[Social determinants of smoking behavior in Germany: results of a 1995 micro-census]. / Soziale Determinanten des Rauchverhaltens in Deutschland: Ergebnisse des Mikrozensus 1995.

OBJECTIVES: The negative health effects of cigarette smoking are nowadays well known. An important prerequisite for the implementation of rewarding health promotion campaigns aiming at reducing the tobacco dependency in the general population is the knowledge about smoking prevalences in different social population groups, and specific information about social factors and determinants influencing smoking behaviour. METHODS: In this regard, the Microcensus is a very valuable data source for Germany. Included in the present analysis are persons aged 18 years and older, which are present in the "Microcensus Public Use File 1995" and had answered the questions about their smoking behaviour (N = 186,424). The dependent study variable is current cigarette smoking. Independent study variables are sociodemographic factors (age, sex, family status), occupational status, unemployment, socio-economic situation and regional-specific variables (size of community, East vs West Germany). RESULTS: All together, 30.5% of the males and 18.0% of the females were current smokers. Significantly higher smoking rates were observed for persons living in metropolitan areas, persons with low educational achievement and low occupational status, for people being divorced, unemployed, and living on social welfare. In a second step, we analysed the cumulative effect of these social factors for current smoking status. In summary, it was found that the cumulation of social determinants explained a great part of the variance in smoking prevalence. Current smoking was four to six times more prevalent in population groups characterised by several unfavourable social conditions compared to more privilege population groups. CONCLUSIONS: Thus, smoking related prevention activities should be evaluated, among others, regarding their potential to reduce the social polarisation of the smoking epidemic.

[Legitimizing and responsibilities of public health reports: public health reports or social court reports?]. / Legitimation und Anspruch einer Gesundheitsberichterstattung: Gesundheitsberichte oder Hofberichte?

Since 1970 various initiatives have been taken to improve the information bases of health reporting. However, the efforts made up to now by the Länder, the Federal Government and its corporate bodies are characterised by a lack of experience and shortage of resources; moreover, they are viewed with a critical eye by the public and in the political area. In this contribution the authors describe various topics and delimitations of a health reporting system which go far beyond health statistics and health programmes altogether. The chances of a national health reporting system are based on the assumption that an objective judgement based on expert knowledge and science will be possible and that beyond all particularistic interests, expert knowledge can be organised in a democratic process. Public health reporting varies between two extremes: On the one hand, the current reporting in the media on health-related subjects which is characterised by disagreement among experts, particularistic interests and emotions, and on the other hand the national health reporting, which, on the platform of policy marketing and political image shaping, is suspected of degenerating to a kind of "royal court reporting". A health reporting system based on expert knowledge and characterised by topics with relevance to health policy, expert quality of its information and neutrality to particularistic interests, should go beyond these two extremes. Given the political conditions of budgeting and distribution conflicts, health reporting has to deal with two main aspects: effectiveness and efficiency of employed resources and with the problems of a fair distribution of these resources to provide equal chances in the health sector. What cannot be solved, by questions of procedure, however, is the problem of truth and objective knowledge as well as the problem of confidence. If the general public lacks confidence in national expert knowledge, a society discourse will not lead to political results. Additionally, the argument that medicine is of little importance for health is used to categorically reject a rational investigation of needs and thus to reduce the health system to the status of a modern religious doctrine. Proceeding on the assumption that due to systematic thinking and acting in the field of science, effective medicine symbolises one of the paradigms of progress, then health reporting system can be justified despite the precarious objective knowledge, provided such reporting generates the confidence it deserves thanks to its quality standards and seriousness.

[Rendering public health reports in cities and regions--results of a model trial in Brandenburg and North Rhine-Westphalia]. / Gesundheitsberichterstattung in Städten und Regionen--Ergebnisse eines Modellversuchs in Brandenburg und Nordrhein-Westfalen.

The purpose of health reporting is to give orienting advices for health policy at regional and local level. In fact, there are only few communities and districts engaged in health reporting. A pilot project run in North Rhine-Westphalia and Brandenburg tried to fill the gap by developing and examining methods and procedures of producing regional health reports. Therefore a system of report topics was drawn up which allowed gradual processing and division of work between the five participating local health departments. Each health department chose three topics to be dealt with during a two-year phase of practice. Those working on the project individually advised and supported planning and realisation of the reports. The "health reporter" in the local health department should organize the production of the reports together with experts. Because of lack of experience or fear of not being accepted in an organizing role this person mainly functioned as author of the report. This had a negative effect on quality and continuity of the work. It can however be regarded as a success of the pilote scheme that this development will be continued in form of a broader planned project supported by the Ministry of Employment, Health and Social Affaires of Northrhine-Westphalia.

[Strategies for the prevention of cardiovascular diseases in the German Federal Republic]. / Strategien zur Prävention von Herz-Kreislauf-Krankheiten in der Bundesrepublik Deutschland.

The increased relevance of cardiovascular prevention for improved population health is mainly a result of recent epidemiologic research. The identification of essential risk factors of the arterio-sclerotic process as well as their interventive modification are generally accepted. The prolongation of the life-expectancy has been achieved more and more by preventive successes in higher age. Participation of the individual and cooperation of institutions are essential prerequisites of the necessary life style change. The German health offices have to be prepared for essential functions in health management.

[Myopia: causes and prevention]. / Myopie: Uraschen und Prävention.

Myopia is the most common disorder of visual function in many literate populations, affecting 70% of some specific groups. The causes may lie in genetic or environmental factors. This article discusses the arguments put forward to support of the biological and environmental theories of the cause of myopia. It is argued that the biological theory has never been proven empirically and that the evidence clearly points to the role of close-range work in the prevalence of myopia as a massdisease. Primary prevention is difficult in this situation and compensatory strategies (relaxation, eye exercises) are rather ineffective. Prevention strategies are discussed and a research program to evaluate their effectiveness and efficiency is proposed.