Excitable Signal Transduction Networks in Directed Cell Migration.

Although directed migration of eukaryotic cells may have evolved to escape nutrient depletion, it has been adopted for an extensive range of physiological events during development and in the adult organism. The subversion of these movements results in disease, such as cancer. Mechanisms of propulsion and sensing are extremely diverse, but most eukaryotic cells move by extending actin-filled protrusions termed macropinosomes, pseudopodia, or lamellipodia or by extension of blebs. In addition to motility, directed migration involves polarity and directional sensing. The hundreds of gene products involved in these processes are organized into networks of parallel and interconnected pathways. Many of these components are activated or inhibited coordinately with stimulation and on each spontaneously extended protrusion. Moreover, these networks display hallmarks of excitability, including all-or-nothing responsiveness and wave propagation. Cellular protrusions result from signal transduction waves that propagate outwardly from an origin and drive cytoskeletal activity. The range of the propagating waves and hence the size of the protrusions can be altered by lowering or raising the threshold for network activation, with larger and wider protrusions favoring gliding or oscillatory behavior over amoeboid migration. Here, we evaluate the variety of models of excitable networks controlling directed migration and outline critical tests. We also discuss the utility of this emerging view in producing cell migration and in integrating the various extrinsic cues that direct migration.

[The Importance of Socioeconomic Status in the Occurrence of Mental Health Problems in 11- to 17-Year-Old Girls and Boys in Germany: Results of KiGGS Wave 2 (2014-2017)]. / Die Bedeutung des sozioökonomischen Status für das Auftreten von psychischen Auffälligkeiten bei 11-bis 17- jährigen Mädchen und Jungen in Deutschland. Ergebnisse der KiGGS-Welle 2 (2014­2017).

AIM OF THE STUDY: The aim of the study was to investigate the distribution pattern of mental health problems (emotional problems, conduct problems, peer problems, hyperactivity) among different socioeconomic groups of 11- to 17-year-old girls and boys. METHODS: Data for this study were obtained from the "German Health Interview and Examination Survey for Children and Adolescents KiGGS Wave 2" (2012-2014, n=15,023). The data on 11- to 17-year-old girls and boys (n=6599) was analyzed overall and separately for two age groups. The dependent variable was the parental version of the "Strengths and Difficulties Questionnaire" (SDQ). As non-dependent variable, a multidimensional index was used, which indicates the socioeconomic status (SES) of the family. Prevalence and odds ratios (ORs) based on logistic regressions are shown. RESULTS: The prevalence of reporting mental health problems in those aged 11 to 17 was 15.7%. Girls were more likely to show internalizing problems whilst boys were more likely to show externalizing problems. The 11- to 17-year-old adolescents with a low SES were about two times (aOR: 2.32; 95%-CI: 1.81-2.97; p<0.001) more likely to report mental health problems. Adolescent girls with a low SES were at a twofold (aOR: 2.06; 95%-CI: 1.49-2.98; p<0.001) increased risk of showing a specific mental health problem such as "emotional problems".Conclusion Mental health problems in adolescents are distributed unequally. 11- to 17-year-old boys are generally more likely to show mental health problems, while girls' SES differences in mental health are more pronounced.

Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high-income countries - a scoping review.

