A national cohort study of community belonging and its influence on premature mortality

BACKGROUND

Community belonging, an important constituent of subjective well-being, is an important target for improving population health. Ageing involves transitioning across different social conditions thus, community belonging on health may vary across the life course. Using a nationally representative cohort, this study estimates the life stage-specific impact of community belonging on premature mortality.

METHODS

Six cycles of the Canadian Community Health Survey (2000-2012) were combined and linked to the Canadian Vital Statistics Database (2000-2017). Respondents were followed for up to 5 years. Multivariable-adjusted modified Poisson regression models were used to estimate the relative risk of premature mortality for three life stages: early adulthood (18-35 years), middle adulthood (36-55 years) and late adulthood (56-70 years).

RESULTS

The final analytical sample included 477 100 respondents. Most reported a 'somewhat strong' sense of belonging (45.9%). Compared with their 'somewhat strong' counterparts, young adults reporting a 'somewhat weak' sense of belonging exhibited an increased relative risk (RR) of 1.76 (95% CI 1.27 to 2.43) for premature mortality, whereas middle-aged adults reporting the same exhibited a decreased RR of 0.82 (95% CI 0.69, 0.98). Among older adults, groups reporting a 'very strong' (RR 1.10, 95% CI 1.01, 1.21) or a 'very weak' sense (RR 1.14, 95% CI 1.01, 1.28) of belonging exhibited higher RRs for premature mortality.

CONCLUSION

The results demonstrate how community belonging relates to premature mortality differs across age groups underscoring the importance of considering life stage-specific perspectives when researching and developing approaches to strengthen belonging.

Sexual orientation, gender expression and socioeconomic status in the National Longitudinal Study of Adolescent to Adult Health

BACKGROUND

Socioeconomic status (SES) is a fundamental contributor to health, yet it is rarely examined relative to gender expression, particularly gender non-conformity and sexual orientation.

METHODS

We use data from 11 242 Wave V respondents (aged 33-44) in the National Longitudinal Study of Adolescent to Adult Health (2016-2018) to examine associations between socially assigned gender expression, sexual orientation and SES, in logistic and multinomial regression models stratified by sex assigned at birth.

RESULTS

Among both women and men a general pattern of heightened risk for lower SES among gender non-conforming sexual minorities relative to gender conforming heterosexuals was observed. Gender non-conforming heterosexuals were also at elevated risk of lower SES compared with their conforming heterosexual peers.

CONCLUSION

Socioeconomic differences by sexual orientation and gender expression have important implications for understanding health disparities among gender non-conforming sexual minorities and their gender conforming heterosexual counterparts.

Relative deprivation and human flourishing: how do upward income comparisons affect health, happiness and life satisfaction?

BACKGROUND

Relative deprivation induced by social comparisons is hypothesised to deleteriously affect health. Previous work has proposed the [Formula: see text] index as a measure of relative deprivation; however, the performance of this novel index still needs further testing in the working-age population. This study examined the association of three relative deprivation measures (the Yitzhaki Index, income rank and the [Formula: see text] index) with human flourishing outcomes.

METHODS

This cross-sectional study analysed data from 2177 working-age adults in Taiwan. We conducted least-squares linear models to investigate the association between relative deprivation measures and health, happiness, life satisfaction, meaning in life, social relationships, and subjective well-being.

RESULTS

When using sex and age as the reference group, for each increased SD in the Yitzhaki Index, the six human flourishing outcomes decreased by 0.10-0.20 SD. The results were consistent across various definitions of the reference group. Based on the Akaike information criterion, the Yitzhaki Index generally showed better model fits for health, happiness, life satisfaction and meaning in life, and had comparable model fits with the income rank for social relationships and subjective well-being. In comparing the relative performance of the [Formula: see text] index, positive α parameters (0<α<1) generally showed better model fits, suggesting that individuals were more sensitive to comparisons with those more distant from their own income level.

CONCLUSION

Policies to reduce relative deprivation by lowering income inequality could contribute to a higher level of health, happiness, life satisfaction, meaning in life, social relationships and subjective well-being.

Impact of climate change on non-communicable diseases caused by altered UV radiation

Background

UV radiation can cause serious skin and eye diseases, especially cancers. UV-related skin cancer incidences have been increasing for decades. The determining factor for this development is the individual UV exposure. Climate change-induced changes in atmospheric factors can influence individual UV exposure.

