[Reasons of Individuals 60 Years and Older in Germany for not Getting Vaccinated against Covid-19]. / Gründe von Menschen ab 60 Jahren in Deutschland, sich nicht gegen Covid-19 impfen zu lassen.

PURPOSE: To identify the reasons of individuals aged 60 years and older in Germany for not getting vaccinated against Covid-19. METHODS: Data for this study were collected in July/August 2021 from "Kommunikation der Corona-Schutzimpfung in Deutschland" (CoSiD)", a representative survey of the general adult population in Germany. The focus was on individuals aged 60 years and older in our current study (n=1,281 individuals). RESULTS: Approximately 92% of individuals 60 years and older were already vaccinated against Covid-19. Among the older unvaccinated, nearly 60% were opposed to vaccination. Major reasons among older (and also younger) unvaccinated persons for "rather not getting vaccinated"/"definitely not" wanting to be vaccinated against Covid-19 were: (1) too little research on the vaccines or too short a time of research (roughly half of the individuals) and (2 and 3) no confidence/general skepticism or because of side effects (in each case, just over a quarter of the group surveyed). CONCLUSION: To increase the vaccination rate, these three arguments must be countered, for instance, during conversations in the context of medical care.

[COVID-19 vaccination status, sources of used information and socio-demographic characteristics-results of the CoSiD study]. / COVID-19-Impfstatus, genutzte Informationsquellen und soziodemografische Merkmale ­ Ergebnisse der CoSiD-Studie.

BACKGROUND: Despite the benefits of a COVID-19 vaccination, too few people in Germany were still considered vaccinated in the summer of 2022. This was explained, among other factors, by socio-demographic differences. The article also analyses this correlation by including the sources of information used on corona vaccination based on the data from the third survey of the "Accompanying research on the communication of corona vaccination in Germany" (CoSiD study, Nov./Dec. 2021; n = 4366 16-year-olds and older). METHODS: Bi- and multivariate correlations were analysed between the uptake of vaccination or the intention to vaccinate of the unvaccinated and socio-demographic characteristics as well as sources of information on COVID-19 vaccination. RESULTS: Of the respondents, 87.7% have been vaccinated at least once. The vaccination rate tends to increase with age, education level and household income and is higher among people in the old federal states and without a migration background. The sources of information on COVID-19 vaccination were mostly discussions among family, friends and colleagues (81.8%) and German TV and radio stations (77.1%). In the multivariate model, higher proportions of people without vaccination intentions were found among respondents who obtained information from TV and radio stations from abroad as well as from social media. DISCUSSION: Information offerings for specific target groups must take social inequalities even more into account. One challenge here is that the use of different information sources is related to different vaccination intentions. In particular, people with vaccination intentions and the undecided can be reached with easily understandable, trustworthy information offerings.

Perceived Norms and Vaccination against COVID-19 among the General Adult Population in Germany: Results of a Nationally Representative Survey.

OBJECTIVE: to examine whether perceived norms are associated with vaccination against COVID-19 (also stratified by age group). STUDY DESIGN: nationally representative survey. METHODS: Data were taken from a sample of the general adult population (n = 3829, 16 to 94 years). Data collection took place from early July to early August 2021, and 3 different groups (1: not yet vaccinated and no intention to vaccinate against COVID-19; 2: not yet, but intended to vaccinate against COVID-19; 3: yes, at least one vaccination against COVID-19) were distinguished in the analyses. Data were adjusted for several sociodemographic and health-related factors. Perceived norms served as key independent variables (1: number of important friends and relatives who would like me to get vaccinated; 2: number of important friends and relatives who already have been vaccinated or still want to do so; 3: how your general practitioner (GP) thinks about Corona vaccination). RESULTS: Multiple logistic regression showed that, in particular, the number of important friends/relatives who would like an individual to get vaccinated is associated with the actual COVID-19 vaccination status among individuals aged 16 to 59 years. Interestingly, all 3 indicators for perceived norms are associated with the likelihood of COVID-19 vaccination status among individuals aged 60 years and over. CONCLUSIONS: Our study adds to the understanding of the association between perceived norms and COVID-19 vaccination status. This highlights potential pathways to increase vaccination rates to further combat the later stages of the pandemic.

