[Memorandum on sustainable reinforcement of prevention and health promotion: challenges at the federal, state and local level]. / Memorandum--Prävention und Gesundheitsförderung nachhaltig stärken: Herausforderungen auf Bundes-, Landes- und kommunaler Ebene.

Research-based evidence and practice-based experience are core requirements for the effective implementation of preventive interventions. The knowledge gained in the Prevention Research Funding Initiative of the German Federal Ministry of Education and Research (2004-2013) was therefore amalgamated, reflected and consolidated in the Cooperation for Sustainable Prevention Research (KNP) meta-project. In annual strategy meetings, researchers and practitioners from the field and other experts developed 3 memoranda providing recommendations for the further development of research and practice in the field of prevention and health promotion. Memorandum III is primarily aimed at decision-makers in politics and administration at the federal, state and local level, in civil society and in the workplace. Its recommendations show that structuring efforts are urgently needed to achieve sustainable policy, particularly in the fields of health, education, employment and social affairs. Memorandum III brings together the knowledge extracted and problems identified in research projects. More so than its 2 predecessors, Memorandum III abstracts knowledge from the individual projects and attempts to derive guidance for action and decision-making, as shown by the 7 recommendations that appear to useful for consensus-building in practice and research. Value judgments are inevitable. Prevention and health promotion are an investment in the future: of social health, social capital and social peace. Improvement of the framework conditions is needed to achieve the harmonized awareness and the sustained effectiveness of these structure-building efforts in different policy areas, spheres of life, fields of action, and groups of actors. This includes the implementation of an overall national strategy as well as the expansion of sources of funding, extension of the legal framework, overarching coordination, and the establishment of a National Center of Excellence to develop and safeguard prevention and health promotion. The memorandum is intended to stimulate a discourse resulting in structure-building and stabilizing measures designed to ensure the sustainability of prevention and health promotion.

[Health promotion effectiveness: testing the German statutory health insurance agencies evaluation system in health promotion, and preliminary findings from 212 health training courses]. / Gesundheitswirkungen von Prävention: Erprobung des Evaluationssystems der Krankenkassen im Individualansatz und erste Befunde aus 212 Gesundheitskursen.

The purpose of this study was to develop a measurement system for the evaluation of health promotion training courses offered by German statutory health insurance companies. In a field test, N=1 671 participants from 212 youth and adult courses for the promotion of either physical activity, coping with stress or nutritional improvement were included. 80% were female. Participants were questioned in a pre-post-design with a three month follow-up. The questionnaires covered health behaviour and health status. Participants' compliance and psychometric quality of the measurement instruments were good. On average, the health insurance companies assigned participants to different interventions adequately according to the participant's individual health problems. The health promotion courses triggered improvements of high effect sizes for health behaviour patterns, of moderate effect sizes for physical complaints, subjective health ratings, and health-related quality of life. Effects decreased after the end of the intervention but remained significantly above the initial values. BMI values continued their improvement after the end of the training courses. Thus, health promotion training courses generated stable health improvements of practically relevant effect sizes. The interventions provided good support and health improvements for all subgroups of participants, regardless of age, gender and educational background. Thus, the health promotion curricula of the health insurance companies offer a ubiquitous and easily accessible but effective intervention for health promotion in Germany, although men are clearly underrepresented among the participants. The trainings may be recommended and used by other health-care suppliers. The evaluation toolkit provides practical and valid instruments for a routine evaluation of health promotion trainings. It should be applied within random sampling designs.

[Health promotion effectiveness: developing and testing a system for routine evaluation in health education, workplace health promotion and setting approach supplied by the German statutory health insurance agencies]. / Gesundheitswirkungen der Prävention: Entwicklung und Erprobung eines Routine-Evaluationssystems für Primärprävention und Gesundheitsförderung der Krankenkassen in Settings, Betrieben und Gesundheitskursen.

