[Factors Influencing Participation in Financial Incentive Programmes of Health Insurance Funds. Results of the Study 'German Health Update']. / Einflussfaktoren für die Teilnahme an Bonusprogrammen der gesetzlichen Krankenversicherung. Ergebnisse der Studie "Gesundheit in Deutschland aktuell".

AIM OF THE STUDY: The statutory health insurance can offer their insured incentive programmes that will motivate for healthy behaviour through a financial or material reward. This study will show results about what factors influence financial incentive programme participation (BPT) including all sorts of statutory health insurance funds and taking into account gender differences. METHODS: For the cross-sectional analysis, data were used from 15,858 participants in the study 'Germany Health Update' (GEDA) from 2009, who were insured in the statutory health insurance. The selection of potential influencing variables for a BPT is based on the "Behavioural Model for Health Service Use" of Andersen. Accordingly, various factors were included in logistic regression models, which were calculated separately by gender: predisposing factors (age, education, social support, and health awareness), enabling factors (income, statutory health insurance fund, and family physician), and need factors (smoking, fruit and vegetable consumption, sports, body mass index, and general health status). RESULTS: In consideration of all factors, for both sexes, BPT is associated with age, health awareness, education, use of a family physician, smoking, and sports activities. In addition, income, body mass index, and diet are significant in women and social support and kind of statutory health insurance fund in men. It is found that predisposing, enabling and need factors are relevant. CONCLUSIONS: Financial incentive programmes reach population groups with greatest need less than those groups who already have a health-conscious behaviour, who receive a reward for this. In longitudinal studies, further research on financial incentive programmes should investigate the existence of deadweight effects and whether incentive programmes can contribute to the reduction of the inequity in health.

[Educational differences in smoking and smoking cessation among young adults. Results from the "German Health Update" (GEDA) Study 2009 and 2010]. / Bildungsunterschiede im Tabakkonsum und Rauchausstieg junger Erwachsener. Ergebnisse der Studie "Gesundheit in Deutschland aktuell" (GEDA) 2009 und 2010.

BACKGROUND: Studies show that adolescents attending upper secondary schools are less likely to smoke than their peers attending lower secondary school types. This article examines how educational differences in smoking behaviour continue in young adulthood. Besides frequency and intensity of tobacco use the main focus is on smoking cessation. METHODS: The analyses were based on information of the 18- to 29-year-old men and women who participated in the nationwide representative telephone survey "German Health Update" (GEDA) 2009 and 2010 carried out by the Robert Koch Institute (n=7,620). Smoking behaviour was measured by several questions on smoking frequency and intensity. Educational status was assessed by the highest school-leaving certificate and classified as low (no school-leaving certificate/Hauptschule certificate), middle (General Certificate of Secondary Education/Realschule certificate), and high (general qualification for university entrance (Abitur)/advanced technical college entrance qualification). In addition to prevalence estimates, age-adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI) were calculated using logistic regression. RESULTS: According to the GEDA study, the prevalence of smoking was 42.6% among men and 36.7% among women aged 18-29 years. The prevalence of current smoking increased with decreasing educational level. The odds of current smoking was 3.72-times higher in lower as compared to higher educated men (95% CI 2.90-4.77) and 3.00-times higher in lower as compared to higher educated women (95% CI 2.30-3.92). Moreover, high intensity of tobacco use was also associated with lower education in men and women. The odds of successful quitting was significantly reduced in the lowest compared to the highest educational group (men: OR=0.45; 95% CI 0.31-0.66; women: OR=0.65; 95% CI 0.44-0.94). CONCLUSION: Our findings suggest that young adults with low education are more likely to start smoking and less likely to quit than their higher educated peers. Therefore, tobacco prevention and cessation initiatives should more focus on lower educated young adults.

[Subjective social status and health-related quality of life among adults in Germany. Results from the German General Social Survey (ALLBUS 2010)]. / Subjektiver Sozialstatus und gesundheitsbezogene Lebensqualität bei Erwachsenen in Deutschland. Ergebnisse der Allgemeinen Bevölkerungsumfrage der Sozialwissenschaften (ALLBUS 2010).

