[Gender equality and the gender gap in life expectancy in Germany]. / Gleichstellung der Geschlechter und Geschlechterunterschiede in der Lebenserwartung in Deutschland.

BACKGROUND: The gender gap in life expectancy is documented worldwide with lower life expectancy in male new-borns. International studies have shown that the gender gap in life expectancy varies markedly with gender inequality. OBJECTIVES: The paper addresses the questions: (1) whether there are life-expectancy differences between the federal states and whether the extent of gender equality at federal level is associated with (2) gender differences in life expectancy and (3) the life expectancy of women and men. MATERIALS AND METHODS: The Gender Inequality Index (GII) developed by the United Nations Development Project was calculated using data from the federal states. Using linear regressions, GII was associated with the gender gap in life expectancy as well as with life expectancy in males and females. RESULTS: The GII varies between 0.065 (Bavaria) and 0.117 (Mecklenburg-Vorpommern) and the gender gap in life expectancy differs by almost two years within Germany. We found a correlation between the gender difference in life expectancy and GII (R2 linear = 0.848) as well as between GII and life expectancy of male (R2 linear = 0.700), but not female newborns (R2 linear = 0.102). The association remains if GDP is taken into account as an indicator of economic power. CONCLUSIONS: Gender equality seems to be positively related to the life expectancy of men. This can be explained by the reduced importance of male gender stereotypes and associated risk behaviors. The requirements for gender-differentiated interventions formulated in the Prevention Act (Präventionsgesetz) are highly significant.

Trends in Absolute and Relative Educational Inequalities in Adult Smoking Since the Early 2000s: The Case of Germany.

Introduction: Since the early 2000s, several tobacco control policies have been implemented in Germany. Current research is inconsistent about how strengthening tobacco control can affect social inequalities in smoking. This study examines whether educational inequalities in adult smoking have widened in Germany since 2003. Methods: Data were used from four cross-sectional national health surveys conducted between 2003 and 2012 (n = 54,197; age = 25-69 years). Participants who smoked daily or occasionally were classified as smokers. The regression-based Slope Index of Inequality and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in smoking, respectively. Results: In each survey year, smoking was associated with lower education. Overall, crude and age-standardized smoking rates declined over time. Stratified by education, trends of declining smoking rates were observed only in the high and medium education groups, whereas no statistically significant trend was found in the low education group. Relative educational inequalities in smoking increased significantly in men (2003: RII=1.74, 95% confidence interval 1.46 to 2.07; 2012: RII = 2.25, 95% confidence interval 1.90 to 2.67; p-trend = .019). Absolute educational inequalities in smoking were not found to have changed significantly during the study period. Conclusions: In the course of declining smoking rates, educational inequalities in smoking persisted in both absolute and relative terms. In men, relative inequalities in smoking may even have widened within only 9 years. Tobacco control policies should not only be targeted at the entire population but also attempt to reduce social inequalities in smoking by focusing more on socially disadvantaged groups. Implications: Smoking is associated with lower education in most European countries and contributes to social inequalities in health. Since the beginning of the 2000s, Germany has implemented a variety of tobacco control policies to reduce smoking in the population. This study reveals that despite a general decline in adult smoking, educational inequalities in smoking have persisted and even widened in Germany since 2003. The findings emphasize that more targeted efforts are needed to tackle smoking-induced inequalities in health.

Gender inequality and the gender gap in life expectancy in the European Union.

The gender gap in life expectancy (GGLE) varies substantially in EU 28 Member States. This paper addresses the question of whether gender inequality affects the GGLE as well as life expectancy (LE) in both genders. We conducted an ecological study and used the gender inequality index (GII) developed by the United Nations as well as the gender difference in LE in 2015. We found a correlation between GGLE and GII (r2=0.180) and between GII and LE of 0.418 (women) and 0.430 (men). Gender equality policies are still necessary and will have an effect on women's as well as men's health.

[Breastfeeding behaviour in Germany-News from KiGGS Wave 2]. / Stillverhalten in Deutschland ­ Neues aus KiGGS Welle 2.