BACKGROUND: By explaining the development of health inequalities, eco-social theories highlight the importance of social environments that children are embedded in. The most important environment during early childhood is the family, as it profoundly influences children's health through various characteristics. These include family processes, family structure/size, and living conditions, and are closely linked to the socioeconomic position (SEP) of the family. Although it is known that the SEP contributes to health inequalities in early childhood, the effects of family characteristics on health inequalities remain unclear. The objective of this scoping review is to synthesise existing research on the mediating and moderating effects of family characteristics on socioeconomic health inequalities (HI) during early childhood in high-income countries. METHODS: This review followed the methodology of "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews". To identify German and English scientific peer-reviewed literature published from January 1st, 2000, to December 19th, 2019, the following search term blocks were linked with the logical operator "AND": (1) family structure/size, processes, living conditions, (2) inequalities, disparities, diversities, (3) income, education, occupation, (4) health and (5) young children. The search covered the electronic databases PubMed, PsycINFO, and Scopus. RESULTS: The search yielded 7,089 records. After title/abstract and full-text screening, only ten peer-reviewed articles were included in the synthesis, which analysed the effects of family characteristics on HI in early childhood. Family processes (i.e., rules /descriptive norms, stress, parental screen time, parent-child conflicts) are identified to have mediating or moderating effects. While families' living conditions (i.e., TVs in children's bedrooms) are suggested as mediating factors, family structure/size (i.e., single parenthood, number of children in the household) appear to moderate health inequalities. CONCLUSION: Family characteristics contribute to health inequalities in early childhood. The results provide overall support of models of family stress and family investment. However, knowledge gaps remain regarding the role of family health literacy, regarding a wide range of children's health outcomes (e.g., oral health, inflammation parameters, weight, and height), and the development of health inequalities over the life course starting at birth.

[Personal Resources of Adolescents in Eastern and Western Germany - Results of the KiGGS Study 15 and 25 years after the German Reunification]. / Personale Ressourcen von Jugendlichen in Ost- und Westdeutschland ­ Ergebnisse der KiGGS-Studie 15 und 25 Jahre nach der Wende.

QUESTIONS: More than 15 years after the German reunification, were there differences in the personal resources among adolescents born around 1989 between East and West? How did the differences of this generation develop? METHODS: Data from the study on the health of children, adolescents and young adults in Germany (KiGGS study) from the years 2003-2006 and 2014-2017 are used to determine the prevalence of low personal resources in 14-17-year-old adolescents in Eastern and Western Germany. Cross-sectional data at both time periods are compared between East and West, and longitudinal data are used to follow the cohort over the course of age RESULTS: Around 15 years after the German reunification, 14- to 17-year-olds from East Germany more frequently show fewer personal resources and have lower self-efficacy expectations than adolescents of the same age in West Germany. 10 years later, these differences are barely visible and have partially reversed. The east-west differences found cannot be explained by the different socio-economic situations of the families in East and West. DISCUSSION: The results show that in the 2000s, adolescents born around 1989 from families living in Eastern Germany, showed a higher risk of having fewer personal resources than adolescents from families living in Western Germany. 25 years after the German reunification this is no longer recognizable. While the differences between East and West decrease over time, the importance of the socio-economic situation of the family for the personal resources of adolescents as a whole increases, to the detriment of those with a lower socioeconomic status. The results indicate the need for targeted interventions to strengthen psychosocial resources especially for children and adolescents in phases of transformation and biographical breaks.

Insight from the maximal activation of the signal transduction excitable network in Dictyostelium discoideum.

Cell migration requires the coordination of an excitable signal transduction network involving Ras and PI3K pathways with cytoskeletal activity. We show that expressing activated Ras GTPase-family proteins in cells lacking PTEN or other mutations which increase cellular protrusiveness transforms cells into a persistently activated state. Leading- and trailing-edge markers were found exclusively at the cell perimeter and the cytosol, respectively, of the dramatically flattened cells. In addition, the lifetimes of dynamic actin puncta were increased where they overlapped with actin waves, suggesting a mechanism for the coupling between these two networks. All of these phenotypes could be reversed by inhibiting signal transduction. Strikingly, maintaining cells in this state of constant activation led to a form of cell death by catastrophic fragmentation. These findings provide insight into the feedback loops that control excitability of the signal transduction network, which drives migration.

Shear force-based genetic screen reveals negative regulators of cell adhesion and protrusive activity.

The model organism Dictyostelium discoideum has greatly facilitated our understanding of the signal transduction and cytoskeletal pathways that govern cell motility. Cell-substrate adhesion is downstream of many migratory and chemotaxis signaling events. Dictyostelium cells lacking the tumor suppressor PTEN show strongly impaired migratory activity and adhere strongly to their substrates. We reasoned that other regulators of migration could be obtained through a screen for overly adhesive mutants. A screen of restriction enzyme-mediated integration mutagenized cells yielded numerous mutants with the desired phenotypes, and the insertion sites in 18 of the strains were mapped. These regulators of adhesion and motility mutants have increased adhesion and decreased motility. Characterization of seven strains demonstrated decreased directed migration, flatness, increased filamentous actin-based protrusions, and increased signal transduction network activity. Many of the genes share homology to human genes and demonstrate the diverse array of cellular networks that function in adhesion and migration.

