Waterpipe (WP) use is popular among youth worldwide, but epidemiological data from Germany are scarce. We aimed to describe prevalence rates of WP use (current, last 12 months, ever) and analysed correlates and trends among 11- to 17-year-olds in Germany. Analyses were based on data from the “German Health Interview and Examination Survey for Children and Adolescents” study during 2014–2017 (n = 6599). Changes in WP use prevalence compared with 2009–2012 were used to describe trends. Associations with sociodemographic characteristics and cigarette smoking were assessed with multivariable logistic regression models. Prevalence of current WP use among adolescents was 8.5% (95% confidence interval (CI) = 7.5–9.6), use in the last 12 months was 19.7% (95% CI = 18.3–21.2), and ever use was 25.8% (95% CI = 24.2–27.5). High prevalence rates were particularly found among 16–17-year-olds. During 2009–2012, these prevalence rates were 9.0%, 18.5%, and 26.1%, respectively. WP use was associated with older age, male sex, migration background, lower educational level, and current smoking status. Among current WP users, 66.2% (95% CI = 60.0–71.9) identified themselves as non-smokers, and 38.1% (95% CI = 32.5–44.0) had used WP ≥ three times in the last month. WP consumption is popular among German youth, and prevalence rates have not changed over time. Specific prevention strategies to reduce harmful WP consumption among youth should be implemented.

Cardiorespiratory fitness (CRF) is an established predictor of adverse health outcomes. The aim of this study is to investigate potential behavioral, interpersonal and socioeconomic correlates of CRF among men and women living in Germany using data from a population-based nationwide cross-sectional study. 1,439 men and 1,486 women aged 18–64 participated in the German Health Interview and Examination Survey (2008–2011) and completed a standardized sub-maximal cycle ergometer test. Maximal oxygen consumption ( V̇O_2max ) in ml·min −1 ·kg −1 was estimated. Mean values of VO 2 max for various anthropometric, behavioral, interpersonal, and sociodemographic variables were estimated. Linear regression analyses using multiple imputations technique for missing values was performed to analyze the influence of potential correlates on CRF. Women with high alcohol consumption had higher V̇O_2max , ( β = 2.20; 95

The COVID-19 pandemic poses new challenges to both individuals and societies that impact health behaviour in many ways. This narrative review brings together initial findings for smoking, alcohol use, nutrition, physical activity and obesity. Smoking and obesity are potential direct risk factors for a severe course of COVID-19, and alcohol abuse, physical inactivity and an unbalanced diet can be indirect risk factors. The constraints of public life to contain the COVID-19 pandemic reduced the opportunities for physical activity and sports, although the initial results on physical activity during this period for Germany do not reflect this assumption. While a part of the population reports making healthier diet choices than before the pandemic, others do not. For smoking and risky alcohol use, data at an aggregate level for the general population do not indicate any behaviour changes. However, different trends appear to be emerging for different population groups pointing to the fact that social inequalities in pandemic-related changes to health behaviour must be assumed. Should further studies confirm these results, this would indicate a need for pandemic-specific prevention measures. Furthermore, specifically during the pandemic, prevention and health promotion measures directed at changes to health behaviour should continue to be implemented and adapted to the restrictions due to the pandemic. Equity in health should be promoted in particular.

ObjectivesThis study aimed to investigate associations between occupational physical activity patterns (physical work demands linked to job title) and leisure time physical activity (assessed by questionnaire) with cardiorespiratory fitness (assessed by exercise test) among men and women in the German working population.DesignPopulation-based cross-sectional study.SettingTwo-stage cluster-randomised general population sample selected from population registries of 180 nationally distributed sample points. Information was collected from 2008 to 2011.Participants1296 women and 1199 men aged 18–64 from the resident working population.Outcome measureEstimated low maximal oxygen consumption (V˙O2max), defined as first and second sex-specific quintile, assessed by a standardised, submaximal cycle ergometer test.ResultsLow estimatedV˙O2maxwas strongly linked to low leisure time physical activity, but not occupational physical activity. The association of domain-specific physical activity patterns with lowV˙O2maxvaried by sex: women doing no leisure time physical activity with high occupational physical activity levels were more likely to have lowV˙O2max(OR 6.54; 95% CI 2.98 to 14.3) compared with women with ≥2 hours of leisure time physical activity and high occupational physical activity. Men with no leisure time physical activity and low occupational physical activity had the highest odds of lowV˙O2max(OR 4.37; 95% CI 2.02 to 9.47).ConclusionThere was a strong association between patterns of leisure time and occupational physical activity and cardiorespiratory fitness within the adult working population in Germany. Women doing no leisure time physical activity were likely to have poor cardiorespiratory fitness, especially if they worked in physically demanding jobs. However, further investigation is needed to understand the relationships between activity and fitness in different domains. Current guidelines do not distinguish between activity during work and leisure time, so specifying leisure time recommendations by occupational physical activity level should be considered.

