Association between Physical Activity and Sleep Difficulties among Adolescents in Germany: The Role of Socioeconomic Status

We examined sleep difficulties among adolescents in Germany and the association with physical activity (PA). Furthermore, we analyzed whether the association varied with the socioeconomic status (SES) among adolescent girls and boys in Germany. Using data from the German Health Interview Examination Survey for Children and Adolescents (KiGGS) study (Wave 2), 6599 adolescents aged 11 to 17 years were included in the analyses. We conducted sex-stratified logistic regression analyses. Dependent variables were unrecommended sleep duration (defined as a duration of sleep that does not meet the recommended duration), sleep-onset difficulties, trouble sleeping, and daytime sleepiness. Most adolescent girls and boys reported sleep difficulties. While no associations between PA and sleep difficulties were observed, a significant interaction between PA and SES was found for sleep duration in boys and daytime sleepiness in girls. Thus, adolescents with low SES had fewer sleep difficulties if they met the recommendation for PA, compared with those in other SES groups. In Germany, a large proportion of adolescents have sleep difficulties. We found that the experience of sleep difficulties varied according to PA, sex, and the family SES. Future sleep promotion programs should consider these differences.Peer Reviewe

Beruflicher Verbleib und Studienzufriedenheit von Berliner Public Health-Absolventinnen und -Absolventen mit sozialwissenschaftlicher Erstqualifikation

Der Postgraduierten-Studiengang Public Health/Gesundheitswissenschaften existiert an der Technischen Universität Berlin seit 1992 und wurde nach Abschluss der Modellversuchsphase 1996 in das reguläre Studienangebot übernommen. Der Studiengang soll künftig in stärkerem Maße medizinisch und naturwissenschaftlich ausgerichtet sein. Inwieweit die bisherige multidisziplinäre Zusammensetzung der Studierenden aufrecht erhalten bleibt oder auch bei der Zulassung eine stärkere Einschränkung auf medizinisch und naturwissenschaftlich qualifizierte Bewerber/innen erfolgt, ist noch ungeklärt. Vor diesem Hintergrund liefert die vorliegende Studie zur Studienzufriedenheit und zum beruflichen Verbleib der Public Health-AbsolventInnen an der TU Berlin Ergebnisse, dies insbesondere mit Blick auf die AbsolventInnen mit sozialwissenschaftlicher Erstqualifikation. Zusammenfassend lässt sich festhalten, dass der Großteil der AbsolventInnen mit dem Studium zufrieden ist und sich beruflich verbessern konnte. Auch hat sich die Berufssituation insbesondere für die Gruppe der SozialwissenschaftlerInnen in den letzten zehn fahren deutlich gewandelt. Den SozialwissenschaftlerInnen ist es gelungen, auf dem Arbeitsmarkt und in den Institutionen des Gesundheitswesens zu überzeugen und sich durchzusetzen. (ICA2

Associations between Parenting Style and Mental Health in Children and Adolescents Aged 11–17 Years: Results of the KiGGS Cohort Study (Second Follow-Up)

Few studies from Germany have investigated the associations between parenting style and children’s and adolescents’ health. Little attention has been directed to whether these associations vary with familial socioeconomic or migration status. The aim of this analysis was to investigate the association between parenting style and the mental health of children and adolescents aged 11–17 years using data from the KiGGS cohort study (second follow-up). We calculated mean Strengths and Difficulties Questionnaire (SDQ) total difficulties scores stratified by parenting style (authoritative, permissive, demanding–controlling, emotional distancing). Linear regression analyses adjusted for age, gender, socioeconomic status, migration status, and family status were performed. We also analyzed moderating effects of socioeconomic and migrations status on associations between parenting style and SDQ scores. There were only small differences between the permissive and the authoritative parenting styles. Significantly higher mean scores were observed for the demanding–controlling and emotional distancing styles for both the mother and father. These associations persisted after full adjustment and did not vary by socioeconomic or migration status. Parenting behavior is an important predictor of children’s and adolescents’ mental health. The promotion of good relationships within families and improving parenting skills offer promising approaches for health promotion in young people.Peer Reviewe