Serology- and PCR-based cumulative incidence of SARS-CoV-2 infection in adults in a successfully contained early hotspot (CoMoLo study), Germany, May to June 2020.

Three months after a coronavirus disease (COVID-19) outbreak in Kupferzell, Germany, a population-based study (n = 2,203) found no RT-PCR-positives. IgG-ELISA seropositivity with positive virus neutralisation tests was 7.7% (95% confidence interval (CI): 6.5-9.1) and 4.3% with negative neutralisation tests. We estimate 12.0% (95% CI: 10.4-14.0%) infected adults (24.5% asymptomatic), six times more than notified. Full hotspot containment confirms the effectiveness of prompt protection measures. However, 88% naïve adults are still at high COVID-19 risk.

[Digital divide-social inequalities in the utilisation of digital healthcare]. / Digital Divide ­ Soziale Unterschiede in der Nutzung digitaler Gesundheitsangebote.

Today, health inequalities are one of the most important issues in public health worldwide. The digitalisation of healthcare is frequently attributed with the potential to reduce health inequalities. At the same time, effective internet usage is a prerequisite of the successful utilisation of digital health interventions. This might be a new obstacle for those who lack the necessary material resources or individual skills.Evidence on how exactly digital health interventions affect health inequalities is scarce. The aim of this study was to present a narrative review of the available literature. The majority of studies showed an association between the usage of digital health interventions and sociodemographic factors. The utilisation was generally higher among younger people and those with higher education and higher income. Only few studies showed no association. Other studies reported higher utilisation among those with higher levels of health literacy while health literacy showed a social gradient to the disadvantage of those in lower socioeconomic position. With a low overall level of evidence, there is currently no indication that digital health interventions are reducing health inequalities.The studies analysed in this review indicate that existing inequalities persist in the digital realm. Further evidence is needed to create a better understanding of the importance of sociodemographic factors for digital health interventions.

[Utilization of outpatient medical services and satisfaction with care in children and adolescents with a migration background-results of the KiGGS study]. / Inanspruchnahme ambulant ärztlicher Leistungen und Zufriedenheit mit der Versorgung bei Kindern und Jugendlichen mit Migrationshintergrund ­ Ergebnisse der KiGGS-Studie.

BACKGROUND AND AIM: Reasons for lower use of medical services by children and adolescents with migration background have not yet been investigated. The aim is therefore to identify factors that are related to the utilization of outpatient medical care and subjective patient satisfaction as well as explain differences according to migration background. METHODS: On the basis of the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS, baseline study: 2003-2006), in which 17,640 children and adolescents participated, prevalences with 95% confidence intervals as well as multivariate binary logistic regression analyzes on the relationship between migration background, country of origin, the use of outpatient medical care services in the last 12 months, and satisfaction with the last medical treatment were calculated. RESULTS: Children up to age 13 with two-sided migration background had lower utilization of specialist doctors compared to those without migration background (OR = 0.64 [0.56-0.74]). However, among the 14- to 17-year-olds, the utilization did not differ significantly (OR = 0.79 [0.60-1.03]). The lower use of outpatient medical care is associated with a shorter length of stay and limited German language skills. In addition, parents from Poland and the former Soviet Union are less likely to be very satisfied with the last outpatient treatment of their 0­ to 13-year-old child, even after adjustments for German language skills and length of stay. CONCLUSION: To make it easier for children with migration background to access specialist services, it is important to reduce language barriers in outpatient medical care and to promote processes of intercultural opening.

[Socio-demographic and employment-related factors in the German National Cohort (GNC; NAKO Gesundheitsstudie)]. / Soziodemografische und erwerbsbezogene Merkmale in der NAKO Gesundheitsstudie.

