Violence and adolescence in urban settings: A public health approach based on the MLIVEA framework

Adolescent violence is a public health issue with global relevance and far-reaching health consequences. It impairs the well-being of those involved and makes demands on health services. The review gives insight into the determinants leading to the health effects of urban violence focusing on young people. For this purpose a new comprehensive framework has been developed and applied. The new framework is called MLIVEA framework due to the structure of its components, which are macro level, local setting, individual level, violent act, health effect and action. Determinants of the macro level are forming societal conditions that contribute to the development of violence in cities. The different local settings are all affected by the macro level and are connecting links to the individual level. The individual level shows risk factors of the individual adolescent concerning psychological, social and biological aspects of personality. The violent acts refer to actual violent events leading to the violence-related health effects. Action can be taken to reduce violence at the macro level, at the local setting level and at the individual level. The advantage of the new framework lies in its presentation of the whole process and the interrelations of factors, which lead to adolescent violence in cities. The MLIVEA framework shows: 1. It is necessary to understand the causes of violence at all the different levels for each city. 2. Best results are gained by carrying out interventions at all the levels. 3. Violence and related health consequences are preventable and have relevance for public health science and action. -- In vielen Ländern gefährden Gewalttaten nicht nur den sozialen Zusammenhalt, sie belasten auch die Gesundheit der Bevölkerung. Insbesondere Jugendliche und junge Erwachsene in Städten sind häufig an Gewalttaten beteiligt, entweder als Opfer oder als Täter. Bei ihnen stellen die gesundheitlichen Folgen von Gewalt eine wichtige Ursache von Mortalität und Morbidität dar. Der Artikel gibt einen Einblick in die Determinanten, die zu den Gesundheitsfolgen von städtischer Gewalt führen und konzentriert sich dabei auf Jugendliche. Für diesen Zweck wurde ein umfassendes Modell entwickelt und angewendet. Das neue Modell wird entsprechend seiner Komponenten MLIVEA genannt: Macro Level, Local Setting, Individual Level, Violent Act, Health Effect und Action. Der Vorteil des Modells liegt in der Darstellung des gesamten Prozesses von der Gewaltentstehung über die Gewalttat und seinen gesundheitlichen Folgen bis hin zu geeigneten Interventionen. MLIVEA zeigt, dass Gewalt und damit zusammenhängende Folgen für die Gesundheit nicht unvermeidbar sind, Präventionsmöglichkeiten durchaus existieren und Public Health dazu beitragen kann, sie zu finden und umzusetzen.

Prevalence and temporal trends of physical activity counselling in primary health care in Germany from 1997–1999 to 2008–2011

Background: For patients, usually the first and most preferred contact person on health issues is still the doctor and most persons see their doctor at least once a year. Therefore, physical activity counselling strategies delivered by a physician seem to be a promising approach for physical activity improvement. The aim of this work is to show prevalence and time trends in physical activity counselling by primary health care physicians from 1997–1999 to 2008–2011 in Germany. Methods: Data from two representative cross-sectional health interview and examination surveys of the Robert Koch Institute were used. Prevalence proportions of physicians’ physical activity counselling and patients’ utilisation of health promotion programmes in relation to physical activity counselling were analysed. Strengths of associations were calculated by using binary logistic regression models. Overall, 11,907 persons aged 18–64 years were included in the analyses. Results: Physical activity counselling prevalence decreased from 11.1 to 9.4 % in men and from 9.3 to 7.7 % in women over ten years. Only persons with accumulated health risks (OR 5.33; 95 % CI 1.89–15.00) and persons with diagnosed diabetes mellitus (OR 3.42; 95 % CI 1.68–6.69) showed significantly higher counselling proportions in 2008–2011 compared to 1997–1999. Men were more often counselled on physical activity than women, but women showed significantly higher participation rates in physical activity promotion programmes in both surveys. In both sexes significantly higher participation rates could be observed in persons who had received some activity counselling by a physician. Conclusion: Although, evidence underlines the positive health effects of regular physical activity; overall, physicians counselling behaviour on physical activity decreased over time. However, it is positive to note that a trend towards a disease-specific counselling behaviour in terms of a tailored intervention could be observed

Intention for Screening Colonoscopy among Previous Non-Participants: Results of a Representative Cross-Sectional Study in Germany

