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

Utilization of preventive care among migrants and non-migrants in Germany: results from the representative cross-sectional study ‘German health interview and examination survey for adults (DEGS1)’

Background In Germany, different health checks for adults are offered for primary and secondary prevention. Previous findings indicate that preventive care utilization varies according to social determinants, especially migration background. This study examined the extent to which migration background is associated with preventive care utilization, independent of factors like age and socioeconomic status and whether length of stay in Germany has a positive effect on the use of preventive care. Methods The first wave of the ‘German Health Interview and Examination Survey for Adults’ (DEGS1) is a comprehensive data collection facilitating the description of the utilization of general health checks, dental check-ups, skin cancer screening, and cervical cancer screening among people aged 18–79 years with and without migration background. Migration background was differentiated in first-generation migrants having immigrated to Germany themselves or second-generation migrants born in Germany. First-generation migrants were further differentiated by length of stay in Germany, and second-generation migrants as having one or two parents who were born abroad. Multivariate binary logistic regression models with average marginal effects were calculated to analyse the associations between preventive care utilization and migration background. Results The sample comprised 7987 participants, 1091 of whom had a migration background. Compared with non-migrants, women and men with migration background— particularly first-generation migrants with length of stay <=20 years in Germany — make less use of preventive care. This association was observed statistically independent from sociodemographic factors. For dental check-ups a significantly lower use was also found for first-generation migrants who have lived in Germany for more than 20 years and second-generation of migrants with two parents born abroad. Post-model predictions showed that the utilization rates of first-generation migrants are gradually converging to the average values for non-migrants. Conclusions Our findings suggest inequalities in realized access to preventive care for first-generation migrants particularly for those who have lived in Germany for 20 years or less. Barriers to the utilization of preventive care may be addressed by informing migrant communities about preventive health care services at an early stage after immigration using migrant-sensitive information strategies.Peer Reviewe

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

Smoking behaviour and passive smoke exposure of adults – Results from GEDA 2019/2020-EHIS

Background: Smoking is a significant health risk and the leading cause of premature death. Passive smoke causes the same negative effects on health as smoking, albeit to a lesser extent. The reduction of tobacco consumption and the protection against passive smoke are thus important health objectives. Methods: The study German Health Update (GEDA 2019/2020-EHIS) is a cross-sectional telephone survey (04/2019 to 09/2020) of the resident population in Germany with questions relating to the current smoking behaviour and relating to the passive smoke exposure. The analysis sample comprises 22,708 persons from 18 years of age. Results: 24.0% of women and 33.9% of men from 18 years of age smoke currently, at least occasionally. Among both sexes, adults from 65 years of age smoke significantly more rarely than adults in the younger age groups. 4.1% of adults, who do not smoke themselves, are subjected daily to passive smoke exposure indoors. This affects in particular young adults and men. There are educational differences in tobacco consumption and in passive smoke exposure to the disadvantage of adults from lower educational groups. Conclusions: In Germany, there is still a need for action for effective measures for tobacco prevention, smoking cessation and tobacco control policy, which are effective in all population groups and which take into account the concerns of socially disadvantaged groups

School entrance examinations as a small-scale data source for health monitoring of children using obesity as an example

Background: In the scope of the nationwide obligatory school entrance examinations (SEE), a standardised assessment of the preparedness for school of preschool children takes place in the federal states of Germany. For this purpose, height and weight of the children are determined. These data are available in aggregated form at county level, but are not yet being regularly compiled and processed at national level for use in policy and research. Methods: In a pilot project, the indexing and merging of SEE data from 2015–2019 was tested in collaboration with six federal states. This was done using obesity prevalence at the time of the school entrance examination. In addition, prevalences were linked to small-scale indicators on settlement structure and sociodemographics from public databases, differences in obesity prevalence at county level were identified, and correlations to regional influencing factors were visualised. Results: It was feasible to merge SEE data from the federal states with little effort. The majority of the selected indicators were freely available in public databases. In an interactive, easily comprehensible and user-friendly Tableau dashboard for visualising the SEE data, it can be seen that obesity prevalences differ significantly between counties that are similar in terms of settlement structure or sociodemographics. Conclusions: Providing federal state SEE data and linking them to small-scale indicators enables region-based analyses and cross-state comparisons of similar counties and provides a data basis for continuous monitoring of the prevalence of obesity in early childhood

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

Selbstwahrgenommene Mundgesundheit und assoziierte Faktoren bei Erwachsenen in Deutschland. Ergebnisse aus GEDA 2019/2020-EHIS

