[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.

Socioeconomic differences in the reduction of face-to-face contacts in the first wave of the COVID-19 pandemic in Germany.

BACKGROUND: The COVID-19 pandemic has led to physical distancing measures to control the spread of SARS-CoV-2. Evidence on contact dynamics in different socioeconomic groups is still sparse. This study aimed to investigate the association of socioeconomic status with private and professional contact reductions in the first COVID-19 wave in Germany. METHODS: Data from two especially affected municipalities were derived from the population-based cross-sectional seroepidemiological CORONA-MONITORING lokal study (data collection May-July 2020). The study sample (n = 3,637) was restricted to working age (18-67 years). We calculated the association of educational and occupational status (low, medium, high) with self-reported private and professional contact reductions with respect to former contact levels in the first wave of the pandemic. Multivariate Poisson regressions were performed to estimate prevalence ratios (PR) adjusted for municipality, age, gender, country of birth, household size, contact levels before physical distancing measures, own infection status, contact to SARS-CoV-2 infected people and working remotely. RESULTS: The analyses showed significant differences in the initial level of private and professional contacts by educational and occupational status. Less private contact reductions with lower educational status (PR low vs. high = 0,79 [CI = 0.68-0.91], p = 0.002; PR medium vs. high = 0,93 [CI = 0.89-0.97], p = 0.001) and less professional contact reductions with lower educational status (PR low vs. high = 0,87 [CI = 0.70-1.07], p = 0.179; PR medium vs. high = 0,89 [CI = 0.83-0.95], p = 0.001) and lower occupational status (PR low vs. high = 0,62 [CI = 0.55-0.71], p < 0.001; PR medium vs. high = 0,82 [CI = 0.77-0.88], p < 0.001) were observed. CONCLUSIONS: Our results indicate disadvantages for groups with lower socioeconomic status in private and professional contact reductions in the first wave of the pandemic. This may be associated with the higher risk of infection among individuals in lower socioeconomic groups. Preventive measures that a) adequately explain the importance of contact restrictions with respect to varying living and working conditions and b) facilitate the implementation of these reductions especially in the occupational setting seem necessary to better protect structurally disadvantaged groups during epidemics.

Socioeconomic Status, Overweight, and Obesity in Childhood and Adolescence­Secular Trends From the Nationwide German Kiggs Study

BACKGROUND: Overweight and obesity in early life increase the risk of chronic disease and ill health later on. We studied secular trends in the prevalence of overweight and obesity among young people in Germany, with consideration of socioeconomic status (SES). METHODS: We used repeated cross-sectional data from 3- to 17-year-olds from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Overweight and obesity were defined according to the body mass index, based on measured height and weight from the KiGGS baseline survey (2003-2006) and the KiGGS second wave (2014-2017). SES was assessed with a composite index of parental education, occupation, and income. RESULTS: In both study periods, the prevalence of overweight and obesity was highest among girls and boys from families of low SES. In the group with lowest SES, the prevalence of overweight rose from 20.0% in 2003-2006 (95% CI [18.0; 22.1]) to 25.5% [20.5; 31.2] in 2014-2017 (p = 0.043). Thus, social differences in the prevalence of overweight increased over time. No such trend was found for the prevalence of obesity. CONCLUSION: Social differences in the prevalence of overweight among children and adolescents increased from the early 2000s to the mid-2010s. Structural measures are needed to help prevent overweight among young people in socially disadvantaged circumstances.

Temporal Dynamics of Socioeconomic Inequalities in COVID-19 Outcomes Over the Course of the Pandemic-A Scoping Review.

Objectives: International evidence of socioeconomic inequalities in COVID-19 outcomes is extensive and growing, but less is known about the temporal dynamics of these inequalities over the course of the pandemic. Methods: We systematically searched the Embase and Scopus databases. Additionally, several relevant journals and the reference lists of all included articles were hand-searched. This study follows the PRISMA guidelines for scoping reviews. Results: Forty-six studies were included. Of all analyses, 91.4% showed stable or increasing socioeconomic inequalities in COVID-19 outcomes over the course of the pandemic, with socioeconomically disadvantaged populations being most affected. Furthermore, the study results showed temporal dynamics in socioeconomic inequalities in COVID-19, frequently initiated through higher COVID-19 incidence and mortality rates in better-off populations and subsequent crossover dynamics to higher rates in socioeconomically disadvantaged populations (41.9% of all analyses). Conclusion: The identified temporal dynamics of socioeconomic inequalities in COVID-19 outcomes have relevant public health implications. Socioeconomic inequalities should be monitored over time to enable the adaption of prevention and interventions according to the social particularities of specific pandemic phases.