The aim of the study was to develop and test a routine evaluation system for all health promotion and education activities funded by the German statutory health insurance companies. The system aims at measuring both individual health effects and the complex organisational effects of setting projects. Measurement instruments were developed synoptically and tested in three field tests (2003-2008). In order to assess the impact of individual health training, 212 courses of the health insurance companies were evaluated. To assess the setting approach, 56 schools participating in a health-promotion project were included, and for workplace health-promotion 6 projects of different health insurance companies were included. The research design was an observational study. Instead of control groups, individual data were compared to reference values for gender- and age-matched groups from national health surveys. The studies consisted of baseline and final assessment (T1/T2), complemented by a follow-up (T3), all adapted to the time of intervention (i. e., 3-24 months for T1/T2 and 3-18 months for T2/T3). The evaluation system provides multilevel-measurement based upon validated questionnaires for health-related structures and processes in institutions, and for the participating individual's subjective health, health problems, health-related quality of life, workplace and institutional satisfaction. Controlling for central confounders is also possible (input and dosage, age, gender, educational background). Thus, short but valid measurement instruments of high usability are available to evaluate the effectiveness of prevention, health promotion and education.

Eating habits, health status, and concern about health: a study among 1641 employees in the German metal industry.

BACKGROUND: Nutrition has been found to be associated with sociodemographic characteristics and concern about health. There is limited knowledge, however, of associations between blue-collar worker's diet, morbidity, and health care utilization. METHODS: We conducted a survey on eating habits, physical symptoms, health care utilization, health status, and concern about health in two German metal companies. A self-administered questionnaire was mailed to employees of whom 1641 participated in the study (response rate 54. 7%). RESULTS: Most employees were characterized by a combination of healthy and unhealthy eating elements. Using linear regression analyses adjusted for age, gender, and occupational status, healthy eating was negatively associated with stomach aches and headaches, but not with cardiovascular disease. Restricted activity days and days in hospital were associated with healthy eating, but self-assessed health status and physician consultations were not. Using stepwise multiple regression analysis, age, gender, and concern about health were strongly and morbidity was weakly related to diet. Occupational status, marital status, and number of children were not associated with nutrition. CONCLUSIONS: Health promotion programs should motivate younger and male employees to participate in and aim toward increasing concern about health.

[1998 social epidemiological analysis of caries incidence and degree of dental restoration in young men]. / Sozialepidemiologische Analyse des Kariesbefalls und zahnmedizinischen Sanierungsgrads junger Männer 1998.

UNLABELLED: Basing on the hypothesis that adult dental health is co-determined by the conditions and influences prevailing in the family of origin during childhood and adolescence, we analysed the associations of socio-economic status of the family, personal dental care behaviour and other educational and structural factors, with caries prevalence (DMF-T) and the level of restoration in 642 young men between 18 and 24 years eligible for conscription. Additionally, we presented the changes in caries prevalence in conscripted persons during the 1990s comparing our results with those of a study conducted in 1989-90. RESULTS: The average number of DMF-T teeth was 5.7. 15% of subjects were caries-free. The mean level of restoration in those with a history of caries was 79.2%. The prevalence of caries and the level of restoration were strongly associated with the level of education, and the socio-economic status of the family of origin. Parental working time, number of siblings, structural deficiencies in the family, parental preventive education and training with regard to dental care, frequency of brushing the teeth, belief in the success of preventive health measures and prevalence of fissure sealings were significantly associated with DMF-T. Frequency of dental visits showed an association with the level of restoration. From 1989/90 to 1998 prevalence of caries in conscripts decreased by 42% (after adjusting for the different levels of education of both studies the decrease was 36%). Whereas in 1989/90 the average number of DMF-T in the 9-year elementary school graduates exceeded those of the high school graduates ("seniors") by 22%, this difference increased to 88% by 1998. More than 40% of the differences in the prevalence of caries among subjects of different educational levels were due to risk factors of social origin, preventive dental behaviour and utilisation of dental services, all of these being less favourable in elementary school or secondary school graduates compared to high-school graduates.

[Development of information, counseling and treatment status for patients with hypertension from 1984-91 in West Germany]. / Entwicklung des Informations-, Beratungs- und Behandlungsstatus von Patienten mit Bluthochdruck von 1984-91 in Westdeutschland.

