Factors associated with non-use of condoms among heterosexually-active single people in Germany: Results from the first representative, population-based German health and sexuality survey (GeSiD)

BACKGROUND: Against the backdrop of rising STI incidence among the heterosexual population, sexually active single people are at particularly high STI transmission risk. Gaining insight into circumstances related to condoms non-use in this population is therefore important for developing effective health interventions. METHODS: The nationally-representative survey, GeSiD (German Health and Sexuality Survey) undertaken 2018–2019, interviewed 4,955 people aged 18–75 years. A total of 343 heterosexually-active single participants answered a question about condom use at last sex. Data on sociodemographic characteristics, sexual behaviours and circumstances of last sex were analysed to identify independently associated factors. RESULTS: Condom non-use at last sex was reported more commonly by participants aged >35 years than by younger participants (48.5 vs 33.7%, respectively) and more likely among longer relationships (adjusted odds ratio [AOR]: 2.43) or early loving relationships (AOR: 3.59) than in one-night-stands. It was also associated with not discussing using condoms before sex (AOR: 6.50) and with reporting non-use of condoms at sexual debut (AOR: 4.75). CONCLUSIONS: Non-use of condoms is a common STI risk behaviour among heterosexually-active single people in Germany and so needs promoting from sexual debut throughout the life course, regardless of relationship type and age, but particularly among middle-aged and older people

Wie gut ist das Wissen über sexuell übertragbare Infektionen in Deutschland? Ergebnisse der ersten bundesweiten repräsentativen Befragung zu Gesundheit und Sexualität (GeSiD)

Hintergrund: Sexuell übertragbare Infektionen (STI) sind ein relevanter Risikofaktor für die sexuelle Gesundheit des Einzelnen und der Bevölkerung. Für eine zielgruppenspezifische Präventionsarbeit ist der Wissensstand zu STI in verschiedenen Bevölkerungsgruppen daher von besonderem Interesse. Ziel: Ziel der vorliegenden Arbeit ist es, den Wissensstand zu neun STI in der deutschen Bevölkerung zu analysieren. Dafür werden Zusammenhänge mit soziodemografischen Variablen, sexualitätsbezogenen Merkmalen sowie der subjektiven Zufriedenheit mit dem Informationsstand untersucht. Methode: Die GeSiD-Studie "Gesundheit und Sexualität in Deutschland" erhob von 4955 Personen per Face-to-Face-Interview repräsentative quantitative Daten zum Wissensstand zu STI. Als Auswahlverfahren wurde eine zweifache Zufallsstichprobe gezogen. Dafür wurden zunächst 200 Sample Points (Gemeinden) in ganz Deutschland regional proportional ausgewählt. Anschließend wurde eine Zufallsstichprobe von Adressen über die jeweiligen Einwohnermeldeämter gezogen. Die Teilnahmequote betrug 30,2 %; das Durchschnittsalter lag bei 46,3 Jahren. Ergebnisse: Wissen über HIV/Aids war in allen Altersgruppen weit verbreitet. Andere STI waren deutlich weniger bekannt. Besonders wenig informiert zeigten sich Ältere und Befragte mit niedrigem Bildungsstand, regionaler sozialer Benachteiligung sowie mit Migrationshintergrund. Eine höhere Anzahl von SexualpartnerInnen hing mit einem besseren Wissensstand zusammen. Gut informiert zeigten sich Personen, die sich nicht als heterosexuell beschreiben, sowie Personen, die schon einmal an einer STI erkrankt waren. Fazit: Heterosexuelle Erwachsene in Deutschland sind unzureichend über STI informiert. Zielgruppenspezifische Anstrengungen zur Verbesserung des Wissens über STI sind nötig, um sexuelles Risikoverhalten zu vermindern und die Inanspruchnahme von Präventionsangeboten zu verbessern.Background: Sexually transmitted infections (STIs) are a relevant risk factor for the sexual health of individuals and the population. Therefore, the level of awareness and knowledge about STIs in different population groups is of particular interest for specific prevention work. Objectives: The aim of this study was to analyze the awareness of and knowledge about nine STIs in the German population. To do so, the study examined correlations with sociodemographic variables, sexuality-related characteristics, and subjective satisfaction with the level of information. Methods: The GeSiD study "German Health and Sexuality Survey" collected representative quantitative data from 4955 persons via face-to-face interviews on the state of knowledge about STIs. As a selection procedure, a two-step random sample was collected. Firstly, 200 sample points (municipalities) were initially selected proportionally across Germany. Secondly, a random sample of addresses was drawn from the respective residents’ registration offices. The participation rate was 30.2%; the average age was 46.3 years. Results: Knowledge about HIV/AIDS was widespread in all age groups, but other STIs were significantly less known. Older people and respondents with a low level of education were particularly poorly informed. Local social disadvantage and a family history of migration were also negatively correlated with knowledge about STIs. A higher number of sexual partners is related to a better level of knowledge. In addition, persons who do not describe their sexual orientation as heterosexual as well as those with a history of STIs were well informed. Conclusion: Heterosexual adults in Germany are insufficiently informed about the risks of STIs. Therefore, target-group-specific efforts are needed to improve knowledge about STIs in order to reduce sexual risk behavior and improve the utilization of prevention programs among socially disadvantaged groups

