Relative and absolute socioeconomic inequality in smoking: time trends in Germany from 1995 to 2013.

PURPOSE: This study aimed to investigate time trends in relative and absolute socioeconomic inequality in smoking prevalence in Germany using several indicators for socioeconomic position. METHODS: We conducted a repeated cross-sectional study using representative samples of the German population aged between 25 and 64 years in 1995, 1999, 2005, 2009, and 2013 (n = 857,264). Socioeconomic position was measured by indicators for income, education, and occupation. Relative and absolute socioeconomic inequalities were estimated with the regression-based relative index of inequality and the slope index of inequality, respectively. Trends in inequalities were estimated with interaction terms for time and relative index of inequality/slope index of inequality. RESULTS: Highest and increasing smoking prevalence was observed among long-term unemployed and people with less than 60% of the median household income. Between 1995 and 2013, relative increases in inequalities in smoking prevalence ranged from 31% (95% confidence interval, 26%-36%; men, occupation) to 94% (95% confidence interval, 84%-104%; women, education). Absolute increases ranged from 6.2 (95% confidence interval, 4.7-7.6) percentage points (men, occupation) to 20.3 (95% confidence interval, 18.9-21.7) percentage points (women, education). CONCLUSIONS: Relative and absolute socioeconomic inequalities in smoking prevalence increased in Germany between 1995 and 2013, with regard to income, education, and occupation, particularly among women.

Design and methods for a cluster-controlled trial conducted at sixty-eight daycare facilities evaluating the impact of "JolinchenKids - Fit and Healthy in Daycare", a program for health promotion in 3- to 6-year-old children.

BACKGROUND: The prevention of overweight and obesity during infancy is a highly relevant public health topic given the significant impact of childhood obesity on acute and chronic diseases, general health, and well-being in later stages of life. Apart from the family setting, daycare facilities (DFs) represent a key setting for health promotion among children under the age of six years. "JolinchenKids - Fit and Healthy in Daycare" is a multi-component program promoting physical activity (PA), healthy eating, and mental well-being in 3- to 6-year-old preschoolers at DFs, originally designed by the German health insurance AOK. To evaluate program effectiveness, a cluster-controlled trial involving 68 DFs is currently conducted. The objective of this article is to describe the background, study design, and aims of this trial. METHODS/DESIGN: Sixty-eight DFs across Germany will be recruited to take part in the study, half of them serving as intervention DFs and half of them as delayed intervention control DFs (which receive the program upon completion of the study). At each DF, height, weight, and body composition, as well as motor skills, will be assessed in twenty 3- to 6-year-old children. Children's eating and PA habits, and mental well-being will be assessed via parental questionnaires. A subsample of children (i.e., at 24 DFs which are randomly selected within a geographic region) will be asked to wear accelerometers at their wrists to objectively measure PA over the course of seven days. To compare changes in body composition, motor skills, eating and PA habits, and mental well-being of children at intervention DFs with those observed among children at delayed intervention control DFs over one year, all measurements will take place at baseline and twelve months after the launch of the program at all DFs. DISCUSSION: This study investigates the influence of a health promotion program in the daycare setting on various outcomes, including body composition and objectively measured PA, in a nationwide sample of 3- to 6-year-old preschoolers. This study will provide evidence regarding the effectiveness of a multi-component program for health promotion in this setting and may provide insights into new strategies for preventing obesity in early life. TRIAL REGISTRATION: German Clinical Trials Register DRKS00011065 (Date of registration 16-09-2016).

Development and evaluation of a tool for retrospective exposure assessment of selected endocrine disrupting chemicals and EMF in the car manufacturing industry.

OBJECTIVES: A system for retrospective occupational exposure assessment combining the efficiency of a job exposure matrix (JEM) and the precision of a subsequent individual expert exposure assessment (IEEA) was developed. All steps of the exposure assessment were performed by an interdisciplinary expert panel in the context of a case-control study on male germ cell cancer nested in the car manufacturing industries. METHODS: An industry-specific JEM was developed and automatic exposure estimation was performed based on this JEM. A subsample of exposure ratings was done by IEEA to identify determinants of disagreement between the JEM and the individual review. Possible determinants were analyzed by calculating odds ratios (ORs) of disagreement between ratings with regard to different dimensions (e.g. high versus low intensity of exposure). Disagreement in ≥20% of the sampled exposure ratings with a statistically significant OR was chosen as a threshold for inclusion of the exposure ratings into a final IEEA. RESULTS: The most important determinants of disagreement between JEM and individual review were working outside of the production line (disagreement 80%), low probability of exposure (disagreement 25%), and exposure depending on specific activities like usage of specific lacquers (disagreement 32%) for jobs within the production line. These determinants were the selection criteria of exposure ratings for the subsequent final IEEA. CONCLUSIONS: Combining a JEM and a subsequent final IEEA for a selected subset of exposure ratings is a feasible and labor-saving approach for exposure assessment in large occupational epidemiological studies.