[The 2022 Poverty and Health Congress against the backdrop of the current crises]. / Der Kongress Armut und Gesundheit 2022 vor dem Hintergrund der aktuellen Krisen.

Since 1995, the Poverty and Health Congress has been organized annually by Gesundheit Berlin-Brandenburg e. V. in cooperation with various partners. It is one of the largest regular public health events in Germany. The congress is a platform for exchange between science, practice, civil society, and politics. In 2022, the motto was "What counts now." Public health and health inequalities were discussed in the light of the SARS-CoV­2 pandemic and the war in Ukraine. Professional exchange on various topics took place in over 100 digital events with more than 2000 participants, among them around 500 speakers.

["From Crisis to Health in All Policies." Conference report from the Poverty and Health 2021 Congress]. / "Aus der Krise zu Health in All Policies". Tagungsbericht vom Kongress Armut und Gesundheit 2021.

The annual Poverty and Health congress, which has been organized by Gesundheit Berlin-Brandenburg e. V. since 1995, has become one of the biggest public health events in Germany. It offers an exchange platform for science, practice, and politics. This year's congress topic was "From Crisis to Health in All Policies," which aimed to address the SARS-CoV­2 pandemic's impact on society in general and public health in particular. Overall, 80 panels were organized with close to 500 experts discussing a wide range of subjects and questions, for example, the connection between poverty and COVID-19, the current challenges in the care sector, the situation of homeless people, and the impact of the pandemic on (young) families or students as well as global questions on vaccination strategy and key issues for a public health strategy for Germany.

Socioeconomic Differences in Walking Time of Children and Adolescents to Public Green Spaces in Urban Areas-Results of the German Environmental Survey (2014-2017).

Public green spaces have a high potential for a positive impact on people's health and wellbeing, especially in urban areas. Studies on environmental justice indicate socially unequal access possibilities to urban green spaces. This article presents results on associations between individual socioeconomic position (SEP) and walking time from home to public green spaces in young people living in urban areas with more than 20,000 inhabitants in Germany. Data were derived from the German Environmental Survey for Children and Adolescents 2014-2017 (GerES V), the environmental module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2). The sample comprises 1149 participants aged 3 to 17 years. A total of 51.5% of the participants reach a public green space on foot within five and 72.8% within ten minutes from home. The lower the participant's SEP, the longer the walking time. Logistic regression models controlling for age group, sex, migration background, and region of residence show that participants with a low SEP have a significantly higher risk (odds ratio = 1.98; 95% confidence interval: 1.31-2.99) of needing more than ten minutes to walk from home to a public green space than participants with a high SEP. GerES V data indicate that young people living in urban areas in Germany do not equally benefit from the health-promoting potential of green spaces, which is an important aspect of environmental health inequalities.

[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.

Intergenerational Educational Pathways and Self-Rated Health in Adolescence and Young Adulthood: Results of the German KiGGS Cohort.

Health differences in social mobility are often analysed by income differences or different occupational positions. However, in early adulthood many young people still have very diffuse income situations and are not always fully integrated into the labour market despite many having finished school. This article focusses on the link between intergenerational educational pathways and self-rated health (SRH) among young adults considering their SRH in adolescence. The data source used is the German KiGGS cohort study. The analysis sample comprises 2175 young people at baseline (t0: 2003⁻2006 age 14⁻17) and first follow-up (t1: 2009⁻2012 age 19⁻24). Combining parent's and young people's highest school degree, the data can trace patterns of intergenerational educational pathways (constant high level of education, upward mobility, downward mobility, constant low level of education). Young people's SRH was recorded at t0 and t1. During adolescence and young adulthood, participants were less likely to report poor SRH if they had a constant high intergenerational education or if they were upwardly mobile. The differences were particularly striking among young adults: average marginal effects (AME) for poor SRH showed much higher risk among downwardly mobile compared to peers with an intergenerational constant high education (AME: 0.175 [0.099; 0.251]), while the upwardly mobile had a significantly lower risk for less than good SRH than peers with an intergenerational constant low level of education (AME: -0.058 [-0.113; -0.004]). In the context of great societal demands and personal developmental needs, educational differences in health tend to increase in young adulthood. Public Health should pay more attention to educational and health inequalities in young adulthood.