[Health information behaviour and health literacy on COVID-19 vaccination of the general population in Germany-findings from the CoSiD study]. / Gesundheitsinformationsverhalten und Gesundheitskompetenzen zur COVID-19-Schutzimpfung von Menschen in Deutschland ­ Befunde der CoSiD-Studie.

BACKGROUND: Although COVID-19 vaccination reduces severe disease progression as well as hospitalisations and deaths, every fourth to fifth person in Germany is not vaccinated against COVID-19. Effective information and communication measures are needed to reach these people. For this, it is important to know the information behaviour as well as the health competences in the area of COVID-19 vaccination, especially of previously unvaccinated people. METHODS: The third representative population survey (November/December 2021; n = 4366) of the CoSiD study (Corona vaccination in Germany) was conducted as a combined telephone and online survey. Bivariate correlations between reported information behaviour, subjective health literacy and vaccination status and intention are investigated. In addition, multivariate correlations of socio-demographic characteristics and subjective health literacy are analysed. RESULTS: Undecided people and people that are more likely to vaccinate were overall less likely to report a good subjective level of information (46.1%; 41.1%) and competences in evaluating information about COVID-19 vaccination (36.5%; 38.8%) as well as decision making (39.0%; 35.9%). Unvaccinated people without vaccination intentions are more likely to report observing information rated as untrustworthy or wrong (60.3%). People with a lower level of education, younger people and people with a migration background report lower levels of heath literacy. DISCUSSION: Communication measures to promote health literacy should specifically address people with uncertain vaccination intentions as well as younger people, people with lower levels of education and people with a migration background.

Factors associated with non-use of condoms among heterosexually-active single people in Germany: Results from the first representative, population-based German health and sexuality survey (GeSiD).

Background: Against the backdrop of rising STI incidence among the heterosexual population, sexually active single people are at particularly high STI transmission risk. Gaining insight into circumstances related to condoms non-use in this population is therefore important for developing effective health interventions. Methods: The nationally-representative survey, GeSiD (German Health and Sexuality Survey) undertaken 2018-2019, interviewed 4,955 people aged 18-75 years. A total of 343 heterosexually-active single participants answered a question about condom use at last sex. Data on sociodemographic characteristics, sexual behaviours and circumstances of last sex were analysed to identify independently associated factors. Results: Condom non-use at last sex was reported more commonly by participants aged >35 years than by younger participants (48.5 vs 33.7%, respectively) and more likely among longer relationships (adjusted odds ratio [AOR]: 2.43) or early loving relationships (AOR: 3.59) than in one-night-stands. It was also associated with not discussing using condoms before sex (AOR: 6.50) and with reporting non-use of condoms at sexual debut (AOR: 4.75). Conclusions: Non-use of condoms is a common STI risk behaviour among heterosexually-active single people in Germany and so needs promoting from sexual debut throughout the life course, regardless of relationship type and age, but particularly among middle-aged and older people.

Frequent Cannabis Use Moderates the Relationship Between Sexual Dysfunction and Depression Among Female German Adults.

