Biomedical subjects

Ulfert Hapke

Publications and source records attributed to Ulfert Hapke.

At least 19 recordsLinked to original sources

PubMed2007

[Improvement of medical care by supporting the intention to change health risk behavior].

A large proportion of disease and death cases could be prevented, if efficacious programs, particularly concerning tobacco smoking, obesity, and alcohol risk drinking, could be applied. Feasible approaches are based, among others, on the Transtheoretical Model of intentional health behavior change. This model allows to develop practical approaches to reduce risk factors of common diseases at the general population level. Evidence about the promotion of the intention to change health risk behaviors revealed successes, e. g., according to smoking cessation. The effects are growing by time. Intervention that is focused at the promotion of change of health risk behaviors can add to the improvement of health care.

Behavior Therapy↗

PubMed2006

Intention to utilize formal help in a sample with alcohol problems: a prospective study.

BACKGROUND: Studies investigating factors of treatment entry have predominantly focussed on persons that have already taken an initial step in the process of help-seeking. With particular emphasis on intention to utilize help, this study aims to detect predictors for alcohol-related help-seeking among a non-help-utilizing sample. METHODS: Using 312 individuals with diverse alcohol problems (dependence, abuse, at-risk drinking), intention to utilize help was assessed in addition to evidence based predictors for utilization of help (e.g. severity of alcohol problem, prior help-seeking). RESULTS: In addition to prior utilization of help (OR=9.76, CI: 4.60-20.74) and adverse consequences from drinking (OR=1.13, CI: 1.02-1.25), intention to utilize help (OR=4.84, CI: 2.04-11.51) was a central predictor for help-seeking. Among individuals who had not obtained prior help, individuals intending to seek help were 8.7 times more likely to utilize help than those not intending to seek help (CI: 1.05-72.2). CONCLUSIONS: In the past, intention to utilize help has been neglected from models investigating treatment entry. This study's findings show that intention is a central factor for utilization of alcohol-specific formal help. Consequently, brief interventions focusing on enhancing motivation are expected to improve early help-seeking among general hospital patients with diverse alcohol problems.

Alcohol Drinking↗

PubMed2006

Post-traumatic stress disorder: the role of trauma, pre-existing psychiatric disorders, and gender.

BACKGROUND: The study is aimed at investigating the influence of trauma type, pre-existing psychiatric disorders with an onset before trauma, and gender on post-traumatic stress disorder (PTSD). METHODS: Traumas, PTSD and psychiatric disorders were assessed in a representative sample of 4075 adults aged 18-64 years using the Composite International Diagnostic Interview. Pre-existing DSM-IV diagnoses of anxiety disorders, depressive disorders, somatoform disorders, alcohol abuse and dependence, nicotine dependence, gender, and the type of trauma were analysed with logistic regressions to estimate the influence of these factors on the risk for developing PTSD. RESULTS: The lifetime prevalence of exposure to any trauma did not vary by gender. The conditional probability of PTSD after exposure to trauma was higher in women (11.1% SE = 1.58) than men (2.9% SE = 0.83). Univariate analyses showed that pre-existing anxiety disorders, somatoform disorders and depressive disorders significantly increase the risk of PTSD. Multivariate analyses revealed that specific types of trauma, especially rape and sexual abuse, pre-existing anxiety disorders and somatoform disorders are predictors of an increased risk of PTSD, while gender and depressive disorder were not found to be independent risk factors. CONCLUSION: Women do not have a higher vulnerability for PTSD in general. However, especially sexually motivated violence and pre-existing anxiety disorders are the main reasons for higher prevalences of PTSD in women.

Adolescent↗

PubMed2006

Changes in the "stages of change" as outcome measures of a smoking cessation intervention: a randomized controlled trial.

OBJECTIVE: Employing changes in the "stages of change" as alternative outcome measures of a smoking cessation intervention. METHOD: RCT carried out between 2002 and 2004 in Germany with 485 daily cigarette smokers recruited from a general population survey. The intervention was conceptually based on the transtheoretical model, involving individualized feedback letters generated by computerized expert-system technology. RESULTS: Latent transition analysis was applied to test models for patterns of change, to evaluate stage of change distributions and transitions over time, and to compare the intervention and control group. The patterns of change across three time points could best be described by a model including stability, one-stage regressions, and one-to-four-stage progressions. There were no significant differences between the intervention and control group in the stage of change distributions at each time point or in the amount of stage transitions over time. CONCLUSION: The efficacy of the intervention could not be demonstrated. Reasons may include oversampling of smokers who are interested in health-related topics but do not intend to quit, and power problems due to substantial attrition.