Breast milk is the optimal nutrition for babies in their first six months of life and provides health benefits for both children and mothers. As part of the Robert Koch Institute's health monitoring, the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) regularly collects population-based data on the health situation of children and adolescents living in Germany, including information on breastfeeding. This article describes breastfeeding behaviour based on the results of KiGGS Wave 2 (2014-2017). The prevalence of breastfeeding and the duration of breastfeeding in the birth cohorts 2009-2016 as well as information on intention to breastfeed and reasons for weaning are described. The results from KiGGS Wave 2 show that breastfeeding proportions for any type of breastfeeding tended to increase between the birth cohorts 2009/2010 and 2013/2014, while the prevalence for full and exclusive breastfeeding show no change. The average duration of breastfeeding has remained constant. Almost 90% of mothers intended to breastfeed their baby after birth and 97% of these mothers actually started breastfeeding. Having insufficient breast milk has often been mentioned as a problem, both by mothers who intended to breastfeed but did not start breastfeeding and by mothers who have been breastfeeding their infants for less than six months. Despite some limitations, the KiGGS study is an important part of breastfeeding monitoring. Regular data collection and the largely consistent study design make it possible to map trends in time and to measure the impact of breastfeeding promotion on the population. KiGGS Wave 2 shows that breastfeeding promotion measures are still necessary.

Changing educational inequalities in sporting inactivity among adults in Germany: a trend study from 2003 to 2012.

BACKGROUND: Social inequalities in health can be explained in part by the social patterning of leisure-time physical activity, such as non-participation in sports. This study is the first to explore whether absolute and relative educational inequalities in sporting inactivity among adults have changed in Germany since the early 2000s. METHODS: Data from four cross-sectional national health surveys conducted in 2003 (n = 6890), 2009 (n = 16,418), 2010 (n = 17,145) and 2012 (n = 13,744) were analysed. The study population was aged 25-69 years in each survey. Sporting inactivity was defined as no sports participation during the preceding 3 months. The regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in sporting inactivity, respectively. RESULTS: Sporting inactivity was consistently more prevalent in less-educated groups. The overall prevalence of sporting inactivity declined significantly over time. However, the decline was observed only in the high and medium education groups, while no change was observed in the low education group. Both absolute and relative educational inequalities in sporting inactivity were found to have widened significantly between 2003 (SII = 0.30, 95% CI = 0.25-0.35; RII = 2.08, 95% CI = 1.83-2.38) and 2012 (SII = 0.41, 95% CI = 0.37-0.45; RII = 3.44, 95% CI = 3.03-3.91). Interaction analysis showed that these increases in inequalities were larger in the younger population under the age of 50 than among the elderly. CONCLUSIONS: The findings suggest that the gap in sports participation between adults with high and low educational attainment has widened in both absolute and relative terms because of an increase in sports participation among the better educated. Health-enhancing physical activity interventions specifically targeted to less-educated younger adults are needed to prevent future increases in social inequalities in health.

[Regional differences in the prevalence of cardiovascular risk factors in men and women in Germany]. / Regionale Unterschiede in der Prävalenz von kardiovaskulären Risikofaktoren bei Männern und Frauen in Deutschland.

BACKGROUND: More than half of all cardiovascular diseases are caused by eight, mostly preventable risk factors. OBJECTIVES: In view of the considerable differences in the prevalence and mortality of cardiovascular diseases between the 16 German federal states, the regional distribution of cardiovascular risk factors was analyzed stratified for men and women, using population-based data. METHODS: Pooled data (n = 62,606) from the national, telephone health surveys "German Health Update" from 2009, 2010 and 2012 were used to estimate the prevalence of physical inactivity, risky alcohol consumption, smoking, low fruit and vegetable consumption, obesity and diagnosed hypertension, diabetes and dyslipidemia and the accumulated number of risk factors stratified for men and women in the federal states. Furthermore, we analyzed the influence of age and social status on prevalence differences. RESULTS: At the national level, 36.0% of men and 26.6% of women had three or more risk factors. Large differences between men and women were found for risky alcohol consumption (32.8% versus 21.7%), low fruit and vegetable consumption (20.6% versus 10.4%) and current smoking (32.6% versus 24.9%). The prevalence of all eight risk factors differed considerably between federal states. The highest prevalence of physical inactivity, obesity, hypertension and diabetes in both sexes as well as risky alcohol consumption in men were observed in the Eastern federal states (except for Berlin). Sachsen-Anhalt was the only federal state with the highest prevalence for two risk factors. Current smoking was most prevalent in the three federal city states Berlin, Hamburg and Bremen. Saarland had the highest prevalence of low fruit and vegetable consumption in both sexes. Regional differences remained after adjustment for age and social status. CONCLUSIONS: There is evidence for regional differences in cardiovascular risk factor levels in Germany that resemble variations in the prevalence and mortality of cardiovascular diseases between federal states with a more unfavorable situation in the East (except for Berlin). Overall, this study shows a considerable need for the prevention of mostly modifiable risk factors for cardiovascular diseases in men and women in Germany.

