Biomedical subjects

Ulfert Hapke

Publications and source records attributed to Ulfert Hapke.

At least 37 records · Page 2Linked to original sources

PubMed2005

Relationships of psychiatric disorders with overweight and obesity in an adult general population.

OBJECTIVE: To explore relationships of smoking and risk drinking status, nicotine and alcohol dependence, and anxiety, depressive, and somatoform disorders with overweight and obesity. RESEARCH METHODS AND PROCEDURES: A probability sample was drawn that was representative for the adult general population, 18 to 64 years of age, in one region of Germany; the participation rate was 70.2%. After excluding those who were pregnant or had a current eating disorder according to the DSM-IV, 4063 individuals remained. Overweight and obesity were defined according to the BMI that was assessed in the face-to-face in-home standardized interview (Composite International Diagnostic Interview) on psychiatric disorders. RESULTS: Men with a former nicotine dependence had higher odds of being overweight than men who never had a nicotine dependence (adjusted odds ratio, 1.5; confidence interval, 1.1 to 2.1). Men at current risk for drinking and current alcohol-dependent or abusing men had lower odds of being overweight compared with men who never were alcohol dependent, abusing, or at risk for drinking (adjusted odds ratio, 0.3; confidence interval, 0.8 to 0.9). Effect sizes were small. No relationship of overweight with depressive, anxiety, or somatoform disorders was found in the multivariate analysis. DISCUSSION: There is a relationship between being overweight and nicotine and alcohol dependence or abuse among men but not among women. Even though one reason for women to refrain from quitting smoking is the fear of weight gain, these results do not support this. This information could help convince women to try to quit smoking.

Adolescent↗

PubMed2005

Comparison of a population-based sample of "risky drinking" smokers and groups consuming just one substance.

This population-based study compares a group of "risky drinking" smokers (n = 137) with groups of either smokers (n = 760) or "risky drinkers" (n = 173) regarding sociodemographic, behavioral and motivational variables. The study took place in a rural and urban region of Germany in 1997. No differences were found in sociodemographics, nicotine-related variables, frequency of alcohol consumption, and most alcohol-related diagnoses. People who drink and smoke show a higher proportion of alcohol dependence (ES: h = .20), drink more alcohol per occasion (ES: d = .39), and are more motivated to decrease alcohol consumption (ES: h = .45). The data suggest focusing research in more alcohol-related clinical settings and examining the relationship between smoking cessation and alcohol reduction.

Alcohol Drinking↗

PubMed2005

Stages of change and other factors in 'light' cigarette smokers.

BACKGROUND: It has become well known that 'light' cigarettes are deceiving in fostering the attitude that they are 'safer' or less health damaging than regular cigarettes. The goal of this study is to analyse the smoking of 'light' cigarettes according to the progress over the stages of change to stop or reduce smoking. METHODS: A sample representing the general population of a northern German region aged 18 to 64 was drawn (T1, N=4075). 1520 smokers of 'light' and regular cigarettes were identified by a face-to-face interview and reassessed longitudinally by questionnaire 30 months later (T2, n=913). RESULTS: At baseline smokers of 'light' cigarettes, in particular males, were more likely to be contemplators or preparators in terms of smoking cessation. Those who smoked 'light' cigarettes were more likely to have made a quit attempt, were more likely to be female, at younger age, never married, higher educated and less nicotine dependent compared to smokers of regular cigarettes. The follow-up data shows that males who smoked 'light' before or changed to 'light' cigarettes were more likely to contemplate or to prepare quitting, had more often tried a quit attempt and stopped smoking more often. CONCLUSION: The results suggest that 'light' cigarettes especially by males are used for reasons of reducing or quitting smoking. It is concluded that as such they deceive the smoker and potentially hinder the process of reducing or quitting.

Adolescent↗

PubMed2005

Association of smoking and nicotine dependence with trauma and posttraumatic stress disorder in a general population sample.

