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Dittmann A, Werner L, Hörz L, Luft T, Finkbeiner F, Storcksdieck genannt Bonsmann S. Sociodemographic and behavioural differences between frequent and non-frequent users of convenience food in Germany. Front Nutr 2024; 11:1369137. [PMID: 38585611 PMCID: PMC10997035 DOI: 10.3389/fnut.2024.1369137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Convenience foods are a double-edged sword in that they provide quick and easy nutrition but may promote non-communicable diseases related to excess intakes of sugar, fat, and salt. To inform the German national reduction and innovation strategy for less sugar, fat, and salt in processed foods, the present study sought to analyse the consumption frequency of selected convenience foods and to determine sociodemographic and behavioural factors that characterise frequent users. Methods In a representative computer-assisted telephone interview survey in the adult German population (N = 3,997) conducted in 2018, consumption frequency of 21 convenience foods was assessed. To characterise frequent in contrast to non-frequent users, data on sociodemographics and behavioural aspects were compared. Statistical analyses comprised chi-square tests with Bonferroni correction as well as Spearman's rank correlation. Cramer's V was used to determine the strength of an association. Results Overall and among frequent users (7.7% of the sample) sweet convenience foods and savoury cooking aids were consumed most frequently. Around 75% of the participants indicated little-to-no consumption of 19 of the 21 convenience foods. Male gender (p < 0.001), younger age (p < 0.001), and not having a high level of education (p = 0.017) were identified as key characteristics of frequent users. Furthermore, frequent users were more likely than non-frequent users to live in a family household (p = 0.003) or without a partner (p < 0.001), and to work in shifts (p = 0.002). Additionally, they showed significantly lower cooking skills (p < 0.001). Conclusion Public health interventions to limit excess intakes of sugar, fat, and salt from convenience food in Germany should target people of male gender, younger age, and having a lower level of education. On the behavioural side, developing the skills to cook from scratch emerged as major point of focus. Simultaneously, reformulation of the food offer should continue in order to help transition to a more health-promoting food environment.
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Skauen JE, Pallesen S, Bjørnebekk A, Chegeni R, Syvertsen A, Petróczi A, Sagoe D. Prevalence and correlates of androgen dependence: a meta-analysis, meta-regression analysis and qualitative synthesis. Curr Opin Endocrinol Diabetes Obes 2023; 30:309-323. [PMID: 37410490 DOI: 10.1097/med.0000000000000822] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
PURPOSE OF REVIEW To investigate the prevalence and correlates of androgen dependence among users. A meta-analysis, meta-regression analysis, and qualitative synthesis were conducted based on a systematic literature search in Google Scholar, ISO Web of Science, PsycNET, and PubMed. RECENT FINDINGS Twenty-six studies were included in the review and 18 studies ( N = 1782) in the statistical analysis. The overall lifetime androgen dependence prevalence was 34.4% [95% confidence interval (CI): 27.8-41.7, Q = 113.1, I2 = 85.0, P < 0.001]. Although males (36.1%, P < 0.001) and females (37.0%, P = 0.188) did not differ ( Q = 0.0, P = 0.930) in dependence prevalence, controlling for other study characteristics, higher study male sample proportion was related to higher dependence prevalence. Combined interview and questionnaire assessments showed higher prevalence compared to interviews only. Publications from 1990-1999 generated higher prevalence compared to 2000-2009 and 2010-2023 publications. Dependents were associated with a wide array of demographic inequalities, and biophysical, cognitive, emotional, and psychosocial problems. SUMMARY One of three persons who initiate androgen use experiences dependence along with various serious disorders. Androgen use and dependence should be considered an important public health issue requiring targeted health interventions.