Adult↗

PubMed2006

Attitudes towards smoking policies and tobacco control measures in relation to smoking status and smoking behaviour.

BACKGROUND: To examine support for various smoking policies and tobacco control measures among lifetime smokers in a country with weak anti-smoking legislation and an underdeveloped anti-smoking climate. METHODS: Current (n = 624) and former smokers (n = 131) from a general population survey filled in the 30-item Smoking Policy Index (SPI). Structural equation modelling was used to confirm the SPI factorial structure and to test whether smoking status and smoking behaviour variables were related to the six dimensions of the SPI. RESULTS: The dimension with the highest support was penalties for sales to minors. Sanctions against smokers had the lowest support. Current smokers compared with former smokers showed lower support on the taxes/fees, public education, and environmental restrictions dimensions while controlling for gender, age, and social status. Within current smokers, unfavourable smoking behaviours were associated with lower support. CONCLUSION: Even in a country with poor tobacco control conditions, lifetime smokers including smokers with highly unfavourable smoking behaviours strongly support smoking policies and tobacco control measures concerning penalties and advertising/promotion. These measures should be used to promote anti-smoking legislation, and strict law enforcement of these measures is expected to be accepted by all smokers. For measures that are not supported by all lifetime smokers, interventions may be useful to increase acceptability. A limitation of the present study is the absence of never-smokers as a comparison group.

Adult↗

PubMed2006

Provision of smoking cessation counseling by general practitioners assisted by training and screening procedure.

OBJECTIVE: To examine which counseling behavior among GPs can be achieved after counseling training when organizational support is provided. METHODS: A random sample of 39 general practices was drawn, 34 took part. GPs received a pre-study assessment followed by a training session for smoking counseling. All patients showing up during a period of 1 week were asked about smoking status. Current smokers, aged 18-70 years were eligible (N=551), 81.8% participated. A documentation sheet, filled in by a study nurse transferred smoking-related information about patient to the GP. GPs were advised to fill in a post-counseling assessment for every patient. A post-study assessment with the GPs was conducted. RESULTS: Frequent barriers for smoking counseling were lack of time and the assumption that patients were not motivated to quit. The GP's documented smoking counseling in 96.0%. The patients (87.8%) could be thoroughly counseled. Younger age of the GP, a high number of patients and the contemplation stage quitting smoking were predictors for realizing counseling. 79.3% of the GPs assessed the procedure to be practicable. CONCLUSIONS: Smoking counseling in the general practice is feasible. PRACTICE IMPLICATION: Involving staff in the screening procedure may support counseling activity of the GP.

Adolescent↗

PubMed2006

Stability of remission from alcohol dependence without formal help.

AIMS: To determine the stability of remission from alcohol dependence without formal help. METHODS: In a cohort of untreated remitters, a follow-up after 24 months was conducted. Participants were recruited through media solicitation and via a general population study. At baseline, all participants (n = 144) fulfilled criteria of remission from alcohol dependence for the previous 12 months without prior use of formal help (sustained full remission according to DSM-IV, neither inpatient nor outpatient treatment, no more than two self help group meetings). Personal interviews were conducted using standardized instruments. RESULTS: In the follow-up period, four individuals died; 92.9% of the remaining participants were re-interviewed (n = 130). Of those interviewed 92.3% showed stable remission without formal help, 1.5% were currently alcohol dependent according to DSM-IV, 1.5% were classified alcohol dependent on grounds of collateral information, 1.5% fulfilled one or two criteria of dependence, and 4.6% utilized formal help. CONCLUSIONS: Untreated remission is not a transient phenomenon. Therefore, studying remitters from alcohol dependence without formal help can yield valid information on pathways to recovery.

Alcoholism↗

PubMed2006

Postpartum return to smoking: identifying different groups to tailor interventions.