BACKGROUND: Sexual dysfunction and heavy substance use (alcohol, tobacco, and cannabis) play an important role in the development of depression, while frequent substance use affects sexual dysfunction. AIM: This study aimed to investigate the association between sexual dysfunction and depression among German adults in a nationally representative sample and the effect of alcohol, tobacco, and cannabis use on this association using moderator analysis. METHODS: Data come from the German Health and Sexuality Survey (GeSiD) with N = 4,955 men and women aged between 18 and 75 years. We used multiple logistic regression analysis to examine the moderation effect of substance use between sexual dysfunction and depression by including an interaction term. OUTCOMES: Self-reported diagnosed and treated depression within the last 12 months and the moderation effect of substance use on the association between sexual dysfunction and depression. RESULTS: Men and women with at least 1 sexual dysfunction were more likely to be affected by depression as compared to those without sexual dysfunction. A moderation effect of frequent cannabis use was found between sexual dysfunction and depression among women. CLINICAL IMPLICATIONS: Clinicians and therapists addressing addiction, depression, and dysfunction should keep the complex interactions in mind. STRENGTHS & LIMITATIONS: This study provides new data on the association between sexual dysfunction and depression among German adults in a nationally representative sample and the moderation effect of substance use on this association. Further studies should disentangle the pathways between sexual dysfunction, cannabis use, and depression through moderated mediation analyses. CONCLUSION: Frequent cannabis use plays a moderating role in the association between sexual dysfunction and depression among German adult women. Belau MH, Wiessner C, Becher H, et al. Frequent Cannabis use Moderates the Relationship between Sexual Dysfunction and Depression Among Female German Adults. J Sex Med 2022;19:940-949.

What is the empirical basis for converting banded ordinal data on numbers of sex partners among MSM into a continuous scale level variable? A secondary analysis of 13 surveys across 17 countries.

BACKGROUND: To provide empirically based guidance for substituting partner number categories in large MSM surveys with mean numbers of sexual and condomless anal intercourse (CAI) partners in a secondary analysis of survey data. METHODS: We collated data on numbers of sexual and CAI partners reported in a continuous scale (write-in number) in thirteen MSM surveys on sexual health and behaviour across 17 countries. Pooled descriptive statistics for the number of sexual and CAI partners during the last twelve (N = 55,180) and 6 months (N = 31,759) were calculated for two sets of categories commonly used in reporting numbers of sexual partners in sexual behaviour surveys. RESULTS: The pooled mean number of partners in the previous 12 months for the total sample was 15.8 partners (SD = 36.6), while the median number of partners was 5 (IQR = 2-15). Means for number of partners in the previous 12 months for the first set of categories were: 16.4 for 11-20 partners (SD = 3.3); 27.8 for 21-30 (SD = 2.8); 38.6 for 31-40 (SD = 2.4); 49.6 for 41-50 (SD = 1.5); and 128.2 for 'more than 50' (SD = 98.1). Alternative upper cut-offs: 43.4 for 'more than 10' (SD = 57.7); 65.3 for 'more than 20' (SD = 70.3). Self-reported partner numbers for both time frames consistently exceeded 200 or 300. While there was substantial variation of overall means across surveys, the means for all chosen categories were very similar. Partner numbers above nine mainly clustered at multiples of tens, regardless of the selected time frame. The overall means for CAI partners were lower than those for sexual partners; however, such difference was completely absent from all categories beyond ten sexual and CAI partners. CONCLUSIONS: Clustering of reported partner numbers confirm common MSM sexual behaviour surveys' questionnaire piloting feedback indicating that responses to numbers of sexual partners beyond 10 are best guesses rather than precise counts, but large partner numbers above typical upper cut-offs are common.

Public Preferences for Exit Strategies From COVID-19 Lockdown in Germany-A Discrete Choice Experiment.

Objectives: To decrease the rapid growth of SARS-CoV-2 in Germany, a stepped lockdown was conducted. Acceptance and compliance regarding entering and exiting lockdown measures are key for their success. The aim of the present study was to analyse the population's preferences for exiting lockdown measures. Methods: To evaluate population's preferences and identify trade-offs between different exit strategies, a discrete choice experiment was conducted on 28-29 April (n = 1,020). Overall, six attributes and 16 choice sets (fractional-factorial design) without an opt-out were chosen. Conditional logit and latent class models were conducted. Results: Most attributes proved to be significant. Two attributes dominated all others: Avoiding a mandatory tracing app, and providing sufficient intensive care capacities. Preventing a high long-term unemployment rate and avoiding the isolation of persons aged 70+, were relevant, though utilities were comparatively lower. We identified subgroups (elderly persons and persons with school children) with different utilities, which indicates specific attributes affecting them dissimilarly. Conclusions: The population prefers cautious re-opening strategies and is at least sceptical about the adoption of severe protection measures. Government should balance interests between subgroups.