BACKGROUND: In epidemiologic studies, standardised measurement of socio-demographic and employment-related factors is becoming increasingly important, as variables such as gender, age, education or employment status are factors influencing health and disease risks. AIMS: The article gives an overview of the scientific background and assessment of socio-demographic factors in the German National Cohort Study. In addition, the distribution of individual characteristics in the cohort as well as relationships with health-related measures are presented by way of example. MATERIAL AND METHODS: The analysis is based on the data of the first half of the baseline survey (n = 101,724). On this basis, we present the distribution of key socio-demographic characteristics and analyse relationships with exemplary selected health indicators (body mass index, self-reported health) to assess the validity of socio-demographic data measurements. RESULTS: On average, study participants were 52.0 years old (SD = 12.4). Of the participants, 53.6% were women, 54.3% had high education, 60.1% were married and 72% were employed while 3.4% were unemployed. Well-established correlations between socio-demographic factors and health could be reproduced with the German National Cohort data. For example, low education, old age and unemployment were associated with an increased prevalence of obesity and poor self-reported health. DISCUSSION: The German National Cohort provides a comprehensive measurement of socio-demographic characteristics. Combined with a wide range of health data and the longitudinal measurements available in the future, this opens up new opportunities for health science and social epidemiological research in Germany.

[Single Parents in Germany: The Interrelation Between Social Support and Mental Health]. / Alleinerziehende Eltern in Deutschland: Der Zusammenhang zwischen sozialer Unterstützung und psychosozialer Gesundheit.

The lives of single mothers and fathers are associated with specific demands, which may result in higher psychosocial and physical strain compared to parents sharing their household with a partner. In this context, social support is known to function as a protective resource. The present article examines how different levels of social support interrelate with levels of mental health in single mothers and fathers in Germany. The data is drawn from the surveys 2009, 2010 and 2012 of the study "German Health Update" (GEDA) by the Robert Koch Institute. The sample includes 2062 single mothers and 242 single fathers. Logistic and negative binomial regressions estimate the interrelation between social support and psychosocial strain (self-reported number of unhealthy days due to psychological strain in the last 4 weeks) and depression (12-month prevalence) for single parents (adjusted for family and socio-economic factors). Single mothers with low social support have a 2-fold statistical odds (OR=2.0, 95% CI: 1.35-2.87) for at least one unhealthy day due to psychosocial strain compared to single mothers with strong social support. The odds for single fathers with low social support are 3.3-fold (95%-CI: 1.09-10.23). Furthermore, the number of unhealthy days increased by a factor of 1.4 (95%-CI: 1.20-1.66) for single mothers with low social support (IRR). The IRR for single fathers of the same group was 1.7-fold (95%-KI: 0.97-3.01). The odds of reported depression in the past twelve months is 1.8-fold (95%-CI: 1.18-2.67) for single mothers and 2.1 (95%-CI: 0.51-8.83) for single fathers with low social support compared to single parents with high social support. The results show that social support is an important resource for the mental health of single parents, regardless of other social circumstances. The results identify key populations to target for future health interventions. However, the correlations between social support and socio-economic status have to be explored further.

[Effects of poverty for health and health behavior of children and adolescents : Results from KiGGS Wave 2]. / Auswirkungen von Armut auf den Gesundheitszustand und das Gesundheitsverhalten von Kindern und Jugendlichen : Ergebnisse aus KiGGS Welle 2.

INTRODUCTION: Differences in the health status and health behavior of children and adolescents are analyzed, taking the income situation of the family into account. METHOD: The data is based on the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). Health outcomes are the subjective health, chronic health limitations, mental disorders, ADHD, consumption of fresh fruit, consumption of sugary soft drinks, physical activity, sports activity during leisure time, overweight, and obesity. The income situation is recorded using the equivalized household income. RESULTS: Poor children and adolescents are more likely to have health problems than their peers from the middle- and, especially, the high-income group; their health behavior is less favorable. The biggest relative income-related differences are found in subjective health. With statistical control for parental education and occupational status, income-related differences in health status remain consistent while being significantly reduced for health behavior. DISCUSSION: The results confirm that low family income has a significant impact on the health of children and adolescents. Partly, this also applies to their health behavior, whereby the observed differences between the income groups can be attributed mainly to parental education and occupational status. This shows once again that children and adolescents growing up in poverty should be a key target group for prevention and health promotion.