This study is aimed at investigating the association between trauma, posttraumatic stress disorder (PTSD), smoking, and nicotine dependence. Data were collected in a representative population sample of 4075 adults aged 18 to 64 with the Composite International Diagnostic Interview. Findings show increased odds ratios (ORs) for smoking (OR: 1.28; 95% CI: 1.09-1.51) and nicotine dependence (OR: 1.52; 95% CI: 1.26-1.82) in traumatized persons, independent of PTSD. Persons with PTSD tended to have higher odds for smoking (OR: 2.12; 95% CI: 1.16-3.90) and nicotine dependence (OR: 2.70; 95% CI: 1.57-4.65), but also had lower rates for quitting smoking (OR: 0.38; 95% CI: 0.17-0.84) and for remission from nicotine dependence (OR: 0.18; CI: 0.05-0.63). We conclude that persons suffering from PTSD might need comprehensive aid in smoking cessation.

Adolescent↗

PubMed2005

Longitudinal relationships among transtheoretical model constructs for smokers in the precontemplation and contemplation stages of change.

BACKGROUND: This study examined the pattern, direction, and magnitude of longitudinal relationships among the constructs involved in the Transtheoretical Model (TTM). PURPOSE: The goal was to explore within-TTM relationships to create an integrated structural model that adequately represents the change process. METHOD: Data were collected as part of a representative general adult population study in Germany. A total of 688 smokers in the precontemplation and contemplation stages of change were assessed two times, 6 months apart, with respect to the TTM constructs. Structural equation modeling was used and a step approach was employed to evaluate the relationships between cognitive-affective processes, behavioral processes, the pros and cons of smoking, and self-efficacy, stratified for baseline stage of change. RESULTS: The model-building process resulted in two final structural equation models detailing longitudinal TTM relationships for precontemplation and contemplation. A structural invariance test showed that the precontemplation model also held for the contemplation sample and visa versa. CONCLUSIONS: The TTM constructs can be integrated in a longitudinal structural model. The findings provide empirical support for specific relationships that are posited in the TTM framework. However, differing relationships between TTM constructs for precontemplation and contemplation could not be established.

Adolescent↗

PubMed2005

Consistency or change in nicotine dependence according to the Fagerström Test for Nicotine Dependence over three years in a population sample.

The goal was to determine whether nicotine dependence levels remain consistent or change over three years. From a population- based sample of 4075 residents aged 18-64, drawn at random, data of 696 individuals was used, who had smoked cigarettes for 21 years on average. Nicotine dependence was assessed by the Fagerström Test for Nicotine Dependence (FTND) at baseline, and 30 and 36 months later. In addition, nicotine dependence and alcohol dependence were diagnosed according to the American Psychiatric Association (DSM-IV). We found an increase in the FTND over 36 months. Subgroups were revealed with sustained high, increasing, decreasing, and sustained low rates of the FTND sum score. Male gender, age at onset of smoking 15 years or younger, DSM-IV nicotine dependence, and DSM-IV alcohol dependence at baseline predicted a sustained high FTND. We conclude that nicotine dependence is increasing even after many years of smoking in an adult population sample.

Adolescent↗

PubMed2005

Psychiatric disorders among at-risk consumers of alcohol in the general population.

OBJECTIVE: At-risk consumption of alcohol has increasingly become the focus of primary and secondary prevention efforts. Little is known about the co-occurrence of psychiatric disorders with at-risk drinking. We examined patterns of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) lifetime co-occurrence of psychiatric disorders in individuals in the general population with at-risk consumption of alcohol, alcohol abuse, alcohol dependence and moderate drinking/abstention, considering potential gender differences. METHOD: Cross-sectional data of a representative general population-based study were analyzed. Based on DSM-IV criteria, participants aged 18-64 (N = 4,074; 2,045 men) were diagnosed using a standardized computer-assisted version of the Munich Composite International Diagnostic Interview (M-CIDI). Nonpsychotic Axis-I lifetime diagnoses were examined. At-risk consumption of alcohol was defined as an average of more than 20 g (0.71 oz) pure alcohol consumption per day for women and 30 g (1.06 oz) for men, with alcohol abuse or alcohol dependence excluded. RESULTS: Almost 9% of participants were identified as at-risk drinkers. Prevalence rates for at-risk drinkers were 16.9% for affective, 18.1% for anxiety and 17.8% for somatoform disorders. Compared with moderate drinkers/abstainers, at-risk drinkers showed a twofold increased risk of having a psychiatric disorder. Subjects with alcohol abuse showed a comparable level of risk and individuals with alcohol dependence showed an even greater risk. Female at-risk drinkers were twice as likely to have a psychiatric disorder as their male counterparts. The odds ratios for psychiatric disorders in at-risk drinkers compared with moderate drinkers/abstainers, however, did not differ in men and women. CONCLUSIONS: Rates of psychiatric co-occurrence among at-risk drinkers were considerably elevated when compared with moderate drinkers/abstainers. These findings underline the relevance of at-risk consumption of alcohol and represent an important challenge to public health efforts regarding screening of psychiatric disorders and referral to appropriate treatment services.