What is the empirical basis for converting banded ordinal data on numbers of sex partners among MSM into a continuous scale level variable? A secondary analysis of 13 surveys across 17 countries

BACKGROUND: To provide empirically based guidance for substituting partner number categories in large MSM surveys with mean numbers of sexual and condomless anal intercourse (CAI) partners in a secondary analysis of survey data. METHODS: We collated data on numbers of sexual and CAI partners reported in a continuous scale (write-in number) in thirteen MSM surveys on sexual health and behaviour across 17 countries. Pooled descriptive statistics for the number of sexual and CAI partners during the last twelve (N = 55,180) and 6 months (N = 31,759) were calculated for two sets of categories commonly used in reporting numbers of sexual partners in sexual behaviour surveys. RESULTS: The pooled mean number of partners in the previous 12 months for the total sample was 15.8 partners (SD = 36.6), while the median number of partners was 5 (IQR = 2-15). Means for number of partners in the previous 12 months for the first set of categories were: 16.4 for 11-20 partners (SD = 3.3); 27.8 for 21-30 (SD = 2.8); 38.6 for 31-40 (SD = 2.4); 49.6 for 41-50 (SD = 1.5); and 128.2 for 'more than 50' (SD = 98.1). Alternative upper cut-offs: 43.4 for 'more than 10' (SD = 57.7); 65.3 for 'more than 20' (SD = 70.3). Self-reported partner numbers for both time frames consistently exceeded 200 or 300. While there was substantial variation of overall means across surveys, the means for all chosen categories were very similar. Partner numbers above nine mainly clustered at multiples of tens, regardless of the selected time frame. The overall means for CAI partners were lower than those for sexual partners; however, such difference was completely absent from all categories beyond ten sexual and CAI partners. CONCLUSIONS: Clustering of reported partner numbers confirm common MSM sexual behaviour surveys' questionnaire piloting feedback indicating that responses to numbers of sexual partners beyond 10 are best guesses rather than precise counts, but large partner numbers above typical upper cut-offs are common

What is the empirical basis for converting banded ordinal data on numbers of sex partners among MSM into a continuous scale level variable? A secondary analysis of 13 surveys across 17 countries