Around 15% of children and adolescents in Germany are overweight or obese. To support the planning, implementation and evaluation of preventive activities, the Robert Koch Institute (RKI) has developed a population-wide monitoring of influencing factors relevant to the development of obesity during childhood (AdiMon). AdiMon is a web-based indicator system providing population-wide meaningful and regularly updated data on factors that influence obesity in kindergarten-age girls and boys (0- to 6-years-old). Towards the end of 2020, the RKI will expand the indicator system to also cover the 7- to 17-year-old age group. To this end, a systematic review of the literature was conducted, a process which served to identify over 80 relevant factors that influence the development of obesity. These factors have been attributed to the categories behaviour, environment, biology, pre- and postnatal, psychosocial factors and context. Compared to a previous literature review for kindergarten-age children, around one tenth of the influencing factors now identified are new, including ‘peer group influences’ and ‘bullying’. As the results highlight, an array of influencing factors must be considered when expanding the monitoring system, ranging from individual health behaviour to the social framework conditions and environmental factors.

This study examines the extent to which health inequalities among children and adolescents in Germany have developed over the past decade. The analyses are based on data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which are representative of the 0- to 17-year-old population in Germany. The KiGGS data were collected in three waves: the KiGGS baseline study (2003-2006), KiGGS Wave 1 (2009-2012) and KiGGS Wave 2 (2014-2017). Prevalences of five health outcomes are considered: general health, mental health problems, physical activity, the consumption of sugary soft drinks, and smoking. Moreover, it defines health inequalities in relation to differences in the socioeconomic status of the family (SES), an index derived from the parents' level of education, occupation and income, and considers both absolute and relative health inequalities. In order to do so, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated using linear probability or log-binomial models. Significant inequalities were identified to the detriment of young people from families with a low SES. These inequalities were particularly pronounced in the KiGGS Wave 2 data with regard to general health and the consumption of sugary soft drinks. Additionally, evidence from trend analyses for these two outcomes suggests that relative inequalities have increased. However, absolute inequalities decreased during the same period, and this also applies to smoking. The persistently high and, in some cases, widened levels of health inequalities indicate that adolescents from families with a low SES do not benefit to the same extent from disease prevention and health promotion measures for children and adolescents as young people from families with a higher SES.

This article examines educational differences in the prevalence of behavioural risk factors among adults and compares the results for Germany with the average from the European Union (EU). Data were derived from the second wave of the European Health Interview Survey, which took place between 2013 and 2015 (EHIS 2). Analyses were conducted using a regression-based calculation of relative and absolute educational differences in the prevalence of behavioural risk factors, based on self-reported data from women and men aged between 25 and 69 (n=217,215). Current smoking, obesity, physical activity lasting less than 150 minutes per week, heavy episodic drinking and non-daily fruit or vegetable intake are more prevalent among people with a low education level than those with a high education level. This applies to Germany as well as the EU average. Overall, the relative educational differences identified for these risk factors place Germany in the mid-range compared to the EU average. However, relative educational differences in current smoking and heavy episodic drinking are more manifest among women in Germany than the EU average, with the same applying to low physical activity among men. In contrast, relative educational differences in non-daily fruit or vegetable intake are less pronounced among women and men in Germany than the average across the EU. Increased efforts are needed in various policy fields to improve the structural conditions underlying health behaviour, particularly for socially disadvantaged groups, and increase health equity.

