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Ulfert Hapke

Publications and source records attributed to Ulfert Hapke.

51 records · Page 3Linked to original sources
PubMed2003

Intentionally reduced smoking among untreated general population smokers: prevalence, stability, prediction of smoking behaviour change and differences between subjects choosing either reduction or abstinence.

AIMS: To compare data from the general population on intentionally reduced smoking and smoking cessation. DESIGN: Longitudinal observation study. SETTING: Northern German region. SUBJECTS: Randomly sampled residents aged 18-64 (T1; n = 4075, response rate 70%). Daily cigarette smokers (n = 1520) were followed up after 30 (T2; n = 913) and 36 months (T3; n = 786). MEASURES: Self-reported smoking-related and socioeconomic variables. Participants were explicitly asked for reduction attempts (reducing cigarettes per day) and maintenance of reduction, which was defined independently of consumption measures. FINDINGS: Between T1 and T2, reduction attempts (39%) were more frequent than quit attempts (33%), and according to self-report, reduction was more likely to be maintained for up to 12 months. Smokers maintaining reduction for up to 6 months had reduced their consumption at T3 by 34% compared with T2. Between T1 and T2, the occurrence of both a reduction and a quit attempt was most frequent (22%), followed by subjects exclusively trying to reduce (17%) and subjects exclusively trying to quit (4%). Subjects who exclusively tried to reduce had a significantly increased probability of further reduction attempts at T3 (OR = 4.4, 95% CI 2.0-10.1), while the probability of quit attempts was equal compared with subjects not attempting to reduce or quit (OR = 1.1, 95% CI 0.3-3.2). DSM-IV nicotine dependence was less common in subjects who exclusively tried to reduce. Other smoking-related and socioeconomic variables did not predict whether individuals attempted to reduce or attempted to quit. CONCLUSIONS: A considerable proportion of general population smokers attempt to reduce, and are able to maintain reduction of, cigarette consumption over time. Reduction attempts did not reduce the probability of a subsequent cessation attempt.

Adolescent↗
PubMed2003

Measuring sense of coherence with only three items: a useful tool for population surveys.

OBJECTIVES: Sense of Coherence is the core construct of Antonovsky's salutogenetic model. To measure Sense of Coherence, a 29-item-questionnaire (SOC-29), a shortened 13-item version, and a simplified measure of only three items (SOC-3) are available. In our study, the last was tested in terms of the psychometric properties and compared with an alternative short form derived from the SOC-29. METHODS: Data with respect to the original SOC-29-scale, the SOC-3, and additional other health measures were collected in a representative general population survey, the German study 'Transitions in Alcohol Consumption and Smoking' (TACOS). Analyses of the factor structures, reliability and validity correlations are reported. RESULTS: The reliability and validity results of the SOC-3 were not encouraging. Subsequent item analyses revealed that three items taken out of the SOC-29 outperformed the SOC-3 in measuring Sense of Coherence in a simplified way. This newly developed instrument is presented as the Brief Assessment of Sense of Coherence (BASOC). CONCLUSION: The BASOC is a superior short form compared with the SOC-3 and is recommended for large surveys with limited space for questions.

Adaptation, Psychological↗
PubMed2002

Naturalistic changes in the readiness to quit tobacco smoking in a German general population sample.

BACKGROUND: This study examines naturalistic changes, i.e., changes that occur without formal interventions, in the motivational readiness to quit tobacco smoking. The transtheoretical model (TTM) with the proposed five stages of change (precontemplation, contemplation, preparation, action, maintenance) is used as the theoretical framework. METHODS: Data were collected as part of a representative general population study in Germany. A total of 786 individuals was assessed two times, 6 months apart, with respect to stage of change. Latent Transition Analysis (LTA) was employed as a special statistical method to analyze stage movements over time. RESULTS: The best-fitting model to describe naturalistic stage movements included both forward and backward movements. A high proportion of the sample was in the precontemplation stage across both measurement occasions. There were high rates of stage regressions over the 6-month period. CONCLUSIONS: In a German representative population of smokers, smoking behavior change toward abstinence does not occur naturally in a substantial amount over the 6-month period without intervention. Differing findings in studies for populations in the United States could be due to methodological differences or differences in tobacco-control conditions.

Adolescent↗
PubMed2002

The role of family and partnership in recovery from alcohol dependence: comparison of individuals remitting with and without formal help.

The aim of this study was to analyse the role of family and partnership in remission from alcohol dependence in treated (n = 50) and untreated (n = 115) individuals. Standardised questionnaires to assess social support, social pressure, coping behaviour, and self-efficacy to stay remitted were used. In both media-solicited samples, social support increased from the pre- to the post-resolution period and was stated as an important resolution maintenance factor. Remitters with formal help experienced more partnership conflicts prior to remission and tended to experience more social pressure from their partner. Social support and social pressure from the family and partner were related to an increase in cognitive coping, as hypothesised, however, only in remitters without formal help, whereas an inverse relationship was found in formal help seekers. Implications for alcohol-related interventions are discussed.

