Background The Communities That Care (CTC) prevention planning and implementation system trains communities throughout a five-phase cycle to (1) build capacity for prevention, (2) adopt science-based prevention, (3) assess the prevention needs of adolescents living in the community, (4) select, and (5) implement evidence-based programs according to their needs. After CTC proved to be effective and cost-effective in the U.S., it is being used by an increasing number of communities in Germany. The aim of this study is to evaluate the effectiveness and cost-effectiveness of CTC in Germany. Methods Communities in CTC-phases 1 to 3 (n = 21) and individually-matched comparison communities (n = 21) were recruited for a non-randomised trial. To assess long-term outcomes, (1) a cohort of 5th Grade students will be surveyed biennially concerning behaviours (antisocial behaviour and substance use) and well-being as well as risk and protective factors. Additionally, (2) biennial cross-sectional surveys will be conducted in 6th, 8th, 10th, and 11th Grade in each community. To assess short-term outcomes, a cohort of ten key informants per community will be surveyed biennially concerning adoption of science-based prevention, collaboration, community support and community norms. (4) In a cross-sectional design, all ongoing prevention programs and activities in the communities will be assessed biennially and data will be collected about costs, implementation and other characteristics of the programs and activities. (5) To monitor the CTC implementation, the members of the local CTC-boards will be surveyed annually (cross-sectional design) about team functioning and coalition capacity. Data analysis will include general and generalised mixed models to assess the average treatment effect of CTC. Mediation analyses will be performed to test the logical model, e.g., adoption of science-based prevention as a mediator for the effectiveness of the CTC approach. Discussion This is the first controlled study to evaluate the effectiveness of a comprehensive community prevention approach in Germany. Evaluating the effectiveness of CTC in Germany is an important prerequisite for further diffusion of the CTC approach. Trial registration This study was registered with German Clinical Trial Register: DRKS00022819 on Aug 18, 2021.

This paper reports on selected results from the study "Health and Lifestyle in Rural Northeast Germany". A special characteristic of this study is the regional focus on peripheral rural communities and the trend study design. It was analyzed whether, and to what extent, associations exist between socioeconomic status and self-rated health in this regional context and over time. Thus, regression analyses were conducted using equivalent income, level of school education, and age as independent variables and self-rated health as the dependent variable. Analyses are based on paper-pencil surveys of the adult residents of 14 rural communities chosen at random in northeast Germany, performed in 1973, 1994, and 2004-2008. In all survey waves, a lower level of school education was associated with poor self-rated health. By contrast, associations between income and health were less consistent and constant over time. The associations between income and health are discussed as being specific to East Germany and as a consequence of social transformation in the context of reunification.

Zusammenfassung Der Beitrag formuliert zunächst drei Hypothesen, die aus Bourdieus Annahme einer Homologie zwischen dem Raum der sozialen Positionen und dem Raum der Lebensstile abgeleitet werden. Diese werden dann mit hierfür gebildeten Indikatoren aus dem Datensatz der Neubrandenburger Landgesundheitsstudie überprüft. Die Zusammenhangsanalysen sprechen für eine Bestätigung der Hypothesen hinsichtlich häufigerer bzw. seltenerer Gesundheitslebensstile in verschiedenen sozialen Milieus.

Over the long term, there have been both improvements, particularly in lifestyle, and turns for the worse, e.g., in life satisfaction. While the latter might be due to the increasing marginalization of rural eastern Germany, we interpret the observed improvements as benefits of modernization.

Integrated strategies of community health promotion (ISCHP) are based on intersectoral collaborations using the Health in All Policies approach to address determinants of health. While effects on health determinants have been shown, evidence on the effectiveness of ISCHP on health outcomes is scarce. The aim of this study is to assess the long-term effects of ISCHP on diabetes mellitus mortality (DMM) in German communities. A nonrandomized evaluation based on secondary county-level official data (1998–2016) was performed. In April 2019, 149 communities in Germany with ISCHP out of 401 were identified. Communities with < 5 measurements of DMM, starting before 1999 or after 2015, were excluded. Analyses included 65 communities with ISCHP (IG) and 124 without ISCHP (CG). ISCHP ran for a mean of 5.6 years. Fixed effects (FE) models were used to estimate effects of ISCHP and duration on DMM taking into account the time-varying average age. The FE estimator for DMM is b =  − 2.48 (95% CI − 3.45 to − 1.51) for IG vs. CG and b =  − 0.30 (95% CI − 0.46 to − 0.14) for ISCHP duration (0–16 years). In the first year of an ISCHP, a reduction of the annual DMM of 0.3 per 100,000 population (1%), and in the 16th year of 4.8 (14%) was achieved. This study provides preliminary evidence of the effectiveness of ISCHP in Germany. Limitations include inaccuracies to classify IG and CG and possible selection bias. Longitudinal county-level data may be an efficient data source to evaluate complex interventions, thereby contributing to further strengthen evidence-based integrated health promotion.

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