Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries.

BACKGROUND: Recently a scale was introduced to quantify the implementation of tobacco control policies at country level. Our study used this scale to examine the potential impact of these policies on quit ratios in European countries. Special attention was given to smoking cessation among lower educational groups. METHODS: Cross-sectional data were derived from national health surveys from 18 European countries. In the analyses we distinguished between country, sex, two age groups (25-39 and 40-59 years) and educational level. Age-standardised quit ratios were calculated as total former-smokers divided by total ever-smokers. In regression analyses we explored the correlation between national quit ratios and the national score on the Tobacco Control Scale (TCS). RESULTS: Quit ratios were especially high (>45%) in Sweden, England, The Netherlands, Belgium and France and relatively low (<30%) in Lithuania and Latvia. Higher educated smokers were more likely to have quit smoking than lower educated smokers in all age-sex groups in all countries. National score on the tobacco control scale was positively associated with quit ratios in all age-sex groups. The association of quit ratios with score on TCS did not show consistent differences between high and low education. Of all tobacco control policies of which the TCS is constructed, price policies showed the strongest association with quit ratios, followed by an advertising ban. CONCLUSION: Countries with more developed tobacco control policies have higher quit ratios than countries with less developed tobacco control policies. High and low educated smokers benefit about equally from the nationwide tobacco control policies.

Applying an equity lens to tobacco-control policies and their uptake in six Western-European countries.

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

[Professional status and development of morbidity of health insurance patients in the period 1990 to 2003. A longitudinal Analysis of Routine Data from the Gmünder Ersatzkasse]. / Berufsstatus und Morbiditätsentwicklung von Krankenversicherten im Zeitraum 1990 bis 2003. Eine Längsschnittsanalyse mit Routinedaten der Gmünder Ersatzkasse.

In Germany there are only insufficient data both with regard to general morbidity events as well as with regard to the effects of specific professions on the morbidity process. For this reason the data of the Gmuender Ersatzkasse (GEK) have been analysed with a longitudinal design for the period 1990 to 2003. Our sample includes all employed members of the GEK who had been insured as of January 1, 1990 and were between 30 and 59 years old at this baseline. The total sample comprises 129,173 men and 13,567 women. The statistical analysis was performed with the statistical package "Transitional Data Analysis" (TDA) which was developed especially for longitudinal data. The analysis includes both cumulated morbidity rates as well as transition rates (Cox regression). The analysis shows that the cumulated morbidity rates of the seven diseases are higher for women than for men in the age category 30-39 years. In the age categories 40-49 and 50-59 years the cumulated morbidity rates are higher for men than for women. With regard to the occupations, the highest morbidity rates are found for manual occupations and services without special skills. The lowest rates are found for professions with high skills, engineers and managers. The results of the longitudinal analysis show distinctive social gradients. For occupations with lower skills the morbidity rates are about 100 percent higher than those of occupations with higher skills. Longitudinal analyses on the basis of health insurance fund data can make an important contribution to the monitoring of health and morbidity and should therefore be conducted also by other health insurance funds.

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education.

OBJECTIVE: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. DESIGN: Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. SETTING: Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. PARTICIPANTS: 451 386 non-institutionalised men and women 25-79 years old. MAIN OUTCOME MEASURES: Smoking status, daily quantity of cigarettes consumed by smokers. RESULTS: Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. CONCLUSIONS: Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

Moderate and vigorous leisure-time physical activity and cardiovascular disease risk factors in West Germany, 1984-1991.

The relationship between leisure-time physical activity (LTPA) and cardiovascular disease (CVD) risk factors was analysed based on data of three cross-sectional National Health Surveys, carried out in West Germany between 1984 and 1991. A total of 7663 males and 7722 females, aged 25-69 years, were examined. A self-administered questionnaire was used to assess LTPA which was defined as the mean duration of time (in minutes) spent during the past week on 14 specified sports during the previous 3 months. The mean time for LTPA per week was 102 minutes for males and 70 minutes for females. No significant differences were observed in LTPA mean duration for the three surveys. Younger age and higher social class were strong predictors for greater LTPA. In multiple linear regression models, after adjustment for age and social class, LTPA was significantly associated with lower systolic and diastolic blood pressure (both sexes), total cholesterol (males only), cigarette smoking (males only) and body mass index (females only), and with higher HDL-cholesterol (both sexes). The data suggest that LTPA plays an important role if aiming at reducing CVD risk factors in the general population.

Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme.

BACKGROUND: This paper describes morbidity differences according to occupational class among men from France, Switzerland, (West) Germany, Great Britain, the Netherlands, Denmark, and Sweden. METHODS: Data were obtained from national health interview surveys or similar surveys between 1986 and 1992. Four morbidity indicators were included. For each country, individual-level data on occupation were recorded according to one standard occupational class scheme: the Erikson-Goldthorpe social class scheme. To describe the pattern of morbidity by occupational class, odds ratios (OR) were calculated for each class using the average of the population as a reference. The size of morbidity differences was summarized by the OR of two broad hierarchical classes. All OR were age-adjusted. RESULTS: For all countries, a lower than average prevalence of morbidity was found for higher and lower administrators and professionals as well as for routine nonmanual workers, whereas a higher than average prevalence was found for skilled and unskilled manual workers and agricultural workers. Self-employed men were in general healthier than the average population. The relative health of farmers differed between countries. The morbidity difference between manual workers and the class of administrators and professionals was approximately equally large in all countries. Consistently larger inequality estimates, with no or slightly overlapping confidence intervals, were only found for Sweden in comparison with Germany. CONCLUSIONS: Thanks to the use of a common social class scheme in each country, a high degree of comparability was achieved. The results suggest that morbidity differences according to occupational class among men are very similar between different European countries.

Social class and risk factors for coronary heart disease in the Federal Republic of Germany. Results of the baseline survey of the German Cardiovascular Prevention Study (GCP).

The relationship between social class and seven important risk factors for coronary heart disease has been evaluated utilising data from the German Cardiovascular Prevention Study baseline survey. Of German residents aged 25 to 69 years, 16,430 were randomly selected from both the six intervention regions and the Federal Republic of Germany to undergo the screening procedures between 1984 and 1986. Among males the prevalence of cigarette smoking and lack of physical activity was associated with social class. For females, overweight and physical activity demonstrated a strong social gradient. No relationship existed between social class and hypercholesterolaemia. The prevalence of Type A behaviour was significantly higher for the upper social classes. The number of CHD risk factors per study subject increased with decreasing social class. Predicted cardiovascular mortality was clearly higher for the lower social class among males in general and for females younger than 60 years. These findings point to the need for risk factor intervention strategies focusing more on the lower social classes in order to achieve more adequate prevention of coronary heart disease.

Differences in self reported morbidity by educational level: a comparison of 11 western European countries.

STUDY OBJECTIVE: To assess whether there are variations between 11 Western European countries with respect to the size of differences in self reported morbidity between people with high and low educational levels. DESIGN AND METHODS: National representative data on morbidity by educational level were obtained from health interview surveys, level of living surveys or other similar surveys carried out between 1985 and 1993. Four morbidity indicators were included and a considerable effort was made to maximise the comparability of these indicators. A standardised scheme of educational levels was applied to each survey. The study included men and women aged 25 to 69 years. The size of morbidity differences was measured by means of the regression based Relative Index of Inequality. MAIN RESULTS: The size of inequalities in health was found to vary between countries. In general, there was a tendency for inequalities to be relatively large in Sweden, Norway, and Denmark and to be relatively small in Spain, Switzerland, and West Germany. Intermediate positions were observed for Finland, Great Britain, France, and Italy. The position of the Netherlands strongly varied according to sex: relatively large inequalities were found for men whereas relatively small inequalities were found for women. The relative position of some countries, for example, West Germany, varied according to the morbidity indicator. CONCLUSIONS: Because of a number of unresolved problems with the precision and the international comparability of the data, the margins of uncertainty for the inequality estimates are somewhat wide. However, these problems are unlikely to explain the overall pattern. It is remarkable that health inequalities are not necessarily smaller in countries with more egalitarian policies such as the Netherlands and the Scandinavian countries. Possible explanations are discussed.