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Affiliation(s)
- Jenny Eriksrød Skauen
- Department of Psychosocial Science
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group, University of Bergen, Bergen
| | - Ståle Pallesen
- Department of Psychosocial Science
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group, University of Bergen, Bergen
| | - Astrid Bjørnebekk
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital
| | - Razieh Chegeni
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group, University of Bergen, Bergen
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - André Syvertsen
- Department of Psychosocial Science
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group, University of Bergen, Bergen
| | - Andrea Petróczi
- School of Life Sciences, Pharmacy and Chemistry, Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
- Institute of Health Promotion and Sport Sciences, Eötvös Loránd University (ELTE), Budapest, Hungary
| | - Dominic Sagoe
- Department of Psychosocial Science
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group, University of Bergen, Bergen
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Rickwood DJ, Coleman-Rose CL. The effect of survey administration mode on youth mental health measures: Social desirability bias and sensitive questions. Heliyon 2023; 9:e20131. [PMID: 37809858 PMCID: PMC10559918 DOI: 10.1016/j.heliyon.2023.e20131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Aim Research on trends in youth mental health is used to inform government policy and service funding decisions. It often uses interviewer-administered surveys, which may be affected by mode effects related to social desirability bias. This study sought to determine the impact of survey administration mode on mental health measures, comparing mode effects for sensitive mental health measures (psychological distress and wellbeing) and non-sensitive (physical activity) measures. Methods Data were from two large national community samples of young Australians aged 12-25 years conducted in 2020 (N = 6238) and 2022 (N = 4122), which used both interviewer-administered and self-report modes of data collection. Results Results showed participants reported lower psychological distress and higher wellbeing in the interviewer-assisted compared with the self-report mode. No mode effects were found for the non-sensitive physical activity measures. No interaction between mode and gender was found, but an age group by mode interaction revealed that those in the 18-21 and 22-25-year age groups were more strongly affected than younger adolescents. Conclusions These findings suggest underestimates of mental health issues from interview survey formats, particularly for young adults. The results show how even a weak mode effect can have a large impact on mental health prevalence indicators. Researchers and policy makers need to be aware of the impact social desirability bias can have on mental health measures and consider taking steps to mitigate this effect.
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Jaschke P, Kosyakova Y, Kuche C, Walther L, Goßner L, Jacobsen J, Ta TMT, Hahn E, Hans S, Bajbouj M. Mental health and well-being in the first year of the COVID-19 pandemic among different population subgroups: evidence from representative longitudinal data in Germany. BMJ Open 2023; 13:e071331. [PMID: 37295837 PMCID: PMC10276970 DOI: 10.1136/bmjopen-2022-071331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES To examine potential deteriorations in mental health and well-being in the first COVID-19 pandemic year compared with the previous decade focusing on the following vulnerable subgroups in Germany: women with minor children in the household, those living without a partner, younger and older adults, those in a precarious labour market situation, immigrants and refugees, and those with pre-existing physical or mental health risks. DESIGN Analyses of secondary longitudinal survey data using cluster-robust pooled ordinary least squares models. PARTICIPANTS More than 20 000 individuals (aged 16+ years) in Germany. PRIMARY AND SECONDARY OUTCOME MEASURES Mental Component Summary Scale (MCS) of the 12-item Short-Form Health Survey measuring mental health-related quality of life, single item on life satisfaction (LS). RESULTS We find a decline in the average MCS in the 2020 survey that is not particularly striking in the overall time course, still resulting in a mean score below those of all preceding waves since 2010. We find no change in LS from 2019 to 2020 against the background of a general upward trend. Regarding vulnerability factors, only the results on age and parenthood are partially in line with our expectations. In 2020, LS declined among the youngest adults; MCS declined among mothers (and women and men without children) but not fathers. Unlike respective comparison groups, refugees, those unemployed before the pandemic and those with pre-existing mental health risks experienced no MCS declines in 2020, whereas persons living without a partner, the eldest, and those with pre-existing health risks exhibited continued increases in LS. CONCLUSIONS There is no evidence for substantial breakdowns in mental health or subjective well-being in the first pandemic year in the German population or its subgroups, particularly when considering developments of the previous decade. Since the majority of hypothesised vulnerable groups to pandemic stressors showed more stable MCS and LS, our results warrant further study.