[Data on disability and participation in Germany : Requirements, analysis options and results]. / Daten zu Behinderung und Teilhabe in Deutschland : Anforderungen, Auswertungsmöglichkeiten und Ergebnisse.

As a basis for political decisions and to meet the statistical requirements of the CRPD, reliable data and reporting on the situation of people with disabilities are essential. Based on results of the preliminary study for a German participation survey, this article firstly defines data requirements and areas of participation. Secondly, data sources regarding participation and disability in Germany that were identified in a literature search are described in detail. Only sources providing population-based data that are collected on a regular basis and that could contribute to participation reporting were taken into account. This includes data from official statistics, (panel) studies or surveys, administrative data and reporting systems. Finally, we exemplarily present the main statistical findings of the 2012 European health and social integration survey (EHSIS), a survey that was specifically designed to investigate participation of persons with disabilities. In addition to the surveys identified in the preliminary study for a German participation survey that could be used or expanded for participation reporting, and the data sources used in the participation report published by the federal government in 2013, the research yielded further publicly available data sources with a high potential for a participation reporting system.

[Prevalence of experience of physical and psychological violence in the general population in the past 12 months. Results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Psychische und körperliche Gewalterfahrungen in den vergangenen 12 Monaten in der Allgemeinbevölkerung. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

Experiences of violence may have considerable psychosocial and health implications. A violence screening tool was implemented in the German Health Interview and Examination Survey for Adults (DEGS1) to depict the perpetrators' and victims' point of view. The study participants were between 18 and 64 years old (n = 5939). The aim of this article is to assess the percentage of people who experienced physical and psychological violence in the last 12 months or who suffered negative effects on their quality of life as a consequence or who were perpetrators of multiple acts of violence. The characteristics of victims, offenders, and their conflict partners are described. Furthermore, specific constellations of violence experience with regard to health-related quality of life are described. Finally, the association between being a victim of violence and different factors is estimated. In total, 2.7% of women and 4.3% of men reported multiple experiences of physical violence in the last 12 months or having their lives negatively impacted as a consequence of violence. Experience of psychological violence was reported by 18.9% of women and 15.4% of men. Women are more likely than men to be both perpetrator and victim within the family. Men are more likely than women to be both the perpetrator and victim outside of the family environment. Regardless of whether they are the victim or perpetrator of violence, the psychological well-being is significantly worse than those of people who did not experience violence. Experience of violence in childhood and adolescence increases the risk of becoming victim or perpetrator of violence later on in life. The findings presented here describe the psychological and physical experience of violence as one part of violence committed in the whole population. Some prevention advice is also presented.

[What are the determinants of childhood obesity? : A literature review as part of the project "Nationwide Monitoring of Childhood Obesity Determinants"]. / Was sind die Einflussfaktoren kindlicher Adipositas? : Eine Literaturübersicht im Rahmen des Projekts "Bevölkerungsweites Monitoring adipositasrelevanter Einflussfaktoren im Kindesalter".