Methods

On the basis of a topic-specific literature research, a review paper was prepared and supplemented by as yet unpublished results of the authors' own studies. The need for scientific research and development is formulated as well as primary prevention recommendations.

Results

Climate change alters the factors influencing UV irradiance and annual UV dose in Germany. First evaluations of satellite data for Germany show an increase in mean peak UV irradiance and annual UV dose for the last decade compared to the last three decades.

Conclusions

The climate change-related influences on individual UV exposure and the associated individual disease incidence cannot yet be reliably predicted due to considerable uncertainties. However, the current UV-related burden of disease already requires primary preventive measures to prevent UV-related diseases.

Study on Health of Older People in Germany (Gesundheit 65+): objectives, design and implementation

Background

The longitudinal population-based study Gesundheit 65+ aimed to close data gaps on health and well-being of older adults in Germany in times of the COVID-19 pandemic.

Methods

The target population comprised persons 65 years and older permanently residing in Germany and with sufficient German language skills. Proxy interviews were possible and consent from legal representatives was obtained as necessary in order to enable participation of physically or cognitively impaired persons. A two-stage sampling process, was used to draw 128 primary sample points (PSUs) and within these PSUs sex- and age-stratified random samples were drawn from population registries. A mixed-mode design was applied to contact the study population and for data collection. Data were collected between June 2021 and April 2023. Participants were surveyed a total of four times at intervals of four months. At month 12 participants were offered a home visit including a non-invasive examination. Data on all-cause mortality and information on neighborhood social and built environment as well as health insurance data will be linked to primarily collected data at the individual level.

Discussion

Results will inform health politicians and other stakeholders in the care system on health and health care needs of older people in Germany.

Impact of climate change on non-communicable diseases due to increased ambient air pollution

Background

The impacts of air pollutants on health range from short-term health impairments to hospital admissions and deaths. Climate change is leading to an increase in air pollution.

Methods

This article addresses, based on selected literature, the relationship between climate change and air pollutants, the health effects of air pollutants and their modification by air temperature, with a focus on Germany.

Results

Poor air quality increases the risk of many diseases. Climate change is causing, among other things, more periods of extreme heat with simultaneously increased concentrations of air pollutants. The interactions between air temperature and air pollutants, as well as their combined effects on human health, have not yet been sufficiently studied. Limit, target, and guideline values are of particular importance for health protection.

Conclusions

Measures to reduce air pollutants and greenhouse gases must be more strictly implemented. An essential step towards improving air quality is setting stricter air quality limit values in Europe. Prevention and adaptation measures should be accelerated in Germany, as they contribute to climate-resilient and sustainable healthcare systems.

Longitudinal bidirectional link between socioeconomic position and health: a national panel survey analysis

BACKGROUND

Health inequities can stem from socioeconomic position (SEP) leading to poor health (social causation) or poor health resulting in lower SEP (health selection). We aimed to examine the longitudinal bidirectional SEP-health associations and identify inequity risk factors.

METHODS

Longitudinal Household Israeli Panel survey participants (waves 1-4), age ≥25 years, were included (N=11 461; median follow-up=3 years). Health rated on a 4-point scale was dichotomised as excellent/good and fair/poor. Predictors included SEP parameters (education, income, employment), immigration, language proficiency and population group. Mixed models accounting for survey method and household ties were used.

RESULTS

Examining social causation, male sex (adjusted OR 1.4; 95% CI 1.1 to 1.8), being unmarried, Arab minority (OR 2.4; 95% CI 1.6 to 3.7, vs Jewish), immigration (OR 2.5; 95% CI 1.5 to 4.2, reference=native) and less than complete language proficiency (OR 2.22; 95% CI 1.50 to 3.28) were associated with fair/poor health. Higher education and income were protective, with 60% lower odds of subsequently reporting fair/poor health and 50% lower disability likelihood. Accounting for baseline health, higher education and income were associated with lower likelihood of health deterioration, while Arab minority, immigration and limited language proficiency were associated with higher likelihood. Regarding health selection, longitudinal income was lower among participants reporting poor baseline health (85%; 95% CI 73% to 100%, reference=excellent), disability (94%; 95% CI 88% to 100%), limited language proficiency (86%; 95% CI 81% to 91%, reference=full/excellent), being single (91%; 95% CI 87% to 95%, reference=married), or Arab (88%; 95% CI 83% to 92%, reference=Jews/other).