Social inequities in cardiovascular disease risk factors in East and West Germany.

Social class related differences in prevalence of cardiovascular disease risk factors in Germany were investigated with special emphasis on comparisons between East and West Germany and on time trends. Databases for West Germany are the first and second National Health Survey (survey 1: N = 4794, survey 2: N = 5315), carried out in the framework of the German Cardiovascular Prevention Study, and for East Germany the first GDR-MONICA project (N = 6125). Different social class indices were applied to evaluate social inequities for hypertension, hypercholesterolemia, cigarette smoking, obesity and predicted cardiovascular disease mortality. As a main result, it was found that very similar patterns in the relation between social class characteristics and cardiovascular disease risk factor prevalence occurred for both parts of Germany. Social class gradients were strongest for obesity and weakest for hypercholesterolemia. Analysis of time trends for the period from 1984 to 1988 (for West Germany only) revealed an increase in social inequalities for hypertension in males and cigarette smoking in females. These findings point to the need to focus more on social disadvantaged segments in the population when community based health promotion and disease prevention programs are brought into action.

Relation between body height and self-reported myocardial infarction in Germany.

BACKGROUND: Several studies have reported an association between body height and the incidence of myocardial infarction. METHODS: We analyzed data from regional and national health surveys that were conducted from 1984-1992 within the framework of the German Cardiovascular Prevention Study. Eligible survey candidates were males and females with German nationality in the age group 25-69 years. The total number of subjects in our study comprised 12,447 males and 13,355 females. The assessment of whether a respondent had ever undergone a myocardial infarction was based on self-reporting by the subject. Multiple logistic regression analyses, controlling for several confounding factors, were carried to calculate odds ratios to estimate th effect of body height on the prevalence of self-reported myocardial infarction, comparing each body-height quintile with the shortest group, which served as the reference group. RESULTS: Without adjusting for confounding variables, a strong association between body height and self-reported myocardial infarction was found in both genders (trend test: p < 0.001), with an unadjusted odds ratio (OR) of 0.41 for males and 0.33 for females. After adjusting for age, the ORs increased to 0.67 (p < 0.05) in males and 0.58 (p < 0.05) in females for quintile 5 (tallest) compared with quintile 1 (shortest). After an additional adjustment for community size, region, social class, and number of CVD risk factors, the ORs of myocardial infarction for quintile 5 (males OR = 0.78, females OR = 0.68) were higher than those for quintile 1, but the results were no longer statistically significant. CONCLUSIONS: Despite the lack of statistical significance, we suggest that the differences in the prevalence of myocardial infarction for the five height quintiles cannot be explained by confounding factors alone. The underlying causes for such height-specific differences remain unknown.

Antihypertensive treatment and serum cholesterol: results of population-based surveys in the German Cardiovascular Prevention Study.

We analyzed the data from three cross-sectional, population-based surveys in West Germany to evaluate the effect of antihypertensive drug therapy on the level of serum cholesterol in German residents (18,344 males; 19,137 females) aged 25-69 years, after excluding persons with missing values (N = 5529) for any study variable. The data were obtained from the national and regional health surveys that were conducted during the years 1984-1992, within the framework of the German Cardiovascular Prevention Study (GCP). The response rates were between 66.0% and 71.4% for the national surveys and between 65.9% and 83.3% for the regional surveys. Blood-pressure and non-fasting cholesterol measurements were carried out under strictly standardized conditions. Multiple linear regression analysis was used to compare the age-adjusted mean value and prevalence for each of the following study variables: total serum cholesterol, HDL-cholesterol, non-HDL cholesterol, and the ratio of HDL cholesterol/total cholesterol for users and non-users of antihypertensive medications. Antihypertensive medications were reportedly taken during the seven days preceding the survey examination by 7.8% of all males and 10.4% of all females. The beta-blocker type of medication was prescribed most frequently for lowering high blood pressure. In both genders, the strongest age-adjusted effect of an increase in cholesterol level was found for beta-blockers. The difference in the age-adjusted means for non-HDL cholesterol values between users and non-users of beta-blockers was 9.2 mg/dL (p < 0.001) in males and 9.0 mg/dL (p < 0.001) in females. Regression analysis carried out to control for several potential confounders confirmed the results. The findings suggest that mass treatment of hypertension with beta-blockers may be associated with reductions in benefit because of an increase in non-HDL and a decrease in HDL cholesterol levels.

