[Key Topics and Activities of Local and District Health Conferences between 2013 and 2022: Results of a Non-Reactive Online Screening]. / Themen und Aktivitäten landesgesetzlich verankerter kommunaler und bezirklicher Gesundheitskonferenzen 2013­2022: Ergebnisse eines non-reaktiven Online-Screenings.

OBJECTIVES: The tasks of the Public Health Service include, amongst others, health promotion and disease prevention, health reporting and health planning. In many places, local or district health conferences (HCs) have been established to network and coordinate municipal stakeholders. HCs have been defined in the laws of the German states of Baden-Wurttemberg, Berlin, Hamburg, Hesse, and North Rhine-Westphalia. As systematic and comprehensive studies of HCs are not available, a descriptive analysis of the characteristic features, key topics and activities of HCs in selected states was performed. METHODS: Based on a non-reactive survey of the activities from 2013 to 2022, all HCs in four states (n=110) were covered. Data on structural features, topics and HC activities were gathered in a systematic approach. The topics these conferences dealt with were matched against the health objectives of the states. Following an internal verification of the results, univariate and bivariate analyses were performed for individual states, districts, and the year of establishment. RESULTS: Overall, topics frequently covered by the HCs are primary care, children's and adolescent health, health at old age, infection prevention and control, physical exercise and diet as well as addiction; in some cases, frequencies of these topics differed heavily among the states and municipalities. The topics covered by the HCs showed a strong association with the health objectives of the respective states. Health care is addressed more often in administrative districts (Landkreise) than in independent cities (kreisfreie Städte). Conferences established more recently (after 2011) exhibited greater activities than older ones in terms of plenary sessions and press releases. CONCLUSION: HCs are marked by a wide range of key topics which are based on health objectives of the respective states; however, noticeable differences exist between rural and urban areas. Conferences established more recently show a higher level of activity than older ones, which might point to sustainability issues under the current constraints. Whereas differences between rural and urban areas had already been noted for health-reporting activities, this was not the case for HC activities. The hypotheses derived from this descriptive analysis warrant further examination in order to ensure that the HCs create a sustainable impact.

[Health in All Policies Within Local Public Health Reporting in Public Health Service]. / Health in All Policies in der kommunalen Gesundheitsberichterstattung im Öffentlichen Gesundheitsdienst.

OBJECTIVES: The Public Health Service, as an administrative policy-oriented actor, can be essential for the implementation of Health in All Policies at the county level. Local Public Health Reporting, anchored in the federal state laws, as basis for planning processes can play a potentially central role in this regard. This study will investigate to what extent local health reports fulfill such an overarching role through integration and administrative intersectorality. METHODS: A quantitative document analysis of published reports (random sample; n=53) was conducted based on a nationwide nonreactive data collection of Local Public Health Reporting. The degree of integration was classified in terms of methodological, content and intersectoral aspects. A stratified analysis was performed according to the type of regional authority, the administrative location of the Public Health Service and the type of report. RESULTS: Integration in the form of data from at least two other subject areas was found in 29 reports (55%). Intersectorality was explicitly recognizable in nine reports (17%), and with an above-average frequency in district-free cities and children/youth reports. Integration of reports on infection protection/vaccination was below average. The organizational location with the social and/or youth fields of action was positively associated with the degree of integration. CONCLUSIONS: From the perspective of Health in All Policies, the degree of integration and intersectorality of Local Public Health Reporting assessed so far is too low. There is potential for development through a beneficial organizational structure and the choice of topics, especially in the field of child and youth health.

Parental Self-Efficacy as a Predictor of Children's Nutrition and the Potential Mediator Effect between the Health Promotion Program "Join the Healthy Boat" and Children's Nutrition.