Self-rated health of university students in Germany–The importance of material, psychosocial, and behavioral factors and the parental socio-economic status

Introduction: Health inequalities start early in life. The time of young adulthood, between late teens and early twenties, is especially interesting in this regard. This time of emerging adulthood, the transition from being a child to becoming an adult, is characterized by the detachment from parents and establishing of an own independent life. From a health inequality perspective, the question about the importance of the socio-economic background of parents is important. University students are an especially interesting group. Many students come from a privileged background and the question of health inequality among university students has not yet been properly studied. Methods: Based on the National Educational Panel Study (NEPS), we analyzed health inequalities among 9,000 students in Germany (∅ 20 years in the first year of their studies) over a period of 8 years. Results: We found that most university students (92%) in Germany reported a good and very good health. Yet, we still found substantial health inequalities. Students whose parents had a higher occupational status reported less health problems. Additionally, we observed that health inequalities had indirect impact on health via health behavior, psychosocial resources, and material conditions. Discussion: We believe our study is an important contribution to the understudied subject of students' health. We see the impact of social inequality on health among such a privileged group like university students as an important sign of the importance of health inequality.Peer Reviewe

Socioeconomic position and self-rated health among female and male adolescents: The role of familial determinants in explaining health inequalities. Results of the German KiGGS study

Objective: Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining the association between the family’s socioeconomic position and adolescents’ self-rated health. The current study aimed to explore whether the association between socioeconomic position and self-rated health was mediated by familial determinants. Methods: Using data from wave 2 of the”German Health Interview and Examination Survey for Children and Adolescents” (KiGGS) (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of income, education, occupational status, socioeconomic position index and adolescents’ subjective social status on self-rated health into direct effects and indirect effects through familial determinants (family cohesion, parental well-being, parental stress, parenting styles, parental obesity, smoking and sporting activity). Results: A significant total effect of all socioeconomic position indicators on self-rated health was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations between income, parental education, the socioeconomic position index and subjective social status were also mediated by familial determinants (family cohesion, parental smoking, obesity and living in a single-mother family). However, a significant direct effect of subjective social status remained. Conclusion: The analysis revealed how a family’s position of socioeconomic disadvantage can lead to poorer health in adolescents through different family practices. The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions (macro-level), community-based strategies (meso-level) and programs to improve parenting and family functioning (micro-level).Peer Reviewe

Health Inequalities in Children and Adolescents: A Scoping Review of the Mediating and Moderating Effects of Family Characteristics

This scoping review systematically mapped evidence of the mediating and moderating effects of family characteristics on health inequalities in school-aged children and adolescents (6–18 years) in countries with developed economies in Europe and North America. We conducted a systematic scoping review following the PRISMA extension for Scoping Reviews recommendations. We searched the PubMed, PsycINFO and Scopus databases. Two reviewers independently screened titles, abstracts and full texts. Evidence was synthesized narratively. Of the 12,403 records initially identified, 50 articles were included in the synthesis. The included studies were conducted in the United States (n = 27), Europe (n = 18), Canada (n = 3), or in multiple countries combined (n = 2). We found that mental health was the most frequently assessed health outcome. The included studies reported that different family characteristics mediated or moderated health inequalities. Parental mental health, parenting practices, and parent-child-relationships were most frequently examined, and were found to be important mediating or moderating factors. In addition, family conflict and distress were relevant family characteristics. Future research should integrate additional health outcomes besides mental health, and attempt to integrate the complexity of families. The family characteristics identified in this review represent potential starting points for reducing health inequalities in childhood and adolescence.Peer Reviewe

Wie steht es um die Gesundheit von Mädchen und Jungen in der COVID-19-Pandemie? Ausgewählte Ergebnisse der KIDA-Studie

