Gender equality and smoking among 15 to 25 year olds-a time-based ecological analysis of developments in Germany from 1960 to 2005.

Introduction: Smoking is a major risk factor for premature death and health problems in which there are significant gender differences in the prevalence of smoking. This ecological study examines the correlation between changes in gender equality and prevalence of smoking among young adults (15-25 years old) in Germany over a period of 45 years (1960-2005). Methods: Gender inequality was measured using the United Nations Gender Inequality Index (GII), which is composed of three dimensions; health, empowerment and labour market. It was calculated for the entire registered German population in five-year intervals with values between 0 and 1 (1 = highest inequality). The smoking prevalence of young women and men in Germany was established using a reconstruction method. A gender smoking ratio (GSR) with values between 0 and 1 was determined (1 = identical smoking prevalence among men and women). The smoking behaviour was illustrated and stratified by education. The correlation between the GII and the GSR was analysed. Results: The GII decreased from 0.98 to 0.56 between 1960 and 2005. The GSR increased from 0.34 to 0.93. There was a strong negative correlation between the GII and the GSR (r = -0.71). The strength of the correlation fell slightly as the level of education decreased. An increase in gender equality as measured by the GII came along with similarities of smoking prevalence between young women and young men. Conclusion: Successful tobacco prevention among young women and men may benefit from involving experts in gender-specific public health research to develop counter-advertising and gender-specific information as needed.

School entrance examinations as a small-scale data source for health monitoring of children using obesity as an example.

Background: In the scope of the nationwide obligatory school entrance examinations (SEE), a standardised assessment of the preparedness for school of preschool children takes place in the federal states of Germany. For this purpose, height and weight of the children are determined. These data are available in aggregated form at county level, but are not yet being regularly compiled and processed at national level for use in policy and research. Methods: In a pilot project, the indexing and merging of SEE data from 2015-2019 was tested in collaboration with six federal states. This was done using obesity prevalence at the time of the school entrance examination. In addition, prevalences were linked to small-scale indicators on settlement structure and sociodemographics from public databases, differences in obesity prevalence at county level were identified, and correlations to regional influencing factors were visualised. Results: It was feasible to merge SEE data from the federal states with little effort. The majority of the selected indicators were freely available in public databases. In an interactive, easily comprehensible and user-friendly Tableau dashboard for visualising the SEE data, it can be seen that obesity prevalences differ significantly between counties that are similar in terms of settlement structure or sociodemographics. Conclusions: Providing federal state SEE data and linking them to small-scale indicators enables region-based analyses and cross-state comparisons of similar counties and provides a data basis for continuous monitoring of the prevalence of obesity in early childhood.

Correction: Starker et al. Intention for Screening Colonoscopy among Previous Non-Participants: Results of a Representative Cross-Sectional Study in Germany. Int. J. Environ. Res. Public Health 2021, 18, 4160.

In the published publication [...].

Health of people with selected citizenships: results of the study GEDA Fokus.

Background: The health situation of people with a history of migration is influenced by a variety of factors. This article provides an overview of the health of people with selected citizenships using various indicators. Methods: The analyses are based on the survey 'German Health Update: Fokus (GEDA Fokus)', which was conducted from November 2021 to May 2022 among people with Croatian, Italian, Polish, Syrian and Turkish citizenship. The prevalence for each health outcome is presented and differentiated by sociodemographic and migration-related characteristics. Poisson regressions were performed to identify relevant factors influencing health situation. Results: Self-assessed general health, the presence of depressive symptoms, prevalence of current smoking and the utilisation of general and specialist healthcare differed according to various factors considered here. In addition to sociodemographic determinants, the sense of belonging to society in Germany and self-reported experiences of discrimination were particularly associated with health outcomes. Conclusions: This article highlights the heterogeneity of the health situation of people with a history of migration and points to the need for further analyses to identify the reasons for health inequalities.

Informal caregivers in Germany - who are they and which risks and resources do they have?

