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Buechel C, Friedmann A, Eber S, Behrends U, Mall V, Nehring I. The change of psychosocial stress factors in families with infants and toddlers during the COVID-19 pandemic. A longitudinal perspective on the CoronabaBY study from Germany. Front Pediatr 2024; 12:1354089. [PMID: 38562139 PMCID: PMC10982396 DOI: 10.3389/fped.2024.1354089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Background Over nearly three years, the COVID-19 pandemic has had a lasting impact on people's lives and mental health worldwide with its far-reaching restrictions and concerns about infections and other personal consequences. Families were particularly affected and showed increased stress and psychological problems. Long-term effects cannot be ruled out. So far, data on young families are sparse. The present longitudinal analysis (n = 932) of the CoronabaBY study investigated the development of parenting stress, parental affective symptoms, and child's mental health in young families with children aged 0-3 years in Germany as well as potential influencing factors. Methods The observational study includes two measurement points over the course of the pandemic (baseline and follow-up). Data was collected by app using standardized questionnaires. Results N = 932 participants, mainly mothers (94.7%) born in Germany (93.1%) with higher education (61.3% with at least high school diploma) and a comfortable financial situation participated in the longitudinal study. Children were on average 14.7 months old at baseline (SD: 12, range: 1-39 months). While the proportion of parents who perceived the pandemic as stressful decreased significantly from baseline (60%) to follow-up (52.3%), the proportion with parenting stress increased significantly (from 40.1% to 45.4%). Both parental and child mental health problems remained constant over time, with infants crying/feeding/sleeping problems ranging above pre-pandemic comparative data. Most predictive for high parenting stress at follow-up was high parenting stress at baseline. This was also true for parental affective symptoms (depression/anxiety) and child mental health problems. Conclusions Despite faded pandemic restrictions, parents remained burdened. Support services do not appear to have been sufficient to help families out of their stressful situation. Our results indicate a need for action regarding low-threshold services that effectively reach affected families. Trial registration The study was pre-registered in OSF (https://osf.io/search/?q=tksh5&page=1).
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Affiliation(s)
- Catherine Buechel
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Anna Friedmann
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Eber
- Professional Association of Pediatricians in Bavaria (BVKJ) and PaedNetz Bayern, Munich, Germany
| | - Uta Behrends
- Children’s Hospital, School of Medicine, Technical University Munich, Munich, Germany
| | - Volker Mall
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Ina Nehring
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Moor I, Herke M, Markert J, Böhm M, Reiß F, Bilz L, Sudeck G, Winter K. Trends in health inequalities in childhood and adolescence in Germany: Results of the HBSC study 2009/10 - 2022. JOURNAL OF HEALTH MONITORING 2024; 9:79-98. [PMID: 38559681 PMCID: PMC10977468 DOI: 10.25646/11876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/27/2023] [Indexed: 04/04/2024]
Abstract
Background Many studies have identified health inequalities in childhood and adolescence. However, it is unclear how these have developed in recent years, particularly since the COVID-19 pandemic. Methods Analyses are based on the German data from the international Health Behaviour in School-aged Children (HBSC) study from 2009/10 (n = 5,005), 2013/14 (n = 5,961), 2017/18 (n = 4,347), and 2022 (n = 6,475). A total of 21,788 students aged approximately between 11 and 15 years were included. Socioeconomic status (SES) was assessed using the Family Affluence Scale (FAS). Several health indicators were analysed stratified by gender using bivariate and multivariate analysis methods. Results In 2022, there are clear socioeconomic inequalities in life satisfaction, self-rated health, fruit and vegetable consumption, and physical activity. These inequalities remained largely constant or increased between 2009/10 and 2022. Between 2017/18 and 2022, no significant changes in inequalities were found. Conclusions Health inequalities are persistent and reduce the chances of growing up healthy. There is no evidence that inequalities in the analysed outcomes have changed during the pandemic period (between 2017/18 and 2022). Rather, the changes in the health indicators seem to affect all adolescents in a similar way.