[Burden in parents of school-aged children during different phases of the COVID-19 pandemic in Germany: an analysis within the COVID-19 snapshot monitoring (COSMO) study]. / Belastung von Eltern mit Kindern im Schulalter während verschiedener Phasen der COVID-19-Pandemie in Deutschland: Eine Analyse der COVID-19-Snapshot-Monitoring-(COSMO­)Daten.

BACKGROUND: Parents face a variety of personal challenges during the COVID-19 pandemic, while simultaneously being confronted with additional, school-related pandemic containment measures. OBJECTIVES: To investigate burden in parents of school-aged children across different phases of the COVID-19 pandemic in Germany and to identify particularly affected subgroups. METHODS: The COSMO project is a repetitive cross-sectional survey monitoring the psychosocial situation of the population in Germany during the pandemic with a sample size of approximately n = 1000 respondents per survey wave. A quantitative analysis of COSMO data was conducted using closed survey questions on the item "burden" as the main outcome, and, if applicable, on parenthood-associated burden from March 2020 until January 2021. RESULTS: During the first COVID-19 wave, parents of school-aged children were significantly more burdened compared to the general study population. However, burden decreased significantly from March/April to June 2020. During the second COVID-19 wave in January 2021, burden was homogeneously high across all groups. Single parenthood, a low household income, having a chronic health condition, a COVID-19 infection and a migration background were associated with higher burden, although none of these factors was consistently significant across the survey waves. Mothers reported to be more affected by parenthood-related burden than fathers. CONCLUSIONS: School measures for infection control have to be weighed carefully against the psychological impact on parental burden with subsequent negative impact on the family system. An English full-text version of this article is available at SpringerLink as Supplementary Information.

[Assessment and operationalization of the characteristic "gender" in representative population-based surveys: challenges and implications with the example of the GeSiD study]. / Erfassung und Operationalisierung des Merkmals "Geschlecht" in repräsentativen Bevölkerungsstichproben: Herausforderungen und Implikationen am Beispiel der GeSiD-Studie.

Representative quantitative surveys assess the participants' gender in order to allow for gender specific analyses of the research questions and to draw conclusions about the populations. This is important in order to develop information and interventions tailored to the target groups. However, although gender is no longer considered exclusively as a binary construct, it is still often surveyed through a binary variable with the response options woman/man or female/male. In this article, we discuss why this approach is outdated or incomplete and why a move away from this approach is important and necessary. Using the GeSiD study on "Health and Sexuality in Germany" as an example, in this discussion post we demonstrate how gender can be assessed by means of a two-step model in which the first step assesses gender assigned at birth and the second step the subjective gender affiliation. At the same time, we discuss the challenges that this approach brings along. We place the results of the GeSiD study into a larger context and discuss the implications and possibilities for operationalizing gender in representative surveys.

[The German health and sexuality survey (GeSiD)-a brief introduction to the study]. / Die GeSiD-Studie "Gesundheit und Sexualität in Deutschland" ­ eine kurze Einführung.

