Regional and social differences concerning overweight, participation in health check-ups and vaccination. Analysis of data from a whole birth cohort of 6-year old children in a prosperous German city

<p>Abstract</p> <p>Background</p> <p>Studies on health inequalities still focus mostly on adults. Research about social disparities and health in children is slowly increasing, also in Germany, but these studies are mostly restricted to individual social variables derived from the parents to determine social class. This paper analyses the data of the medical check-up prior to school enrolment to determine differences concerning overweight, participation in health check-ups and immunization; it includes individual social variables but also regional variables describing the social environment of the children.</p> <p>Methods</p> <p>The dataset includes 9,353 children who started school in 2004 in Munich, Germany. Three dependent variables are included (i.e. overweight, health check-ups, vaccinations). The individual level social variables are: children's sex, mother tongue of the parents, Kindergarten visit. On the small scale school district level, two regional social variables could be included as well, i.e. percentage of single-parent households, percentage of households with low educational level. Associations are assessed by cross tables and regression analyses. The regional level variables are included by multilevel analyses.</p> <p>Results</p> <p>The analyses indicate that there is a large variation between the school districts concerning the three dependent variables, and that there is no district with very 'problematic values' for all three of them (i.e. high percentage of overweight, low levels of health check-ups and vaccinations). Throughout the bivariate and multivariate analyses, the mother tongue of the children's parents shows the most pronounced association with these dependent variables; i.e. children growing up in non-German-speaking families tend to be more overweight and don't visit preventive check-ups as often as children of German-speaking parents. An opposite association can be seen concerning vaccinations. Regional level influences are present as well, but they are rather small when the individual level social variables are controlled for.</p> <p>Conclusion</p> <p>The dataset of the medical check-up prior to school enrolment offers a great opportunity for public health research, as it comprises a whole age cohort. The number and scope of variables is quite limited, though. On one hand, it includes only few variables on health or health related risks. On the other, it would be important to have more information from the region where the children live, e.g. the availability of community and health care services for parents and children, social networks of families with children, areas where children can play outside, traffic noise and air pollution. Despite these shortcomings, the need for specific interventions can already be derived from the data analyzed here, e.g. programs to reduce overweight in children should focus on parents with a mother tongue other than German.</p

Kinder-Umwelt-Survey—das Umweltmodul im KiGGS

Seit Mai 2003 läuft bundesweit die Feldarbeit des Kinder-Umwelt-Surveys (KUS) als ein Modul des Kinder- und Jugendgesundheitssurveys (KiGGS). In diesem Umweltmodul werden 1.800 Kinder, die zufällig aus der Stichprobe der ca. 18.000 Kinder und Jugendlichen des KiGGS ausgewählt wurden, hinsichtlich gesundheitsrelevanter Umweltbelastungen untersucht. Im Vorfeld sind in einer Pilotphase (Pretest) die Durchführbarkeit und Praktikabilität der eingesetzten Erhebungs- und Untersuchungsinstrumente erfolgreich geprüft worden. Es wurden dabei praktische Erfahrungen zur Optimierung der Feldarbeit im Hauptsurvey gesammelt. Die Feldarbeit des KUS wird im Wesentlichen von den Umweltinterviewern der im KiGGS eingesetzten 3 Teams durchgeführt. Die Vorbereitung, Organisation und Begleitung dieser Arbeit erfolgt über das Koordinationszentrum am Robert Koch-Institut, das diesen Umwelt-Survey im Auftrag des Umweltbundesamtes und gefördert vom Bundesministerium für Umwelt, Naturschutz und Reaktorsicherheit sowie dem Bundesministerium für Bildung und Forschung durchführt. Sowohl der Kinder- und Jugendgesundheitssurvey als auch das Umweltmodul werden über die gesamte Laufzeit (Mai 2003–Mai 2006) durch eine interne und externe Qualitätskontrolle hinsichtlich der Struktur-, Prozess- und Ergebnisqualität evaluiert. Die bisherigen Einschätzungen ergaben, dass die eingesetzten Teams den Anforderungen im Feld voll gerecht werden und die Koordination dieser Arbeit über das Robert Koch-Institut gut funktioniert. Bis Juli 2004 nahmen 722 Kinder am Kinder-Umwelt-Survey teil.The field work of the German Environmental Survey for Children (GerES IV) was started nationwide in May 2003. The survey is a module of the National Health Interview and Examination Survey for Children and Adolescents (KiGGS). This environmental survey includes a representative subsample of 1800 children from the 18,000 participants of the KiGGS who are being examined regarding health-relevant environmental exposure. The investigational programme of the survey was tested successfully in a pilot study (pretest) the results of which contributed to the optimisation of the main study. The field work is essentially done by the environmental interviewer of the three teams of the KiGGS. Preparation, organization and accompaniment of the work is done by the coordination centre of the Robert Koch Institute on Federal Environmental Agency (UBA) instructions. Funding agencies are the Federal Ministry of Education and Research (BMBF) and the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU). Both the KiGGS and the environmental module are evaluated by internal and external quality assurance during the whole study period (May 2003–May 2006). Up to now the established teams have done their field work very well and the coordination of the overall project by the Robert Koch Institute works well, too. A total of 722 subjects had taken part in the GerES IV by July 2004