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Affiliation(s)
- Philipp Jaschke
- Migration and International Labour Studies, Institute for Employment Research (IAB), Nuremberg, Germany
| | - Yuliya Kosyakova
- Migration and International Labour Studies, Institute for Employment Research (IAB), Nuremberg, Germany
- Professorship of Migration Research, University of Bamberg, Bamberg, Germany
| | - Coline Kuche
- Department of Sociology, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Lena Walther
- Klinik für Psychiatrie und Psychotherapie, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Laura Goßner
- Migration and International Labour Studies, Institute for Employment Research (IAB), Nuremberg, Germany
| | - Jannes Jacobsen
- Deutsches Zentrum für Integrations- und Migrationsforschung (DeZIM), Berlin, Germany
- Berlin Social Science Center (WZB), Berlin, Germany
| | - Thi Minh Tam Ta
- Klinik für Psychiatrie und Psychotherapie, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Eric Hahn
- Klinik für Psychiatrie und Psychotherapie, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Silke Hans
- Department of Sociology, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Malek Bajbouj
- Klinik für Psychiatrie und Psychotherapie, Charite Universitatsmedizin Berlin, Berlin, Germany
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Calloway EE, Carpenter LR, Gargano T, Sharp JL, Yaroch AL. New measures to assess the "Other" three pillars of food security-availability, utilization, and stability. Int J Behav Nutr Phys Act 2023; 20:51. [PMID: 37101157 PMCID: PMC10134599 DOI: 10.1186/s12966-023-01451-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND In recent reviews of available measures, no existing measures assessed all four pillars of food security and most only assessed one or two pillars-predominantly the access pillar. The purpose of this study was to preliminarily develop novel measures of availability, utilization, and stability that are complementary to the USDA's household food security survey measure (HFSSM). METHODS A formative phase included an expert advisory group, literature scans, and interviews with individuals experiencing food insecurity. From April-June 2021, the new measures were piloted in five states (California, Florida, Maryland, North Carolina, and Washington). The cross-sectional pilot survey included the new measures (perceived limited availability, utilization barriers, and food insecurity stability), scales and items for validation (e.g., food security, and self-reported dietary and health outcomes), and demographic questions. Exploratory factor analysis was used to assess dimensionality, internal consistency was assessed using Kuder-Richardson formula 21 (KR21), and convergent and discriminant validity were assessed using Spearman's correlation coefficients. Also, a brief screener version was created for the utilization barriers measure that may be necessary for certain applications (e.g., clinical intake screening to inform referrals to assistance programs). RESULTS The analytic samples (perceived limited availability (n = 334); utilization barriers (n = 428); food insecurity stability (n = 445)) were around 45 years old on average, most households had children, over two-thirds were food insecure, over three-fourths were women, and the samples were racially/ethnically diverse. All items loaded highly and unambiguously to a factor (factor loadings range 0.525-0.903). Food insecurity stability showed a four-factor structure, utilization barriers showed a two-factor structure, and perceived limited availability showed a two-factor structure. KR21 metrics ranged from 0.72 to 0.84. Higher scores for the new measures were generally associated with increased food insecurity (rhos = 0.248-0.497), except for one of the food insecurity stability scores. Also, several of the measures were associated with statistically significantly worse health and dietary outcomes. CONCLUSIONS The findings support the reliability and construct validity of these new measures within a largely low-income and food insecure sample of households in the United States. Following further testing, such as Confirmatory Factor Analysis in future samples, these measures may be used in various applications to promote a more comprehensive understanding of the food insecurity experience. Such work can help inform novel intervention approaches to address food insecurity more fully.
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Affiliation(s)
- Eric E Calloway
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA.