OBJECTIVE: (a) To describe a population-based sample of women postpartum who smoked before pregnancy on grounds of the perceived advantages and disadvantages of nonsmoking and the self-efficacy not to smoke. (b) To identify grouping characteristics that can differentiate among those women. This could lead to the development of intervention strategies that are of different efficacy depending on the cluster the woman is member of. SAMPLE: A population-based sample of 317 women who had smoked at the beginning of pregnancy and who were smoke-free at the time of giving birth. DATA: Data about the acquisition stages of change to restart smoking, the perceived advantages of nonsmoking and the self-efficacy to remain smoke free on grounds of the Transtheoretical Model of Behavior Change was assessed. Smoking status was assessed 12 months later. STATISTICAL ANALYSIS: A cluster analysis was used to identify different groups; a logistic regression was calculated to assure the external validity of the clusters identified. RESULTS: The acquisition stages of change do not fit the situation of nonsmoking women postpartum in Germany, but four different clusters of ex-smoking women postpartum were identified on grounds of the other TTM-constructs. These are: the protected, the high risk, the premature and the ambivalent group. The clusters are associated with relapse after 12 months, none of the other variables controlled for was statistically significant. CONCLUSIONS: The TTM contributes to a better understanding of nonsmoking women postpartum. Further studies have to replicate the clusters found and have to find whether interventions tailored to these clusters are more effective in preventing relapse than other interventions.

Adolescent↗

PubMed2006

Midwives' attitudes to counselling women about their smoking behaviour during pregnancy and postpartum.

OBJECTIVE: to investigate the attitudes of midwives to counselling women about their smoking behaviour during pregnancy and postpartum. DESIGN: survey using postal questionnaires. SETTING: the entire federal state of Mecklenburg-West-Pomerania in Germany. PARTICIPANTS: 189 midwives constituting 77% of all midwives working in that State. FINDINGS: midwives reported that they assessed smoking behaviour regularly (77%), addressed the consequences of smoking (70%) and advised women to quit. Among the midwives, 81% saw low chances of success and parents' expectations as the biggest barriers to counselling. Midwives reported that about 28% of women quit following their advice. KEY CONCLUSIONS: smoking and exposure to environmental tobacco smoke are seen as prominent health threats that midwives reported they addressed routinely, including giving advice to stop smoking. IMPLICATIONS FOR PRACTICE: midwives should be supported in learning effective intervention strategies to further strengthen their work. They are a target population to deliver brief smoking interventions.

Adult↗

PubMed2006

Alcohol consumption and health-services utilization in Germany.

OBJECTIVE: This study tests two hypotheses. The first is that a U-shaped or inverse linear association exists between alcohol consumption and health-services utilization. Although this relationship has been examined previously, conclusions have been inconsistent. Additional research is needed to explain why abstainers use more health services than drinkers. Our second hypothesis is that abstainers with a history of heavy drinking seek out more health services than those without heavy drinking histories. METHOD: Data were from two surveys conducted in Germany (N's=4268 [51% women] and 6857 [52% women]). Alcohol consumption was assessed using a quantity-frequency measure. RESULTS: Outpatient and inpatient services showed an inverse linear relation with alcohol consumption. Among abstainers, those with a drinking history exhibited a higher use of outpatient visits but were not more likely to have been hospitalized. CONCLUSIONS: This study supports the view that alcohol consumption is associated with decreased utilization of health services. Results provide some evidence for the hypothesis that former heavy drinkers have higher health-services utilization than either moderate drinkers or other abstainers.

Adult↗

PubMed2006

The reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a German general practice population sample.

OBJECTIVE: Our goal was to analyze the retest reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a primary-care setting and recommend a cut-off value for the different alcohol-related diagnoses. METHOD: Participants recruited from general practices (GPs) in two northern German cities received the AUDIT, which was embedded in a health-risk questionnaire. In total, 10,803 screenings were conducted. The retest reliability was tested on a subsample of 99 patients, with an intertest interval of 30 days. Sensitivity and specificity at a number of different cut-off values were estimated for the sample of alcohol consumers (n=8237). For this study, 1109 screen-positive patients received a diagnostic interview. Individuals who scored less than five points in the AUDIT and also tested negative in a second alcohol-related screen were defined as "negative" (n=6003). This definition was supported by diagnostic interviews of 99 screen-negative patients from which no false negatives could be detected. As the gold standard for detection of an alcohol-use disorder (AUD), we used the Munich-Composite International Diagnostic Interview (MCIDI), which is based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. RESULTS: On the item level, the reliability, measured by the intraclass correlation coefficient (ICC), ranged between .39 (Item 9) and .98 (Item 10). For the total score, the ICC was .95. For cut-off values of eight points and five points, 87.5% and 88.9%, respectively, of the AUDIT-positives, and 98.9% and 95.1%, respectively, of the AUDIT-negatives were identically identified at retest, with kappa = .86 and kappa = .81. At the cut-off value of five points, we determined good combinations of sensitivity and specificity for the following diagnoses: alcohol dependence (sensitivity and specificity of .97 and .88, respectively), AUD (.97 and .92), and AUD and/or at-risk consumption (.97 and .91). CONCLUSIONS: Embedded in a health-risk questionnaire in primary-care settings, the AUDIT is a reliable and valid screening instrument to identify at-risk drinkers and patients with an AUD. Our findings strongly suggest a lowering of the recommended cut-off value of eight points.