Overweight and obesity, as well as their associated risk factors for diseases, are already prevalent in childhood and, therefore, promoting healthy eating is important. Parental self-efficacy (PSE) and early health-promotion can be helpful in promoting healthy eating. The aim of this study was to examine the influence of PSE on children's nutrition behavior and identify PSE as a mediator between an intervention and children's nutrition. The kindergarten-based health-promotion program "Join the Healthy Boat" was evaluated in a randomized controlled trial with 558 children (4.7 ± 0.6 years; 52.3% male) participating at both times. Linear and logistic regressions as well as mediation analyses with potential covariates such as parental outcome expectancies or parental nutrition were carried out using questionnaire data. In children, PSE was positively associated with fruit and vegetable intake (ß = 0.237; p < 0.001) and showed a protective effect on soft drink consumption (OR 0.728; p = 0.002). Parental nutrition was a stronger predictor of children's intake of fruit, vegetables (ß = 0.451; p < 0.001), and soft drinks (OR 7.188; p < 0.001). There was no mediator effect of PSE. However, outcome expectancies were associated with PSE (ß = 0.169; p = 0.032). In conclusion, interventions should promote self-efficacy, outcome expectancies, and healthy nutrition for parents as well in order to strengthen the healthy eating habits of children.

Intervention Effects of a Kindergarten-Based Health Promotion Programme on Motor Abilities in Early Childhood.

Background: Physical activity is positively related to motor abilities. Especially in childhood, an active lifestyle is important to support healthy motor development. The low-threshold health promotion programme "Join the Healthy Boat" in kindergartens promotes physical activity in order to also improve motor abilities. Here, effects of the programme on children's motor abilities after 1 year were investigated. Materials and Methods: The longitudinal study included 419 children (3.7 ± 0.6 years) from 58 kindergartens throughout south-west Germany (intervention: 254, control: 165). Children in the intervention group received physical activity promotion with a focus on motor ability development, led by teachers, through one kindergarten year; children in the control group followed the normal kindergarten routine. At baseline and follow-up, motor tests (3-min-run, one-leg-stand, standing long jump, sit-and-reach-test) were performed, anthropometric measures (body weight and height) were taken and a parental questionnaire was issued. Intervention effects were assessed using differential measures (follow-up - baseline) adjusted for gender, age, socioeconomic status (SES) and baseline values, with covariance analyses. Results: Children in the intervention group showed a significant improvement in endurance performance (F(1.329)=20.95, p<0.000, Î·P2=0.060) , which applies to boys (F(1,172)=13,66, p≤0.000, Î·P2=0,074)  and girls (F(1,152)=7,48, p≤0.007,ηP2=0,047) . No significant intervention effects on endurance performance were found for children with low baseline values, children with a low SES, and children aged 5 years, nor for any other assessed motor ability. Conclusions: The theory-based, teacher-centered intervention promoting physical activity in order to also improve motor abilities has shown a positive effect on endurance performance in kindergarten children, but no other motor ability. Future interventions should therefore be either longer, more intense and take into account children's age, initial level of performance and their SES. In addition, the influence of teachers should be considered more closely in future research.

[Methodological Challenges of Prevention Reporting - More to it Than Just Evidence Reporting!] / Methodische Herausforderungen der Präventionsberichterstattung.

BACKGROUND: The German Prevention Act came into force in 2015 with the aim of strengthening prevention of disease and health promotion, focussing on settings-based approaches. An established field of public health action is thus strengthened and expanded by a set of rules that has largely come into force as a social security law. The implementation of legislation is to be accompanied by the establishment of a prevention reporting system. AIMS: Types of reporting are contextualized and delimited from one another by means of the planning stages of the public health action cycle with their different goals, content and data sources. RESULTS: Prevention reports must reflect not only the state of health and intervention features but also intended and unintended structural changes in the public health action field. Due to its obvious relevance to the envisioned settings, the local level seems to be of particular importance. Special attention also deserves legally unintended shifts of tasks from public to social security financing. A reporting system misconceived primarily as evidence reporting would be likely to fail the intended strengthening of settings-based approaches and instead would favour downstream measures that are easier to evaluate.

Physicians' perspectives on implementing the prevention scheme "Physical Activity on Prescription": Results of a survey in Bavaria.