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Affiliation(s)
- Irene Moor
- Martin Luther University Halle-Wittenberg, Halle (Saale), Medical Faculty, Interdisciplinary Centre for Health Sciences (PZG), Institute of Medical Sociology
| | - Max Herke
- Martin Luther University Halle-Wittenberg, Halle (Saale), Medical Faculty, Interdisciplinary Centre for Health Sciences (PZG), Institute of Medical Sociology
| | - Jenny Markert
- Martin Luther University Halle-Wittenberg, Halle (Saale), Medical Faculty, Interdisciplinary Centre for Health Sciences (PZG), Institute of Medical Sociology
| | - Marie Böhm
- Martin Luther University Halle-Wittenberg, Halle (Saale), Medical Faculty, Interdisciplinary Centre for Health Sciences (PZG), Institute of Medical Sociology
| | - Franziska Reiß
- University Medical Centre Hamburg-Eppendorf, Centre for Psychosocial Medicine, Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Child Public Health Research Section
| | - Ludwig Bilz
- Brandenburg University of Technology, Cottbus-Senftenberg, Institute of Health
| | - Gorden Sudeck
- Eberhard Karls University of Tübingen, Institute of Sports Science
- Eberhard Karls University of Tübingen, Interfaculty Research Institute for Sport and Physical Activity
| | - Kristina Winter
- Martin Luther University Halle-Wittenberg, Halle (Saale), Medical Faculty, Interdisciplinary Centre for Health Sciences (PZG), Institute of Medical Sociology
- Nordhausen University of Applied Sciences, Institute for Social Medicine, Rehabilitation, Sciences and Health Services Research
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Reiß F, Behn S, Erhart M, Strelow L, Kaman A, Ottová-Jordan V, Bilz L, Moor I, Ravens-Sieberer U. Subjective health and psychosomatic complaints of children and adolescents in Germany: Results of the HBSC study 2009/10 - 2022. JOURNAL OF HEALTH MONITORING 2024; 9:7-22. [PMID: 38559686 PMCID: PMC10977472 DOI: 10.25646/11868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/14/2023] [Indexed: 04/04/2024]
Abstract
Background Subjective health and well-being are important health indicators in childhood and adolescence. This article shows current results and trends over time between 2009/10 and 2022. Methods The Health Behaviour in School-aged Children (HBSC) study examined subjective health, life satisfaction and psychosomatic complaints of N = 21,788 students aged 11 to 15 years in the school years 2009/10, 2013/14, 2017/18 and in the calendar year 2022. Multivariate regression analyses show the associations between sociodemographic characteristics and well-being in 2022, as well as trends since 2009/10. Results The majority of children and adolescents indicate a good subjective health and high life satisfaction. About half of the girls and one third of the boys report multiple psychosomatic health complaints, with a clear increase over time. Older adolescents, girls and gender diverse adolescents are at an increased risk of poor well-being. Subjective health and life satisfaction varied between 2009/10 and 2022, with a significant deterioration between 2017/18 and 2022. Conclusions The high proportion of children and adolescents with psychosomatic complaints, as well as the observed gender and age differences, underline the need for target group-specific prevention, health promotion and continuous health monitoring.
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Affiliation(s)
- Franziska Reiß
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Research Section Child Public Health, Hamburg, Germany
| | - Steven Behn
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Research Section Child Public Health, Hamburg, Germany
| | - Michael Erhart
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Research Section Child Public Health, Hamburg, Germany
- Alice Salomon University of Applied Sciences Berlin, Health and Rehabilitation Science, Berlin, Germany
| | - Lisa Strelow
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Research Section Child Public Health, Hamburg, Germany
| | - Anne Kaman
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Research Section Child Public Health, Hamburg, Germany
| | - Veronika Ottová-Jordan
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Research Section Child Public Health, Hamburg, Germany
| | - Ludwig Bilz
- Brandenburg University of Technology Cottbus-Senftenberg, Institute of Health, Cottbus, Germany
| | - Irene Moor
- Martin Luther University Halle-Wittenberg, Medical Faculty, Interdisciplinary Centre for Health Sciences (PZG), Institute of Medical Sociology, Halle (Saale), Germany
| | - Ulrike Ravens-Sieberer
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Research Section Child Public Health, Hamburg, Germany
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Fischer-Grote L, Fössing V, Aigner M, Fehrmann E, Boeckle M. Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis. JMIR Ment Health 2024; 11:e46637. [PMID: 38315524 PMCID: PMC10877489 DOI: 10.2196/46637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/21/2023] [Accepted: 10/21/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The prevalence of mental illness increased in children, adolescents, and young adults during the COVID-19 pandemic, while at the same time, access to treatment facilities has been restricted, resulting in a need for the quick implementation of remote or online interventions. OBJECTIVE This study aimed to give an overview of randomized controlled studies examining remote or online interventions for mental health in children, adolescents, and young adults and to explore the overall effectiveness of these interventions regarding different symptoms. METHODS A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, PsycInfo, Psyndex, Embase, and Google Scholar. A meta-analysis was conducted using a random effects model to calculate overall effect sizes for interventions using standardized mean differences (SMDs) for postintervention scores. RESULTS We identified 17 articles with 8732 participants in the final sample, and 13 were included in the quantitative analysis. The studies examined different digital interventions for several outcomes, showing better outcomes than the control in some studies. Meta-analyses revealed significant medium overall effects for anxiety (SMD=0.44, 95% CI 0.20 to 0.67) and social functioning (SMD=0.42, 95% CI -0.68 to -0.17) and a large significant effect for depression (SMD=1.31, 95% CI 0.34 to 2.95). In contrast, no significant overall treatment effects for well-being, psychological distress, disordered eating, and COVID-19-related symptoms were found. CONCLUSIONS The qualitative and quantitative analyses of the included studies show promising results regarding the effectiveness of online interventions, especially for symptoms of anxiety and depression and for training of social functioning. However, the effectiveness needs to be further investigated for other groups of symptoms in the future. All in all, more research with high-quality studies is required.