CONCLUSION

Policy aimed at reducing health inequity should address both social causation (language, cultural, economic and social barriers to good health) and health selection (protecting income during illness and disability).

Climate change and public health in Germany - An introduction to the German status report on climate change and health 2023

Global warming of 1.5°C and even 2°C is likely to be exceeded during the 21^st century. Climate change poses a worldwide threat and has direct and indirect effects on infectious diseases, on non-communicable diseases and on mental health. Not all people are equally able to protect themselves against the impacts of climate change; particularly populations that are vulnerable due to individual factors (children, older persons, those immunocompromised or with pre-existing conditions), social factors (the socially disadvantaged), or living and working conditions (e. g. people who work outdoors) are subject to an increased risk. Concepts such as One Health or Planetary Health provide a framework to frame both climate change itself and adaptation strategies or sets of actions for environmental human and animal health. Knowledge of climate change impacts has grown in recent years, and mitigation and adaptation strategies have been developed.

Exploring the relationship between working from home, mental and physical health and wellbeing: a systematic review

Background

Understanding the impact of working from home on health and wellbeing is of great interest to employers and employees alike, with a strong need for up-to-date guidance. The aim of this systematic review was to identify, appraise and synthesise existing research evidence that explores the impact of home working on health and wellbeing outcomes for working people and health inequalities in the population.

Methods

We conducted a systematic review of qualitative, quantitative and observational studies. We searched databases, reference lists and UK grey literature and completed citation searching of included papers. We extracted and tabulated key data from the included papers and synthesised narratively. Factors associated with the health and wellbeing of people working at home reported in the literature were displayed by constructing mind maps of each individual factor which had been identified. The findings were combined with an a priori model to develop a final model, which was validated in consultation with stakeholders.

Results

Of 96 studies which were found to meet the inclusion criteria for the review, 30 studies were published before the COVID-19 pandemic and a further 66 were published during the pandemic. The quality of evidence was limited by the study designs employed by the authors, with the majority of studies being cross-sectional surveys (n = 59). For the most part, for studies which collected quantitative data, measures were self-reported. The largest volume of evidence identified consisted of studies conducted during the COVID-19 pandemic which looked at factors which influence the relationship between working from home and measures relating to mental health and wellbeing. Fifteen studies which considered the potential for working at home to have different effects for different subgroups suggested that working at home may have more negative consequences during the COVID-19 pandemic for women and in particular, mothers. There was very little evidence on age (two studies), ethnicity (one study), education or income (two studies) in terms of moderating home working effects, and very limited evidence from before the COVID-19 pandemic. The concept of enforced working from home and having 'no choice' was reported in only one paper prior to the pandemic and two papers reporting on working from home as a result of COVID-19. However, the concept of lack of choice around working from home was implicit in much of the literature - even though it was not directly measured. There were no clear patterns of wellbeing measures which changed from positive to negative association (or vice versa) during the pandemic.

Limitations

The quality of the evidence base was very much limited by study designs, particularly for studies published during the COVID-19 pandemic, with the majority of studies consisting of data collected by cross-sectional surveys (often online). Due to the rapidly expanding nature of the evidence on this topic, it is possible that new studies were published after the final citation searches were conducted.

Discussion

The evidence base for the factors which influence the relationship between home working and health-related outcomes has expanded significantly as a result of the need for those whose work could be done from home to work at home during the COVID-19 pandemic. Our findings suggest that there are factors relating to the external context, the role of employers and the circumstances of the employee which contribute to determining whether someone works at home and what the associated impacts on health and wellbeing may be. Learning from the COVID-19 lockdown experience will be important to inform future policy on home and hybrid working.

Future work

There is a need for better-quality studies of the health impact of home working, in particularly studies which recruit a range of participants who are representative of the working population and which are designed to minimise sampling/recruitment biases and response biases.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (project reference 18/93 PHR Public Health Review Team) and will be published in full in Public Health Research; Vol. 11, No. 4. See the NIHR Journals Library website for further project information. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Study registration

This study is registered as PROSPERO 2021 CRD42021253474.

Food insecurity and its association with health and well-being in middle-aged and older adults in India

AIM

Food insecurity is a global public health concern; however, there is limited knowledge about its health impacts in India. We examined the associations of food insecurity with socioeconomic conditions, chronic disease and various domains of health and well-being in a community sample of middle-aged and older adults (45+ years) in India.