Adolescent↗

PubMed2005

Psychiatric comorbidity including nicotine dependence among individuals with eating disorder criteria in an adult general population sample.

The goal was to analyze psychiatric disorders among individuals who satisfied at least one eating disorder criterion (EDC). The data derived from a cross-sectional survey study with a probability sample of residents of a northern German area with 4075 study participants, aged 18-64 years (participation rate 70.2%). Face-to-face in-home computer-aided interviews (Composite International Diagnostic Interview) were used to assess the diagnostic criteria of eating disorders and nicotine dependence, alcohol dependence, depressive, anxiety, and somatoform disorders according to the Diagnostic and Statistical Manual (DSM-IV). Former or current smokers had an odds ratio (OR) of 1.7 (95% confidence intervals, CI, 1.1-2.4 and 1.1-2.6, respectively) for one EDC compared with never smokers. Subjects with a lifetime psychiatric disorder were more likely to have two or more EDC than individuals who never had the respective disorder (nicotine dependence: OR 2.5, CI 1.5-4.2; alcohol dependence or abuse: OR 2.4, CI 1.2-4.7; depressive disorders: OR 2.2, CI 1.4-3.4; anxiety disorders: OR 2.9, CI 1.9-4.5). To conclude, nicotine dependence, alcohol dependence or abuse, depressive disorders, and anxiety disorders are related to two or more EDC in this adult general population sample.

Adolescent↗

PubMed2005

Readiness for change and readiness for help-seeking: a composite assessment of client motivation.

AIMS: To investigate the correspondence between readiness for behaviour change in general and readiness for alcohol related help-seeking in particular. A related aim was to examine how, if at all, measures of dependence severity, use, and consequences were related to a composite measure depicting agreements and disagreements between general change readiness and help-seeking readiness. METHODS: Non-treatment seeking alcohol-dependent patients, numbering 549, from general hospitals in Germany were interviewed. RESULTS: When taking into account both dimensions of motivation, findings indicate 42% of the subjects were characterized by different motivation levels regarding readiness for change and readiness for help-seeking. Higher help-seeking readiness was associated with higher alcohol problem severity. Readiness to change was not affected by alcohol problem severity. CONCLUSIONS: Findings underscore the need to evaluate both motivational constructs in determining clients' need and receptivity to formal help.

Adult↗

PubMed2005

Intention to change drinking behaviour in general practice patients with problematic drinking and comorbid depression or anxiety.

AIMS: This paper examines the interaction of intention to change drinking behaviour with comorbid depression and anxiety in pro-actively recruited individuals with a range of drinking problems. METHODS: Cross-sectional data of 408 general practice (GP) patients aged 18-64 years, who meet the diagnostic criteria of alcohol dependence or abuse according to DSM-IV, criteria of at-risk drinking or binge drinking, were drawn from a brief intervention study. Of the sample, 89 participants were diagnosed with comorbid anxiety and/or depressive disorders. The Transtheoretical Model (TTM) of behaviour change constructs: stages and processes of change, self-efficacy, and decisional balance were assessed in relation to presence and absence of the respective psychiatric disorders. RESULTS: Analysis including all categories of problematic drinking revealed comorbid anxiety and/or depression to be significantly related to later stages of change. Within subgroups, this was only true for alcohol abuse, not for dependence, at-risk or binge drinking. In addition, comorbidity was related to higher use of processes of change and more pros and cons of drinking, when compared to non-comorbid participants. Comorbid individuals showed higher temptation to drink and lower self-efficacy to abstain from drinking. Separate analyses of readiness to change drinking between the categories anxiety/no comorbidity and depression/no comorbidity both obtained significance, while for anxiety disorders, this was more profound. A multinomial logistic regression analysis revealed that adverse consequences better predicted readiness to change when compared to comorbidity. DISCUSSION: Individuals with problematic drinking and comorbid anxiety or depression may be well accessible for pro-active intervention to reduce drinking. Strategies should focus on the enhancement of coping skills to control temptation and self-efficacy.