Background: The aim of this study is to describe the social characteristics, the health and living situation and the prevalence of behavioral risk factors of adult informal caregivers compared to non-caregivers in Germany. Methods: We used data from the German Health Update (GEDA 2019/2020-EHIS survey) which is a cross-sectional population-based health interview survey conducted between 04/2019 and 09/2020. The sample comprised 22,646 adults living in private households. Three mutually exclusive groups of providing informal care or assistance were differentiated: intense caregivers (informal care ≥10 h/week), less-intense caregivers (informal care<10 h/week) and non-caregivers. For the three groups weighted prevalences of social characteristics, health status (self-perceived health, health-related activity limitations, chronic diseases, low back disorder or other chronic back defect, depressive symptoms), behavioral risk factors (at-risk drinking, current smoking, insufficient physical activity, non-daily fruit and vegetable consumption, obesity) and social risk factors (single household, low social support) were calculated and stratified by gender. Separate regression analyses adjusted for age-group were conducted to identify significant differences between intense and less-intense caregivers vs. non-caregivers, respectively. Results: Overall, 6.5% were intense caregivers, 15.2% less-intense caregivers and 78.3% non-caregivers. Women provided care more often (23.9%) than men (19.3%). Informal care was most frequently provided in the age group of 45 to 64 years. Intense caregivers reported worse health status, were more often current smokers, physical inactive, obese and lived less often alone than non-caregivers. However, in age-group adjusted regression analyses only few significant differences were seen: Female and male intense caregivers had more often a low back disorder and lived less often alone compared to non-caregivers. In addition, male intense care-givers reported more often worse self-perceived health, health-related activity limitation, and the presence of chronic diseases. In contrast, less-intense caregivers and non-caregivers differed in favor of the less-intense caregivers. Discussion: A substantial proportion of the adult German population provides informal care regularly, especially women. Intense caregivers are a vulnerable group for negative health outcomes, especially men. In particular measures to prevent low back disorder should be provided. As the necessity of providing informal care will probably increase in the future, this will be important for the society and public health.

Smoking behaviour and passive smoke exposure of adults - Results from GEDA 2019/2020-EHIS.

Background: Smoking is a significant health risk and the leading cause of premature death. Passive smoke causes the same negative effects on health as smoking, albeit to a lesser extent. The reduction of tobacco consumption and the protection against passive smoke are thus important health objectives. Methods: The study German Health Update (GEDA 2019/2020-EHIS) is a cross-sectional telephone survey (04/2019 to 09/2020) of the resident population in Germany with questions relating to the current smoking behaviour and relating to the passive smoke exposure. The analysis sample comprises 22,708 persons from 18 years of age. Results: 24.0% of women and 33.9% of men from 18 years of age smoke currently, at least occasionally. Among both sexes, adults from 65 years of age smoke significantly more rarely than adults in the younger age groups. 4.1% of adults, who do not smoke themselves, are subjected daily to passive smoke exposure indoors. This affects in particular young adults and men. There are educational differences in tobacco consumption and in passive smoke exposure to the disadvantage of adults from lower educational groups. Conclusions: In Germany, there is still a need for action for effective measures for tobacco prevention, smoking cessation and tobacco control policy, which are effective in all population groups and which take into account the concerns of socially disadvantaged groups.

Survey of sex/gender diversity in the GEDA 2019/2020-EHIS study - objectives, procedure and experiences.

Sex/gender diversity is increasingly recognised by society and should be taken into account more in population-representative studies, as they are important data sources for targeting health promotion, prevention and care. In 2019, the Robert Koch Institute started a population-representative health survey with the study Health in Germany Update (GEDA 2019/2020-EHIS) with a modified, two-stage measures of sex/gender. The survey covered sex registered at birth and gender identity with an open response option. This article describes the aims, the procedure and the experiences with the operationalisation of sex/gender and the results. Out of 23,001 respondents, 22,826 persons are classified as cisgender, 113 persons as transgender and 29 persons as gender-diverse. 33 respondents were counted as having missing values. A survey of interviewers showed that the two-stage measures of sex/gender had a high level of acceptance overall and that there were only a few interview drop-outs. On the basis of previous experience, the modified query can be used for further surveys, but should also be adapted in perspective. For this purpose, participatory studies are desirable that focus on how the acceptance of measures of sex/gender can be further improved and how hurtful experiences in the context of the questions asked can be avoided.

Health situation in Germany during the COVID-19 pandemic. Developments over time for selected indicators of GEDA 2019/2020 - An update.