Zusammenfassung Die Vermeidung des Rauchens und der Passivrauchbelastung von Kindern und Jugendlichen ist ein wichtiges gesundheitspolitisches Ziel. Die wiederholt erhobenen Daten der KiGGS-Studie zeigen einen deutlichen Rückgang bei Tabakkonsum und Passivrauchbelastung. Dazu dürften sowohl Maßnahmen der Tabakkontrollpolitik als auch Präventionsprogramme beigetragen haben. Dennoch besteht noch Handlungsbedarf bei der Verbesserung der Tabakkontrollpolitik, vor allem im Bereich des Tabakwerbeverbots.

Abstract Background Studies show that occupational physical activity (OPA) has less health-enhancing effects than leisure-time physical activity (LTPA). The spare data available suggests that OPA rarely includes aerobic PAs with little or no enhancing effects on cardiorespiratory fitness (CRF) as a possible explanation. This study aims to investigate the associations between patterns of OPA and LTPA and CRF among adults in Germany. Methods 1,204 men and 1,303 women (18-64 years), who participated in the German Health Interview and Examination Survey 2008-2011, completed a standardized sub-maximal cycle ergometer test to estimate maximal oxygen consumption (VO2max). Job positions were coded according to the level of physical effort to construct an occupational PA index and categorized as low vs. high OPA. LTPA was assessed via questionnaires and dichotomized in no vs. any LTPA participation. A combined LTPA/OPA variable was used (high OPA/ LTPA, low OPA/LTPA, high OPA/no LTPA, low OPA/no LTPA). Information on potential confounders was obtained via questionnaires (e.g., smoking and education) or physical measurements (e.g., waist circumference). Multi-variable logistic regression was used to analyze associations between OPA/LTPA patterns and VO2max. Results Preliminary analyses showed that less-active men were more likely to have a low VO2max with odds ratios (ORs) of 0.80 for low OPA/LTPA, 1.84 for high OPA/no LTPA and 3.46 for low OPA/no LTPA compared to high OPA/LTPA. The corresponding ORs for women were 1.11 for low OPA/LTPA, 3.99 for high OPA/no LTPA and 2.44 for low OPA/no LTPA, indicating the highest likelihood of low fitness for women working in physically demanding jobs and not engaging in LTPA. Conclusions Findings confirm a strong association between LTPA and CRF and suggest an interaction between OPA and LTPA patterns on CRF within the workforce in Germany. Women without LTPA are at high risk of having a low CRF, especially if they work in physically demanding jobs. Key messages Women not practicing leisure-time physical activity are at risk of having a low cardiorespiratory fitness, especially if they work in physically demanding jobs. Different impact of domains of physical activity should be considered when planning interventions to enhance fitness among the adult population.

BACKGROUND:Enhanced cardiorespiratory fitness (CRF) is now a well-established predictor of numerous adverse health outcomes. Knowledge about the pathways leading to enhanced CRF is essential for developing appropriate interventions. Hence, the aim of this review was to provide a detailed overview of the current state of research regarding individual factors associated with or influencing CRF among the general adult population.METHODS:We searched the PubMed, EMBASE, and Cochrane Library databases and also conducted a search for grey literature (Google Scholar). Eligible indicators of CRF were objectively assessed measures of CRF by submaximal or maximal exercise testing measured using treadmill or cycle ergometer tests. We included quantitative observational studies of the general adult population. Using a semi-quantitative approach, we compiled summary tables aggregating the study results for each potential correlate or determinant of CRF.RESULTS:We identified 3005 studies, 78 of which met the inclusion criteria. Almost all of these studies were conducted in high-income countries. Study quality scores assessing the risk of bias in the individual studies ranged from 40 to 100%. Male sex, age (inverse), education, socioeconomic status, ethnicity, body mass index (inverse), body weight (inverse), waist circumference, body fat (inverse), resting heart rate (inverse), C-reactive protein (inverse), smoking (inverse), alcohol consumption, and multiple measures of leisure-time physical activity were independently and consistently associated with CRF.CONCLUSIONS:In synthesizing the current research on the correlates and determinants of CRF among adults, this systematic review identified gaps in the current understanding of factors influencing CRF. Beyond the scope of this review, environmental and interpersonal determinants should be further investigated.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42017055456.