The impact of occupation on self-reported cardiovascular morbidity in western Germany: gender differences.

BACKGROUND: In Germany, research is sparse on the associations between occupation and cardiovascular risk factors and disease or whether such associations differ for men and women. METHODS: We analyzed the data from 12,093 males and 12,125 females aged 40-69 years, who participated in three regional and national health surveys that were conducted in western Germany between 1984-1991 as part of the German Cardiovascular Prevention Study. Hypertension, total and HDL cholesterol levels, and obesity were based on standardized measurements, whereas smoking, diabetes, and history of myocardial infarction, stroke, and angina pectoris were based on self-report, using standardized questionnaires. Occupations were categorized into 13 (males) or 12 (females) groups as proposed by Blossfeld, as well as according to the 30 most frequent specific occupations. Multiple logistic regression analyses were used to adjust for age, cardiovascular risk factors, and socio-economic status (SES). RESULTS: Among males, after adjusting for age, cardiovascular risk factors and SES, all 12 occupational groups had significantly elevated odds rations for the prevalence of cardiovascular disease when compared with the reference category of professionals. Among females, no significant increase in cardiovascular disease was found in any of the 11 main occupational groups. Teachers were used as the reference category for the 30 most frequent occupations. In males, five occupations (carpenter, locksmith, warehouse clerk, doorman, and driver) yielded significantly elevated age-adjusted odds ratios for the prevalence of self-reported cardiovascular disease. In females, we found significant associations with cardiovascular disease only for two occupations (kindergarten-teacher and cook). CONCLUSION: The findings suggest that certain aspects of the workplace and its culture, particularly in blue-collar occupations, influence the cardiovascular risk in men to a greater extent than in women.

Social correlates of cigarette smoking cessation: findings from the 1995 microcensus survey in Germany.

BACKGROUND: An increasing percentage of smokers are quitting this unhealthy behavior during their life course. The aim of this study is to analyze which social factors play an important role regarding ex-smoking in Germany. METHODS: Data were derived from the 1995 German Microcensus, which is a representative survey for the population in Germany. Included in the analysis were 44,553 current smokers and 23,780 ex-smokers. The independent variables were education, occupational status, family status, unemployment/social welfare, household income, and community size. A two-stage statistical modeling procedure was used, initially to assess the most important effects of the independent variables on smoking cessation and secondly, to analyze the cumulative effects of the independent variables. RESULTS: The most striking effects observed for smoking cessation were family status and education. For example, in males aged 30 to 49 years, the percentages of ex-smokers of all ever smokers were 44.7% for married males with high education compared with only 14.6% for males with low education. The corresponding percentages for females were 44.0% and 17.6%. CONCLUSIONS: Such striking differences in the social polarization of smoking cessation in Germany demonstrate the importance of anti-smoking policies and new strategies that avoid a further increase in the social inequality of smoking behavior.

Poverty, health, and nutrition in Germany.

OBJECTIVE: To investigate the relation between poverty and several variables describing health and nutrition behavior in East Germany and West Germany. METHODS: Data are from the third National Health Survey in West Germany and the first Health Survey for the new federal states of Germany (1991/92). Both health surveys included a self-administered questionnaire ascertaining sociodemographic variables, smoking history, nutritional behavior (using a food-frequency list), physical activity, and a medical examination comprising measurements of height, weight, blood pressure, and blood sampling for serum cholesterol determination. Participants included 4958 subjects in the West Survey and 2186 subjects in the East Survey aged 25-69 years, with a respective net response rate of 69.0% and 70.2%. Poverty was defined as a household equivalence income of 62.5% or less of the median income of the general population. RESULTS: The lowest income group (poverty or near poverty) comprised 11.6% of East German versus 15.9% of West German males and 14.8% of East German versus 19.3% of West German females. For most but not all health and nutrition parameters, less favorable results were obtained for subjects with an equivalence income below or near poverty. The most striking poverty-related differences regarding cardiovascular disease risk factors were found for lack of regular exercise for both genders and obesity in females. No poverty-related differences were found for the prevalence of hypercholesterolemia, despite a much higher prevalence of obesity in persons with an income below the poverty line. Current nutritional behavior and changes in nutritional behavior during the last three years was strongly related to income status, with a more unhealthy status for low-income population groups in both East and West Germany. CONCLUSIONS: In Germany, poverty has strong effects on individual health status and nutritional behavior. Because of rising unemployment rates and reductions in social security payments for low-income groups, it is likely that the negative consequences of poverty on health are increasing.