[Socioeconomic differences in health and need for care among the elderly]. / Sozioökonomische Unterschiede in der Gesundheit und Pflegebedürftigkeit älterer Menschen.

In view of the continuing increase in life expectancy, the question arises as to the state of health in which these years of gained life can be spent. The research findings on social differences in health and life expectancy suggest that this question has to be answered differently for different population groups. Even after the age of 65, persons with a low socioeconomic status are more likely to be affected by chronic illnesses and complaints, functional limitations of everyday activities, as well as impairments of well-being and health-related quality of life. With a significant proportion of people with low socioeconomic status still dying prematurely, the increase in lifetime that is observed for all population groups could increase the social gap in health in later life. This implies the challenge of giving special attention to the needs of socially disadvantaged groups in policies and programs aiming to improve the health of older people and preventing the need for care.

[Associations of maternal educational background with health and health behavior in infants]. / Der Bildungsstand von Müttern im Zusammenhang mit der Gesundheit und dem Gesundheitsverhalten ihrer Kleinkinder.

BACKGROUND: The basis for healthy development is established during the first years of one's life. In this early phase, parents can significantly influence the health conditions under which their child grows up. Parental education can play a key role in this regard. This study examines the association of maternal education with health and health behavior in infants. METHODS: A subsample of the representative German KiGGS study (Wave 1, 2009-2012) on the health of children and adolescents was investigated. Data from 1727 mothers who reported on health-specific characteristics of their infants (0 to 2 years), on their own educational background, and on characteristics of the family were analyzed. The influence of maternal education on indices of health and health behavior in infants was investigated by means of logistic regression; additional predictors were considered in regression models. RESULTS: Higher maternal education was associated with better health behavior, but not with overall infant health. The impact of maternal education on health behavior remained significant when considering other predictors (financial worries, low maternal age at childbirth, premature birth/low birth weight). Overall, low maternal education was accompanied by an accumulation of additional risks. CONCLUSIONS: Higher maternal education can help infants have a good start in their lives. The impact of poor health behavior on infant health may not become apparent until later in their lives. For prevention and intervention, it is important to identify sensitive stages of development during childhood and the underlying mechanisms of the relationship between maternal education and infant health behavior.

[Improving access to migrant populations for epidemiological research-guided interviews with German experts]. / Zugangswege zu Menschen mit Migrationshintergrund für die epidemiologische Forschung ­ eine Befragung von Expertinnen und Experten.

BACKGROUND: In Germany, reliable information on the health of people with migration background (PMB) is scarce. Therefore, the Robert Koch Institute initiated the project "Improving health monitoring in migrant populations (IMIRA)" to improve the inclusion of PMB into the federal health monitoring. OBJECTIVE: The objective of this article is to identify challenges and strategies in accessing migrant populations with epidemiological research. MATERIAL AND METHODS: A total of 24 guided interviews with experts from Germany were conducted. Experts were scientists from various disciplines with a research focus on migration, civil servants in the area of migration, and experts from the field. The interview focused on challenges and strategies regarding access to migrants in research. The written summaries of the interviews were analyzed. RESULTS: Challenges in accessing PMB include language, sociodemographic and cultural barriers, fears, structural, and practical difficulties. Further challenges arise from the heterogeneity and motivation of the groups. Strategies to increase accessibility among PMB can be found in the research process, methods, communication, and diversity-sensitive research culture. Confidence-building is considered significant. DISCUSSION: Experts report a variety of strategies that focus on addressing and including PMB directly: strengthening of participatory approaches, new forms of translation, and measures to increase trust in research should be the focus of future efforts. The willingness to participate in epidemiological research can be increased with appropriate strategies and thus data on the health of migrant populations can be improved sustainably.

[The health status of children and adolescents with migration background in Germany : Results from KiGGS Wave 2]. / Zur gesundheitlichen Lage von Kindern und Jugendlichen mit Migrationshintergrund in Deutschland : Ergebnisse aus KiGGS Welle 2.