| | - Leah R Carpenter
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA
| | - Tony Gargano
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA
| | | | - Amy L Yaroch
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA
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Assessing targeted invitation and response modes to improve survey participation in a diverse New York City panel: Healthy NYC. PLoS One 2023; 18:e0280911. [PMID: 36701347 PMCID: PMC9879422 DOI: 10.1371/journal.pone.0280911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Healthy NYC is an innovative survey panel created by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) that offers a cost-effective mechanism for collecting priority and timely health information. Between November 2020 and June 2021, invitations for six different surveys were sent to Healthy NYC panelists by postal mail, email, and text messages. Panelists had the option to complete surveys online or via paper survey. METHODS We analyzed whether panelists varied by sociodemographic characteristics based on the contact mode they provided and the type of invitation that led to their response using logistic regression models. Poisson regression models were used to determine whether the number of invitations received before participating in a survey was associated with sociodemographic characteristics. RESULTS Younger age and higher education were positively associated with providing an email or text contact. Furthermore, age, race, and income were significant predictors for invitation modes that led to a survey response. Black panelists had 72% greater odds (OR 1.72 95% CI: 1.11-2.68) of responding to a mail invite and 33% lesser odds (OR 0.67, 95% CI: 0.54-0.83) of responding to an email invite compared with White panelists. Additionally, in five of the six surveys, more than half of the respondents completed surveys after two invites. Email invitations garnered the highest participation rates. CONCLUSIONS We recommend using targeted invitation modes as an additional strategy to improve participation in panels. For lower-income panelists who do not provide an email address, it may be reasonable to offer additional response options that do not require internet access. Our study's findings provide insight into how panels can tailor outreach to panelists, especially among underrepresented groups, in the most economical and efficient ways.
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Magnitude of depression and its associated factors among patients with diabetes mellitus at public hospitals in Southwest Ethiopia, 2021. Sci Rep 2022; 12:22134. [PMID: 36550160 PMCID: PMC9780233 DOI: 10.1038/s41598-022-26330-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Depression is the third-leading cause of disability measured in terms of disability-adjusted life-years. When depression coexists with diabetes mellitus, it is associated with major health consequences and results in poor health outcomes, decreased quality of life, lost productivity and increased risk of death. The current study aimed to assess the magnitude of depression and its associated factors among adult patients with diabetes mellitus attending follow-up at the public hospitals of Buno Bedele zone, Southwest Ethiopia. A multi-centre cross-sectional study was done among people living with diabetes mellitus at an outpatient clinic of Buno Bedele zone hospitals. The study period was from April to May 2021. A systematic random sampling technique was used to select the study participants. Data were collected using a structured questionnaire. Depression was assessed by the Patient Health Questionnaire-9. Patient Health Questionnaire-9 is a validated tool to assess depression with sensitivity 86% and specificity 67%. The collected data were cleaned, edited, and entered into epi-data version 3.1, and analysed using SPSS version 24. Logistic regression analysis was employed to identify factors associated with depression occurrence. A p value of 0.05 was considered statistically significant. A total of 310 study participants were included in this study. Among study participants, 41.6% fulfilled the criteria for depression. Variables significantly associated with depression were female gender [AOR: 2.26, 95% CI (1.30, 3.95)], duration of diabetes greater than 5 years [AOR: 2.68, 95% CI (1.57, 4.56)], poor social support [AOR: 2.46, 95% CI (1.10, 5.49)], moderate social support [AOR: 2.63, 95% CI (1.34, 5.16)], current alcohol consumption [AOR: 3.55, 95% CI (1.20, 10.52)] and previous alcohol consumption [AOR = 2.81, 95% CI (1.40, 5.60)]. According to this study, depression is relatively common among diabetic individuals. Being a female, having diabetes for a long time, having poor social support, using alcohol now and in the past were factors that substantially linked to depression. Healthcare professionals should consider screening for depression using the Patient Health Questionnaire-9 or other validated tools in all diabetic patients, especially in those who are at higher risk.