The spread of the coronavirus SARS-CoV-2 in 2020 and the containment measures associated therewith have changed many aspects of daily life. An impact on health even beyond infections itself is assumed as well. The health situation of the population in the first phase of the pandemic was thus analysed using data from the German Health Update (GEDA 2019/2020-EHIS). By continuing the survey, the analyses for 2020 are completed (n=26,507 participants), whereby the focus is now on the third phase of the pandemic (second wave of infection, gradual reintroduction of containment measures). The health indicators are presented on a monthly basis. As in the first phase of the pandemic, no pandemic-related changes were observed for tobacco smoking/ second-hand smoke exposure and for received/lack of/provided support. In contrast to the first phase of the pandemic, declines in utilisation of medical services and depressive symptoms are not observed in the third phase. The increase in body weight/body mass index after the first phase of the pandemic did not continue. The survey period allows for a comparison of the periods before and as of the pandemic situation. A decrease in the medical services utilisation and depressive symptoms as well as an increase in the body weight/body mass index is observed in the period from March 2020 to January 2021 compared to the pre-pandemic period from April 2019 to March 2020.

Participation of the adult population in preventive measures for non-communicable diseases during the COVID-19 pandemic in 2020/2021.

Background: In 2020/2021, the COVID-19 pandemic and the protective measures associated therewith severely limited the opportunity to participate in prevention and health promotion measures. The article examines the utilisation of the measures and possible factors that are associated with a lower participation during these pandemic years. Methods: It is based on data acquired between March and August 2021 from the study 'COVID-19 vaccination rate monitoring in Germany' (COVIMO), a cross-sectional telephone survey. The data was used to examine the participation in preventive measures in the last 12 months in terms of sociodemographic factors and to analyse a decreased participation with regard to pandemic-related factors. The analysis sample includes individuals aged 18 years and over (n=3,998). Results: 63% of participants generally did not use these programmes, 7% indicated an unchanged participation, 28% reported having participated in fewer measures, and 2% in more measures. Men reported significantly more often than women that they generally do not participate in prevention and health promotion measures. A relevant pandemic-related factor for decreased participation of men was the less clearly perceived comprehensibility of the regulations against the spread of SARS-CoV-2. Conclusions: Prevention and health promotion should be part of the contingency planning in epidemically significant situations to prevent a decreased participation and to promote health and gender-related equal opportunities even in a crisis.

[Self-perceived oral health and associated factors among adults in Germany. Results from GEDA 2019/2020-EHIS]. / Selbstwahrgenommene Mundgesundheit und assoziierte Faktoren bei Erwachsenen in Deutschland. Ergebnisse aus GEDA 2019/2020-EHIS.

BACKGROUND AND AIM OF THE WORK: Information on the oral health of the population is important for the assessment of (preventable) disease burden, for the estimation and planning of health resources and costs, and for the evaluation of health inequalities. The aim of this work is to investigate for the first time self-perceived oral health, including associated factors, based on data from a nationally representative sample for the adult population in Germany. MATERIAL AND METHODS: The data basis is the nationwide German Health Update study (GEDA 2019/2020-EHIS, n = 22,708 aged 18 years and older). In the telephone interview, the participants were asked how they would describe the state of their teeth and gums - "very good," "good," "fair," "bad," or "very bad." Sociodemographic, behavioral, and dental characteristics are examined as associated factors. Prevalences and results of multivariate binary logistic regressions (odds ratios, OR) are reported. RESULTS AND DISCUSSION: Of the participants, 71.4% perceived their oral health as very good or good, 28.6% as fair to very bad. Difficulty in chewing and biting on hard foods (OR 4.0), unmet dental care needs (OR 2.3), male gender (OR 1.5), and not consuming fruits and vegetables daily (OR 1.2) were the most important associated factors for fair to very bad self-perceived oral health; for men, low education (OR 2,1), daily smoking (OR 1.6) and not receiving dental care annually (OR 1.4) were also important. From the results, starting points for promoting oral health can be derived.

[Age-specific trends in risky drinking in Germany: collectivity or polarisation?] / Altersspezifische Trends des risikoreichen Alkoholkonsums in Deutschland: Parallele oder unterschiedliche Verläufe?

