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Objectives: To examine cross-sectional and longitudinal associations between physical exercise and cognitive function across different age groups in a nationwide population-based sample of adults aged 18-79 years in Germany.Design: Cross-sectional/prospective.Methods: Cognitive function was assessed in the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009-2012, n=3535), using a comprehensive neuropsychological test battery. Cognitive domain scores for executive function and memory were derived from confirmatory factor analysis. Regular physical exercise in the last three months was assessed by self-report and defined as no exercise, <2 and ≥2h (hours) of exercise per week. A subgroup of DEGS1-MH participants who previously participated in the German National Health Interview and Examination Survey 1998 (GNHIES98, 1997-1999, n=1624) enabled longitudinal analyses with a mean follow-up of 12.4 years.Results: Compared to no exercise, more weekly physical exercise was associated with better executive function in cross-sectional (<2h: β=0.12; ≥2h: β=0.17; all p<0.001) and longitudinal analyses (<2h: β=0.14, p<0.001; ≥2h: β=0.15, p=0.001) using linear regression models adjusted for age, sex, education, smoking, alcohol consumption, fruit and vegetable consumption and obesity. Slightly weaker associations were found for memory in cross-sectional (<2h: β=0.08, p=0.009; ≥2h: β=0.08, p=0.026) and longitudinal analysis (<2h: β=0.09, p=0.036; ≥2h: β=0.08, p=0.114). There was no evidence of interaction between physical exercise and age.Conclusions: Higher levels of physical exercise were associated with better executive function and memory in cross-sectional and longitudinal analyses with no evidence for differential effects by age. [ABSTRACT FROM AUTHOR]

Objective: The aim was to test if people with different alcohol use problem severity benefitted differentially from brief alcohol interventions delivered in-person versus through computer-generated feedback letters.Methods: Nine hundred sixty-one 18-64year old general hospital inpatients with at-risk alcohol use (mean age=40.9years [standard deviation=14.1], 75% men) were randomized to a) in-person counseling, b) computer-generated individualized feedback letters, or c) assessment only. Both interventions were delivered on the ward and 1 and 3 months later. Outcome was the change in the self-reported alcohol use per day at 6-, 12-, 18-, and 24-month follow-up. The Alcohol Use Disorder Identification Test (AUDIT) score was tested as a moderator of the effect of in-person counseling and computer-generated feedback letters, with higher AUDIT scores indicating more severe alcohol problems.Results: Compared to assessment only, computer-generated feedback letters more strongly reduced alcohol use over 24 months among persons with AUDIT scores of about 8 and lower (ps <0.05). In-person counseling tended to be superior over assessment only among persons scoring high on the AUDIT, but differences were not statistically significant. Six-, 12-, and 18-month differences between in-person counseling and computer-generated feedback letters were significant (ps<0.05) for persons with AUDIT scores below 7.1-7.7. The differences between both interventions attenuated at 24-month follow-up.Conclusions: Computer-based intervention delivery may be superior over in-person delivery for people with low levels of alcohol use problem severity, whereas those with more severe alcohol problems may require more intensive care. [ABSTRACT FROM AUTHOR]

Objective: to test if people with different day-to-day drinking patterns benefitted differently from two brief alcohol interventions (BAIs).Methods: A total of 1243 job-seekers with at-risk alcohol use aged 18-64 years (64% men) were randomized to (a) intervention tailored to the motivational stage (ST), (b) non-stage tailored intervention (NST), or (c) assessment only (AO). ST and NST contained individualized computer-generated feedback letters. Follow-ups were conducted at months 3, 6, and 15. Using growth mixture models, day-to-day drinking patterns were identified based on the number of drinks consumed on each day in the week prior to baseline assessment. To test drinking pattern-specific intervention effects, zero-inflated growth models were used. Outcomes were (1) the 15-month change in the likelihood of any alcohol use and (2) the 15-month change in the total number of drinks per week when alcohol was consumed.Results: Four day-to-day drinking patterns were found: daily medium use (2-4 drinks/day; 47%), daily low use (1-2 drinks/day; 29%), weekend only use (18%), and no use (6%). Only persons with daily low use benefitted from intervention, with higher odds of being abstinent after 15 months in the ST group compared to AO (odds ratio, OR=1.67, p=0.001) and NST group (OR=1.43, p=0.035). ST worked better among persons with daily low use compared to daily medium use (OR=1.91, p=0.001).Conclusions: Among at-risk drinking persons with regular low-quantity alcohol use, stage tailored BAIs may be superior over no BAI and non-stage tailored BAIs. [ABSTRACT FROM AUTHOR]