The prevention scheme called "Rezept für Bewegung" (Physical Activity on Prescription, PAP) enables physicians to formally prescribe participation in health-oriented sports programs to their patients. The PAP scheme aims to strengthen the binding character of physicians' patient counselling for physical activity. The research objective was to investigate the physicians' awareness and their use of PAP as a prevention tool in patient counselling, as well as perceived barriers to implementation. A cross-sectional total population mail questionnaire survey was performed in two districts of Bavaria. 2,821 physicians in private practice were contacted; the response rate was 32.7 %. Descriptive data analysis of 923 questionnaires was carried out using SPSS. Only 26.4 % of the respondents (244/923) were familiar with the PAP scheme, and only 7.7 % (71/923) used PAP at least once a month when counselling their patients. Key barriers to implementation include lack of information on the prevention scheme, a limited choice of local matching sports programs and an unclear commitment of health insurances to reimburse patients for participation fees. Every third physician distrusts PAP to be an efficient way of improving physical activity in patients. To foster the implementation of PAP in the future, awareness-raising campaigns and an expansion of sports programs might be helpful. In order to strengthen the physicians' confidence in the effectiveness of preventive patient counselling on physical activity, existing research evidence needs to be spread among physicians.

[The Load of Injustice: A Longitudinal Analysis of the Impact of Subjectively Perceived Income Injustice on the Risk of Stress-Associated Diseases Based on the German Socio-Economic Panel Study]. / Die Last der Ungerechtigkeit. Eine Längsschnittanalyse auf Basis des SOEPs zum Einfluss subjektiv wahrgenommener Einkommensgerechtigkeit auf das Risiko einer stressassoziierten Erkrankung.

BACKGROUND: Income injustice is regarded as a psychosocial strain and associated with an increased risk of stress-related diseases. The physiological stress response is thereby considered as a central link. The aim of the study is to reveal the influence of subjectively perceived income injustice on stress-associated diseases, taking into consideration the load duration. METHOD: Based on the German Socio-Economic Panel Study, data on 5,657 workers in the survey years 2005-2013 were analyzed. The dependent variable reflect the doctor's diagnosed new cases of diabetes, asthma, cardiopathy, stroke, hypertension and depression in the years 2009-2013 as an index. Key predictor is the injustice perception of one's income. In order to operationalize the duration of the injustice perception, the values of the variable for the years 2005, 2007 and 2009 were accumulated. Using logit models, stratified for gender and volume of employment, factors were identified that affect the probability of stress-related diseases. RESULTS: If income was perceived as unjust for over 5 years, the odds of stress-related diseases were strongly enhanced for women (OR 1.64; 95% CI 1.17-2.30). Women working full-time seemed to be particularly affected (OR 2.43; 95% CI 1.54-3.84). Men working full-time perceiving their income as unjust also showed an increased risk for stress diseases (OR 1.43; CI 1.03-1.98). The more often income was assessed as unjust, the higher was the probability of stress-related diseases. CONCLUSIONS: Perceived income injustice seems to be a significant risk factor for stress-related diseases within a dose-response relationship with increasing duration of exposure. Findings of stress research indicate that this represents the 'allostatic load'. Gender-specific differences in stress reaction as well as in the appraisal of the stressors can be associated with gender-specific work and life conditions and therefore provide explanatory approaches for the revealed effects.

Electronic media use and insomnia complaints in German adolescents: gender differences in use patterns and sleep problems.