Until 2020, there was no representative sex survey for Germany with published data. The GeSiD study "Health and Sexuality in Germany" is the first nationwide, representative sex survey. The aim of this paper is to provide a brief introduction to the German health and sexuality (GeSiD) survey.A total of 4955 persons (2336 men, 2619 women) aged 18-75 years were interviewed between 2018 and 2019. The computer-assisted face-to-face interviews had an extensive self-completion section and asked about a wide range of sexual behaviour and sexual health topics. Data on sexual identity, relationships, sexual behaviour, and sexual health were assessed. Data show, among other things, that only a minority of respondents had ever talked to a healthcare provider about HIV/AIDS or other sexually transmitted infections (STIs).Data show a clear need for education, information dissemination, and training in the area of sexual health.

[How good is the knowledge about sexually transmitted infections in Germany? : Results of the first nationwide representative German health and sexuality survey (GeSiD)]. / Wie gut ist das Wissen über sexuell übertragbare Infektionen in Deutschland? : Ergebnisse der ersten bundesweiten repräsentativen Befragung zu Gesundheit und Sexualität (GeSiD).

BACKGROUND: Sexually transmitted infections (STIs) are a relevant risk factor for the sexual health of individuals and the population. Therefore, the level of awareness and knowledge about STIs in different population groups is of particular interest for specific prevention work. OBJECTIVES: The aim of this study was to analyze the awareness of and knowledge about nine STIs in the German population. To do so, the study examined correlations with sociodemographic variables, sexuality-related characteristics, and subjective satisfaction with the level of information. METHODS: The GeSiD study "German Health and Sexuality Survey" collected representative quantitative data from 4955 persons via face-to-face interviews on the state of knowledge about STIs. As a selection procedure, a two-step random sample was collected. Firstly, 200 sample points (municipalities) were initially selected proportionally across Germany. Secondly, a random sample of addresses was drawn from the respective residents' registration offices. The participation rate was 30.2%; the average age was 46.3 years. RESULTS: Knowledge about HIV/AIDS was widespread in all age groups, but other STIs were significantly less known. Older people and respondents with a low level of education were particularly poorly informed. Local social disadvantage and a family history of migration were also negatively correlated with knowledge about STIs. A higher number of sexual partners is related to a better level of knowledge. In addition, persons who do not describe their sexual orientation as heterosexual as well as those with a history of STIs were well informed. CONCLUSION: Heterosexual adults in Germany are insufficiently informed about the risks of STIs. Therefore, target-group-specific efforts are needed to improve knowledge about STIs in order to reduce sexual risk behavior and improve the utilization of prevention programs among socially disadvantaged groups.

Methodology of the German National Sex Survey - GeSiD (German Health and Sexuality Survey).

The German Health and Sexuality Survey (GeSiD) was carried out in 2018/2019 to provide up-to-date measures of sexual behavior, sexual attitudes and sexual lifestyles of the adult population. We describe the methods used in GeSiD which surveyed the general population in Germany aged 18-75 years (with oversampling of younger adults aged 18-35 years). This article focuses on study design, recruitment, and response rate and discusses the strategies implemented to enhance the response rate compared to the pilot study. Overall, 4.955 interviews were completed with a response rate of 30.2%. The data were weighted by age, gender, education, nationality, and region to reduce possible bias. Compared to the German 2018 census, the weighted sample provides good representativeness for selected respondent characteristics. The computer-assisted interviews consisted of a combination of face-to-face and self-completion components. They covered a broad perspective on sexual health, which included topics such as online sexual activities, pleasure, sexual dysfunction, and sexual violence. Reliable data on sexual and reproductive health in Germany are urgently needed for evidence-based prevention and health promotion work, to inform sexual health policy and for cross-national comparisons of the development of sexual behavior in Europe.

[Demand-driven communication strategy of the Federal Centre for Health Education (BZgA) during the COVID-19 pandemic]. / Bedarfsbezogene Kommunikationsstrategie der Bundeszentrale für gesundheitliche Aufklärung (BZgA) während der COVID-19-Pandemie.