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Calloway EE, Carpenter LR, Gargano T, Sharp JL, Yaroch AL. Development of three new multidimensional measures to assess household food insecurity resilience in the United States. Front Public Health 2022; 10:1048501. [PMID: 36589949 PMCID: PMC9794863 DOI: 10.3389/fpubh.2022.1048501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction This study aimed to develop and test novel self-administered measures (Absorptive capacity, Adaptive capacity, and Transformative capacity) of three aspects of a household's resilience to financial shocks (e.g., job loss) that can increase food insecurity risk. Methods Measures were piloted in a convenience sample of households at risk for food insecurity in the United States. The survey included the new measures, validation variables (financial shock, household food security, general health, personal resilience to challenges, and financial wellbeing), and demographic questions. Exploratory factor analysis was used to assess dimensionality, internal consistency was assessed [Cronbach's alpha (CA)], and construct validity was assessed (Spearman's correlation). Also, brief screener versions of the full measures were created. Results Participants in the analytic samples (n = 220-394) averaged 44 years old, 67% experienced food insecurity, 47% had a high school diploma or less, 72% were women, and the sample was racially/ethnically diverse. Scores for Absorptive capacity [one factor; CA = 0.70; Mean = 1.32 (SD = 0.54)], Adaptive capacity [three factors; CAs 0.83-0.90; Mean = 2.63 (SD = 0.85)], and Transformative capacity [three factors; CAs 0.87-0.95; Mean = 2.70 (SD = 1.10)] were negatively associated with financial shocks (-0.221 to -0.307) and positively associated with food insecurity (0.310-0.550) general health (0.255-0.320), personal resilience (0.231-0.384), and financial wellbeing (0.401-0.474). Discussion These findings are encouraging and support reliability and validity of these new measures within this sample. Following further testing, such as Confirmatory Factor Analysis in future samples, these measures may prove useful for needs assessments, program evaluation, intake screening, and research/surveillance. Widespread adoption in the future may promote a more comprehensive understanding of the food insecurity experience and facilitate development of tailored interventions on upstream causes of food insecurity.
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Affiliation(s)
- Eric E. Calloway
- The Gretchen Swanson Center for Nutrition, Omaha, NE, United States,*Correspondence: Eric E. Calloway
| | | | - Tony Gargano
- The Gretchen Swanson Center for Nutrition, Omaha, NE, United States
| | - Julia L. Sharp
- Graybill Statistical Laboratory, Colorado State University, Fort Collins, CO, United States
| | - Amy L. Yaroch
- The Gretchen Swanson Center for Nutrition, Omaha, NE, United States
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Simon A, Ebinger M, Holoch E. [Health Literacy Among German Health Professionals-To-Be - Exploratory Pilot Study]. DAS GESUNDHEITSWESEN 2022; 84:1039-1049. [PMID: 34918315 PMCID: PMC11248464 DOI: 10.1055/a-1657-9627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Health literacy is defined as the ability to collect, understand, evaluate and use health information. Previous studies have shown that the German population has only an average level of health literacy. Health professionals such as nurses, doctors or midwives need to be health literate themselves to promote patients' health literacy, as well as to protect and promote their own health. So far, there is a lack of research about health literacy among health professionals in Germany. The objective of this study was to assess the health literacy of health professionals. METHOD The study involved 583 participants from the final year classes of the DHBW Stuttgart and dual cooperation partners (vocational schools and academic teaching hospitals). These included graduates of nursing, midwifery and therapy (physiotherapy/logo-/occupational therapy), as well as management in health care and medical students in their practical year. The questionnaire HLS-EU-Q16 was used to record health literacy. By means of 16 questions, the participants rated on a 4-point scale how easy or difficult it was for them to find, understand, assess and implement health-related information. RESULTS The study showed that only 30.1% of the participants had sufficient health literacy; 48.9% of the participants showed problematic health literacy, 21.0% inadequate health literacy. The analysis of the individual questions showed that, in almost all areas, paticipants reported more problems in finding, understanding, assessing and implementing health-related information than respondents in other European countries. CONCLUSIONS The present study shows that young health professionals have limited health literacy. Further research is needed to obtain a more comprehensive and differentiated picture of health literacy among health professionals. Health literacy skills and competencies should be systematically introduced in health professions-related study curricula, as well as in bedside training.