BACKGROUND: Obesity can impair health even in childhood and unfold negative health consequences through an individual's lifespan. In Germany, to date, a systematic and periodically updated synopsis of the multifaceted determinants of childhood obesity is lacking. In this paper, we present the results of a systematic literature review on childhood obesity determinants, which was conducted over the course of the implementation of nationwide monitoring. METHODS: The review was carried out in three steps. Initially, a search for etiological models of childhood obesity was conducted. Based on these results, a systematic review of reviews on childhood obesity determinants was carried out. Finally, the results were verified by taking international guidelines on childhood obesity into account. RESULTS: In total, 21 etiological models, 75 reviews and 7 guidelines were identified. Over 60 determinants were extracted from these publications and were summarized into the following categories: nutritional behavior, physical activity behavior, sleeping pattern, biological determinants and diseases, prenatal and early childhood determinants, psycho-social determinants, food environment, moveability/walkability, setting and social environment, health promotion and prevention, socioeconomic, demographic, and sociocultural determinants. CONCLUSION: This review demonstrates the complex patterns of childhood obesity determinants in correspondence with a socio-ecological approach. The review will form the basis for the monitoring-system "Nationwide Monitoring of Childhood Obesity Determinants", which will be implemented at the Robert Koch Institute by the end of 2017.

Palaeohexaploid ancestry for Caryophyllales inferred from extensive gene-based physical and genetic mapping of the sugar beet genome (Beta vulgaris).

Sugar beet (Beta vulgaris) is an important crop plant that accounts for 30% of the world's sugar production annually. The genus Beta is a distant relative of currently sequenced taxa within the core eudicotyledons; the genomic characterization of sugar beet is essential to make its genome accessible to molecular dissection. Here, we present comprehensive genomic information in genetic and physical maps that cover all nine chromosomes. Based on this information we identified the proposed ancestral linkage groups of rosids and asterids within the sugar beet genome. We generated an extended genetic map that comprises 1127 single nucleotide polymorphism markers prepared from expressed sequence tags and bacterial artificial chromosome (BAC) end sequences. To construct a genome-wide physical map, we hybridized gene-derived oligomer probes against two BAC libraries with 9.5-fold cumulative coverage of the 758 Mbp genome. More than 2500 probes and clones were integrated both in genetic maps and the physical data. The final physical map encompasses 535 chromosomally anchored contigs that contains 8361 probes and 22 815 BAC clones. By using the gene order established with the physical map, we detected regions of synteny between sugar beet (order Caryophyllales) and rosid species that involves 1400-2700 genes in the sequenced genomes of Arabidopsis, poplar, grapevine, and cacao. The data suggest that Caryophyllales share the palaeohexaploid ancestor proposed for rosids and asterids. Taken together, we here provide extensive molecular resources for sugar beet and enable future high-resolution trait mapping, gene identification, and cross-referencing to regions sequenced in other plant species.

International differences in self-reported health measures in 33 major metropolitan areas in Europe.

BACKGROUND: The increasing concentration of populations into large conurbations in recent decades has not been matched by international health assessments, which remain largely focused at the country level. We aimed to demonstrate the use of routine survey data to compare the health of large metropolitan centres across Europe and determine the extent to which differences are due to socio-economic factors. METHODS: Multilevel modelling of health survey data on 126,853 individuals from 33 metropolitan areas in the UK, Republic of Ireland, Sweden, Norway, Finland, Spain, Belgium and Germany compared general health, longstanding illness, acute sickness, psychological distress and obesity with the average for all areas, accounting for education and social class. RESULTS: We found some areas (Greater Glasgow; Greater Manchester, Cheshire and Merseyside; Northumberland, Tyne and Wear and South Yorkshire) had significantly higher levels of poor health. Other areas (West Flanders and Antwerp) had better than average health. Differences in individual socio-economic circumstances did not explain findings. With a few exceptions, acute sickness levels did not vary. CONCLUSION: Health tended to be worse in metropolitan areas in the north and west of the UK and the central belt and south east of Germany, and more favourable in Sweden and north west Belgium, even accounting for socio-economic composition of local populations. This study demonstrated that combining national health survey data covering different areas is viable but not without technical difficulties. Future comparisons between European regions should be made using standardized sampling, recruitment and data collection protocols, allowing proper monitoring of health inequalities.