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Affiliation(s)
- Linda Fischer-Grote
- Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Clinical Psychology and Psychotherapy, University Hospital Krems, Krems, Austria
| | - Vera Fössing
- Research Centre Transitional Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Martin Aigner
- Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Psychiatry for Adults, University Hospital Tulln, Tulln, Austria
| | - Elisabeth Fehrmann
- Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Markus Boeckle
- Research Centre Transitional Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria
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Fischer L, Liegmann K, Morgenstern M, Dadaczynski K. Effectiveness of the holistic primary school-based intervention MindMatters: study protocol for a cluster-randomised controlled trial. Trials 2023; 24:711. [PMID: 37941015 PMCID: PMC10631112 DOI: 10.1186/s13063-023-07731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The prevalence of mental health problems in childhood and adolescence has increased significantly, not least due to the COVID-19 pandemic in Germany and other countries worldwide. Although holistic school interventions to promote mental health and prevent mental health problems are considered promising, there is currently uncertainty about their effectiveness due to evaluation studies with heterogeneous methodological quality. This paper presents the study protocol for the evaluation of the primary school module of MindMatters. METHODS As part of a universal mental health intervention, the MindMatters primary school module 'Learning Together with Emotions' aims to promote social-emotional learning (SEL) in the classroom across five skill areas. In addition to classroom activities, the intervention includes a school development module to help primary schools create structures and processes to maintain and promote mental health. To evaluate the effectiveness of the intervention, a two-arm cluster-randomised controlled trial will be conducted, including schools implementing MindMatters over a 12-month period and a control group with no access to the intervention. Data will be collected before and 18 months after initiation of the intervention. Controlled for baseline conditions, multilevel regression analysis will be used to examine primary intervention outcomes at the pupil level (i.e. reductions in mental and behavioural problems). Further mediation and moderation analyses will examine whether proximal outcomes predict changes in mental health outcomes and whether school-level factors influence the effectiveness of the intervention. DISCUSSION This study will contribute to strengthen the evidence base for holistic school (mental) health promotion interventions using a study design with high internal validity. Based on an intervention model, the results will not only provide insights into the relationship between proximal and distal outcomes, but will also allow conclusions to be drawn about how the implementation of the intervention affects its effectiveness. Finally, the findings also address the question of whether improved mental health has a positive effect on primary school pupils' academic performance. TRIAL REGISTRATION German Clinical Trials Register DRKS00023762. Registered on 5 January 2021.
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Affiliation(s)
- Lisa Fischer
- Department of Health Sciences, Fulda University of Applied Sciences, Fulda, Germany.