Adaptation, Psychological↗
PubMed2002

Remission from alcohol dependence without help: how restrictive should our definition of treatment be?

OBJECTIVE: Studies on untreated remissions from addictive behaviors have utilized very different definitions of treatment, ranging from regular self-help group participation to almost no help at all. The purpose of this article is to examine the impact of different treatment definitions on triggering and maintenance mechanisms of recovery. METHOD: Sample 1 consists of 103 remitted alcohol dependent subjects (30% female) who never received any kind of treatment or counseling for alcohol problems. Sample 2 consists of 75 remitted alcohol dependent subjects (20% female) who received minor help, defined as contact with alcohol treatment not exceeding nine self-help group sessions or three counseling sessions by a specialty provider. Sample 3 consists of 50 remitted alcohol dependent subjects (24% female) who regularly participated in self-help group meetings. All participants were media recruited. Groups were compared on grounds of a comprehensive, standardized interview, including the assessment of sociodemographic and substance related variables as well as triggering and maintenance factors of remission. RESULTS: On most triggering and maintenance factors of the remission, remitters from alcohol dependence who received minor help are comparable with remitters who received no help, and both groups differ significantly from regular self-help group participants. CONCLUSIONS: Inconsistencies in studies on recovery from alcohol dependence without treatment cannot be accounted for by varying definitions of treatment, as the inclusion of subjects who received some minor help does not lead to a bias in most variables associated with remission.

Adult↗
PubMedDate not supplied

An intervention to support postpartum women to quit smoking or remain smoke-free.

Effectiveness studies among pregnant and postpartum women indicate that pregnancy and the postpartum period provide a window of opportunity to promote smoking cessation and smoke-free families. Yet, there is a lack of information about interventions that are portable to routine care. The goal of this article is to describe the structure, basic strategies, and the application of a smoking cessation and relapse prevention intervention for postpartum women in the general population. By using the stages of change concept and motivational interviewing, a classification of current and former smokers is given, and basic strategies and techniques are described to counsel women postpartum with regard to smoking.

Counseling↗
PubMedDate not supplied

[Antonovsky's sense of coherence scale and presentation of a psychiatric diagnosis].

Despite a wide reception of Antonovsky's salutogenetic model, only recently representative data measuring sense of coherence with the Sense of Coherence Scale (SOC) have been collected for Germany. Meanwhile, norms have been published for the long (SOC-29) and the short-form (SOC-13) of the scale. Also an alternative short-form (SOC-9L) has been developed. Basis of this investigation are data from 4002 subjects (70.2 % response rate) from a representative sample in the City of Lübeck and the surrounding communities. In addition to a comprehensive battery of psychometric instruments, the Munich-Composite International Diagnostic Interview (M-CIDI) was used to derive DSM-IV diagnostic criteria. In this study, test statistical parameters for SOC-items stemming from a representative survey are reported. Internal consistencies (Cronbach's alpha) for the three forms are: SOC-29 = 0.91, SOC-13 = 0.86 und SOC-9L = 0.85. Critical differences with an alpha of 5 % are ascertained at: SOC-29 = 17.73, SOC-13 = 11.55 und SOC-9L = 8.61. Arithmetic means (and standard deviations) of the three scales for the whole sample are: SOC-29 = 155 (23), SOC-13 = 70 (11), SOC-9L = 51 (8). Also descriptive values, respecting age and gender for the three forms of the SOC are referred. Additionally all three SOC forms for the whole sample are contrasted with SOC scores of subjects who a) never fulfilled criteria for a psychiatric disorder in their lifetime, b) fulfilled criteria for a psychiatric disorder once in their lifetime, and c) fulfilled criteria for a psychiatric disorder in the last 12 months. Subjects who never fulfilled criteria showed highest scores, those who did so within the last 12 months showed lowest scores. The other two group scored in between.

Adolescent↗
PubMedDate not supplied

Predictors of increased body mass index following cessation of smoking.

The objective of this study was to explore nicotine withdrawal symptoms as predictors of increased body mass index (BMI) after an attempt to quit or reduce tobacco smoking. The authors used a survey study, with a probability sample of 4,075 18-64-year-old residents. The participation rate was 70.2%, which included 1,545 current daily smokers. Follow-ups were carried out for current smokers after thirty and 36 months. The authors found that smokers who experienced increased appetite or weight gain (IAW) as a nicotine withdrawal symptom had a higher BMI than smokers without IAW. They concluded that IAW after quitting might be a specific determinant of the BMI increase following smoking cessation in a subgroup of smokers.