Haplotype divergence in Beta vulgaris and microsynteny with sequenced plant genomes.

We characterized two overlapping sugar beet (Beta vulgaris) bacterial artificial chromosome (BAC) clones representing different haplotypes. A total of 254 kbp of the genomic sequence was determined, of which the two BACs share 92 kbp. Eleven of 15 genes discovered in the sequenced interval locate to the overlap region. The haplotypes differ in exons by 1% (nucleotide level) and in non-coding regions by 9% (6% mismatches, 3% gaps; alignable regions only). Large indels or high sequence divergence comprised 11% of either sequence. Of such indels, 68 and 45%, respectively, could be attributed to haplotype-specific integration of transposable elements. We identified novel repeat candidates by comparing the two BAC sequences to a set of genomic sugar beet sequences. Synteny was found with Arabidopsis chromosome 1 (At1), At2 and At4, Medicago chromosome 7, Vitis chromosome 15 and paralogous regions on poplar chromosomes II and XIV.

Frequent epigenetic inactivation of RASSF2 in thyroid cancer and functional consequences.

BACKGROUND: The Ras association domain family (RASSF) encodes for distinct tumor suppressors and several members are frequently silenced in human cancer. In our study, we analyzed the role of RASSF2, RASSF3, RASSF4, RASSF5A, RASSF5C and RASSF6 and the effectors MST1, MST2 and WW45 in thyroid carcinogenesis. RESULTS: Frequent methylation of the RASSF2 and RASSF5A CpG island promoters in thyroid tumors was observed. RASSF2 was methylated in 88% of thyroid cancer cell lines and in 63% of primary thyroid carcinomas. RASSF2 methylation was significantly increased in primary thyroid carcinoma compared to normal thyroid, goiter and follicular adenoma (0%, 17% and 0%, respectively; p < 0.05). Patients which were older than 60 years were significantly hypermethylated for RASSF2 in their primary thyroid tumors compared to those younger than 40 years (90% vs. 38%; p < 0.05). RASSF2 promoter hypermethylation correlated with its reduced expression and treatment with a DNA methylation inhibitor reactivated RASSF2 transcription. Over-expression of RASSF2 reduced colony formation of thyroid cancer cells. Functionally our data show that RASSF2 interacts with the proapoptotic kinases MST1 and MST2 and induces apoptosis in thyroid cancer cell lines. Deletion of the MST interaction domain of RASSF2 reduced apoptosis significantly (p < 0.05). CONCLUSION: These results suggest that RASSF2 encodes a novel epigenetically inactivated candidate tumor suppressor gene in thyroid carcinogenesis.

High-throughput identification of genetic markers using representational oligonucleotide microarray analysis.

We describe a novel approach for high-throughput development of genetic markers using representational oligonucleotide microarray analysis. We test the performance of the method in sugar beet (Beta vulgaris L.) as a model for crop plants with little sequence information available. Genomic representations of both parents of a mapping population were hybridized on microarrays containing in total 146,554 custom made oligonucleotides based on sugar beet bacterial artificial chromosome (BAC) end sequences and expressed sequence tags (ESTs). Oligonucleotides showing a signal with one parental line only, were selected as potential marker candidates and placed onto an array, designed for genotyping of 184 F(2) individuals from the mapping population. Utilizing known co-dominant anchor markers we obtained 511 new dominant markers (392 derived from BAC end sequences, and 119 from ESTs) distributed over all nine sugar beet linkage groups and calculated genetic maps. Further improvements for large-scale application of the approach are discussed and its feasibility for the cost-effective and flexible generation of genetic markers is presented.

Influencing factors of obesity in school-age children and adolescents - A systematic review of the literature in the context of obesity monitoring.