Adolescent↗

PubMed2004

Smoking, nicotine dependence and psychiatric comorbidity--a population-based study including smoking cessation after three years.

BACKGROUND: Evidence suggests that nicotine-dependent smokers are at increased risk for psychiatric comorbidity but general population data that included the number of nicotine dependence and withdrawal symptoms according to DSM-IV, the Fagerstrom Test for Nicotine Dependence (FTND), somatoform disorders and the number of psychiatric diagnoses are rare. The goal of the present study was to analyse relationships of smoking and nicotine dependence with psychiatric disease and whether psychiatric disease predicts the sustaining of smoking after three years. METHODS: Cohort study with a random adult population sample in a northern German region (N = 4075) including a baseline measurement of ever daily smokers aged 18-64 (n = 2458), a first follow-up of the current smokers at baseline (n = 1552) after 30 months and a second follow-up after 36 months. Measures included DSM-IV diagnoses by the Composite International Diagnostic Interview, FTND, smoking cessation by interview. RESULTS: Current daily smokers showed higher odds of a substance use disorder other than nicotine dependence compared with never smokers (odds ratio, OR, 4.6; confidence interval, CI, 2.9-7.2), affective (OR 1.8; CI 1.4-2.5), anxiety (OR 1.6; CI 1.2-2.0) or somatoform disorder (OR 1.4; CI 1.0-1.8). DSM-IV nicotine dependence and the FTND were positively related with the number of psychiatric diagnoses. Psychiatric comorbidity did not predict the maintenance of smoking or quitting. CONCLUSIONS: Findings of increased rates of mental disorders among smokers and nicotine-dependent smokers in the adult general population are supported by this study. The number of nicotine dependence and withdrawal symptoms are related to mental disorders. In addition, somatoform disorders show relationships with smoking similar to relationships with depressive or anxiety disorders. The intention to stop smoking should be proactively supported among these comorbid patients.

Adolescent↗

PubMed2004

Impact of psychiatric disorders in the general population: satisfaction with life and the influence of comorbidity and disorder duration.

BACKGROUND: Psychiatric disorders as defined by DSM-IV are found to be highly prevalent in the general population. However, little is known about aspects defining the burden caused by different disorders. OBJECTIVES: The aim of this study was to evaluate the impact of different psychiatric disorders in the community with respect to life satisfaction taking into account the effects of comorbidity and disorder duration. METHOD: Psychiatric 12-month disorders and life satisfaction were assessed in a random sample of 4075 adults from the general population using the Composite International Diagnostic Interview and the Satisfaction With Life Scale (SWLS). Separate analyses were performed for comorbid and pure disorders. Disorder duration was defined by the time since disorder onset for participants fulfilling diagnostic criteria within the last year. RESULTS: SWLS scores were significantly lower for all diagnostic subgroups except for bipolar disorders, compared to subjects with no 12-month diagnosis. Effect sizes were medium to large. Comorbidity was significantly associated with lower satisfaction with life. Pure disorders are associated with less but still significantly reduced SWLS scores, except alcohol abuse, major depression and specific phobia. Mean duration of disorder was lowest for dysthymia (5.9 years) and highest for specific phobia (24.5 years). The only significant correlation between disorder duration and SWLS was found for major depression (r = -0.26) and no trend for the direction of the relation could be identified across disorders. CONCLUSIONS: The impact of mental disorders in the community was confirmed by using the subjective measure of life satisfaction. Comorbidity is a key factor in determining the extent of reduction in satisfaction with life. Measures of disorder persistence should be examined by refined research strategies. Comprehensive analyses of mental disorders--exceeding the prevalence or a single measure of burden--have to be considered to define the most urgent needs in the community.