METHODS

Cross-sectional nationally representative data were collected in wave 1 (2017-2018) of the Longitudinal Ageing Study in India. Food insecurity was measured by questions of access and availability of food. We used logistic regression analyses to examine associations of food insecurity with poor self-rated health, limitations in activities of daily living (ADLs), instrumental ADLs, low life satisfaction, depression, sleep problems and low body mass.

RESULTS

Food insecurity related to all seven indicators of poor health and well-being, even after controlling for material wealth and the presence of multimorbidity (which food insecurity also predicted). Associations with mental health were stronger for those for physical health. For instance, food insecurity related to a threefold increase in probable depression (OR=2.9, 95% CI=2.4 to 3.4) and low life satisfaction (OR=3.4, 95% CI=2.9 to 3.8).

CONCLUSIONS

Food insecurity is a powerful social determinant of poor health among older adults in India. Policy measures to improve population health and well-being should closely follow trends in food insecurity, particularly among those living in poverty and with multiple health conditions.

Life course partnership history and objectively measured physical functional ability in Danish middle-aged adults

BACKGROUND

Partnership break-up and living alone is associated with several negative health-related outcomes. Little is known about the association with physical functional ability in a life course perspective. The aim of this study is to investigate (1) the association between number of partnership break-ups and years living alone across 26 years of adult life respectively and objectively measured physical capability in midlife, (2) how the joint exposure of accumulated break-ups or years living alone respectively, and education relates to physical capability in midlife and (3) potential gender differences.

METHODS

Longitudinal study of 5001 Danes aged 48-62. Accumulated number of partnership break-ups and years living alone were retrieved from national registers. Handgrip strength (HGS) and number of chair rises (CR) were recorded as outcomes in multivariate linear regression analyses adjusted for sociodemographic factors, early major life events and personality.

RESULTS

Increasing number of years living alone was associated with poorer HGS and fewer CR. Concomitant exposure to short educational level and break-ups or long duration of time living alone respectively was associated with poorer physical capability compared with the groups with long educational level and no break-ups or few years lived alone.

CONCLUSION

Accumulated number of years living alone but not break-ups was associated with poorer physical functional ability. Joint exposure to a high number of years lived alone or break-ups respectively and having a short education was associated with the lowest levels of functional ability, which points towards an important target group for interventions. No gender differences were suggested.

Health of people with selected citizenships: results of the study GEDA Fokus

Background

The health situation of people with a history of migration is influenced by a variety of factors. This article provides an overview of the health of people with selected citizenships using various indicators.

Methods

The analyses are based on the survey 'German Health Update: Fokus (GEDA Fokus)', which was conducted from November 2021 to May 2022 among people with Croatian, Italian, Polish, Syrian and Turkish citizenship. The prevalence for each health outcome is presented and differentiated by sociodemographic and migration-related characteristics. Poisson regressions were performed to identify relevant factors influencing health situation.

Results

Self-assessed general health, the presence of depressive symptoms, prevalence of current smoking and the utilisation of general and specialist healthcare differed according to various factors considered here. In addition to sociodemographic determinants, the sense of belonging to society in Germany and self-reported experiences of discrimination were particularly associated with health outcomes.

Conclusions

This article highlights the heterogeneity of the health situation of people with a history of migration and points to the need for further analyses to identify the reasons for health inequalities.

Variability in perceived burden and health trajectories among older caregivers: a population-based study in Sweden

BACKGROUND

The negative effects of informal caregiving are determined by the characteristics of the caregiver-care receiver dyad and the context of care. In this study, we aimed to identify which subgroups of older informal caregivers (1) experience the greatest subjective burden and (2) incur a faster decline in objective health status.

METHODS

From a total of 3363 older participants in the Swedish National study on Aging and Care in Kungsholmen (SNAC-K), we identified 629 informal caregivers (19.2%, mean age 69.9 years). Limitations to life and perceived burden were self-reported, and objective health status was quantified using the comprehensive clinical and functional Health Assessment Tool (HAT) score (range: 0-10). Ordered logistic regressions and linear mixed models were used to estimate the associations between caregiving-related exposures and subjective outcomes (cross-sectionally) and objective health trajectories (over 12 years), respectively.