Association between malignant tumors of the thyroid gland and exposure to environmental protective and risk factors.

Risk factors for thyroid carcinomas and adenomas were investigated using a standard questionnaire in a case-control study in Southwestern Germany, a known iodine deficiency area. A clinical registry, set up after the Chernobyl accident at the University hospital Mannheim, served as the basis for 174 incident cases of each diagnostic group. Interview data were compared within and with prevalences from a population-based matched control group of equal size from the entire area. The protective role of coffee drinking and the consumption of cruciferous vegetables, such as broccoli, were confirmed for both genders. A high consumption of tomatoes (> 200/year) was associated with an elevated risk of > 2.5 for malignant tumors but not for benign tumors in both genders. In both genders, both treatment for goiter (hyperthyroidism) and decaffeinated coffee consumption were associated with an increased risk for malignant tumors, but less so for adenomas. In women, early menarche (< 13 years) and stillbirth after first pregnancy, as well as hysterectomy, were substantial risk factors. Occupational variables and radiation, including medical indications and mammography, did not reveal particular risks. We did not address the role of regular iodine substitution, but did analyze the consumption of freshwater fish and seafood. Multivariate analyses of the most prominent risk factors confirmed the persistence of tomato consumption as a risk factor. In view of experimental evidence on the carcinogenicity of organophosphates and the neurotoxicant effect of certain agrochemicals on neuroendocrinologically regulated organs, we postulate that in Germany, importing off-season tomatoes from areas with a known history of possible inexperienced use of agrochemicals may be associated with a promoting effect for malignant neoplasias of the thyroid gland in terms of promoting already existent proliferating tissue growth.

Social gradient of CVD risk in Germany before/after unification.

A social gradient of cardiovascular risk has been found in several European countries, including the former East and West Germany. Have any changes have occurred in Germany, particularly in the east, since the wall came down? We analyzed the results of three compatible, population-based, interview-and-examination health surveys that were performed in both parts of Germany between 1984 and 1992. Total years of education was the social indicator. Systolic/diastolic blood pressure, body mass index, prevalence of hypertension, obesity, and cigarette smoking showed a social gradient in favor of higher social class groups; the social gradient for total cholesterol and hyper-cholesterolemia in men was less clear. Despite a much higher risk-factor profile in the east, neither a difference between the social gradients of the former East and West Germany nor a clear trend after the wall came down were found. In both areas, the social gradient clearly increased only for women smokers. Overall, we found very little evidence to support the idea that the ferocity of socioeconomic changes in the east had already led to a higher gradient of cardiovascular risk in 1991/1992 relative to that in the western part of the German population.

[Cardiovascular risk factors and occupation: results of the health survey of the German Cardiovascular Prevention Study]. / Kardiovaskuläre Risikofaktoren und Beruf: Resultate der Gesundheitssurveys der Deutschen Herz-Kreislauf-Präventionsstudie.

It is examined which occupation specific differences exist in the prevalence of cardiovascular disease risk factors in the Federal Republic of Germany (old federal states). The following risk factors for cardiovascular diseases were considered: cigarette smoking, hypertension, hypercholesterolemia, low HDL-cholesterol, obesity, diabetes mellitus, lack of physical activity and Type-A behavior. Data basis are the national and regional health surveys, conducted in the framework of the German Cardiovascular Prevention Study between 1984 and 1991. 17,596 males and 17,403 females, aged 25-69 years, were included in the analysis. Occupations were coded according to the classification of the Germany Federal Statistical Office. With the exception of Type-A behavior it was found for all cardiovascular disease risk factors that higher prevalence rates exist for less qualified occupations. The differences in risk factor prevalence were strongest for obesity and lack of physical activity. Only minor differences were found for hypercholesterolemia. This analysis confirms the results of other studies that health related aspects in the lifestyles of the most qualified occupational groups (professionals, managers, engineers) are characterized by non-smoking, leisure-time physical activity and avoidance of overweight. Up to now, there are no hints that these lifestyles may be adopted from members of less qualified occupations as well.