Around 15% of children and adolescents in Germany are overweight or obese. To support the planning, implementation and evaluation of preventive activities, the Robert Koch Institute (RKI) has developed a population-wide monitoring of influencing factors relevant to the development of obesity during childhood (AdiMon). AdiMon is a web-based indicator system providing population-wide meaningful and regularly updated data on factors that influence obesity in kindergarten-age girls and boys (0- to 6-years-old). Towards the end of 2020, the RKI will expand the indicator system to also cover the 7- to 17-year-old age group. To this end, a systematic review of the literature was conducted, a process which served to identify over 80 relevant factors that influence the development of obesity. These factors have been attributed to the categories behaviour, environment, biology, pre- and postnatal, psychosocial factors and context. Compared to a previous literature review for kindergarten-age children, around one tenth of the influencing factors now identified are new, including 'peer group influences' and 'bullying'. As the results highlight, an array of influencing factors must be considered when expanding the monitoring system, ranging from individual health behaviour to the social framework conditions and environmental factors.

Risky Alcohol Consumption and Heavy Episodic Drinking among Parents in Germany: Results of a Nationwide Cross-Sectional Study.

Introduction: Risky alcohol consumption (RAC) and heavy episodic drinking (HED) by parents can have negative effects on their children. At present, little is known about these forms of alcohol consumption among parents in Germany. The aim of this analysis is to estimate the percentage of parents living in Germany who practise RAC and HED and to study associations between these consumption patterns and sociodemographic factors. Material and Methods: The data basis comprises the data of the nationwide studies "Gesundheit in Deutschland aktuell" (GEDA) of 2009, 2010, and 2012. The data were collected by means of computer-assisted telephone interviews (CATI). Our analysis included all participants living in a household with at least one child of their own under 18 years of age (n = 16,224). Information on RAC and HED was collected using the AUDIT-C screening instrument. Logistic regression models were used to study the relationship between parental alcohol consumption and sociodemographic variables. Results: 18.4% of the mothers and 29.6% of the fathers exhibited RAC; 8.4% of the mothers and 21.0% of the fathers practised HED. After mutual adjustment, RAC showed a significant association with the level of education, income (only mothers), employment status (only mothers), migration background, relationship status (only mothers), and the age of the youngest child. HED showed a significant association with income (only mothers), the age of the youngest child (only mothers), and the level of education (only fathers). Conclusions: The presented analysis emphasizes the relevance of preventive measures to reduce parental alcohol consumption. In addition to universal interventions, risk group-specific measures (e.g., for parents with high income) are needed to reduce parental alcohol consumption and thus support a healthy development of children.

Socioeconomic Inequalities in the Rise of Adult Obesity: A Time-Trend Analysis of National Examination Data from Germany, 1990-2011.

OBJECTIVE: Despite extensive study of the obesity epidemic, research on whether obesity has risen faster in lower or in higher socioeconomic groups is inconsistent. This study examined secular trends in obesity prevalence by socioeconomic position and the resulting obesity inequalities in the German adult population. METHODS: Data were drawn from three national examination surveys conducted in 1990-1992, 1997-1999 and 2008-2011 (n = 18,541; age range: 25-69 years). Obesity was defined by a body mass index ≥30 kg/m2 using standardised measurements of body height and weight. Education and equivalised household disposable income were used as indicators of socioeconomic position. Time trends in socioeconomic inequalities in obesity were examined using linear probability and log-binomial regression models. RESULTS: In each survey period, the highest socioeconomic groups had the lowest prevalence of obesity. The low and medium socioeconomic groups showed increases in obesity prevalence, whereas no such trend was observed in the high socioeconomic groups. Absolute inequalities in obesity by income increased by an average of 0.53 percentage points per year (95% confidence interval [CI] 0.01-1.05, p = 0.047) among men and 0.47 percentage points per year (95% CI 0.05-0.90, p = 0.029) among women. Absolute inequalities in obesity by education increased on average by 0.64 percentage points per year (95% CI 0.19-1.08, p = 0.005) among women but not among men (0.33 percentage points, 95% CI -0.27 to 0.92, p = 0.283). CONCLUSIONS: These findings suggest a widening obesity gap between the top and the bottom of the socioeconomic spectrum. This has the potential to have adverse consequences for population health and health inequalities in coming decades. Interventions that are effective in preventing and reducing obesity in socially disadvantaged groups are needed.

European Health Interview Survey (EHIS) 2 - Background and study methodology.