Introduction. Risky alcohol consumption (RAC) and heavy episodic drinking (HED) by parents can have negative effects on their children. At present, little is known about these forms of alcohol consumption among parents in Germany. The aim of this analysis is to estimate the percentage of parents living in Germany who practise RAC and HED and to study associations between these consumption patterns and sociodemographic factors. Material and Methods. The data basis comprises the data of the nationwide studies "Gesundheit in Deutschland aktuell" (GEDA) of 2009, 2010, and 2012. The data were collected by means of computer-assisted telephone interviews (CATI). Our analysis included all participants living in a household with at least one child of their own under 18 years of age (n = 16,224). Information on RAC and HED was collected using the AUDIT-C screening instrument. Logistic regression models were used to study the relationship between parental alcohol consumption and sociodemographic variables. Results. 18.4% of the mothers and 29.6% of the fathers exhibited RAC; 8.4% of the mothers and 21.0% of the fathers practised HED. After mutual adjustment, RAC showed a significant association with the level of education, income (only mothers), employment status (only mothers), migration background, relationship status (only mothers), and the age of the youngest child. HED showed a significant association with income (only mothers), the age of the youngest child (only mothers), and the level of education (only fathers). Conclusions. The presented analysis emphasizes the relevance of preventive measures to reduce parental alcohol consumption. In addition to universal interventions, risk group-specific measures (e.g., for parents with high income) are needed to reduce parental alcohol consumption and thus support a healthy development of children.

Im Kindesund Jugendalter werden die Weichen für das Gesundheitsverhalten im späteren Leben gestellt. Gesundheitsbezogene Einstellungen und Verhaltensmuster, die sich in jungen Jahren ausbilden, haben oftmals bis ins Erwachsenenalter hinein Bestand. Studien zeigen, dass gesundheitsriskante Verhaltensweisen bereits im Kindesund Jugendalter in bestimmten Bevölkerungsgruppen vermehrt auftreten. Die Ergebnisse aus KiGGS Welle 2 bestätigen, dass sich 3bis 17-jährige Kinder und Jugendliche mit niedrigem sozioökonomischen Status (SES) häufiger als Gleichaltrige aus sozial bessergestellten Familien ungesund ernähren, seltener Sport treiben und häufiger übergewichtig oder adipös sind. Während sich im Hinblick auf den Alkoholkonsum bei den 11bis 17-Jährigen nur geringfügige soziale Unterschiede abzeichnen, zeigt sich beim Tabakkonsum, dass Mädchen und Jungen mit niedrigem SES häufiger rauchen als Gleichaltrige mit hohem SES. Prävention und Gesundheitsförderung zielen darauf ab, Kinder und Jugendliche an eine gesundheitsbewusste Lebensweise heranzuführen und die strukturellen Voraussetzungen für gesundheitsförderliches Verhalten zu verbessern. Eine Kombination aus verhaltensund verhältnispräventiven Ansätzen scheint dabei besonders erfolgversprechend zu sein. Angesichts der bereits früh im Lebenslauf ausgeprägten sozialen Unterschiede im Gesundheitsverhalten sollten Maßnahmen noch stärker als bisher sozial benachteiligte Kinder und Jugendliche und deren Lebensbedingungen in den Blick nehmen. SOZIOÖKONOMISCHER STATUS · BEWEGUNG · ERNÄHRUNG · GESUNDHEITSMONITORING · KIGGS

In Germany, smoking prevalence among adolescents has significantly declined since the early 2000s. However, data show that adolescent smoking rates considerably differ between different types of secondary schools. The aim of our study was to examine how educational inequalities in adolescent smoking behaviour have developed over time.Data were used from four population-based studies (each consisting of repeated cross-sectional surveys from 2001-2015): the representative surveys of the Federal Centre for Health Education, the German Health Interview and Examination Survey for Children and Adolescents, the Health Behaviour in School-aged Children Study, and the European School Survey Project on Alcohol and Other Drugs. Each study comprised different age groups (within the age range of 11-17 years) and used different smoking measures. Adolescents' educational status was based on the attended type of secondary school. Absolute and relative educational inequalities were presented as prevalence differences and prevalence ratios, respectively.Despite methodical differences, all four studies similarly reveal that adolescent smoking rates have significantly declined in all educational groups. However, lower smoking rates among secondary school students attending higher educational tracks could be observed. While absolute educational inequalities tended to decrease over time, relative inequalities between educational groups remained rather stable or even increased.Declining adolescent smoking rates suggest that smoking may have lost some of its attractiveness for young people. Our findings further emphasize the importance of tobacco control measures such as raising cigarette taxes, smoking bans, and increasing minimum legal age for tobacco purchase. As relative educational inequalities in adolescent smoking rates did not diminish over time, setting- and target group-specific interventions should focus more on students in middle and lower secondary school tracks.