Early detection of colorectal cancer has the potential to reduce mortality at population level. Colonoscopy is the preferred modality for colon cancer screening and prevention, but attendance rates are low. To exploit colonoscopy’s preventive potential, it is necessary to identify the factors influencing uptake, especially among previous non-participants. This analysis of cross-sectional data involved 936 non-participants in screening colonoscopy aged 55 years or older in Germany. Differences between non-participants with and without future participation intentions were investigated in terms of socio-demographic factors, health status, attitudes and beliefs, and medical counselling. Logistic regression models were fitted to estimate associations between intention to participate and selected factors. Intention to participate was lower among women than among men. For both genders, intention to participate was positively associated with younger age. For women, higher socioeconomic status and counselling were positively associated with intention to participate. Men showed a positive association with favouring joint decision-making. The results draw attention to starting points for improving acceptance of and participation in screening colonoscopy. This includes good medical counselling and successful physician–patient communication, for which the information and communication skills of both medical professions and the general public should be strengthened. Gender differences should be considered.Peer Reviewe

The alcohol improvement programme: evaluation of an initiative to address alcohol-related health harm in England

Aims: The evaluation aimed to assess the impact of The Alcohol Improvement Programme (AIP). This was a UK Department of Health initiative (April 2008–March 2011) aiming to contribute to the reduction of alcohol-related harm as measured by a reduction in the rate of increase in alcohol-related hospital admissions (ARHAs). Methods: The evaluation (March 2010–September 2011) used a mix of qualitative and quantitative methods to assess the impact of the AIP on ARHAs, to describe and assess the process of implementation, and to identify elements of the programme which might serve as a ‘legacy’ for the future. Results: There was no evidence that the AIP had an impact on reducing the rise in the rate of ARHAs. The AIP was successfully delivered, increased the priority given to alcohol-related harm on local policy agendas and strengthened the infrastructure for the delivery of interventions. Conclusion: Although there was no measurable short-term impact on the rise in the rate of ARHAs, the AIP helped to set up a strategic response and a delivery infrastructure as a first, necessary step in working towards that goal. There are a number of valuable elements in the AIP which should be retained and repackaged to fit into new policy contexts

Inanspruchnahme präventiver Maßnahmen. Eine Analyse von Einflussfaktoren auf die Nutzung von Verhaltensprävention bei Erwachsenen