Family status and self-reported health in West Germany.

The goal of the study was to examine the association between family status and several health-related variables, such as perceived general health, health behavior and self-reported morbidity. Data were derived from Health Surveys conducted in West Germany in the framework of the German Cardiovascular Prevention Study. 25'229 males and 26'097 females, aged 25 to 69 years, were examined. Age-adjusted prevalence odds ratios, calculated by multiple logistic regression analysis, were used as effect measure. The reference category was "married, living with partner" throughout. For most health-related variables significantly higher prevalence odds ratios, indicating unhealthy conditions, were observed for "singles", including persons never married, persons living separated, and divorced or widowed persons. Two or more unhealthy health behaviors were found most frequently for divorced persons of either sex. Age-adjusted odds ratios for self-reporting of three or more chronic diseases were 1.31 (p < 0.01) for divorced males, and 1.66 (p < 0.001) for divorced females. Both men and women who were divorced or separated were characterized by an unfavourable health profile.

[Social class and risk factors for coronary heart disease--results of the Regional DHP(German Cardiovascular Prevention) Health Surveys]. / Soziale Schicht und Risikofaktoren für koronare Herzkrankheiten--Resultate der regionalen DHP-Gesundheitssurveys.

Prior to the start of the intervention activities in the five study regions of the German Cardiovascular Prevention Study (GCP), health surveys of representative samples of the population (25 to 69 years) were carried out between 1984 and 1986. In all, 11,527 persons participated in the study. Important socio-structural differences existed between the five study regions. An ecological analysis relating social class characteristics to the prevalence of CHD-risk factors did not show any significant findings. However, a pooling of the data of the five study regions resulted in the demonstration, for both sexes, of a significant association of social class with cigarette smoking and overweight. Hypertension and hypercholesterolemia were not related to social class. The proportion of persons with three or more CHD-risk factors was clearly higher in lower social classes. These findings point to the need for risk factor intervention strategies focusing more on the lower social classes in order to achieve more adequate prevention of coronary heart disease.

[Correlation between educational status, chronic diseases and cardiovascular risk factors in young adults 18-29 years of age: results of a 1998 comprehensive German health survey]. / Der Zusammenhang zwischen Bildungsstatus, chronischen Krankheiten und kardiovaskulären Risikofaktoren bei jungen Erwachsenen im Alter von 18 bis 29 Jahren: Ergebnisse des Bundesgesundheitssurveys 1998.

OBJECTIVES: The aim of the study is to investigate the association between educational attainment and the prevalence of chronic diseases and cardiovascular risk factors for the German population aged 18-29 years. METHODS: The data source is the Federal Health Survey 1998 (BGS98), which is representative for Germany. The response rate for the survey is 61.4%. Included in the analysis are 616 females and 637 males. Indicator for educational atteinment is the highest achieved school degree ("Abitur" n = 375, "mittlere Reife" n = 566, "Hauptschule" n = 312). RESULTS: For eight of the 43 items for self-reported diseases in the BGS98-questionnaire persons in the age group 18-29 yielded a higher prevalence than older adults. For altogether 11 diseases, which showed a prevalence greater than 3% in the age group 18-29 years, only minor associations with educational attainment were observed. Statistically significantly increased prevalences are observed for allergic disorders in persons with higher education and for long-term headache in persons with lower education. Regarding smoking, obesity and lack of sports activities remarkably and statistically significant education related differences are observed. The percentage of persons showing simultaneously two or three of these risk factors was 33% for study subjects with "Hauptschulabschluss" compared to only 8% for study subjects with "Abitur". CONCLUSIONS: Educational attainment is still a strong predictor for health behaviour. This finding should be considered in future health promotion compaigns.