Background The consumption of tobacco products is regarded as the largest preventable risk factor for a large number of serious diseases. It causes around 121,000 deaths per year in Germany alone [1]. Over the last two decades, various tobacco control measures have been taken and extended over time such as increasing tobacco taxes, advertising bans and implementing age restrictions as well as smoking bans to protect non-smokers from second hand smoke exposure. Overall, tobacco consumption has decreased during this period [2] and the proportion of smokers among children and adolescents declined significantly. However, as a large proportion of the population continues to smoke, reducing tobacco consumption remains one of the key objectives of public health [3, 4]. Smoking in childhood and adolescence may still be experimental in character, but it often proves to be the beginning of a consumption pattern that is highly stable over the life course [5, 6]. In this context, this article uses longitudinal data from the KiGGS cohort to examine trajectories of smoking behaviour during the transition from adolescence to young adulthood. Indicator and methodology The analyses presented here are based on self-reports on current smoking (any smoking, even occasional) and on the age of smoking initiation. The data is taken from the KiGGS cohort, a study that follows the participants of the KiGGS baseline study (2003-2006) [7] into adulthood. The sample includes 2,159 young adults (1,159 women; 1,000 men) aged 19 and 24 years old who have participated again in the first follow-up telephone survey of KiGGS Wave 1 (2009-2012). In total, 57.8% of the original 3,736 14 to 17 year-olds in the KiGGS baseline study with valid information on current smoking at both measurement times were included. Transition probabilities were calculated, that means the percentage probability of the transition from smoking to non-smoking or vice versa from the KiGGS baseline study to KiGGS Wave 1. Socioeconomic status (SES) was determined using the data provided by parents on education, occupation and income at the time of the KiGGS baseline study [8]. Possible bias caused by selective re-participation was partially taken into account through multivariate weighting [7]. Journal of Health Monitoring · 2018 3(1) DOI 10.17886/RKI-GBE-2018-029 Robert Koch Institute, Berlin

This review aims to (1) consolidate evidence regarding the association between socioeconomic status (SES) and cardiorespiratory fitness (CRF), (2) conduct a meta-analysis of the association between SES and CRF using methodologically comparable data, stratified by sex, and (3) test whether the association varies after adjustment for physical activity (PA).

Zusammenfassung Das Rauchen ist in den Industrienationen das bedeutendste einzelne Gesundheitsrisiko und die führende Ursache vorzeitiger Sterblichkeit. Zu den vordringlichen Zielen von Public Health gehört es daher, den Tabakkonsum in der Bevölkerung zu reduzieren. Wie die Tabaksteuerstatistik und bevölkerungsweite Studien zeigen, ist sowohl der Zigarettenabsatz als auch der Anteil der Jugendlichen und Erwachsenen, die rauchen, in den letzten 25 Jahren deutlich zurückgegangen. Diese positive Entwicklung ist sicherlich auch auf Maßnahmen zurückzuführen, die im Zuge einer verstärkten Tabakkontrollpolitik in Deutschland umgesetzt wurden. Insbesondere beim konsequenten und flächendeckenden Nichtraucherschutz, bei der Tabaksteuer und bei umfassenden Tabakwerbeverboten besteht weiterhin Potential zur Verbesserung.

Seit Beginn der 2000er-Jahre ist der Anteil der Jugendlichen, die rauchen, in Deutschland deutlich zurückgegangen. Vorliegende Daten weisen jedoch auf erhebliche Unterschiede im Rauchverhalten von Schülern unterschiedlicher Schulformen hin. Der Beitrag untersucht, wie sich Bildungsunterschiede im Rauchverhalten von Jugendlichen im Zeitverlauf entwickelt haben.