Introduction When intentions are expressed, e.g., when filling in a health questionnaire, people may have unrealistic beliefs towards behavior change resulting in strong intentions to change. These may fail to correspond to reality when the behavior actually should be performed. Belief incongruence was tested as a possible source of the intention–behavior gap. Methods The study sample consisted of 433 job agency clients with at-risk alcohol use (64% men, mean age = 30.6 ( SD = 11.6) years). Behavioral, normative, and control beliefs, intention, and alcohol use were assessed at baseline and three months later. The influence of belief incongruence on the intention–behavior gap was examined using latent interaction models. Results The gap between stated intentions and at-risk alcohol use three months later was larger when the according normative beliefs were incongruent (total effect: b = − 0.44, p < 0.05 for persons with congruent beliefs vs. b = − 0.06, p > 0.10 for persons with incongruent beliefs). When controlling for the mediating effect of changes in intentions, the association between belief incongruence and intention–behavior gap was attenuated (direct effect: b = − 0.56, p < 0.01 for persons with congruent beliefs vs. b = − 0.28, p < 0.05 for persons with incongruent beliefs). Neither behavioral belief incongruence nor control belief incongruence was significantly associated with the intention–behavior gap. Conclusions Normative belief incongruence may contribute to the gap between intentions to adhere to recommended drinking limits and subsequent at-risk alcohol use. Focusing on the reduction of misperceptions about drinking norms could help to increase the proportion of persons who succeed in translating their intentions into behavior. [ABSTRACT FROM AUTHOR]

Background Persons not intending to change are an important target population for public health efforts. The aim of this study was to investigate whether subgroups characterized by different trajectories of alcohol use frequency and quantity among persons with unhealthy drinking but no intention to change benefitted differently from a stage tailored intervention. Methods This study was part of a randomized controlled trial among job-seekers. The participants of the intervention group ( n = 413) received feedback letters tailored to their motivational stage. The control group ( n = 414) received minimal assessment only. Among all participants, 629 (76.1%) did not intend to change alcohol use and constitute the study sample (60.7% men; mean age = 29.7 years, SD = 10.8). 3-, 6-, and 15-month follow-ups were conducted. Growth mixture modeling was applied to identify classes representing the heterogeneity in the development of alcohol use frequency and quantity and the influence of the intervention on different trajectories. Results Four classes were identified: a class of persons who achieved abstinence (2%), a class with low-frequent drinking with declining quantity (35%), a class with high-frequent drinking with low but slightly increasing quantity (30%), and a class with constant heavy episodic drinking (33%). Although non-significant, there was a tendency of different intervention effects for different classes. Conclusions A sample of persons not intending to change unhealthy alcohol use was composed of subgroups characterized by different trajectories of alcohol use quantity and frequency. Trends towards beneficial intervention effects on motivation and drinking outcomes were not significant, possibly due to low power. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate sociodemographic-, living situation- and substance-related variables as predictors of current risky alcohol use for both female and male general hospital inpatients. Method: The sample of 6050 female and 8282 male general hospital inpatients was recruited in 2002–2004. Using the Alcohol Use Disorder Identification Test-Consumption, they were assigned to four drinking groups: abstinent, moderate use, slightly increased use and notably increased use. Gender-specific predictors of group affiliation were determined using multivariate multinomial logistic regressions. Results: In both genders, younger age, rural living environment, the occurrence of lifetime alcohol use disorders (AUDs) and current tobacco smoking were positively associated with risky alcohol use. Higher education was positively associated with slightly and notably increased use for women. Living alone, being divorced/ widowed and being unemployed (relative risk ratios=1.4–1.7) were positively associated with notably increased use for men. In both genders, older age, less education and the occurrence of lifetime AUDs were positively associated with abstinence. Conclusions: Higher educated women are likely to report risky alcohol use. Marriage may have a protective effect on level of alcohol use for men only. In addition to the implementation of routine alcohol screening, the examined data may provide cost-effective information that could be used to tailor interventions. [Copyright &y& Elsevier]