Jordan S. Inanspruchnahme präventiver Maßnahmen. Eine Analyse von Einflussfaktoren auf die Nutzung von Verhaltensprävention bei Erwachsenen. Bielefeld: Universität Bielefeld; 2020.#### Background: Behavioural and community level prevention approaches are used in strategies to prevent and control noncommunicable diseases. Behavioural prevention is criticised for contributing to the prevention dilemma, i.e. these programmes reach groups with the greatest need badly and thus further increase health inequalities. In this context, the dissertation examines the use of prevention with representative data for Germany on the question which factors influence the use of behavioural prevention in adults and takes into account the use of bonus programmes of the statutory health insurance funds. #### Methods: Based on the ‘Behavioural Model of Health Care Use’ (Andersen 1995), (1) predisposing factors such as gender, age and education or social status, (2) enabling factors such as type of health insurance and (3) need factors such as health behaviour and health status were analysed. The data basis comprised the ‘German Health Interview and Examination Survey for Adults’ (DEGS1), the ‘German National Health Interview and Examination Survey 1998’ (GNHIES98) and the study ‘German Health Update’ from 2009 (GEDA 2009). Bivariate analyses were used to calculate relative frequencies with 95% confidence intervals and logistic regression models and estimated odds ratios to calculate group differences. #### Results: The analyses showed that the factors gender, age and social status or educational level influenced the use of behavioural prevention. The type of health insurance and the types of statutory health insurance as well as medical counselling on health behaviour, but also health behaviour and health status were associated with the use. Age and education, health consciousness and the use of a general practitioner and health behaviour were important factors for participation in a bonus programme. #### Discussion and conclusion: The results on the predisposing, enabling and need factors of behavioural prevention support the vertical and horizontal inequality in the use of behavioural prevention and the demand to give priority to community level prevention. Behavioural prevention should primarily be integrated into community level prevention and multi-level approaches. Monitoring the use of prevention at the population level together with its influencing factors can make an important contribution to understanding the complex interactions and to the evaluation of various prevention strategies.#### Hintergrund: Bei den Strategien zur Eindämmung nichtübertragbarer Erkrankungen werden verhaltens- und verhältnispräventive Ansätze verwendet. An Verhaltensprävention wird kritisiert, dass sie zum Präventionsdilemma beiträgt, d. h., diese Angebote erreichen die Gruppen mit dem größten Bedarf schlecht und die gesundheitliche Ungleichheit vergrößert sich weiter. Vor diesem Hintergrund untersucht die Dissertation die Inanspruchnahme von Prävention mit repräsentativen Daten für Deutschland unter der Fragestellung, welche Faktoren die Nutzung von Verhaltensprävention bei Erwachsenen beeinflussen und berücksichtigt dabei die Inanspruchnahme von Bonusprogrammen der gesetzlichen Krankenversicherung. #### Methoden: Orientiert am „Verhaltensmodell der Versorgungsinanspruchnahme“ (Andersen 1995) erfolgten die Analysen von (1.) prädisponierenden Faktoren wie Geschlecht, Alter und Bildung bzw. Sozialstatus, (2.) ermöglichenden Faktoren beispielsweise der Kassenart und (3.) Bedarfsfaktoren wie dem Gesundheitsverhalten und -zustand. Datengrundlage bildeten die „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1), der Bundes-Gesundheitssurvey (BGS98) und die Studie „Gesundheit in Deutschland aktuell“ (GEDA 2009). Mit bivariaten Analysen wurden relative Häufigkeiten mit 95%-Konfidenzintervallen und mit logistischen Regressionsmodellen und geschätzten Odds Ratios wurden Gruppenunterschiede berechnet. #### Ergebnisse: Die Analysen zeigten, dass die Einflussfaktoren Geschlecht, Alter und Sozialstatus bzw. Bildungsstand die Inanspruchnahme verhaltenspräventiver Maßnahmen beeinflussten. Die Art der Krankenversicherung, die Kassenarten der gesetzlichen Krankenversicherung sowie eine ärztliche Beratung zum Gesundheitsverhalten, aber auch das Gesundheitsverhalten und der Gesundheitszustand waren mit der Inanspruchnahme assoziiert. Für eine Bonusprogrammteilnahme waren Alter und Bildung, das Gesundheitsbewusstsein und die Nutzung einer Hausärztin bzw. eines Hausarztes sowie das Gesundheitsverhalten bedeutsam. #### Diskussion und Fazit: Die Ergebnisse zu den prädisponierenden, ermöglichenden und Bedarfsfaktoren von Verhaltensprävention bestätigen die vertikale und horizontale Ungleichheit in der Inanspruchnahme von Verhaltensprävention und die Forderung, der Verhältnisprävention Vorrang zu geben. Verhaltensprävention sollte primär in verhältnispräventive und Mehrebenenansätze integriert werden. Die Beobachtung der Inanspruchnahme von Prävention auf Bevölkerungsebene zusammen mit ihren Einflussfaktoren kann dabei ein wichtiger Beitrag zum Verständnis der komplexen Wechselwirkungen und bei der Evaluation der verschiedenen Präventionsstrategien sein

Participatory epidemiology: the contribution of participatory research to epidemiology

Background: Epidemiology has contributed in many ways to identifying various risk factors for disease and to promoting population health. However, there is a continuing debate about the ability of epidemiology not only to describe, but also to provide results which can be better translated into public health practice. It has been proposed that participatory research approaches be applied to epidemiology as a way to bridge this gap between description and action. A systematic account of what constitutes participatory epidemiology practice has, however, been lacking. Methods: A scoping review was carried out focused on the question of what constitutes participatory approaches to epidemiology for the purpose of demonstrating their potential for advancing epidemiologic research. Relevant databases were searched, including both the published and non-published (grey) literature. The 102 identified sources were analyzed in terms of comparing common epidemiologic approaches to participatory counterparts regarding central aspects of the research process. Exemplary studies applying participatory approaches were examined more closely. Results: A highly diverse, interdisciplinary body of literature was synthesized, resulting in a framework comprised of seven aspects of the research process: research goal, research question, population, context, data synthesis, research management, and dissemination of findings. The framework specifies how participatory approaches not only differ from, but also how they can enhance common approaches in epidemiology. Finally, recommendations for the further development of participatory approaches are given. These include: enhancing data collection, data analysis, and data validation; advancing capacity building for research at the local level; and developing data synthesis. Conclusion: The proposed framework provides a basis for systematically developing the emergent science of participatory epidemiology

Factors in the Use of Workplace Health Promotion on Back Health. Results of the Survey “German Health Update”