| | | | | | - Kevin Dadaczynski
- Department of Health Sciences, Fulda University of Applied Sciences, Fulda, Germany
- Center for Applied Health Sciences, Leuphana University Lueneburg, Lueneburg, Germany
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Ravens-Sieberer U, Devine J, Napp AK, Kaman A, Saftig L, Gilbert M, Reiß F, Löffler C, Simon AM, Hurrelmann K, Walper S, Schlack R, Hölling H, Wieler LH, Erhart M. Three years into the pandemic: results of the longitudinal German COPSY study on youth mental health and health-related quality of life. Front Public Health 2023; 11:1129073. [PMID: 37397777 PMCID: PMC10307958 DOI: 10.3389/fpubh.2023.1129073] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose For the past three years, the German longitudinal COPSY (COVID-19 and PSYchological Health) study has monitored changes in health-related quality of life (HRQoL) and the mental health of children and adolescents during the COVID-19 pandemic. Methods A nationwide, population-based survey was conducted in May-June 2020 (W1), December 2020-January 2021 (W2), September-October 2021 (W3), February 2022 (W4), and September-October 2022 (W5). In total, n = 2,471 children and adolescents aged 7-17 years (n = 1,673 aged 11-17 years with self-reports) were assessed using internationally established and validated measures of HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), depressive symptoms (CES-DC, PHQ-2), psychosomatic complaints (HBSC-SCL), and fear about the future (DFS-K). Findings were compared to prepandemic population-based data. Results While the prevalence of low HRQoL increased from 15% prepandemic to 48% at W2, it improved to 27% at W5. Similarly, overall mental health problems rose from 18% prepandemic to W1 through W2 (30-31%), and since then slowly declined (W3: 27%, W4: 29%, W5: 23%). Anxiety doubled from 15% prepandemic to 30% in W2 and declined to 25% (W5) since then. Depressive symptoms increased from 15%/10% (CES-DC/PHQ-2) prepandemic to 24%/15% in W2, and slowly decreased to 14%/9% in W5. Psychosomatic complaints are across all waves still on the rise. 32-44% of the youth expressed fears related to other current crises. Conclusion Mental health of the youth improved in year 3 of the pandemic, but is still lower than before the pandemic.
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Affiliation(s)
- Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janine Devine
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Napp
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Kaman
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lynn Saftig
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martha Gilbert
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Reiß
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Constanze Löffler
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Robert Schlack
- Department for Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Heike Hölling
- Department for Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lothar Heinz Wieler
- Department for Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- Research Cluster Digital Global Public Health, Hasso-Plattner-Institute, University of Potsdam, Potsdam, Germany
| | - Michael Erhart
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Public Health, Alice Salomon University of Applied Sciences, Berlin, Germany
- Department of Psychology, Apollon University of Applied Sciences, Bremen, Germany
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Hansen J, Galimov A, Unger JB, Sussman SY, Hanewinkel R. Mental Health and Physical Complaints of German Children and Adolescents before and during the COVID-19 Pandemic: A Repeated Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054478. [PMID: 36901485 PMCID: PMC10001698 DOI: 10.3390/ijerph20054478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 06/01/2023]
Abstract
The potential impact of the COVID-19 pandemic on young people's mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schools in Germany. Assessments took place from November to February each year. Two data collections were conducted before the COVID-19 pandemic in 2018-2019 and in 2019-2020. Collections during the pandemic took place in 2020-2021 and 2021-2022. A total of 63,249 data observations were included in the analyses. Multilevel analyses were used to examine temporal trends in mean emotional problems (e.g., often unhappy, downhearted), hyperactivity-inattention (e.g., constantly fidgeting or squirming), conduct problems (e.g., fights with other children), and physical complaints. Models were adjusted for age, gender, school type, socioeconomic status, and sensation seeking. During the COVID-19 pandemic, children and adolescents in Germany experienced an increase in emotional problems from the pre-pandemic cohort 2019-2020 to the pandemic cohort 2021-2022 (β = 0.56, 95% CI (0.51-0.62)) and, over the course of the pandemic, reported elevated levels of physical complaints (β = 0.19, 95% CI (0.16-0.21)). Findings of increased emotional problems and physical complaints after the two years of the pandemic support the ongoing demand for low-threshold health promotion and prevention and the need for further monitoring of young people's health in Germany.
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Affiliation(s)
- Julia Hansen
- Institute for Therapy and Health Research, IFT-Nord, Harmsstraße 2, 24114 Kiel, Germany
| | - Artur Galimov
- Tobacco Center of Regulatory Science, Department of Population and Public Health Sciences, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Jennifer B. Unger
- Tobacco Center of Regulatory Science, Department of Population and Public Health Sciences, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Steve Y. Sussman
- Tobacco Center of Regulatory Science, Department of Population and Public Health Sciences, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Reiner Hanewinkel
- Institute for Therapy and Health Research, IFT-Nord, Harmsstraße 2, 24114 Kiel, Germany
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