Hintergrund und Ziel der Arbeit: Informationen zur Mundgesundheit der Bevölkerung sind wichtig für die Einschätzung von (vermeidbarer) Krankheitslast, für die Einschätzung und Planung von Gesundheitsressourcen und -kosten sowie für die Beurteilung gesundheitlicher Ungleichheiten. Ziel dieser Arbeit ist es, erstmals auf Datenbasis einer bundesweit repräsentativen Stichprobe für die erwachsene Bevölkerung in Deutschland die selbstwahrgenommene Mundgesundheit einschließlich assoziierter Faktoren zu untersuchen. Material und Methoden: Datenbasis ist die Studie Gesundheit in Deutschland aktuell (GEDA 2019/2020-EHIS, n = 22.708 ab 18 Jahre). Im telefonischen Interview wurden die Teilnehmenden gefragt, wie sie den Zustand ihrer Zähne und ihres Zahnfleischs beschreiben würden – „sehr gut“, „gut“, „mittelmäßig“, „schlecht“, „sehr schlecht“. Soziodemografische, verhaltensbezogene und zahnmedizinische Merkmale werden als assoziierte Faktoren untersucht. Ausgewiesen werden Prävalenzen und Ergebnisse multivariater binär-logistischer Regressionen (Odds Ratios, OR). Ergebnisse und Diskussion: 71,4 % der Befragten schätzten ihre Mundgesundheit als sehr gut oder gut ein, 28,6 % als mittelmäßig bis sehr schlecht. Die wichtigsten assoziierten Faktoren waren Beeinträchtigungen beim Kauen und Beißen (OR 4,0), ein unerfüllter zahnmedizinischer Versorgungsbedarf (OR 2,3), männliches Geschlecht (OR 1,5) und ein nicht täglicher Obst- und Gemüsekonsum (OR 1,2), bei Männern zudem eine niedrige Bildung (OR 2,1), das tägliche Rauchen (OR 1,6) und eine nicht jährliche zahnmedizinische Inanspruchnahme (OR 1,4). Aus den Ergebnissen lassen sich Ansatzpunkte zur Förderung der Mundgesundheit ableiten.Background and aim of the work: Information on the oral health of the population is important for the assessment of (preventable) disease burden, for the estimation and planning of health resources and costs, and for the evaluation of health inequalities. The aim of this work is to investigate for the first time self-perceived oral health, including associated factors, based on data from a nationally representative sample for the adult population in Germany. Material and methods: The data basis is the nationwide German Health Update study (GEDA 2019/2020-EHIS, n = 22,708 aged 18 years and older). In the telephone interview, the participants were asked how they would describe the state of their teeth and gums – “very good,” “good,” “fair,” “bad,” or “very bad.” Sociodemographic, behavioral, and dental characteristics are examined as associated factors. Prevalences and results of multivariate binary logistic regressions (odds ratios, OR) are reported. Results and discussion: Of the participants, 71.4% perceived their oral health as very good or good, 28.6% as fair to very bad. Difficulty in chewing and biting on hard foods (OR 4.0), unmet dental care needs (OR 2.3), male gender (OR 1.5), and not consuming fruits and vegetables daily (OR 1.2) were the most important associated factors for fair to very bad self-perceived oral health; for men, low education (OR 2,1), daily smoking (OR 1.6) and not receiving dental care annually (OR 1.4) were also important. From the results, starting points for promoting oral health can be derived.Peer Reviewe

Rauchverhalten und Passivrauchbelastung Erwachsener – Ergebnisse aus GEDA 2019/2020-EHIS

Hintergrund: Rauchen ist ein bedeutendes Gesundheitsrisiko und die führende Ursache vorzeitiger Sterblichkeit. Passivrauch verursacht dieselben negativen gesundheitlichen Folgen wie das Rauchen, wenn auch in einem geringeren Ausmaß. Die Verringerung des Tabakkonsums und der Schutz vor Passivrauch sind daher wichtige gesundheitspolitische Ziele. Methode: Die Studie Gesundheit in Deutschland aktuell (GEDA 2019/2020-EHIS) ist eine telefonische Querschnittbefragung (04/2019 bis 09/2020) der in Deutschland lebenden Wohnbevölkerung mit Fragen zum aktuellen Rauchverhalten und zur Passivrauchbelastung. Die Analysestichprobe umfasst 22.708 Personen ab 18 Jahren. Ergebnisse: 24,0 % der Frauen und 33,9 % der Männer ab 18 Jahren rauchen aktuell, zumindest gelegentlich. Bei beiden Geschlechtern rauchen Erwachsene ab 65 Jahren deutlich seltener als Erwachsene in den jüngeren Altersgruppen. 4,1 % der Erwachsenen, die selbst nicht rauchen, sind täglich Passivrauchbelastung in geschlossenen Räumen ausgesetzt. Das betrifft besonders junge Erwachsene und Männer. Es bestehen Bildungsunterschiede im Tabakkonsum und in der Passivrauchbelastung zuungunsten von Erwachsenen aus unteren Bildungsgruppen. Schlussfolgerungen: In Deutschland besteht weiterhin Handlungsbedarf für eine effektive Maßnahmen der Tabakprävention, Rauchentwöhnung und Tabakkontrollpolitik, die in allen Bevölkerungsgruppen wirken und die Belange sozial benachteiligter Gruppen berücksichtige