Adolescent↗

PubMed2004

Nicotine dependence, quit attempts, and quitting among smokers in a regional population sample from a country with a high prevalence of tobacco smoking.

BACKGROUND: Nicotine dependence might function as a barrier to smoking cessation. Therefore, the goal was to determine whether single symptoms of nicotine dependence are related to the number of quit attempts and smoking status. METHODS: In a random population sample of 4075 women and men aged 18-64, drawn from 47 German communities, data about nicotine dependence according to the US Diagnostic and Statistical Manual of Mental Disorders and according to the Fagerström Test for Nicotine Dependence (FTND), and data on quit attempts and quitting were collected at baseline with an interview and 30 months later with a questionnaire. RESULTS: Nicotine dependence, in particular withdrawal, was related to a high number of quit attempts and to remaining a current smoker. The urgent need for tobacco, craving for nicotine, smoking to avoid withdrawal, and the expectation of increased appetite or weight gain correctly classified smoking status in 72.1% of individuals through logistic regression analysis. CONCLUSIONS: Nicotine dependence is a strong factor that may partly explain the failure of a subpopulation of smokers to live abstinent. Population-based interventions should include measures of tobacco control and brief interventions carried out, for example, by experts in health care.

Adult↗

PubMed2004

Subtyping general population smokers not intending to quit by stages to reduce smoking.

The present study proposes target groups for preventive measures in smokers not intending to quit based on the intention to reduce smoking using the stages of change concept. Smokers were identified within a representative general population sample (T1; N=4,075) and assessed after 30 months (T2; N=913) and 36 months (T3; N=786). The cross-sectional analyses of the present study included at T2 677 smokers not intending to quit within the next 6 months (cessation-precontemplation stage). The prospective analyses were based on 584 of these smokers who were followed up at T3. At T2, 9.1% intended to reduce substantially within the next 6 months (reduction-contemplation stage), 1.2% intended to reduce substantially within the next 4 weeks (reduction-preparation stage), 3.7% had already reduced for up to 6 months (reduction-action stage), and 8.2% had maintained reduction for more than 6 months (reduction-maintenance stage). Subjects in the different reduction stages differed with respect to previous quit or reduction attempts, degree of nicotine dependence, and amount of cigarette consumption. Advanced reduction stages were significantly associated with increased chance of future reduction attempts. Future progress in the cessation stages (OR=4.7, 95% CI=1.5-13.1) and future quit attempts (OR=4.8, 95% CI=1.3-15.2) were significantly more likely for those in the reduction-action stage compared with the reduction-precontemplation stage. Analyses separating the components of the stage measure revealed further need for the validation of the common operational definition. In conclusion, a substantial subgroup of smokers not intending to quit could be subtyped by the reduction stages and might be accessible by smoking-reduction interventions. Our data did not support an undermining effect associated with later reduction stages with respect to future quit attempts and progress within the cessation stages.

Adolescent↗

PubMed2004

Nicotine dependence and lifetime amount of smoking in a population sample.

AIM: To determine how the age at starting smoking, any quit attempts and the single nicotine dependence criteria are related to the lifetime amount of smoking. METHODS: A population-based sample of 4075 18 to 64-year-olds drawn at random in northern Germany was used. It included 836 former and 1601 current smokers. They were interviewed face-to-face at their homes with the Composite International Diagnostic Interview which provides a nicotine dependence diagnosis (DSM-IV). Also included was the Fagerström Test for Nicotine Dependence. RESULTS: The rates of smokers who started smoking at a young age, who had five or more quit attempts in the past and who fulfilled the single nicotine dependence criteria increased with the lifetime amount of tobacco smoked. CONCLUSION: Nicotine dependence may be a main impeding factor against efforts to decrease smoker rates.