Abstract: Aim: The aims were to investigate differences between alcohol dependent inpatients who seek alcohol treatment and those who do not seek alcohol specific but general hospital treatment, and to investigate problem drinking 12months after hospitalization. Methods: Two samples of alcohol dependent inpatients were recruited: N =571 at general hospitals and N =473 at psychiatric alcohol detoxification units, and were followed-up 12months later. Results: Multivariate logistic regression analyses revealed that higher age, living alone, being employed, previous help-seeking, increased severity of dependence, increased adverse consequences from drinking and increased motivation were significant predictors of receiving alcohol detoxification vs. general hospital treatment. A composite assessment of motivation to change and to seek help was the strongest predictor of positive outcome 12months later. Conclusions: Alcohol dependent individuals who receive detoxification in psychiatric care have a more severe alcohol problem and fewer social resources than those treated in general hospitals. Interventions targeting at enhancing motivation to change and to seek help should be part of routine general hospital care and of detoxification treatment in psychiatric care. [Copyright &y& Elsevier]

Little is known about the natural course of health-related behaviors such as tobacco smoking, at-risk alcohol use, vegetable and fruit intake and physical activity in general hospital patients after discharge. The aim was to investigate whether patients identified with at-risk alcohol use change their health-related behaviors over two years. Eighteen to 64-year-old patients with at-risk alcohol use were identified through systematic screening as part of a randomized controlled trial. Patients with indication of an alcohol use disorder were excluded. Data of patients who received treatment as usual were analyzed (n = 220). Alcohol use, tobacco smoking, vegetable/ fruit intake, physical activity and body-mass-index were assessed at baseline, after 6, 12, 18, and 24 months. Latent growth models were calculated. Twenty-four months after discharge, participants reported less physical activity (p =.04), a higher body-mass-index (p =.01), no change in vegetable/ fruit intake (p =.11) and smoking status (p =.87), fewer cigarettes per week among smokers (p <.001), and less alcohol use (p <.001) compared to baseline. The data revealed that patients with at-risk alcohol use increased or did not change energy-balance related behaviors and decreased substance-use related behaviors over 2 years after hospitalization. These findings underline the need of implementing multi-behavioral interventions into routine care. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this study was to analyze motivation to change drinking behavior and motivation to seek help in general hospital inpatients with problem drinking and alcohol-related diseases. Method: The sample consisted of 294 general hospital inpatients aged 18–64 years. Inpatients with alcohol-attributable disease were classified according to its alcohol-attributable fraction (AAF; AAF=1, AAF<1 and AAF=0). Baseline differences in alcohol-related variables, demographics and motivation between the AAF groups were analyzed. Furthermore, differences in motivation to change, in motivation to seek help and in the amount of alcohol consumed from baseline to follow-up between the AAF groups were evaluated. Results: During hospital stay, motivation to change was higher among inpatients with alcohol-attributable diseases than among inpatients who had no alcohol-attributable diseases [F(2)=18.40, P<.001]. Motivation to seek help was higher among inpatients with AAF=1 than among inpatients with AAF<1 and AAF=0 [F(2)=21.66, P<.001]. While motivation to change drinking behavior remained stable within 12 months of hospitalization, motivation to seek help decreased. The amount of alcohol consumed decreased in all three AAF groups. Conclusions: Data suggest that hospital stay seems to be a “teachable moment.” Screening for problem drinking and motivation differentiated by AAFs might be a tool for early intervention. [Copyright &y& Elsevier]