BACKGROUND: To provide empirically based guidance for substituting partner number categories in large MSM surveys with mean numbers of sexual and condomless anal intercourse (CAI) partners in a secondary analysis of survey data. METHODS: We collated data on numbers of sexual and CAI partners reported in a continuous scale (write-in number) in thirteen MSM surveys on sexual health and behaviour across 17 countries. Pooled descriptive statistics for the number of sexual and CAI partners during the last twelve (N = 55,180) and 6 months (N = 31,759) were calculated for two sets of categories commonly used in reporting numbers of sexual partners in sexual behaviour surveys. RESULTS: The pooled mean number of partners in the previous 12 months for the total sample was 15.8 partners (SD = 36.6), while the median number of partners was 5 (IQR = 2-15). Means for number of partners in the previous 12 months for the first set of categories were: 16.4 for 11-20 partners (SD = 3.3); 27.8 for 21-30 (SD = 2.8); 38.6 for 31-40 (SD = 2.4); 49.6 for 41-50 (SD = 1.5); and 128.2 for 'more than 50' (SD = 98.1). Alternative upper cut-offs: 43.4 for 'more than 10' (SD = 57.7); 65.3 for 'more than 20' (SD = 70.3). Self-reported partner numbers for both time frames consistently exceeded 200 or 300. While there was substantial variation of overall means across surveys, the means for all chosen categories were very similar. Partner numbers above nine mainly clustered at multiples of tens, regardless of the selected time frame. The overall means for CAI partners were lower than those for sexual partners; however, such difference was completely absent from all categories beyond ten sexual and CAI partners. CONCLUSIONS: Clustering of reported partner numbers confirm common MSM sexual behaviour surveys' questionnaire piloting feedback indicating that responses to numbers of sexual partners beyond 10 are best guesses rather than precise counts, but large partner numbers above typical upper cut-offs are common

Establishing a Mental Health Surveillance in Germany: Development of a framework concept and indicator set

In the course of the recognition of mental health as an essential component of population health, the Robert Koch Institute has begun developing a Mental Health Surveillance (MHS) system for Germany. MHS aims to continuously report data for relevant mental health indicators, thus creating a basis for evidence-based planning and evaluation of public health measures. In order to develop a set of indicators for the adult population, potential indicators were identified through a systematic literature review and selected in a consensus process by international and national experts and stakeholders. The final set comprises 60 indicators which, together, represent a multidimensional public health framework for mental health across four fields of action. For the fifth field of action ‘Mental health promotion and prevention’ indicators still need to be developed. The methodology piloted proved to be practicable. Strengths and limitations will be discussed regarding the search and definition of indicators, the scope of the indicator set as well as the participatory decision-making process. Next steps in setting up the MHS will be the operationalisation of the single indicators and their extension to also cover children and adolescents. Given assured data availability, the MHS will contribute to broadening our knowledge on population mental health, supporting a targeted promotion of mental health and reducing the disease burden in persons with mental disorders

Aufbau einer Mental Health Surveillance in Deutschland: Entwicklung von Rahmenkonzept und Indikatorenset

Im Zuge der Anerkennung psychischer Gesundheit als wesentlicher Bestandteil der Bevölkerungsgesundheit wird am Robert Koch-Institut eine Mental Health Surveillance (MHS) für Deutschland aufgebaut. Ziel der MHS ist die kontinuierliche Berichterstattung relevanter Kennwerte zum Zweck einer evidenzbasierten Planung und Evaluation von Public-Health- Maßnahmen. Zur Entwicklung eines Indikatorensets für die erwachsene Bevölkerung wurden potenzielle Indikatoren durch eine systematische Literaturrecherche identifiziert und in einem strukturierten Konsentierungsprozess durch internationale und nationale Expertinnen und Experten beziehungsweise Stakeholder ausgewählt. Das finale Set enthält 60 Indikatoren, die ein mehrdimensionales Public-Health-Rahmenkonzept psychischer Gesundheit in vier Handlungsfeldern abbilden. Im fünften Handlungsfeld „Gesundheitsförderung und Prävention“ besteht Bedarf der Indikatorenentwicklung. Die pilotierte Methodik erwies sich als praktikabel. Diskutiert werden Stärken und Limitationen der Recherche und Definition von Indikatoren, der Umfang des Indikatorensets sowie die partizipative Entscheidungsfindung. Nächste Schritte zur Etablierung der MHS bestehen in der Operationalisierung von Indikatoren und der Erweiterung unter anderem auf das Kindes- und Jugendalter. Bei gesicherter Datenverfügbarkeit wird die MHS zum Wissen über die Gesundheit der Bevölkerung beitragen und die gezielte Förderung psychischer Gesundheit sowie die Verringerung der Krankheitslast psychischer Störungen unterstützen