Data from three nationally representative cross-sectional health surveys from 1984-86 (T0, n = 4790), 1987-88 (T1, n = 5335), and 1990-91 (T2, n = 5311) were analysed to determine changes in the utilisation of ambulatory services, degree of monitoring, risk factor awareness, drug treatment, and control, and medical counselling of hypertensive patients (actual hypertension prevalence) in West Germany. The percentage of hypertensives who had consulted a physician within the last year increased from 87% (T0) to 92% (T2) in men (p < 0.01), and from 94% to 96% in women (p > 0.05). The proportion of male (female) hypertensive patients who had their blood pressure measured by a physician within the last year was 87% (92%) in T2 (p-value for seven-year changes > 0.05). At T2, 50% (58%) of all male (female) hypertensives, whose blood pressure had been measured, were aware of their hypertension, with no significant changes during the study period. At T2, male (female) hypertensives in contact with a physician reported on medical recommendation of more physical activity in 16% (14%), reduced salt intake in 21% (25%), and reduced smoking/smoking cessation (only actual smokers) in 35% (31%) of cases. Counselling improved significantly only in hypertensive women. Although females had their hypertension more frequently treated with antihypertensive drugs (T0: 53%, T1: 53%, T2: 55%, p > 0.05), the increase of pharmaceutical treatment was stronger in men (T0: 34%, T1: 42%, T2: 45%, p < 0.01). Of those hypertensives treated with antihypertensive drugs, 55% (men) and 50% (women) had their blood pressure controlled below the 160/95 mmHg threshold in T2 with no significant changes during the study period. Suggestions are made for improving risk-factor awareness, and a higher quality and better integration of pharmaceutical treatment and non-pharmaceutical counselling of hypertensive patients.

[Attitudes and health status as determinants of participation in individually oriented health promotion]. / Einstellungen und Gesundheitsstatus als Bestimmungsfaktoren einer Beteiligung an Massnahmen verhaltensorientierter Gesundheitsförderung.

In a cross-sectional health survey among employees of a large German metal company with 974 study participants, attitudes and aspects of the individual health status were identified which predispose employees to take part in individual health promotion activities. Apart from higher participation rates in women and white collar employees, participants reported on average a less favourable subjective health status, more complaints and diseases, better health related behaviours, and a more intensive utilization of curative and preventive medical services than nonparticipants. Among men, participation in all types of courses increased from the youngest to the oldest group, among women only until the middle-aged groups with a consequent decline thereafter. In men, the image of a person living health-consciously showed the strongest positive association with participation, and not the degree of internal control and responsibility with respect to the maintenance of health or the acquisition and overcoming of disease. The low participation of blue collar workers compared to white collar employees could be attributed to group specific differences in individual health consciousness only to a very small extent. Blue collar participants reported a positive image of a person living health-consciously that was more similar to that of white collar participants than to that of nonparticipants of their own occupational group. Advertisement for health promoting activities should place more emphasis on increasing the image of personal health promotion than on internal control and responsibility for health.

[Back pain in industry: prevalence, correlation with work conditions and requests for reassignment by employees]. / Rückenschmerzen im Betrieb: Verbreitung, Zusammenhänge mit Arbeitsbedingungen und Anderungswünsche der Beschäftigten.

Using data from a cross-sectional survey of 974 employees of a metal company in Germany, we analysed the frequency of chronic back pain, ist associations with working conditions, and the requests for workplace modifications, expressed by persons afflicted with chronic back pain. With a prevalence of 32% chronic back pain was the most common health problem. Physical work exposures, such as lifting and carrying as well as working in an awkward position, were strongly (multivariable odds ratios > or = 2.8) associated with chronic back pain, whereas environmental factors were moderately (multivariable odds ratios = 1.6) associated. Most psychosocial stressors, such as time pressure, and conflicts with co-workers and superiors, were moderately associated with chronic back pain as well (age-adjusted odds ratios between 1.4 and 1.8). Stress symptoms, such as irritation and strain, are rated as mediators by possibly linking psychosocial stressors to chronic back pain. If the individual subject is compelled to perform monotonous or repetitive work, he feels underrated, and this has proved to be a risk factor in its own right. Prolonged exposure to physical stressors (> 7 years) was associated with a strongly elevated risk for chronic back pain (age-adjusted odds ratios > or = 4.0 compared to the nonexposed). Blue collar workers afflicted with chronic back pain requested a reduction of their physical work load significantly more often than their non-afflicted colleagues. In contrast, female white collar employees with chronic back pain layed most emphasis on more physical exercise at work. Worksite health promotion programmes should consider these differences in order to meet the specific needs and preferences of different occupational groups.