Adolescent↗

PubMed2005

Psychometric properties of the 'Processes of Change' scale for alcohol misuse and its short form (POC-20).

UNLABELLED: Regarding the processes of change, one of the core constructs of the transtheoretical model of intentional behavior change (TTM), extensive research has been done in the field of smoking. However, little is known about the processes of change for alcohol misuse and their measurement. This study's goals were to investigate the psychometric properties of the German Processes of Change (POC) scale and to refine a short version. METHOD: A sample of 653 non-treatment seeking general hospital patients with alcohol problems was used. Construct validity of the POC was analyzed using confirmatory factor analysis. As another validity aspect the use of processes of change across the stages of change was investigated. RESULTS: Internal consistency of the POC-20 ranged between r=.57 and .94. Construct validity was also good (CFI=.94). In line with TTM postulates subjects in later stages reported more behavioral processes compared to individuals in earlier stages. CONCLUSION: Findings indicated superiority of the POC-20 over the long version and good validity of the measure in a high per capita consumption nation.

Adult↗

PubMed2005

Relationships of psychiatric disorders with sleep duration in an adult general population sample.

The objective was to explore psychiatric disorders as potential predictors of sleep duration. A cross-sectional survey study with a probability sample of residents of a northern German area was carried out. There were 4075 study participants, aged 18--64 years, with a participation rate of 70.2%. Face-to-face in-home computer-aided interviews (Composite International Diagnostic Interview) provided diagnoses of nicotine and alcohol dependence, alcohol abuse, depressive, anxiety and somatoform disorders according to the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV), and included questions about sleep duration. Results show that subjects with a short sleep duration of 5h or less had significantly increased odds ratios (OR) for current nicotine dependence (OR 1.9,; confidence interval, CI, 1.2--2.9), alcohol dependence (OR 2.6, CI 1.2--5.6), depressive disorder (OR 3.0, CI 1.7--5.4) or anxiety disorder (OR 2.1, CI 1.3--3.4) compared to individuals who never had the respective psychiatric disorder after adjustment for sex, age, and school education in a multinomial regression analysis. The conclusion is drawn that current nicotine or alcohol dependence, depressive, and anxiety disorders may add to short sleep duration in this random adult general population sample.

Adolescent↗

PubMed2005

Self-rated general health and psychiatric disorders in a general population sample.

The purpose of this study was to explore the relationships between nicotine and alcohol dependence, depressive, anxiety and somatoform disorders with self-rated general health (GH). A cohort study of a random sample of the non-institutionalised general population aged 18-64 with a participation rate of 70.2% was carried out in a German area (n = 4075 at baseline). A follow-up of tobacco smokers or heavy drinkers (n = 1083, 79.4% of those who had given consent to be followed-up) was conducted 30 months after baseline measurement. The assessments included self-ratings of GH and Diagnostic and Statistical Manual (DSM-IV) diagnoses based on the Composite International Diagnostic Interview. The results show that nicotine dependence, anxiety disorders and somatoform disorders moderately predicted self-rated GH at follow-up (general linear model, R(2) = 0.12). We conclude that psychiatric disorders may contribute to the prediction of a low self-rated GH.

Adolescent↗

PubMed2005

Stage of change transitions and processes of change, decisional balance, and self-efficacy in smokers: a transtheoretical model validation using longitudinal data.

Interactions were examined between stage of change transitions and intraindividual increases or decreases in the processes of change, pros and cons of smoking, and situational temptations longitudinally. A total of 786 ever smokers was assessed 2 times, 6 months apart, with respect to the transtheoretical model (TTM) constructs. Two significant discriminant functions within initial precontemplators and 1 significant function within initial contemplators were found. Ten out of 15 TTM variables contributed to at least 1 function. The functions mainly distinguished between preabstinence (precontemplation, contemplation, or preparation) and abstinence (action or maintenance) stages of change, that is, between current and former smokers. This is one of the few studies providing a longitudinal validation of the postulates of the TTM.

Adolescent↗