Adolescent↗
PubMedDate not supplied

Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires.

Most screening questionnaires are developed in clinical settings and there are few data on their performance in the general population. This study provides data on the area under the receiver-operating characteristic (ROC) curve, sensitivity, specificity, and internal consistency of the Alcohol Use Disorders Identification Test (AUDIT), the consumption questions of the AUDIT (AUDIT-C) and the Lübeck Alcohol Dependence and Abuse Screening Test (LAST) among current drinkers (n = 3551) of a general population sample in northern Germany. Alcohol dependence and misuse according to DSM-IV and at-risk drinking served as gold standards to assess sensitivity and specificity and were assessed with the Munich-Composite Diagnostic Interview (M-CIDI). AUDIT and LAST showed insufficient sensitivity for at-risk drinking and alcohol misuse using standard cut-off scores, but satisfactory detection rates for alcohol dependence. The AUDIT-C showed low specificity in all criterion groups with standard cut-off. Adjusted cut-points are recommended. Among a subsample of individuals with previous general hospital admission in the last year, all questionnaires showed higher internal consistency suggesting lower reliability in non-clinical samples. In logistic regression analyses, having had a hospital admission increased the sensitivity in detecting any criterion group of the LAST, and the number of recent general practice visits increased the sensitivity of the AUDIT in detecting alcohol misuse. Women showed lower scores and larger areas under the ROC curves. It is concluded that setting specific instruments (e.g. primary care or general population) or adjusted cut-offs should be used.

Adult↗
PubMedDate not supplied

The readiness to change questionnaire in subjects with hazardous alcohol consumption, alcohol misuse and dependence in a general population survey.

AIMS: To investigate properties and aspects of validity of the Readiness to Change Questionnaire (RCQ) when applied to hazardous drinking, alcohol-abusing or alcohol-dependent subjects sampled from the general population. METHODS: In a representative survey conducted in the general population of a region in northern Germany, participants were randomly selected from resident registration office files, contacted and interviewed personally (n = 4.075). A total of 302 subjects who showed hazardous drinking behaviour (n = 202) or met diagnostic criteria of alcohol misuse (n = 46) or alcohol dependence (n = 54) were assessed and diagnosed using the Munich Composite International Diagnostic Interview (M-CIDI) according to DSM-IV diagnostic criteria. The battery of self-report questionnaires comprised, among others, the RCQ, and two methods of allocation were used, the quick method and the refined method of allocation. According to the method of allocation used, the stages are: precontemplation (PC), contemplation (C), preparation (P) and action (A); P may only be assigned using the refined method. RESULTS: The RCQ, a brief instrument to assess stages of change in individuals sampled from the general population, gave internal consistencies of: PC = 0.68, C = 0.79, A = 0.83. Allocation to stages of change according to the quick method resulted in 67% of subjects being allocated to PC, 24% to C and 8% to A and according to the refined method in 58% to PC, 15% to C, 4% to P, 4% to A, with 19% not being classified because of non-theory-consistent scale profiles. CONCLUSIONS: Classification did not differ substantially according to the method of allocation. A three-factor solution, as reported in the literature, could not be replicated. Allocation to stages of change with the RCQ reflected predictions made from the Transtheoretical Model of behaviour change.

Adult↗
PubMedDate not supplied

Estimation of tobacco- or alcohol-attributable disease rates in national hospital care: an approach based on routine in-patient disease register data and systematic diagnosis of alcohol use disorders.

AIMS: The goal of this paper was to estimate and compare the numbers and rates of tobacco- or alcohol-attributable disease (TAAD) in in-patient-treated cases in a high tobacco smoking and alcohol consumption country, based on different estimates. METHODS: Two samples, three TAAD estimates, and tobacco- or alcohol-attributable fractions were used. Sample 1 included all disease cases aged 25-64 years and treated more than 24 h as in-patients during the year 1997 (n = 7 344 079) in the hospitals in Germany. Sample 2 included all in-patients aged 25-64 years (n = 1136) consecutively admitted to one general hospital. The first estimate of the TAAD was the routine main diagnosis based on the treating physician's report to the in-patient disease register (IDR) in sample 1. The second estimate included up to three routine treatment diagnoses in sample 2, and the third estimate a diagnosis of alcohol dependence or misuse according to DSM-III-R or ICD-10, as well as harmful or hazardous alcohol consumption, in sample 2. The tobacco- and alcohol-attributable fractions were calculated based on the method for the estimation of tobacco- and alcohol-attributable mortality, originally provided for the Centers for Disease Control in the USA. RESULTS: When the three estimates were combined, a total of 37.8% of all in-patient treatment cases had at least one diagnosis that was attributable in part or fully to tobacco smoking, alcohol dependence, alcohol misuse, or harmful or hazardous alcohol drinking. When the tobacco- and the alcohol-attributable fractions were considered, of all treatment cases, 10.5% could be revealed as attributable to smoking or alcohol consumption according to the one main diagnosis based on the IDR. When all three estimates were combined, the rate was 30.2%. This corresponded to 32.2% of the national in-patient hospital care costs. CONCLUSIONS: The TAAD rate is underestimated when using one routine diagnosis alone. Additional alcohol misuse or dependence diagnoses are needed, which may be obtained with a reasonable level of resources in a sample of hospitals. TAAD rates may be used for the planning and practice of brief intervention and as an outcome measure for population-based intervention.