[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 educational inequalities in smoking among adolescents in Germany : Evidence from four population-based studies]. / Zeitliche Entwicklung von Bildungsunterschieden im Rauchverhalten von Jugendlichen in Deutschland : Ergebnisse aus vier bevölkerungsweiten Studien.

BACKGROUND: In Germany, smoking prevalence among adolescents has significantly declined since the early 2000s. However, data show that adolescent smoking rates considerably differ between different types of secondary schools. The aim of our study was to examine how educational inequalities in adolescent smoking behaviour have developed over time. METHODS: Data were used from four population-based studies (each consisting of repeated cross-sectional surveys from 2001-2015): the representative surveys of the Federal Centre for Health Education, the German Health Interview and Examination Survey for Children and Adolescents, the Health Behaviour in School-aged Children Study, and the European School Survey Project on Alcohol and Other Drugs. Each study comprised different age groups (within the age range of 11-17 years) and used different smoking measures. Adolescents' educational status was based on the attended type of secondary school. Absolute and relative educational inequalities were presented as prevalence differences and prevalence ratios, respectively. RESULTS: Despite methodical differences, all four studies similarly reveal that adolescent smoking rates have significantly declined in all educational groups. However, lower smoking rates among secondary school students attending higher educational tracks could be observed. While absolute educational inequalities tended to decrease over time, relative inequalities between educational groups remained rather stable or even increased. DISCUSSION: Declining adolescent smoking rates suggest that smoking may have lost some of its attractiveness for young people. Our findings further emphasize the importance of tobacco control measures such as raising cigarette taxes, smoking bans, and increasing minimum legal age for tobacco purchase. As relative educational inequalities in adolescent smoking rates did not diminish over time, setting- and target group-specific interventions should focus more on students in middle and lower secondary school tracks.

Socioeconomic differences in the health behaviour of children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study.

Childhood and adolescence are key determining stages for health behaviour in the life course. Frequently, health-related attitudes and patterns of behaviour that develop at young age are also maintained at adult age. As studies show, already during childhood and adolescence, patterns of health risk behaviour are more common in certain population groups. KiGGS Wave 2 results confirm that 3- to 17-year-old children and adolescents from families with low socioeconomic status (SES) eat a less healthy diet, do fewer sports and are more often overweight or obese than their peers from more affluent backgrounds. Whereas socioeconomic differences appear to have little effect on levels of alcohol consumption among 11- to 17 year-olds, girls and boys with low SES smoke more frequently than their peers with high SES. Prevention and health promotion encourage children and adolescents to adopt healthy lifestyles, and aim to drive structural changes to stimulate behaviour which promotes good health. Combining measures that target individual behaviour and a settings-based approach appears to be the most promising preventative approach to reduce health inequalities among young people. Due to the clear impacts of socioeconomic differences on health behaviour already at young age measures for disadvantaged children and adolescents and their living conditions should be given an even stronger focus in the future.

[Solidarity in health. Report on the 2017 Poverty and Health Congress]. / Gesundheit solidarisch gestalten. Tagungsbericht vom Kongress Armut und Gesundheit 2017.

The annual congress Armut und Gesundheit (Poverty and Health), which is organized by Gesundheit Berlin-Brandenburg e. V. and takes place at the Technical University of Berlin has become one of the biggest public health events in Germany. It constitutes an exchange platform for sciences, practice, and politics. This year's congress topic was solidarity in health, aiming to emphasize the responsibility that society and its actors have to bear in order to warrant health equity. Overall, 121 activities took place, with more than 500 experts and moderators discussing a wide range of subjects and questions including regional disparities in poverty, ethics in public health, the current situation of homeless and people without insurance, time trends in health inequalities, health and healthcare of refugees and asylum seekers, and the current progress and challenges in connection with the German prevention act.