INTRODUCTION: According to Skog's collectivity of drinking cultures theory, changes in alcohol consumption in all groups and strata of the population take place as parallel displacement in the distribution of consumption. The aims of the present paper are (1) to illustrate temporal trends in risky drinking and episodic heavy drinking by age and gender and (2) to examine whether the trends are parallel in all age groups ("collectivity") or diverge between age groups ("polarisation"). METHODS: The data are based on nine surveys of the Epidemiological Survey of Addiction (ESA) between 1995 and 2018. Risky drinking was defined as daily consumption of more than 12 g (for women) or 24 g (for men) of pure alcohol and episodic heavy drinking as consumption of five or more glasses of alcohol (about 70 g pure alcohol) on at least one day in the past 30 days. Linear regressions were calculated separately for age groups (18-29, 30-39, 40-49, and 50-59 years) and gender to predict the temporal effect on risky drinking or episodic heavy drinking and to test trends for differences. RESULTS: The temporal changes of risky drinking by age group show soft collectivity among men and polarisation among women. Trends in episodic heavy drinking indicate polarisation for both genders; while the prevalence increased in the youngest and oldest age groups, it decreased in all other age groups. DISCUSSION: In light of a general decrease, the increasing trends in risky drinking in specific groups indicate the need for strengthening behavioural prevention. For the positive development to continue and to avoid a trend reversal, public health measures such as alcohol tax increases and reductions of alcohol availability need to be intensified.

Utilization of preventive care among migrants and non-migrants in Germany: results from the representative cross-sectional study 'German health interview and examination survey for adults (DEGS1)'.

BACKGROUND: In Germany, different health checks for adults are offered for primary and secondary prevention. Previous findings indicate that preventive care utilization varies according to social determinants, especially migration background. This study examined the extent to which migration background is associated with preventive care utilization, independent of factors like age and socioeconomic status and whether length of stay in Germany has a positive effect on the use of preventive care. METHODS: The first wave of the 'German Health Interview and Examination Survey for Adults' (DEGS1) is a comprehensive data collection facilitating the description of the utilization of general health checks, dental check-ups, skin cancer screening, and cervical cancer screening among people aged 18-79 years with and without migration background. Migration background was differentiated in first-generation migrants having immigrated to Germany themselves or second-generation migrants born in Germany. First-generation migrants were further differentiated by length of stay in Germany, and second-generation migrants as having one or two parents who were born abroad. Multivariate binary logistic regression models with average marginal effects were calculated to analyse the associations between preventive care utilization and migration background. RESULTS: The sample comprised 7987 participants, 1091 of whom had a migration background. Compared with non-migrants, women and men with migration background- particularly first-generation migrants with length of stay <=20 years in Germany - make less use of preventive care. This association was observed statistically independent from sociodemographic factors. For dental check-ups a significantly lower use was also found for first-generation migrants who have lived in Germany for more than 20 years and second-generation of migrants with two parents born abroad. Post-model predictions showed that the utilization rates of first-generation migrants are gradually converging to the average values for non-migrants. CONCLUSIONS: Our findings suggest inequalities in realized access to preventive care for first-generation migrants particularly for those who have lived in Germany for 20 years or less. Barriers to the utilization of preventive care may be addressed by informing migrant communities about preventive health care services at an early stage after immigration using migrant-sensitive information strategies.

Intention for Screening Colonoscopy among Previous Non-Participants: Results of a Representative Cross-Sectional Study in Germany.

Early detection of colorectal cancer has the potential to reduce mortality at population level. Colonoscopy is the preferred modality for colon cancer screening and prevention, but attendance rates are low. To exploit colonoscopy's preventive potential, it is necessary to identify the factors influencing uptake, especially among previous non-participants. This analysis of cross-sectional data involved 936 non-participants in screening colonoscopy aged 55 years or older in Germany. Differences between non-participants with and without future participation intentions were investigated in terms of socio-demographic factors, health status, attitudes and beliefs, and medical counselling. Logistic regression models were fitted to estimate associations between intention to participate and selected factors. Intention to participate was lower among women than among men. For both genders, intention to participate was positively associated with younger age. For women, higher socioeconomic status and counselling were positively associated with intention to participate. Men showed a positive association with favouring joint decision-making. The results draw attention to starting points for improving acceptance of and participation in screening colonoscopy. This includes good medical counselling and successful physician-patient communication, for which the information and communication skills of both medical professions and the general public should be strengthened. Gender differences should be considered.

Factors in the Use of Workplace Health Promotion on Back Health. Results of the Survey "German Health Update".