RESULTS

Having a dual role (providing and receiving care simultaneously), caring for a spouse, living in the same household as the care receiver and spending more hours on caregiving were associated with more limitations and burden. In addition, having a dual role (β=-0.12, 95% CI -0.23 to -0.02) and caring for a spouse (β=-0.08, 95% CI -0.14 to -0.02) were associated with a faster HAT score decline. Being female and having a poor social network were associated with an exacerbation of the health decline.

CONCLUSIONS

Both the heterogeneity among caregivers and the related contextual factors should be accounted for by policymakers as well as in future research investigating the health impact of informal caregiving.

Time-resolved dynamic disability adjusted life-years estimation

The quantification of how healthy the indoor air is, is a complex issue comprising of a large number of contaminants of various sources. The health implication of exposure to each of the contaminant deemed of importance can be expressed using Disability Adjusted Life Years (DALYs). The sum of all DALYs indicates how harmful the indoor air was during the investigated time-frame. This metric was originally developed by the World Bank and the WHO. In 2012, Logue et. al described two methods to estimate the DALYs related to exposure to contaminants in the indoor air based on the yearly mean exposure concentration of a population. The downside of these methods is that, when detailed exposure concentration profiles are available the method results in a loss of information. A novel method was developed to estimate DALYs originating from exposure to indoor pollutants that can be used for time-resolved exposure concentration data without this loss of information: Dynamic DALYs. The advantage of this method is that it can be calculated in real-time and for short or long periods of data. As such it can be used for pin-pointing problematic events in the exposure profile of a person and, as it can be calculated in real-time, makes it a candidate for use in automated optimization problems. The use of Dynamic DALYs is demonstrated for a simulation case-study of an occupied apartment. One continuously ventilated system (Dcont) and one smart ventilation system (Dsmart) are compared. Sources of typically indoor generated Volatile Organic Compounds (VOCs) were added and the related exposure profile and Dynamic DALY results of the working adult were analyzed. The results showcase detailed and more summative results with regards to health and energy use using the novel indicator. For Dcont and Dsmart the total Dynamic DALYs are 2.2 years and 8.6 years, respectively (population of 100 000, duration of 1 year), for the VOCs and sources considered in the analysis.

C5: A Step Towards Smart World with Enhanced Holistic Wellbeing

Today our life without smart gadgets is beyond imagination. In fact, smart apps are now the inseparable part of a human life. The use of technology has provided more comfortable and easier life than ancient times, but the overuse of social media and mobile devices may lead to numerous Psychological, Physical and Psychosomatic (P3) disorders, such as eyestrain, anxiety, fatigue, and difficulty focusing on important tasks. They may also create serious health malfunctions, such as depression and hypertension. Social media may be the first solution that comes to mind when we are lonely; it seems to be a quick and easy access to number of people. However, many studies have shown that our online networks, although they may offer an illusion of connectedness, rather make us even lonelier and more segregated. The overuse of technology may have a significant impact on developing children and teenagers. Mind is the powerhouse of a human body, and the activity level determines the overall health of a person. Hyperactive or hypoactive minds, both are the signs of abnormality and to avoid such conditions C5 (Creativity, Contentment, Confidence, Calmness, Concentration) concept is being practiced. In this paper, we present a novel idea of using C5 concept for overall harmonical holistic development. A good relationship is established between C5 growth along with HEALTH (Harmony, Energy, Aesthetics, Limberness, Tranquility & Happiness). The convenience of C5 concept to assess anxiousness and stressed mental state of a person through empathetic intelligence by applying haptic Aps via tactile internet makes our world smarter than present times to dwell in with a proper care of ourselves and our related people giving better outcomes in our personal and professional fronts.

Developing a reference protocol for structured expert elicitation in health-care decision-making: a mixed-methods study

BACKGROUND

Many decisions in health care aim to maximise health, requiring judgements about interventions that may have higher health effects but potentially incur additional costs (cost-effectiveness framework). The evidence used to establish cost-effectiveness is typically uncertain and it is important that this uncertainty is characterised. In situations in which evidence is uncertain, the experience of experts is essential. The process by which the beliefs of experts can be formally collected in a quantitative manner is structured expert elicitation. There is heterogeneity in the existing methodology used in health-care decision-making. A number of guidelines are available for structured expert elicitation; however, it is not clear if any of these are appropriate for health-care decision-making.