[Eating habits of employees in the metal industry: determinants and patterns]. / Ernährungsgewohnheiten bei Beschäftigten in der Metallindustrie: Determinanten und Muster.

We conducted a survey on chances and barriers of occupational health promotion and health behaviour including diet in two South German metal companies. Only a small percentage of the 1641 participants consumed healthy food each day, but many avoided eating unhealthy food. Most employees are characterized by a combination of healthy and unhealthy elements. The group of "healthy eaters" consists of more women than men, more older than younger people and more non-manual than manual workers. The level of education and number of children have not been associated with eating habits. Healthy eaters consumed less alcohol and tobacco and were more engaged in sports and in health promotion programmes than unhealthy eaters.

[Need adjustment of utilization of occupational health promotion for reducing back pain? Results of an employee survey of the metal industry]. / Bedarfsgerechtigkeit der Inanspruchnahme betrieblicher Gesundheitsförderung zur Reduktion von Rückenschmerzen? Ergebnisse einer Mitarbeiterbefragung in der Metallindustrie.

We analysed data of a cross-sectional survey of 974 employees in the German metal industry to determine the degree to which worksite health promotion matches the needs of employees. 27% of study participants have already taken part in individually oriented health promotion, and another 48% want to participate most readily in activities aiming at preventing and reducing musculo-skeletal complaints. Recent participation (within a fourteen-month period) in these classes was low among male blue collar workers (7%) compared to male and female white collar employees (18 and 26%). Among blue collar workers the percentage of subjects who suffered from chronic back pain and did not recently participate in the relevant classes of the company health insurance plan (unserved prevalence) was 30%, compared to 17 and 26% in male and female white collar employees. Participants were less exposed to work-related predictors of chronic back pain than non-participants. Participants were, however, more often afflicted with chronic back pain than non-participants. In addition, the intention to participate was strongly associated with this type of complaint. Shift work was the most important single explanation for the low participation rates of blue collar workers. Suggestions are advanced to neutralise the adverse effects of shift work on participation, to strengthen the primary preventive functions of individual worksite health promotion, and to integrate it with structural measures of health and safety at work.

Smoking behavior and attitude toward smoking regulations and passive smoking in the workplace. A study among 974 employees in the German metal industry.

BACKGROUND: Smoking regulations at the workplace have been found to be acceptable and effective in many studies conducted in the United States. There is limited knowledge, however, on acceptance and effects of smoking regulations in European countries, particularly among blue collar employees. METHODS: We conducted a survey on smoking behaviour and attitude toward smoking regulations and passive smoking in a South German metal company. A self-administered questionnaire was mailed to 1,500 predominantly blue collar employees of whom 974 participated in the study (response rate 64.9%). RESULTS: About 30% of the employees were not allowed to smoke at their immediate work area. Among them, about 95% of both smokers and nonsmokers agreed with this smoking policy. More than 60% of nonsmoking blue collar workers were bothered by passive smoking at work whether or not smoking was allowed at their immediate work area. In contrast, the proportion of nonsmoking white collar employees who were bothered by passive smoking varied from 52% if smoking was allowed at their immediate work area to 18% if smoking was not allowed. Prevalence of active smoking and average amount of smoking among active smokers were considerably lower among employees who were not allowed to smoke at work than among other employees. These differences were partly due to confounding by occupation, however, which was strongly related to both smoking habits and smoking policy. CONCLUSIONS: Our results, which confirm and extend previous findings, give further support to the acceptability and potential effectiveness of smoking regulations at the workplace. Particular efforts should be devoted to limit both active and passive smoking among blue collar employees.