Electronic media play an important role in the everyday lives of children and adolescents and have been shown to be associated with sleep problems. The objective of this study was to assess the associations between time spent using different electronic media and insomnia complaints (IC) in German adolescents with particular respect to gender differences in use patterns and associations with IC. Cross-sectional data of a weighted total of 7533 adolescents aged 11-17 stem from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS study) that was conducted from 2003 to 2006. The assessment of IC and time spent using different electronic media (television, computer/internet, video games, total screen time, mobile phones, and music) was included in a self-report questionnaire. Binary logistic regression analyses were performed to assess associations between time spent per day with each electronic media and IC. Age, SES, emotional problems (anxiety/depression) and presence of a medical condition were considered as covariates in the adjusted model. Boys and girls were considered separately. For boys: computer/internet use of ≥3 h/d (AOR = 2.56, p < 0.05) and total screen time of ≥8 h/d (AOR = 2.45, p < 0.01) were associated with IC in users. Playing video games for 0.5-2 h/d reduced the odds for IC (AOR = 0.60, p < 0.05) compared to nonusers. For girls: Listening to music for ≥3 h/d was associated with IC (AOR = 4.24, p < 0.05) compared to non-listeners. Everyday use of electronic media devices is associated with IC in adolescents. Clinicians dealing with adolescents referred for sleep problems should be aware of gender-specific patterns of media use and sleep problems.

Insomnia complaints and substance use in German adolescents: did we underestimate the role of coffee consumption? Results of the KiGGS study.

The purpose of the study was to study the associations of tobacco, alcohol, marijuana, and coffee use and insomnia complaints (IC) in adolescents with special consideration of the influence of coffee consumption on these relationships. 7698 Subjects aged 11-17 years were investigated in a cross-sectional study within the German Health Interview and Examination Survey for Children and Adolescents. Self-report questionnaires were distributed to the participants. Hierarchical regression analyses were performed to assess possible effects of coffee consumption on the association of tobacco, alcohol, and marijuana use with IC. Common risk factors for insomnia were included in the adjusted analyses. Tobacco, alcohol, marijuana and coffee use displayed significant bivariate associations with IC. After adjusting the first three substances for coffee consumption, their associations with IC were reduced considerably. After additionally adjusting for other potential confounders (age, gender, socio-economic status, externalizing and internalizing psychiatric problems, media use, bodyweight, medical condition), frequent coffee consumption, high alcohol intake and frequent smoking contributed to the prediction of IC in male subjects while frequent coffee consumption and high alcohol intake predicted the occurrence of IC in females. Coffee consumption could be an important risk factor for IC in adolescents and it significantly affects the association of smoking, alcohol, and marijuana with IC. Future research that includes long-term studies about psychoactive substance use (PSU) and sleep should also consider coffee consumption. Parents, educators, clinicians, and researchers should be aware of the potentially hazardous influence of PSU, especially coffee, alcohol and tobacco, on sleep in young individuals.

Impaired sleep quality and sleep duration in smokers-results from the German Multicenter Study on Nicotine Dependence.

Cigarette smoking is a severe health burden being related to a number of chronic diseases. Frequently, smokers report about sleep problems. Sleep disturbance, in turn, has been demonstrated to be involved in the pathophysiology of several disorders related to smoking and may be relevant for the pathophysiology of nicotine dependence. Therefore, determining the frequency of sleep disturbance in otherwise healthy smokers and its association with degree of nicotine dependence is highly relevant. In a population-based case-control study, 1071 smokers and 1243 non-smokers without lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorder were investigated. Sleep quality (SQ) of participants was determined by the Pittsburgh Sleep Quality Index. As possible confounders, age, sex and level of education and income, as well as depressiveness, anxiety, attention deficit hyperactivity, alcohol drinking behaviour and perceived stress, were included into multiple regression analyses. Significantly more smokers than non-smokers (28.1% versus 19.1%; P < 0.0001) demonstrated a disturbed global SQ. After controlling for the confounders, impaired scores in the component scores of sleep latency, sleep duration and global SQ were found significantly more often in smokers than non-smokers. Consistently, higher degrees of nicotine dependence and intensity of smoking were associated with shorter sleep duration. This study demonstrates for the first time an elevated prevalence of sleep disturbance in smokers compared with non-smokers in a population without lifetime history of psychiatric disorders even after controlling for potentially relevant risk factors. It appears likely that smoking is a behaviourally modifiable risk factor for the occurrence of impaired SQ and short sleep duration.