OBJECTIVES

The overall aim was to establish a protocol for structured expert elicitation to inform health-care decision-making. The objectives are to (1) provide clarity on methods for collecting and using experts' judgements, (2) consider when alternative methodology may be required in particular contexts, (3) establish preferred approaches for elicitation on a range of parameters, (4) determine which elicitation methods allow experts to express uncertainty and (5) determine the usefulness of the reference protocol developed.

METHODS

A mixed-methods approach was used: systemic review, targeted searches, experimental work and narrative synthesis. A review of the existing guidelines for structured expert elicitation was conducted. This identified the approaches used in existing guidelines (the 'choices') and determined if dominant approaches exist. Targeted review searches were conducted for selection of experts, level of elicitation, fitting and aggregation, assessing accuracy of judgements and heuristics and biases. To sift through the available choices, a set of principles that underpin the use of structured expert elicitation in health-care decision-making was defined using evidence generated from the targeted searches, quantities to elicit experimental evidence and consideration of constraints in health-care decision-making. These principles, including fitness for purpose and reflecting individual expert uncertainty, were applied to the set of choices to establish a reference protocol. An applied evaluation of the developed reference protocol was also undertaken.

RESULTS

For many elements of structured expert elicitation, there was a lack of consistency across the existing guidelines. In almost all choices, there was a lack of empirical evidence supporting recommendations, and in some circumstances the principles are unable to provide sufficient justification for discounting particular choices. It is possible to define reference methods for health technology assessment. These include a focus on gathering experts with substantive skills, eliciting observable quantities and individual elicitation of beliefs. Additional considerations are required for decision-makers outside health technology assessment, for example at a local level, or for early technologies. Access to experts may be limited and in some circumstances group discussion may be needed to generate a distribution.

LIMITATIONS

The major limitation of the work conducted here lies not in the methods employed in the current work but in the evidence available from the wider literature relating to how appropriate particular methodological choices are.

CONCLUSIONS

The reference protocol is flexible in many choices. This may be a useful characteristic, as it is possible to apply this reference protocol across different settings. Further applied studies, which use the choices specified in this reference protocol, are required.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 37. See the NIHR Journals Library website for further project information. This work was also funded by the Medical Research Council (reference MR/N028511/1).

The health of lesbian, gay, bisexual, transgender and intersex people

Sex, gender and sexual orientation are diverse, as are the ways of living associated with them. The extent to which people can live a free and self-determined life according to their own body, gender, sexuality and way of life influences their social resources, opportunities for participation and discrimination and has an influence on their life situation and health. A narrative review of lesbian, gay, bisexual, transgender and intersex (LGBTI) health was conducted including international and German reviews, meta-analyses and population-based studies. The focus of this article is the legal, social and medical recognition as well as health status of LGBTI people in Germany. While the legal framework in Germany for homosexual and bisexual people has gradually improved, many civil society stakeholders have pointed to major deficits in the medical and legal recognition of transgender and intersex people. In addition, scientific findings frequently have not yet found its way into medical practice to an adequate extent. Available data on LGBTI health indicate a need for action in the areas of mental health and health care provision. However, due to a lack of comprehensive data, conclusions cannot be drawn on the general health situation and health resources of LGBTI people. For the concrete planning and implementation of measures as well as the differentiated portrayal of the situation in Germany, the databases must be expanded, not least via population-representative surveys.

30 years after the fall of the Berlin Wall: Regional health differences in Germany

Following the fall of the Berlin Wall in November 1989, considerable effort was made to bring the living conditions and levels of social participation in the former East German federal states into line with the former West German federal states. As a result, differences in health between the East and the West diminished significantly, in many cases as early as the 1990s, examples being life expectancy and cardiovascular mortality. In regard to health behaviour, the overall tendency has also clearly been one of convergence. Thus, only very small differences can be observed today, for example in the use of tobacco or in the prevalence of obesity. Yet the results also highlight the insufficiency of regarding the remaining differences as a simple comparison between East and West. Instead, the focus should shift towards smaller-scale approaches that take regional differences in living conditions into account.