Schuleingangsuntersuchungen als kleinräumige Datenquelle für ein Monitoring der Kindergesundheit am Beispiel Adipositas

Hintergrund: Im Rahmen der bundesweit verbindlichen Schuleingangsuntersuchungen (SEU) findet in den Ländern eine standardisierte Erfassung der Schulreife von Vorschulkindern statt. Dazu werden auch Körpergröße und -gewicht der Kinder bestimmt. Diese Daten liegen aggregiert auf Kreisebene vor, eine regelmäßige Zusammenführung und Aufbereitung auf Bundesebene zur Nutzung für Politik und Forschung erfolgt bisher nicht. Methode: In einem Pilotprojekt wurde in Zusammenarbeit mit sechs Ländern die Erschließung und Zusammenführung von SEU-Daten der Jahre 2015 – 2019 erprobt. Dies erfolgte am Beispiel der Adipositasprävalenz zum Zeitpunkt der Schuleingangsuntersuchung. Zusätzlich wurden die Prävalenzen mit kleinräumigen Indikatoren zu Siedlungsstruktur und Soziodemografie aus öffentlichen Datenbanken verknüpft, Unterschiede in der Adipositasverbreitung auf Kreisebene identifiziert und Zusammenhänge mit regionalen Einflussfaktoren visualisiert. Ergebnisse: Die Zusammenführung der SEU-Daten der Länder war mit geringem Aufwand möglich. Die Mehrheit der ausgewählten Indikatoren war frei in öffentlichen Datenbanken verfügbar. In einem interaktiven, leicht verständlichen und nutzungsfreundlichen Tableau-Dashboard zur Visualisierung der SEU-Daten kann abgelesen werden, dass sich die Adipositasprävalenzen deutlich zwischen siedlungsstrukturell oder soziodemografisch ähnlichen Kreisen unterscheiden. Schlussfolgerungen: Die Bereitstellung der SEU-Daten der Länder und die Verknüpfung mit kleinräumigen Indikatoren ermöglichen regionalisierte Analysen und länderübergreifende Vergleiche ähnlicher Kreise und stellen eine Datengrundlage für ein kontinuierliches Monitoring der Adipositasprävalenz im frühen Kindesalter dar

Health-promoting behaviour among adults in Germany – Results from GEDA 2019/2020-EHIS

Health-promoting behaviours are important at any age to prevent diseases and to promote well-being. Using data from GEDA 2019/2020-EHIS, a Germany-wide, representative survey, this article describes how often the adult population in Germany reports certain types of health-promoting behaviour in their everyday lives. The behaviours considered are non-smoking, low-risk alcohol consumption, achievement of the World Health Organization’s (WHO) recommendations on aerobic physical activity, at least daily fruit and vegetable consumption, and maintaining a body weight within the normal range. This article describes the proportion of people who report these behaviours in their everyday lives by gender, age and education level, the number of health-promoting behaviours each person reports and the most common combinations in which they occur. Young adults between 18 and 29 years are most likely to achieve a health-promoting lifestyle. The proportion of people who report at least 150 minutes of physical activity per week and a normal body weight is lower in later adulthood than among 18- to 29-year-olds. The recommendation to eat fruit and vegetables daily is implemented least often of all five aspects of health behaviour under study. Finally, women are more likely to lead a health-promoting lifestyle than men.Health-promoting behaviours are important at any age to prevent diseases and to promote well-being. Using data from GEDA 2019/2020-EHIS, a Germany-wide, representative survey, this article describes how often the adult population in Germany reports certain types of health-promoting behaviour in their everyday lives. The behaviours considered are non-smoking, low-risk alcohol consumption, achievement of the World Health Organization’s (WHO) recommendations on aerobic physical activity, at least daily fruit and vegetable consumption, and maintaining a body weight within the normal range. This article describes the proportion of people who report these behaviours in their everyday lives by gender, age and education level, the number of health-promoting behaviours each person reports and the most common combinations in which they occur. Young adults between 18 and 29 years are most likely to achieve a health-promoting lifestyle. The proportion of people who report at least 150 minutes of physical activity per week and a normal body weight is lower in later adulthood than among 18- to 29-year-olds. The recommendation to eat fruit and vegetables daily is implemented least often of all five aspects of health behaviour under study. Finally, women are more likely to lead a health-promoting lifestyle than men.Peer Reviewe