Adult↗
PubMedDate not supplied

Strength of the relationship between tobacco smoking, nicotine dependence and the severity of alcohol dependence syndrome criteria in a population-based sample.

AIMS: Little is known about the relationship between current and past smoking behaviour and the severity of alcohol dependence. The purpose was to explore the strength of this relationship. METHODS: A random population sample of 18 to 64 year-olds from northern Germany was used (n = 4075; participation rate: 70%). It included 761 cigarette smokers fulfilling at least one alcohol-dependence criterion. The severity of alcohol dependence according to the alcohol-dependence syndrome criteria frequency (ASF) was estimated by a standardized questionnaire based on diagnostic instruments of the alcohol dependence syndrome and which included five response categories, from 'never' to 'daily'. Nicotine dependence was diagnosed according to the Diagnostic and Statistical Manual of mental disorders (DSM-IV) with the Composite International Diagnostic Interview (CIDI). As a second measure, the Fagerström Test of Nicotine Dependence (FTND) was used. RESULTS: The number of cigarettes and years of daily smoking, nicotine dependence, and the number of nicotine dependence symptoms each showed a relationship with the ASF. Effect size (w) were 0.17-0.21 for chi-squared (chi(2)) tests. In a general linear regression model with the ASF as the dependent variable (R(2) = 0.17), number of years of daily smoking, age at onset of smoking, number of attempts to reduce or quit, the number of nicotine-dependence symptoms according to DSM-IV and the FTND sum score were retained as independent variables. CONCLUSIONS: Long-term smoking, a large number of nicotine-dependence symptoms according to DSM and a strong urge to smoke according to the FTND are related with a high ASF.

Adolescent↗
PubMedDate not supplied

Somatoform pain disorder in the general population.

BACKGROUND: Chronic pain disorder is assumed to represent a frequent and disabling condition. However, data on the prevalence of somatoform pain symptoms and somatoform pain disorder in the community are limited to date. METHODS: German versions of the Composite International Diagnostic Interview were administered to a representative national sample of 4,075 people. Somatoform pain disorder was diagnosed by standardized diagnostic algorithm based on the DSM-III-R criteria (absence of adequate physical findings). One subgroup was identified as also meeting the DSM-IV criterion B for 'significant distress or psychosocial impairment due to the somatoform pain'. RESULTS: A lifetime prevalence rate of somatoform pain disorder according to DSM-III-R of 33.7% and a 6-month rate of 17.3% was found. When applying the DSM-IV B criterion, the prevalence rate dropped to 12.3 and 5.4%, respectively. In both groups more than 95% of the probands had contacted their doctor because of the pain. In 25% of the probands the pain was positively assigned to psychological factors. A female:male ratio of 2:1 was found. CONCLUSIONS: Somatoform pain disorder (DSM-III-R) is a frequent condition. However, only about one third of these subjects is severely distressed or impaired by the pain. A clear operationalized concept of the DSM-IV criterion C 'psychological factors are judged to have an important role in the onset, severity, exacerbation or maintenance of the pain' should be provided in the further development of the diagnosis 'pain disorder' in order to make this diagnosis suitable for general population surveys.

Adolescent↗
PubMedDate not supplied

Specific somatoform disorder in the general population.

The authors assessed the validity of the recently proposed diagnosis for specific somatoform disorder in the general population. German versions of the DSM-IV adapted Composite International Diagnostic Interview were administered to a representative sample of 4075 individuals. Multivariate analyses were used to compare impairment, life satisfaction, and use of health care. A total of 803 of 4075 subjects (19.7%) with undifferentiated somatization disorder were identified, which included 51 subjects (1.3%) who met criteria for specific somatoform disorder. Subjects with specific somatoform disorder were more impaired, had lower life satisfaction, and had higher use of health care than subjects with undifferentiated somatization disorder only. The proposed diagnosis of specific somatoform disorder demonstrated a high validity independent of comorbid depressive and anxiety disorders.

Activities of Daily Living↗