Background: The influence of the working environment on the back health of employees is well-documented. Many companies have begun to offer employees access to services to promote back health. Factors affecting the use of these offers at the population level have received little investigation to date. The current study examined the socio-demographic factors, physical activity and health-related factors, and work-related factors associated with the use of offers of workplace health promotion for back health in Germany. Materials and Methods: In the representative population-based cross-sectional survey "German Health Update" (GEDA 2014/2015-EHIS) conducted by the Robert Koch Institute, 12,072 employees aged 18-64 years old were surveyed from November 2014 to July 2015 regarding the use of back health services in their companies. In addition to socio-demographic factors, the survey examined working hours, physical activity in leisure time, health awareness, and subjective complaints in the lower back or other chronic back problems in the last 12 months. The interaction of these factors with the utilization of back health services was tested using multiple logistic regression models. Results: Women used back health services more often than men (women: 25.5%; men: 18.1%). Female gender was associated with part-time employment (OR 0.72) and a strong to very strong level of health awareness (OR 1.40). Male gender was associated with age between 30 and 44 years (OR 1.99) and 45-64 years (OR 2.02), low socioeconomic status (OR 0.48), endurance activity of <2.5 h per week (OR 0.62), and absence of lower back pain or other chronic back conditions for the last 12 months (OR 0.48). Conclusion: The present study is the first to provide findings regarding the factors associated with the utilization of workplace health promotion to promote back health at the population level, and from the perspective of employees in Germany. The results revealed that the relevant factors for participating in offers differ for women and men. To reach more employees, workplace health promotion offers for back health should be designed specifically for each individual, considering gender and age, working hours, health awareness and behavior, and health state.

Physical activity counselling by physicians - Results from the KomPaS study.

Physical activity counselling aimed at promoting physical and sporting activity is easily accessible and has the potential to reach many people. Until now, very little has been known about the factors influencing physical activity counselling and their frequency. However, the study 'KomPaS: survey on communication and patient-safety', provides current data about this topic. The analyses published here are based on data from 4,561 people aged 18 or older who were interviewed by telephone between May and September 2017 and who stated that they had visited a physician's practice or outpatient clinic in the last twelve months. 28.6% of participants reported having received a physician's counselling about sporting activity during the past twelve months. Sex, age and socioeconomic status have an impact on how frequently participants reported a physical activity counselling by a physician as well as changes to physical activity. As such, differences associated with sex, age and socioeconomic status should be taken into account during physical activity counselling so as to provide various population groups with targeted support.

Health-promoting behaviour among adults in Germany - Results from GEDA 2019/2020-EHIS.

Health-promoting behaviours are important at any age to prevent diseases and to promote well-being. Using data from GEDA 2019/2020-EHIS, a Germany-wide, representative survey, this article describes how often the adult population in Germany reports certain types of health-promoting behaviour in their everyday lives. The behaviours considered are nonsmoking, low-risk alcohol consumption, achievement of the World Health Organization's (WHO) recommendations on aerobic physical activity, at least daily fruit and vegetable consumption, and maintaining a body weight within the normal range. This article describes the proportion of people who report these behaviours in their everyday lives by gender, age and education level, the number of health-promoting behaviours each person reports and the most common combinations in which they occur. Young adults between 18 and 29 years are most likely to achieve a health-promoting lifestyle. The proportion of people who report at least 150 minutes of physical activity per week and a normal body weight is lower in later adulthood than among 18- to 29-year-olds. The recommendation to eat fruit and vegetables daily is implemented least often of all five aspects of health behaviour under study. Finally, women are more likely to lead a health-promoting lifestyle than men.

Utilisation of outpatient medical services in Germany - Results from GEDA 2019/2020-EHIS.

Outpatient health care provision plays an important role in the identification and treatment of health problems. Data are needed on the utilisation of health care services and their determinants to enable health policy decision-making and needs-based care provision. The analyses set out in this article are based on current data on the utilisation of outpatient health care services. The data stem from the German Health Update (GEDA 2019/2020-EHIS), a nationwide cross-sectional survey of the resident population in Germany that is undertaken as part of the health monitoring conducted at the Robert Koch Institute. Around 80% of the population aged 18 or over were treated at least once within twelve months by a general practitioner, 60% by a specialist, and 10% received psychiatric or psychotherapeutic treatment. Less than half of those eligible had had a stool test during the past two years, and just over half had had a colonoscopy in the past ten years. Around 80% of women and 70% of men had had their blood pressure checked within the last year, and 60% had had their blood cholesterol or blood sugar levels monitored. Over 50% reported that they had taken medically prescribed drugs in the past two weeks. In general, most of the indicators under study suggest that utilisation increases with age and that utilisation is higher among women than men, with the exception of psychiatric and psychotherapeutic services, among others.