Adolescent↗

PubMed2004

Prevalence, characteristics, associated mental disorders and predictors of DSM-IV nicotine dependence.

OBJECTIVE: Focussing on ever-smokers and comparing nicotine-dependent with nondependent subjects, we examined the characteristics, associations of nicotine dependence with other mental disorders as well as predictors of nicotine dependence. Never-smokers were not included in the reference group of the nondependent subjects, but were analyzed as a third group. METHODS: Data of 1,636 never-smokers and 2,437 ever-smokers (i.e. 1,520 current smokers, 917 former smokers) were taken from the German Transitions in Alcohol Consumption and Smoking Study. Assessments were made using the Composite International Diagnostic Interview. RESULTS: About a third of the ever-smokers met the criteria for nicotine dependence in some point in their lives. Nicotine-dependent smoking was significantly associated with various substance use disorders, affective disorders and anxiety disorders using nondependent smoking as a reference group. Comparing never-smokers and nondependent ever-smokers, significant associations were found for substance use disorders only. Smoking behavior variables, alcohol abuse or dependence and anxiety disorders but not sociodemographic variables and affective disorders were predictors for nicotine dependence. CONCLUSION: Nicotine-dependent smoking is distinct from smoking alone and nicotine-dependent smokers are a characteristically different subgroup within the smoking population.

Adolescent↗

PubMed2004

Readiness to change versus readiness to seek help for alcohol problems: the development of the Treatment Readiness Tool (TReaT).

OBJECTIVE: This study developed and psychometrically evaluated a short self-report measure for treatment readiness, a construct correlated with but distinct from general change readiness. This measure, the Treatment Readiness Tool (TReaT), was based on the transtheoretical model of behavior change. METHOD: A nontreatment-seeking sample of 748 patients from general hospitals who met criteria for at-risk or harmful drinking was recruited as part of an intervention study in Western Pomerania, Germany. RESULTS: Exploratory (n = 498) and confirmatory (n = 250) factor analyses supported the presence of a three-factor structure (Precontemplation, Contemplation and Preparation) among high-risk drinkers who were not seeking treatment. High internal item consistency was found for the three TReaT scales, and strong convergent validity was obtained with measures of alcohol use and consequences. Pearson correlations between the three TReaT scales and parallel scales collected by a measure of general change readiness indicated that the two constructs were relatively distinct (19% shared variance). CONCLUSIONS: The findings suggest that measurement of treatment readiness might have advantages in predicting treatment compliance, processes and outcome relative to measures of general behavior change readiness. The predictive validity of the measure needs to be investigated in future studies, however.

Adolescent↗

PubMed2004

Depressive disorders are related to nicotine dependence in the population but do not necessarily hamper smoking cessation.

BACKGROUND: Evidence shows considerable comorbidity between nicotine dependence and depression. However, little is known from the population about specific factors involved. The goal was to analyze smoking, nicotine dependence, and depression cross-sectionally and to analyze whether or not depression predicts the sustenance of smoking after 3 years. METHOD: A population-based random sample, representative for the adult population aged 18 to 64 years in a German region, was interviewed face to face (N = 4075). Among these were 2458 daily smokers, of whom 320 (13.0%) had a lifetime diagnosis of depression. Current smokers at baseline were followed up 36 months later. Measurements included DSM-IV diagnoses of depression and nicotine dependence by the Composite International Diagnostic Interview. Smoking cessation was defined as the abstinence from smoking for at least 4 consecutive weeks. RESULTS: The rate of subjects with a depressive disorder among female never nicotine dependents was 13.7% and among female current nicotine dependents 31.6% (chi(2) = 49.9, df = 2, p <.001); the respective rate among male never nicotine dependents was 5.6% and among male current nicotine dependents 13.4% (chi(2) = 20.2, df = 2, p <.001). Subjects with a lifetime history of depressive disorder revealed the same rate of smoking cessation after 3 years as those without a depressive disorder (chi(2) = 0.7, df = 1, not significant). The use of nicotine replacement therapy was equally distributed among subjects with a depressive disorder and those without a depressive disorder (chi(2) = 0.03, df = 1, not significant). CONCLUSION: The risk for depression increases as the number of nicotine dependence symptoms increases or dependence criteria are fulfilled. Despite this association, depressed subjects may show the same prospect for smoking cessation as nondepressed subjects.