Health reporting on people with a migration background - Selection and definition of (core) indicators

As part of the project Improving Health Monitoring in Migrant Populations (IMIRA), a (core) set of indicators was developed to describe the health of people with a migration background. This work was underpinned by research into and assessment of relevant data sources in the field of migration and health. Initially, four fields of action were identified together with a number of associated topics and potential indicators for each of the area's individual topics. The choice of core indicators was based on (1) a systematic comparison of widely accepted indicator systems, (2) an assessment of public health relevance, (3) comprehensibility and (4) informative value, as well as (5) the availability of (largely) representative data that could properly account for the diversity of the migrant population. The (core) indicator set was finalised using an internal and external indicator development process that involved an interdisciplinary expert panel. This resulted in the selection of 25 core indicators; 41 additional indicators were documented as part of an 'extended' indicator set. The (core) set of indicators is to be continually developed in line with the work being undertaken to improve the integration of people with a migration background in the health monitoring conducted at the Robert Koch Institute. In the future, the indicator set is to be incorporated into an overall concept to regular, migration-related health reporting.

The health of single mothers and fathers in Germany

In every fifth family in Germany, one parent lives alone with children in the household. Life as a single parent is often marked by challenges that include adopting sole responsibility for the child's education and care, alongside employment commitments, and the difficulties of reconciling work and family life. Moreover, despite comparatively high employment rates, single parents - and their children - are greatly affected by poverty. This paper compares the health of single parents and parents living in partnership and analyses the extent to which single parents' health varies according to their socio-economic and employment status, and social support. The analysis was conducted using data from the German Health Update (GEDA) study in 2009, 2010 and 2012 on fair or poor self-rated general health, as well as depression, back pain, obesity, smoking, sporting inactivity and the non-utilization of dental check-ups. The analyses are based on data from 9,806 women and 6,279 men living in a household with at least one child under the age of 18. The study identified a significantly higher prevalence for all health indicators (apart from obesity) among single mothers compared to mothers living with a partner. In the case of single fathers, higher prevalences were found for depression, smoking and the non-utilization of dental check-ups. On average, the lower socio-economic status of women can explain a certain proportion of the health impairment of single parents, but not for men. However, a lower socio-economic status or social support do not account for the health impairments of single parents. Therefore, the higher prevalence of health impairments among single parents cannot simply be attributed to differences in employment status or to lower levels of social support; rather, certain health indicators show a cumulative effect between single-parents status and the social factors mentioned above. The results presented here provide a differentiated view of the relationship between the health and social situation of single parents. Improving the financial position of one-parent families and making it easier to reconcile work and family life are important steps that would help improve the health of single parents.

Association between barriers and facilitators to meeting the Dietary Guidelines for Americans and body weight status of caregiver-child dyads: the Healthy Eating and Lifestyle for Total Health Study

BACKGROUND

Few Americans meet the Dietary Guidelines for Americans (DGA), yet a large percentage are overweight.

OBJECTIVE

The goal of this research was to examine the association between barriers and facilitators to meeting the DGA and weight in a multisite study.

DESIGN

This was a cross-sectional study in which 836 caregiver-child dyads among 3 race/ethnic groups completed the questionnaire across 6 sites participating in the HEALTH (Healthy Eating and Lifestyle for Total Health) Study. Barriers and facilitators to meeting the DGA were assessed by using a validated questionnaire developed specifically for the HEALTH Study. Heights and weights were measured. A series of bivariate regression analyses were conducted to examine the association between caregiver body mass index (BMI) or child BMI z score and the barriers and facilitators to meeting the DGA, adjusting for appropriate covariates in the models. Path analysis was used to examine the relation of caregiver and child barriers and facilitators to their relative BMIs.

RESULTS

In children, the BMI z score was associated positively (P < 0.001) with total barriers and negatively (P < 0.001) with total facilitators. In caregivers, BMI was associated positively only with total barriers (P < 0.0001). For each of the 8 MyPyramid components, barriers consistently were associated positively (P < 0.0001) and facilitators were associated negatively (P < 0.001) with BMI z score in children (with the exception of the fruit and physical activity components). For caregivers, most of the barriers to meeting recommendations for meats and beans; solid fats, alcohol, and added sugars; and physical activity components were associated positively (P < 0.01) with BMI. Path analyses show that caregiver facilitators were significantly related to children's facilitators to meeting DGA recommendations (standardized β: 0.12; P < 0.001).

CONCLUSION

To our knowledge, our findings are among the first to show associations between weight and barriers and/or facilitators to meeting the DGA in a national, large sample of caregiver-child dyads. This trial was registered at clinicaltrials.gov as NCT02725970.