With the declaration of a pandemic situation of national significance by the German Bundestag, the Federal Centre for Health Education (BZgA) is fulfilling its task of providing information for understanding the pandemic situation and implementing the necessary protective measures in a clear manner throughout Germany within the framework of the adapted National Pandemic Plan COVID-19. The BZgA targets its information according to the needs of specific groups and actively involves multipliers.In order to incorporate the perspectives of the population as well as those of prevention and health promotion professionals into the services developed by the BZgA, given the particularly initial low level of knowledge in the population, various methods and data sources were used: the COVID-19 Snapshot Monitoring (COSMO) population survey, the monitoring of citizens' enquiries via telephone and e­mail to the BZgA, surveys of counselling professionals from nationwide telephone and online counselling centres, surveys of health professionals in early help (NZFH) and interdisciplinary practice expert hearings. Beyond providing pure information, practical and everyday offers should be developed and provided according to WHO guidelines and evidence-based criteria of effective communication in order to support the competences for a gradual adaptation to a "new normality".The paper describes the data-based and evidence-informed development process of communication content and offers, their dissemination via existing websites and channels for other topics as well as their integration into the new online platform www.zusammengegencorona.de . This demonstrates how demand-driven and target group-specific communication offers can be implemented beyond the classic and proven campaign appearance.

Establishing a Mental Health Surveillance in Germany: Development of a framework concept and indicator set.

In the course of the recognition of mental health as an essential component of population health, the Robert Koch Institute has begun developing a Mental Health Surveillance (MHS) system for Germany. MHS aims to continuously report data for relevant mental health indicators, thus creating a basis for evidence-based planning and evaluation of public health measures. In order to develop a set of indicators for the adult population, potential indicators were identified through a systematic literature review and selected in a consensus process by international and national experts and stakeholders. The final set comprises 60 indicators which, together, represent a multidimensional public health framework for mental health across four fields of action. For the fifth field of action 'Mental health promotion and prevention' indicators still need to be developed. The methodology piloted proved to be practicable. Strengths and limitations will be discussed regarding the search and definition of indicators, the scope of the indicator set as well as the participatory decision-making process. Next steps in setting up the MHS will be the operationalisation of the single indicators and their extension to also cover children and adolescents. Given assured data availability, the MHS will contribute to broadening our knowledge on population mental health, supporting a targeted promotion of mental health and reducing the disease burden in persons with mental disorders.

[Health Promotion and Disease Prevention - Results of the Working Group 6 of the Forum Future Public Health, Berlin 2016]. / Gesundheitsförderung und Prävention.

The increase in so-called lifestyle-related diseases emphasizes that focusing health care systems on the diseased population is insufficient to meet the challenges of population health. Instead, a proactive reorientation of health care structures towards more disease prevention, health promotion, and health protection is necessary. In addition to national institutions, municipal and non-governmental structures (public health services, health conferences etc.) play a central role in the implementation of such structural changes, as they are the societal organizations in direct contact with citizens.

Are bisexually active men a 'bridge' for HIV transmission to the 'general population' in Germany? Data from the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS).

To assess the situation of bisexually active men in the German HIV epidemic, data from a 2010 internet survey about sexual health among men who have sex with men were used to assess HIV testing rates, condom use and risk contact among the following groups of respondents: bisexually active single men, bisexually active men with a regular female partner, bisexually active men with a regular male partner and exclusively homosexually active men. Of the 54,387 respondents from Germany, 12% reported having sex contacts with both men and women in the previous year. Descriptive statistics were used to explore the sample's socio-demographic characteristics and to identify relevant inter-group differences in sexual attraction, identity, awareness among contacts of attraction to men, number of sex partners, history of anal intercourse, recruitment of partners online, history of HIV testing and drug use. Multivariable regression analyses were used to assess potential associations between these variables and risk contacts, defined as having reported unprotected anal intercourse with male partners of unknown or discordant serostatus in the previous year. Bisexually active groups reported relatively few risk contacts, strengthening the argument that there is little support for the existence of a substantial 'bisexual bridge' in Germany.