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Affiliation(s)
- Anke Simon
- Fakultät Wirtschaft, Studienzentrum Gesundheitswissenschaften & Management, Duale Hochschule Baden-Württemberg Stuttgart, Stuttgart, Deutschland
| | - Margrit Ebinger
- Fakultät Wirtschaft, Studienzentrum Gesundheitswissenschaften & Management, Duale Hochschule Baden-Württemberg Stuttgart, Stuttgart, Deutschland
| | - Elisabeth Holoch
- Fakultät Wirtschaft, Studienzentrum Gesundheitswissenschaften & Management, Duale Hochschule Baden-Württemberg Stuttgart, Stuttgart, Deutschland
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Calloway EE, Carpenter LR, Gargano T, Sharp JL, Yaroch AL. Development of new measures to assess household nutrition security, and choice in dietary characteristics. Appetite 2022; 179:106288. [DOI: 10.1016/j.appet.2022.106288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/15/2022] [Accepted: 08/24/2022] [Indexed: 11/02/2022]
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Hermans L, Braekman E, Drieskens S, Demarest S. Organizing the health interview survey at the local level: design of a pilot study. ARCHIVES OF PUBLIC HEALTH = ARCHIVES BELGES DE SANTE PUBLIQUE 2022; 80:155. [PMID: 35689255 PMCID: PMC9185910 DOI: 10.1186/s13690-022-00909-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022]
Abstract
Background The local Health Interview Study (LHIS) was developed to gain health information at the level of the municipality in Flanders, the northern part of Belgium. It enables municipalities to make evidence-based decisions in their public health policy. To test the feasibility of implementing the LHIS, a pilot study was conducted in Melle, a small Flemish municipality with 11.736 inhabitants. Methods The target sample size was 1000 (≥ 15 years). A systematic sampling technique was applied with substitutes for non-respondents who were matched in terms of statistical sector, age and sex. Selected persons were contacted by post to complete the questionnaire and in case of non-response, a reminder was sent. Questionnaires were collected using a concurrent mixed-mode design: a paper and pencil, and web option. All questions were selected from the Belgian Health Interview Survey relating to health status and determinants of health. Results One thousand twenty-two questionnaires were obtained after inviting 3137 individuals (response rate = 32.6%). Older adults were more likely to participate than younger adults, and women more than men. The final sample resembled the initial sample in terms of sex and statistical sector, but not in terms of age. Younger adults were underrepresented whereas older adults were overrepresented. Lastly, older adults were more likely to fill in the questionnaire on paper than younger adults, and women more than men. Conclusion The LHIS can be successfully implemented in Flemish municipalities. The method, however, does not guarantee that the composition of the final sample reflects the initial sample. Therefore, weights should be added in the analyses to correct for potential deviations in sample composition. Furthermore, implementing a sequential mixed-mode design with a web option preceding a paper and pencil option in future studies could reduce costs and improve data quality. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00909-z.
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Affiliation(s)
- Lize Hermans
- Sciensano, Scientific Direction Public Health and Epidemiology, Juliette Wytsmanstraat 14, B-1050, Brussels, Belgium.
| | - Elise Braekman
- Sciensano, Scientific Direction Public Health and Epidemiology, Juliette Wytsmanstraat 14, B-1050, Brussels, Belgium
| | - Sabine Drieskens
- Sciensano, Scientific Direction Public Health and Epidemiology, Juliette Wytsmanstraat 14, B-1050, Brussels, Belgium
| | - Stefaan Demarest
- Sciensano, Scientific Direction Public Health and Epidemiology, Juliette Wytsmanstraat 14, B-1050, Brussels, Belgium
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Mounce LTA, Salema NE, Gangannagaripalli J, Ricci-Cabello I, Avery AJ, Kadam UT, Valderas JM. Development of 2 Short Patient-Report Questionnaires of Patient Safety in Primary Care. J Patient Saf 2022; 18:161-170. [PMID: 35344976 DOI: 10.1097/pts.0000000000000880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) is a valid and reliable instrument (61 items across 5 domains) of patients' perceptions of safety. Stakeholder feedback has supported shorter versions for improving choice and facilitating uptake of routine patient-centered evaluation. We sought to develop 2 shorter versions of PREOS-PC: one including the shortest possible scales that met established measurement performance standards and a screening version including a single item per domain. METHODS A total of 1244 patients from 45 general practices across England completed PREOS-PC questionnaires. All scale items in PREOS-PC underwent Item Response Theory analysis, applying standard criteria for the item reduction. Cognitive debriefing from 10 patient interviews allowed for the assessment of the instruments' readability. The instruments' psychometrics properties were reassessed in a validation sample of 1557 patients in 21 English general practices. RESULTS "PREOS-PC Compact" includes 25 items and 2 open-ended questions across the 5 domains, 44% of the length of the original instrument. "PREOS-PC Screen" consists of 6 items: the best-performing single items for 2 domains, 1 item modified from original items for each of the remaining 3 domains, and 1 open-ended question. The evaluation of the instruments confirmed they were acceptable to patients and met standards for readability; construct, convergent, and divergent validity; and reliability. CONCLUSIONS PREOS-PC Compact meets high-performance standards while reducing patient burden for routine monitoring of patient safety in primary care. PREOS-PC Screen is a concise tool apt for incorporation into audits and to target more in-depth review as needed.