BACKGROUND: The impact of subjective perception of social status on health has been analysed in international health research for several years. However, in Germany the empirical analysis of the relation between subjective social status (SSS) and health is still in the very early stages. This study investigates if health-related quality of life (HRQoL) in German adults is associated with SSS over and above conventional measures of social status. METHODS: The results are based on the German General Social Survey (ALLBUS 2010), a representative cross-sectional survey of the adult resident population in Germany (n=2 827). HRQoL was assessed with 4 items referring to self-rated health (SRH) and impairment of well-being due to bodily pain, depressiveness, and loneliness. SSS was measured with a 10-point scale where participants rated their status in society. The impact of SSS on HRQoL was analysed separately for men and women using logistic regression models adjusted for age, school education, net equivalent household income, and occupational position. RESULTS: Poorer SRH, bodily pain, depressiveness, and loneliness occurred significantly more often in men and women with low SSS compared to those with higher SSS. After adjusting for age, education, income, and occupation, the effects of SSS on SRH and depressiveness remained significant in men and women (SRH: men: OR=4.76; 95% CI=2.52-8.99; women: OR=2.95; 95% CI=1.74-4.99; depressiveness: men: OR=2.86; 95% CI=1.60-5.10; women: OR=2.75; 95% CI=1.65-4.56). The effects of SSS on bodily pain and loneliness were observed only in women after adjustment for objective status indicators (OR=1.75; 95% CI=1.07-2.86 and OR=3.03; 95% CI=1.43-6.42, respectively). CONCLUSION: These findings indicate that self-perception of social disadvantage affects HRQoL in German adults independently and partly gender-specifically. Hence, complementary to objective status indicators the SSS offers additional potential for describing and explaining health inequalities.

Area-level and individual correlates of active transportation among adults in Germany: A population-based multilevel study.

This study aimed at estimating the prevalence in adults of complying with the aerobic physical activity (PA) recommendation through transportation-related walking and cycling. Furthermore, potential determinants of transportation-related PA recommendation compliance were investigated. 10,872 men and 13,144 women aged 18 years or older participated in the cross-sectional 'German Health Update 2014/15 - EHIS' in Germany. Transportation-related walking and cycling were assessed using the European Health Interview Survey-Physical Activity Questionnaire. Three outcome indicators were constructed: walking, cycling, and total active transportation (≥600 metabolic equivalent, MET-min/week). Associations were analyzed using multilevel regression analysis. Forty-two percent of men and 39% of women achieved ≥600 MET-min/week with total active transportation. The corresponding percentages for walking were 27% and 28% and for cycling 17% and 13%, respectively. Higher population density, older age, lower income, higher work-related and leisure-time PA, not being obese, and better self-perceived health were positively associated with transportation-related walking and cycling and total active transportation among both men and women. The promotion of walking and cycling among inactive people has great potential to increase PA in the general adult population and to comply with PA recommendations. Several correlates of active transportation were identified which should be considered when planning public health policies and interventions.

Implementation of the European health interview survey (EHIS) into the German health update (GEDA).

BACKGROUND: This methodological paper describes the integration of the 'European Health Interview Survey wave 2' (EHIS 2) into the 'German Health Update' 2014/2015 (GEDA 2014/2015-EHIS). METHODS: GEDA 2014/2015-EHIS is a cross-sectional health survey. A two-stage stratified cluster sampling approach was used to recruit persons aged 15 years and older with permanent residence in Germany. Two different modes of data collection were used, self-administered web questionnaire and self-administered paper questionnaire. The survey instrument implemented the EHIS 2 modules on health status, health care use, health determinants and social background variables and additional national questions. Data processing was conducted according to the quality and validation rules specified by Eurostat. RESULTS: In total, 24,824 questionnaires were completed. The response rate was 27.6%. The two-stage cluster sample method seems to have been successful in achieving a sample with high representativeness. The final micro data file was inspected, approved and certified by Eurostat. Access to micro data of the EHIS 2 can be provided by Eurostat via research contract and to the GEDA 2014/2015-EHIS public use file by the Research Data Centre of the Robert Koch Institute. First EHIS 2 results are available at the Eurostat website. CONCLUSIONS: Integrating a multinational health survey into an existing national health monitoring system was a challenge in Germany. The national survey methodology for conducting the survey had to be further developed in order to meet the overarching goal of harmonizing the health information from national statistical offices and public health research institutes across the European Union. The harmonized EHIS 2 data source will profoundly impact international public health research in the near future. The next EHIS wave 3 will be conducted around 2019.