Quality of Life as an Outcome Criterion in Public Health Research : A Contribution to Developing a Questionnaire for Children and Adolescents in Germany

Die „Gesundheitsbezogene Lebensqualität“ hat sich in der gesundheitswissenschaftlichen Forschung als ein wichtiges Konstrukt zur Darstellung des gesundheitlichen Gesamtbefindens des Menschen etabliert. Sie wird als Evaluationskriterium von Präventions-, Gesundheits-förderungs- und Behandlungsmaßnahmen sowie zur epidemiologischen Beschreibung der bio-psycho-sozialen Gesundheit spezifischer Bevölkerungsgruppen verwandt. In jüngerer Zeit entstand der Bedarf, auch die Lebensqualität von Kindern und Jugendlichen in nationalen und internationalen Gesundheitssurveys zu erheben. Hierfür stand bislang kein interkulturell vergleichbares Verfahren zur Verfügung. Im europäischen KIDSCREEN-Projekt wurden ein solches Instrument für Kinder und Jugendliche im Alter von acht bis 18 Jahren sowie eine Proxyversion für die Eltern entwickelt. Im ersten Teil der Arbeit wird die Entwicklung des Verfahrens (Konzeptexploration, Itemgenerierung und qualitative Itemreduzierung) dargestellt. Im zweiten Teil wird die psychometrische Prüfung des deutschen Fragebogens vorgenommen sowie der Frage nachgegangen, ob die soziodemografischen Merkmale Alter und Geschlecht sowie sozioökonomische Indikatoren einen Einfluss auf die gesundheitsbezogene Lebensqualität von Kindern und Jugendlichen haben. Die psychometrische Prüfung der Kinder- und Jugendlichen- sowie der Proxy-Version des Fragebogens ermittelte gute bis sehr gute Eigenschaften hinsichtlich Reliabilität und konvergenter Validität. Berechnungen zur diskriminanten Validität ergaben, dass in allen zehn Lebensqualitätsdimensionen gesunde Kinder und Jugendliche höhere Werte angeben als chronisch kranke Kinder und Jugendliche. Bezüglich des Einflusses des Alters und des Geschlechts auf die gesundheitsbezogene Lebensqualität zeigte sich erstens, dass Jungen eine höhere Lebensqualität angeben als Mädchen, zweitens, dass Kinder ihre Lebensqualität höher einschätzen als Jugendliche und drittens, dass sich die Verschlechterung der Lebensqualität zum Jugendlichenalter hin (z.B. Stimmungen und Gefühle sowie die Selbstwahrnehmung) insbesondere bei den weiblichen Jugendlichen vollzieht. Der familiäre Wohlstand wurde als relevante Einflussgröße auf die gesundheitsbezogene Lebensqualität im Jugendalter identifiziert. Beim Vergleich der Einschätzung der Lebensqualität der Kinder und Jugendlichen im Selbst- und im Fremdbericht (Eltern als Proxys), ergaben sich die meisten Diskrepanzen bei acht- bis elfjährigen Kindern und ihren Eltern. Wahrnehmungsdiskrepanzen verhaltensnaher und von außen beobachtbarer Lebensqualitätsaspekte verringern sich zum Jugendlichenalter hin, hinsichtlich internaler und emotionsverankerter Lebensqualitätsaspekte verstärken sie sich. Die Entwicklung und Prüfung des vorliegenden Instrumentes trägt dazu bei, die gesundheits-bezogene Lebensqualität von Kindern und Jugendlichen im Selbstbericht in reliabler und valider Weise zu erfassen und in die gesundheitswissenschaftliche Forschung einzubeziehen."Health-related quality of life" has established itself in Public Health research as an important construct for representing a person's overall health-related well-being. It is used as an evaluation criterion for prevention, health promotion and treatment measures, as well as for the epidemiological description of the bio-psycho-social health of specific groups of the population. In recent times, the need arose to also document the quality of life of children and adolescents in national and international health surveys. No interculturally comparable questionnaire has so far been available for doing this. In the framework of the European KIDSCREEN project, an instrument of this kind was developed for children and adolescents between the ages of 8 and 18, as well as a proxy version for parents. The first part of the thesis describes the development of the questionnaire (concept exploration, item generation and qualitative item reduction). The second part deals with the psychometric testing of the German questionnaire, also examining the question of whether the sociodemographic attributes of age and gender, as well as socioeconomic indicators, have an influence on the health-related quality of life of children and adolescents. Psychometric testing of the children and adolescents questionnaire, and of the proxy version, indicated good to very good characteristics in terms of reliability and convergent validity. Analyses regarding discriminant validity revealed that, in all ten quality-of-life dimensions, healthy children and adolescents indicate higher values than chronically ill children and adolescents. As regards the influence of age and gender on the health-related quality of life, it was found firstly that boys indicate a higher quality of life than girls, secondly that children give a higher assessment of their quality of life than adolescents, and thirdly that the decrease in quality of life towards adolescence (e.g. moods and emotions, self-perception) occurs particularly among young females. Family affluence was identified as being a relevant determinant of health-related quality of life in adolescence. When comparing the assessments of the quality of life of children and adolescents in the self-report and the external report (parents as proxies), most discrepancies were found among 8 to 11 year-old children and their parents. Discrepancies in perception as regards behaviour-related and externally observable aspects of the quality of life become less marked towards adolescence, whereas they become greater as regards internal and emotion-based aspects of the quality of life. The development and testing of the present instrument contributes to documenting the health-related quality of life of children and adolescents in self-reports in a reliable and valid manner, and to incorporating the construct in Public Health research