Background: The influence of the working environment on the back health of employees is well-documented. Many companies have begun to offer employees access to services to promote back health. Factors affecting the use of these offers at the population level have received little investigation to date. The current study examined the socio-demographic factors, physical activity and health-related factors, and work-related factors associated with the use of offers of workplace health promotion for back health in Germany. Materials and Methods: In the representative population-based cross-sectional survey “German Health Update” (GEDA 2014/2015-EHIS) conducted by the Robert Koch Institute, 12,072 employees aged 18–64 years old were surveyed from November 2014 to July 2015 regarding the use of back health services in their companies. In addition to socio-demographic factors, the survey examined working hours, physical activity in leisure time, health awareness, and subjective complaints in the lower back or other chronic back problems in the last 12 months. The interaction of these factors with the utilization of back health services was tested using multiple logistic regression models. Results: Women used back health services more often than men (women: 25.5%; men: 18.1%). Female gender was associated with part-time employment (OR 0.72) and a strong to very strong level of health awareness (OR 1.40). Male gender was associated with age between 30 and 44 years (OR 1.99) and 45–64 years (OR 2.02), low socioeconomic status (OR 0.48), endurance activity of <2.5 h per week (OR 0.62), and absence of lower back pain or other chronic back conditions for the last 12 months (OR 0.48). Conclusion: The present study is the first to provide findings regarding the factors associated with the utilization of workplace health promotion to promote back health at the population level, and from the perspective of employees in Germany. The results revealed that the relevant factors for participating in offers differ for women and men. To reach more employees, workplace health promotion offers for back health should be designed specifically for each individual, considering gender and age, working hours, health awareness and behavior, and health state.Peer Reviewe

Participation of the adult population in preventive measures for non-communicable diseases during the COVID-19 pandemic in 2020/2021

Background: In 2020/2021, the COVID-19 pandemic and the protective measures associated therewith severely limited the opportunity to participate in prevention and health promotion measures. The article examines the utilisation of the measures and possible factors that are associated with a lower participation during these pandemic years. Methods: It is based on data acquired between March and August 2021 from the study ‘COVID-19 vaccination rate monitoring in Germany’ (COVIMO), a cross-sectional telephone survey. The data was used to examine the participation in preventive measures in the last 12 months in terms of sociodemographic factors and to analyse a decreased participation with regard to pandemic-related factors. The analysis sample includes individuals aged 18 years and over (n=3,998). Results: 63% of participants generally did not use these programmes, 7% indicated an unchanged participation, 28% reported having participated in fewer measures, and 2% in more measures. Men reported significantly more often than women that they generally do not participate in prevention and health promotion measures. A relevant pandemic-related factor for decreased participation of men was the less clearly perceived comprehensibility of the regulations against the spread of SARS-CoV-2. Conclusions: Prevention and health promotion should be part of the contingency planning in epidemically significant situations to prevent a decreased participation and to promote health and gender-related equal opportunities even in a crisis

Motivational readiness for physical activity and health literacy: results of a cross-sectional survey of the adult population in Germany

Background: Health literacy, defined as the knowledge, motivation, and competences to use health information to improve health and well-being, is associated with regular physical activity. However, there is limited evidence on whether health literacy is also related to the motivational readiness for physical activity in a general population. The aim of this study was to investigate whether motivational readiness for leisure-time physical activity is associated with health literacy. Methods: Analyses were based on data of 21,895 adults from the cross-sectional German Health Update and European Health Interview Survey 2014/2015 (GEDA 2014/2015-EHIS). Motivational readiness for leisure-time physical activity was assessed with stages of change for physical activity with a set of validated items. It was then classified, according to an established algorithm, into five stages: precontemplation, contemplation, preparation, action, and maintenance. Health literacy was measured with the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and categorised as low, medium, and high. For bivariate and multinomial logistic regression analyses, the stages were categorised in three phases as: (1) no intention (precontemplation), (2) planning (contemplation or preparation), and (3) in activity (action or maintenance). The models were adjusted for sex, age, education, health consciousness, self-efficacy, and self-perceived general health status. Results: High compared to low health literacy was associated with a 1.65-times (95% CI = 1.39-1.96) greater probability of being in activity than planning. High compared to low health literacy was associated with a reduced risk of having no intention to change physical activity behaviour (relative risk ratio, RRR = 0.84, 95% CI = 0.75-0.95). The associations persisted after adjusting for covariates. Conclusion: High health literacy was positively associated with more advanced phases of motivational readiness for leisure-time physical activity. Therefore, taking health literacy into account in interventions to promote motivational readiness for leisure-time physical activity could be a useful approach