BACKGROUND: Even though 36.5% of children and adolescents living in Germany have a migration background (MB), data on the health of this population is scarce. With population-based data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), reliable statements can be given. METHODS: Data from KiGGS Wave 2 is used in order to report on general health status, mental health, and the distribution of allergic diseases among children and adolescents aged 3-17 years (n = 13,568). To determine overweight, standardized measurements of body weight and height (n = 3463) were used. In addition to the MB (none/one-sided/two-sided), the socioeconomic status (SES) is considered. In multivariate analyses among children and adolescents with MB, SES and the parents' duration of stay in Germany were included. RESULTS: Participants with a two-sided MB show lower prevalence of neurodermatitis (3.5% vs. 6.9%) and ADHS (2.0% vs. 5.1%) than those without a migration background and higher prevalence of fair to poor general health status (6.1% vs. 3.9%). Children and adolescents with a two-sided migration background are more often affected by overweight than those without migration background (22.1% vs. 12.2%). After considering SES, the chances of a diagnosed neurodermatitis and ADHS remain higher and the chances for overweight are lower in children and adolescents with a migration background than among those without migration background. If only children with MB are considered, SES and partially the parents' duration of stay in Germany are associated with health outcomes. CONCLUSION: Differences in the general health status of children and adolescents with and without MB vary depending on the observed indicators. The heterogeneity of children and adolescents with MB, e.g. regarding SES and parents' duration of stay, should be considered when planning and implementing measures of health promotion.

[Socioeconomic inequalities in health in later life]. / Soziale Ungleichheit und Gesundheit im höheren Lebensalter.

BACKGROUND: Socioeconomic differences in health and life expectancy are key issues for public health and health policy. In the course of demographic change, in addition to childhood, adolescence and middle adulthood, old age is increasingly becoming the focus of attention in research on health inequalities, with a special emphasis on the transition from working age to retirement. OBJECTIVE: How do health inequalities change in the transition from middle to older age and then to very old age? MATERIAL AND METHODS: This article reviews the studies available for Germany, supplemented with new analyses based on the German Health Update study and the German Socioeconomic Panel study. In order to set the findings in the context of international research on health inequalities in old age, selected studies from other countries and international comparative studies are additionally considered. RESULTS: Social differences in health and remaining life-expectancy also exist in older age, although to a slightly lesser extent than in middle age. There is evidence that as age progresses, health inequalities narrow in some health domains but there is also isolated evidence that health inequalities may widen with age. CONCLUSION: The existence of health inequalities in old age indicates that older people from disadvantaged social groups have a particular need for healthcare and support. This poses special challenges for the medical, nursing and psychosocial care system as well as for the social security systems.

Trends in Absolute and Relative Educational Inequalities in Adult Smoking Since the Early 2000s: The Case of Germany.

Introduction: Since the early 2000s, several tobacco control policies have been implemented in Germany. Current research is inconsistent about how strengthening tobacco control can affect social inequalities in smoking. This study examines whether educational inequalities in adult smoking have widened in Germany since 2003. Methods: Data were used from four cross-sectional national health surveys conducted between 2003 and 2012 (n = 54,197; age = 25-69 years). Participants who smoked daily or occasionally were classified as smokers. The regression-based Slope Index of Inequality and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in smoking, respectively. Results: In each survey year, smoking was associated with lower education. Overall, crude and age-standardized smoking rates declined over time. Stratified by education, trends of declining smoking rates were observed only in the high and medium education groups, whereas no statistically significant trend was found in the low education group. Relative educational inequalities in smoking increased significantly in men (2003: RII=1.74, 95% confidence interval 1.46 to 2.07; 2012: RII = 2.25, 95% confidence interval 1.90 to 2.67; p-trend = .019). Absolute educational inequalities in smoking were not found to have changed significantly during the study period. Conclusions: In the course of declining smoking rates, educational inequalities in smoking persisted in both absolute and relative terms. In men, relative inequalities in smoking may even have widened within only 9 years. Tobacco control policies should not only be targeted at the entire population but also attempt to reduce social inequalities in smoking by focusing more on socially disadvantaged groups. Implications: Smoking is associated with lower education in most European countries and contributes to social inequalities in health. Since the beginning of the 2000s, Germany has implemented a variety of tobacco control policies to reduce smoking in the population. This study reveals that despite a general decline in adult smoking, educational inequalities in smoking have persisted and even widened in Germany since 2003. The findings emphasize that more targeted efforts are needed to tackle smoking-induced inequalities in health.