Präventionsberichterstattung macht sich auf den Weg. Informationen und Erkenntnisse aus dem Bund-Länder-Workshop der GBE 2017

Peer Reviewe

The launch of prevention reporting: the 2017 national and federal state level workshop of German Federal Health Reporting

Peer Reviewe

Die aktuelle Datenlage zur sexuellen Gesundheit im deutschsprachigen Raum

Background!#!The association between the presence of a diagonal earlobe crease (DEC) and coronary artery disease has been prescribed earlier. However, it is unclear whether patients with acute myocardial infarction (AMI) and DEC have a higher risk of dying.!##!Methods!#!Study participants were persons with AMI who were included in the KORA Myocardial Infarction Registry Augsburg from August 2015 to December 2016. After taking pictures of both earlobes, two employees independently assessed the severity of DEC in 4°. For analysis, the expression of the DEC was dichotomized. Information on risk factors, severity and therapy of the AMI was collected by interview and from the medical record. Vital status post AMI was obtained by population registries in 2019. The relationship between DEC and survival time was determined using Cox proportional hazards models.!##!Results!#!Out of 655 participants, 442 (67.5%) showed DEC grade 2/3 and 213 (32.5%) DEC grade 0/1. Median observation period was 3.06 years (5-1577 days). During this period, 26 patients (12.2%) with DEC grade 0/1 and 92 patients (20.8%) with grade 2/3 died (hazard ratio 1.91, 95% confidence interval (CI) 1.23-2.96, p = 0.0037). In the fully adjusted model, patients with DEC grade 2/3 had a 1.48-fold increased risk of death compared to the DEC grade 0/1 patient group (CI 0.94-2.34, p = 0.0897). The fully adjusted model applied for 1-year survival revealed a significant, 2.57-fold hazard ratio of death (CI 1.07-6.17, p = 0.0347) for the patients with DEC grade 2/3.!##!Conclusions!#!Our results indicate that DEC is independently associated with 1-year AMI survival