Hintergrund: Es ist bekannt, dass es bei Kindern geschlechterbezogene Unterschiede im Gesundheitsverhalten sowie in der körperlichen und psychischen Gesundheit gibt. Die COVID-19-Pandemie beeinflusste durch veränderte Lebensbedingungen die Gesundheit und die Lebensweisen von Kindern und Jugendlichen. Die vorliegende Arbeit untersucht, ob sich mehr als zwei Jahre nach Pandemiebeginn Geschlechterunterschiede bei ausgewählten Gesundheitsindikatoren zeigen. Methode: In der Studie Kindergesundheit in Deutschland aktuell (KIDA) wurden telefonische Querschnittsbefragungen mit Eltern von 3- bis 15-Jährigen (n = 3.478) durchgeführt. Elternangaben zur allgemeinen und psychischen Gesundheit des Kindes, zu erhöhten Versorgungs- oder Unterstützungsbedarfen sowie zur körperlichen Aktivität und Nutzung von Sportangeboten wurden standardisiert erfragt. Geschlechterunterschiede wurden mit Chi2-Tests bewertet. Ergebnisse: Für 91 % der Mädchen und 92 % der Jungen wurde die allgemeine Gesundheit durch ihre Eltern als (sehr) gut eingeschätzt (Unterschied nicht signifikant). Erhöhte Versorgungs- und Unterstützungsbedarfe wurden für 10,6 % der 3- bis 15-Jährigen angegeben (Mädchen: 9 %, Jungen 12 %, n. s.). Jungen erreichten mit 60 % signifikant häufiger die WHO-Bewegungsempfehlungen als Mädchen (54 %). Für je 93 % der Jungen und Mädchen wurde eine gute bis ausgezeichnete psychische Gesundheit angegeben. Bei Veränderungen der psychischen Gesundheit im Vergleich zum vorpandemischen Zeitraum fanden sich keine Unterschiede in den Antworten zu Mädchen im Vergleich zu Jungen. Schlussfolgerungen: Für einzelne Parameter und Altersgruppen fanden sich Geschlechterunterschiede, die zusammen mit anderen sozialen Determinanten der Gesundheit bewertet und bei präventiven Maßnahmen berücksichtigt werden müssen

SARS-CoV-2 Transmissibility Within Day Care Centers—Study Protocol of a Prospective Analysis of Outbreaks in Germany

Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults. Methods and Analysis: COALA (“Corona outbreak-related examinations in day care centers”) is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance. Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.Peer Reviewe

High weekly integral dose and larger fraction size increase risk of fatigue and worsening of functional outcomes following radiotherapy for localized prostate cancer

IntroductionWe hypothesized that increasing the pelvic integral dose (ID) and a higher dose per fraction correlate with worsening fatigue and functional outcomes in localized prostate cancer (PCa) patients treated with external beam radiotherapy (EBRT). MethodsThe study design was a retrospective analysis of two prospective observational cohorts, REQUITE (development, n=543) and DUE-01 (validation, n=228). Data were available for comorbidities, medication, androgen deprivation therapy, previous surgeries, smoking, age, and body mass index. The ID was calculated as the product of the mean body dose and body volume. The weekly ID accounted for differences in fractionation. The worsening (end of radiotherapy versus baseline) of European Organisation for Research and Treatment of Cancer EORTC) Quality of Life Questionnaire (QLQ)-C30 scores in physical/role/social functioning and fatigue symptom scales were evaluated, and two outcome measures were defined as worsening in >= 2 (WS2) or >= 3 (WS3) scales, respectively. The weekly ID and clinical risk factors were tested in multivariable logistic regression analysis. ResultsIn REQUITE, WS2 was seen in 28% and WS3 in 16% of patients. The median weekly ID was 13.1 L center dot Gy/week [interquartile (IQ) range 10.2-19.3]. The weekly ID, diabetes, the use of intensity-modulated radiotherapy, and the dose per fraction were significantly associated with WS2 [AUC (area under the receiver operating characteristics curve) =0.59; 95% CI 0.55-0.63] and WS3 (AUC=0.60; 95% CI 0.55-0.64). The prevalence of WS2 (15.3%) and WS3 (6.1%) was lower in DUE-01, but the median weekly ID was higher (15.8 L center dot Gy/week; IQ range 13.2-19.3). The model for WS2 was validated with reduced discrimination (AUC=0.52 95% CI 0.47-0.61), The AUC for WS3 was 0.58, ConclusionIncreasing the weekly ID and the dose per fraction lead to the worsening of fatigue and functional outcomes in patients with localized PCa treated with EBRT