[Differences in subjective health, mental health, and health behavior among 11- to 17-year-olds at secondary schools in Germany : Results of the German health interview and examination survey for children and adolescents: first follow-up (KiGGS Wave 1)]. / Unterschiede in der subjektiven und psychischen Gesundheit und im Gesundheitsverhalten bei 11- bis 17-jährigen Jugendlichen an weiterführenden Schulen in Deutschland : Ergebnisse der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland: Erste Folgebefragung (KiGGS Welle 1).

BACKGROUND: Social inequalities in health can already be found among children and adolescents to the disadvantage of socially deprived population groups. This paper aims to detect, whether differences in subjective health, mental health and health behavior among young people are due to the secondary school type attended and whether these associations exist independently of the family's socioeconomic position (SEP). METHODS: The data basis was the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 1, 2009-2012). Data of 11- to 17-year-old girls and boys (n = 4665) who attend different types of secondary schools in Germany were analyzed. The dependent variables were self-rated health, findings of the Strengths and Difficulties Questionnaire (SDQ) for the detection of psychological abnormalities, as well as self-reported information regarding leisure sport, tobacco, and alcohol consumption. Prevalence and odds ratios (ORs) based on logistic regressions are shown. RESULTS: For the majority of the examined indicators, it can be shown that adolescents in lower secondary schools are more likely to report worse self-rated health and mental problems and engage in unhealthy behavior than peers in grammar schools ("Gymnasium"). The differences decrease after controlling for family's SEP but mostly remain statistically significant. Adolescents who don't attend grammar schools are most strongly disadvantaged in terms of inattention/hyperactivity for both gender (OR: 2.29 [1.70-3.08]), smoking among girls (2.91 [1.85-4.57]) and physical inactivity (no leisure sport) among boys (OR: 2.71 [1.85-3.95]). DISCUSSION: Unequal health opportunities should be viewed in relation to people's living conditions. For adolescents, school constitutes an important setting for learning, experience, and health. The results indicate divergent needs of school-based health promotion and prevention regarding differences among gender and type of school.

[Trends in smoking among adults in Germany : Evidence from seven population-based health surveys from 1991-2015]. / Zeitliche Trends beim Rauchverhalten Erwachsener in Deutschland : Ergebnisse sieben bundesweiter Gesundheitssurveys 1991­2015.

BACKGROUND: Despite decreasing smoking prevalence, tobacco use remains a key public health problem in Germany. For planning, managing, and evaluating tobacco control measures, regular data collection on smoking behavior in the population is essential. The aim of this article is to present trends in adult tobacco use since the early 1990s based on data from the health monitoring of the Robert Koch-Institute (RKI). METHODS: Analyses are based on data from 106,158 individuals aged 18 to 79 years, who participated in seven RKI health surveys from 1991-2015. Trends in tobacco consumption were analyzed using different indicators of smoking behavior, stratified by age, cohort, and gender. RESULTS: An overall falling smoking prevalence can be attributed primarily to a significant decline in the younger age groups since the early 2000s. Trend analysis by cohort reveals a declining prevalence for almost all cohorts over time from 1991-2015. Historically there has been is a sharp increase in the prevalence of women who have ever smoked between the 1930-1934 and 1950-1959 cohorts. The proportion of men who have ever smoked slightly decreased between the 1930-1934 and 1980-1984 cohorts. DISCUSSION: The shown overall decline happened concurrently with various tobacco prevention measures implemented during this period in Germany. If present trends related to continuous high smoking rates are sustained, it can be assumed that the tobacco consumption of the population will remain the source of adverse health outcomes. Accordingly, tobacco prevention measures and the promotion of smoking cessation in all age groups should be a public health priority.