcome model was built to test the main hypothesis. RESULTS: Multilevel analyses validated the significant effects of the individual risk factors of being older (OR = 2.02), being male (OR = 1.41) and being native born (OR = 1.32) on becoming a problematic alcohol user. Regarding the aggregated country-level predictor 'proportion of problematic alcohol users', the effect of behavioral contagion was also confirmed (OR = 1.05). CONCLUSIONS: The contagion effect regarding alcohol use behavior calls for a focus on environmental prevention efforts. By decreasing the public acceptance of (adolescent) alcohol use, the average proportion of problematic adolescent alcohol users in European countries may be reduced.

Cross-cultural variation in the association between family's socioeconomic status and adolescent alcohol use.

INTRODUCTION AND AIMS: This study estimates cross-country variation in socioeconomic disparities in adolescent alcohol use and identifies country-level characteristics associated with these disparities. DESIGN AND METHODS: The association between socioeconomic status (family wealth and parental education) and alcohol use (lifetime use and episodic heavy drinking) of 15- to 16-year-olds from 32 European countries was investigated. Country-level characteristics were national income, income inequality and per capita alcohol consumption. Multilevel modelling was applied. RESULTS: Across countries, lifetime use was lower in wealthy than in less wealthy families (odds ratio [OR](girls)  = 0.95, OR(boys)  = 0.94). The risk of episodic heavy drinking, in contrast, was higher for children from wealthier families (OR(girls)  = 1.04, OR(boys)  = 1.08) and lower when parents were highly educated (ORs = 0.95-0.98). Socioeconomic disparities varied substantially between countries. National wealth and income inequality were associated with cross-country variation of disparities in lifetime use in few comparisons, such that among girls, the (negative) effect of family wealth was greatest in countries with unequally distributed income (OR = 0.86). Among boys, the (negative) effect of family wealth was greatest in low-income countries (OR = 1.00), and the (positive) effect of mothers' education was greatest in countries with high income inequality (OR = 1.11). DISCUSSION AND CONCLUSIONS: Socioeconomic disparities in adolescent alcohol use vary across European countries. Broad country-level indicators can explain this variation only to a limited extent, but results point towards slightly greater socioeconomic disparities in drinking in countries of low national income and countries with a high income inequality. [Gomes de Matos E, Kraus L, Hannemann T-V, Soellner R, Piontek D. Cross-cultural variation in the association between family's socioeconomic status and adolescent alcohol use.

Are psychotherapeutic effects on family caregivers of people with dementia sustainable? Two-year long-term effects of a telephone-based cognitive behavioral intervention.

OBJECTIVES: Evaluation of long-term effects of an individualized short-term telephone intervention (seven sessions), based on a comprehensive cognitive behavioral therapy (CBT) approach. The study goal was to evaluate the maintenance of intervention effects regarding well-being, quality of life, and health at two years post treatment. METHOD: Participants (n = 105) were (partly) randomized after baseline assessment in a two-arm study (intervention, control group/usual care). Depressive symptoms were assessed with the German version of the Center for Epidemiologic Studies Depression Scale (CES-D). Caregivers' physical complaints were measured with the Gießener Beschwerdebogen (GBB-24), and quality of life with the World Health Organization quality of life -BREF (WHOQOL-BREF). Emotional well-being and perceived health status were assessed using thermometer scaling. Data were analyzed by intention-to-treat analyses, including for those who terminated the intervention prematurely but still delivered data, using ANCOVAs. RESULTS: Long-term intervention effects were found for emotional well-being (p = 0.019). For the subgroup of caregivers who were still caring at home at follow-up, the intervention led to an increased health status (p = 0.023), fewer bodily complaints (global measure p= 0.014, rheumatic pain p = 0.027, heart trouble p = 0.042), and a higher quality of life (overall p = 0.044 and subscale environment p = 0.030). CONCLUSION: The short-term CBT intervention via telephone showed long-term effects two years after treatment on emotional well-being, health status, bodily complaints, and quality of life.

Concept mapping as an approach for expert-guided model building: The example of health literacy.

Concept mapping served as the starting point for the aim of capturing the comprehensive structure of the construct of 'health literacy.' Ideas about health literacy were generated by 99 experts and resulted in 105 statements that were subsequently organized by 27 experts in an unstructured card sorting. Multidimensional scaling was applied to the sorting data and a two and three-dimensional solution was computed. The three dimensional solution was used in subsequent cluster analysis and resulted in a concept map of nine "clusters": (1) self-regulation, (2) self-perception, (3) proactive approach to health, (4) basic literacy and numeracy skills, (5) information appraisal, (6) information search, (7) health care system knowledge and acting, (8) communication and cooperation, and (9) beneficial personality traits. Subsequently, this concept map served as a starting point for developing a "qualitative" structural model of health literacy and a questionnaire for the measurement of health literacy. On the basis of questionnaire data, a "quantitative" structural model was created by first applying exploratory factor analyses (EFA) and then cross-validating the model with confirmatory factor analyses (CFA). Concept mapping proved to be a highly valuable tool for the process of model building up to translational research in the "real world".

Substance Use Patterns Among Adolescents in Europe: A Latent Class Analysis.

BACKGROUND: Several researchers have investigated substance use patterns using a latent class analysis; however, hardly no studies exist on substance use patterns across countries. OBJECTIVES: Adolescent substance use patterns, demographic factors, and international differences in the prevalence of substance use patterns were explored. METHODS: Data from 25 European countries were used to identify patterns of adolescent (12-16 years, 50.6% female) substance use (N = 33,566). RESULTS: Latent class analysis revealed four substance use classes: nonusers (68%), low-alcohol users (recent use of beer, wine, and alcopops; 16.1%), alcohol users (recent use of alcohol and lifetime use of marijuana; 11.2%), and polysubstance users (recent use of alcohol, marijuana, and other illicit drugs; 4.7%). Results support a general pattern of adolescent substance use across all countries; however, the prevalence rates of use patterns vary for each country. CONCLUSIONS/IMPORTANCE: The present research provides insight into substance use patterns across Europe by using a large international adolescent sample, multidimensional indicators and a variety of substances. Substance use patterns are helpful when targeting policy and prevention strategies.