Adolescent↗

PubMed2003

The Fagerström test for nicotine dependence in two adult population samples-potential influence of lifetime amount of tobacco smoked on the degree of dependence.

BACKGROUND: The Fagerström test for nicotine dependence (FTND) has been widely used in clinical samples but seldom in population samples. Data are particularly lacking for a large range of ages. The goal was to describe the FTND sum score distribution in the adult population and to show potential variation according to the number of years of smoking. METHODS: Random adult population samples from two northern areas in Germany were used. Sample 1 included 1460 current smokers aged 20-64 years and sample 2 included 1135 current smokers aged 20-79 years. One cross-sectional and longitudinal and one cross-sectional study were conducted. The FTND was administered during face-to-face computer-aided interviews. RESULTS: The mean FTND sum score for those aged 20-64 was 3.2 among sample 1 and 2.5 among sample 2. The number of years of smoking and age did not affect the FTND sum score whereas it was positively correlated with the lifetime amount of tobacco smoked. CONCLUSIONS: Dependence according to the FTND does not increase with the number of years of smoking. Population-based interventions addressing the needs of dependent smokers across all age groups are needed.

Adult↗

PubMed2003

Relation among stage of change, demographic characteristics, smoking history, and nicotine dependence in an adult German population.

BACKGROUND: The aim of this study was to provide evidence about the individual intention to quit smoking and accompanying characteristics in a country with a low amount of tobacco control (TC) provisions. METHODS: This study used a random sample of the population aged 18-64 in a German area to make a quantitative estimation of the stages of change to quit smoking among current smokers who had at least one quit attempt (n = 1075). RESULTS: The rate of those who did not intend to stop smoking (precontemplators) was 76.4%, that of those who intended to quit during the next 6 months (contemplators) was 17.0%, and that of those who intended to quit during the next 4 weeks was 6.6%. The three groups did not differ according to gender or age. Of those who had at least 16 years of education, more were contemplators than were those with fewer years of education. Among those who had somatic complaints or nausea from smoking, who had their first cigarette within 1 h or less after awakening, and who had more quit attempts, more were in the contemplation or preparation stage. CONCLUSIONS: Nicotine dependence may add to contemplating about quitting. The precontemplation rate was substantially higher than in samples from nations or states which show a large amount of TC provisions.

Adult↗

PubMed2003

Probabilities of alcohol high-risk drinking, abuse or dependence estimated on grounds of tobacco smoking and nicotine dependence.

AIMS: To estimate probabilities of alcohol high-risk drinking, alcohol abuse and alcohol dependence on grounds of smoking-behaviour related variables and single nicotine dependence criteria. DESIGN: Cross-sectional population-based study. SETTING: Adult population of a region in north Germany. PARTICIPANTS: Cigarette smokers (n = 2437) among a random sample of 4075 females and males aged 18-64, drawn in 1996. MEASUREMENT: Smoking, nicotine dependence according to the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV) and the Fagerström Test for Nicotine Dependence (FTND); increasing alcohol-related harm (ARH): high-risk drinking, DSM-IV alcohol abuse, remitted and current alcohol dependence diagnosed by the Composite International Diagnostic Interview (CIDI). FINDINGS: Having smoked 30 cigarettes or more per day, onset of smoking at the age of 17 or younger, nicotine dependence and single nicotine dependence criteria revealed odds ratios higher than 4.0 for alcohol dependence. For alcohol dependence, a logistic regression model showed an increased odds ratios for male gender, smoking for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems, craving for nicotine, withdrawal experience 1 day or longer, smoking first cigarette in the morning 5 minutes or less after waking. The probability of increasing ARH was more likely in males, smokers for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems and smoking first cigarette in the morning 5 minutes or less after waking. CONCLUSIONS: Gender and single nicotine dependence criteria show particularly high probabilities of alcohol dependence and increasing ARH. Interventions need to take these connections into account.

Adolescent↗