The scientific assessment of health issues, the design and further development of political guidelines as well as the targeted planning of measures in the European Union (EU) require data on population health. For this reason, all EU Member States regularly collect data on the health status, provision of healthcare, health determinants and socioeconomic situation of their respective populations in the European Health Interview Survey (EHIS). Participants are at least 15 years old and live in private households. The second wave of EHIS (EHIS 2) was conducted between 2013 and 2015. For EHIS 2, each EU Member State drew a nationally representative population sample from population registers, censuses, dwelling registers or other statistical or administrative sources. Data collection modes within individual EU Member States were used, according to nationally established methods, including the use of mixed-mode surveys. Across all EU Member States, data collection took an average of eight months to complete. Member States made considerable efforts to achieve the highest possible response rates. The harmonised EHIS data collected are highly comparable and constitute an important information base for European health policy and health reporting.

Time trends in healthy lifestyle among adults in Germany: Results from three national health interview and examination surveys between 1990 and 2011.

BACKGROUND: The combined impact of multiple healthy behaviors on health exceeds that of single behaviors. This study aimed to estimate trends in the prevalence of a healthy lifestyle among adults in Germany. METHODS: A data set of 18,058 adults aged 25-69 years from three population-based national health examination surveys 1990-92, 1997-99 and 2008-11 with complete information for five healthy behavior factors was used. A 'daily intake of both fruits and vegetables, 'sufficient physical exercise', 'no current smoking' and 'no current risk drinking' were assessed with self-reports and 'normal body weight' was calculated based on measured body weight and height. A dichotomous 'healthy lifestyle' indicator was defined as meeting at least four out of five healthy behaviors. Age-standardized prevalence was calculated stratified by sex, age groups (25-34, 35-44, 45-54 and 55-69 years) and education level (low, medium and high). Trends were expressed in relative change (RC) between 1990-92 and 2008-11. RESULTS: In Germany, the overall prevalence of healthy lifestyle increased from 9.3% in 1990-92 to 13.5% in 1997-99 and to 14.7% in 2008-11 (RC: +58.1%). The prevalence increased among men and women and in all age groups, with the exception of men aged 45-54 years. The RC of increasing healthy lifestyle prevalence between 1990-92 and 2008-11 was stronger albeit on a higher level among women compared to men. Therefore, the gender difference in healthy lifestyle has increased, but age-related differences have overall decreased in this period. Among high educated men the prevalence of a healthy lifestyle increased between 1990-92 and 2008-11 from 10.6% to 16.3% (p = 0.01) and among high educated women from 16.4% to 30.3% and also among medium educated women (10.9 to 16.6, p<0.01), but no significant increase in healthy lifestyle prevalence was observed among men with low and medium education and among women with low education level. CONCLUSIONS: The prevalence of a lifestyle with at least four out of five healthy behaviors markedly increased from 1990-92 to 2008-11. Nevertheless, additional health promotion interventions are needed to improve the number of combined healthy behavior factors and the awareness in the population that each additional healthy behavior factor leads to a further improvement in health, especially in men in the age-range 45 to 54 years, and among persons with low education level.

Road map towards a harmonized pan-European surveillance of obesity-related lifestyle behaviours and their determinants in children and adolescents.

OBJECTIVES: To develop a road map towards a harmonized pan-European surveillance system for children and adolescents. METHODS: Representatives of five European surveillance systems and the German Health Interview and Examination Survey for Children and Adolescents contributed to the road map through a structured workshop in 2016. RESULTS: A conceptual framework for this road map was developed with seven action points (APs) guiding the successive cross-country harmonization. First, key indicators of health behaviour and their determinants in children and adolescents will be identified (AP1, 2); short screening instruments will be developed and implemented to assess and monitor key indicators (AP3, 4). In parallel, optional supplementary modules could be implemented to provide objective data (AP5). This would allow mutual calibration and improvement of existing instruments before their progressive replacement by more comparable measurement tools (AP6). The establishment of a competence platform is envisaged for guiding the harmonization process (AP7). CONCLUSIONS: This approach builds on existing systems, provides comparable key health indicators across European regions, helps to assess temporal trends and-once in place-will facilitate health reporting and monitoring of national and international health targets.