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Affiliation(s)
- Luke T A Mounce
- From the Health Services and Policy Research Group, University of Exeter Medical School, Exeter
| | - Nde-Eshimuni Salema
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | | | - Anthony J Avery
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Umesh T Kadam
- Department of Health Sciences, University of Leicester, England
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Haase S, Zweigenthal V, Müller A. Using online spaces to recruit Kenyan queer womxn and trans men in restrictive offline settings. Arch Public Health 2022; 80:82. [PMID: 35287711 PMCID: PMC8919149 DOI: 10.1186/s13690-022-00824-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding and addressing healthcare and service delivery inequalities is essential to increase equity and overcome health disparities and service access discrimination. While tremendous progress has been made towards the inclusion of sexual and gender minorities in health and other research, gaps still exist. Innovative methods are needed to close these. This case study describes and reflects on using online-based data collection to ascertain sexual health decision-making and health service utilisation among Kenyan queer womxn and trans men. METHODS Case study The study used a mixed-methods approach in two phases with triangulated quantitative and qualitative elements. Both elements used web-based technology to gather data. RESULTS Using online spaces to recruit and collect data from queer womxn and trans men exceeded expectations. A total of 360 queer womxn and trans men responded to the digitally distributed survey, and 33 people, queer womxn and trans men, as well as key informants, participated in the interviews, which were primarily conducted on Zoom and Skype. The case study analyses the risks and benefits of this approach and concludes that online sampling approaches can mitigate risks and enable effective and safe sampling of a marginalised group in a restrictive legal setting: Kenyan queer womxn and trans men. CONCLUSION Using online spaces when researching marginalised populations could effectively overcome risks around stigma, discrimination and violence. It could be an effective way to understand these populations' healthcare needs better. Factors contributing to success included building trusting relationships with key members of the community, strategic and opportune timing, a nuanced understanding of the mobile landscape, and carefully chosen safety and security measures. However, it should be noted that conducting research online could increase the risk of further marginalising and excluding those without access to web-based technology.
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Affiliation(s)
- Stephanie Haase
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Virginia Zweigenthal
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Alex Müller
- Department of Medical Ethics and History of Medicine, Universitätsmedizin Göttingen, Göttingen, Germany
- Gender Health and Justice Research Unit, University of Cape Town, Cape Town, South Africa
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14
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Depression and Anxiety Symptoms in Adolescents and Young Adults in Greece: prevalence and associated factors. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Stahl K, Groene O. ASK ME!-Routine measurement of patient experience with patient safety in ambulatory care: A mixed-mode survey. PLoS One 2021; 16:e0259252. [PMID: 34851966 PMCID: PMC8635405 DOI: 10.1371/journal.pone.0259252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/15/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Routine measurement of patient safety from the patients’ perspective receives increasing attention as an important component of safety measurement systems. The aim of this study was to examine patients’ experience with patient safety in ambulatory care and the results’ implications for routine patient safety measurement in ambulatory care. Design Cross-sectional mixed-mode survey. Setting General practitioner and specialist practices. Participants Patients aged >18 years seeking care in ambulatory care practices between February and June 2020. Methods A 22-item-questionnaire was completed in the practice or at home either on paper or online. Multivariate logistic regression was used to analyse the influence of survey mode and patient characteristics on patient experience with patient safety. Results The overall response rate was 71.1%. Most patients completed the questionnaire on site (76.6%) and on paper (96.1%). Between 30.1% to 68.5% of the respondents report the most positive option for patient experience with the main domains of patient safety. A total of 2.9% of patients reported having experienced a patient-safety event (PSE) during the last 12 months. Patients who filled in the questionnaire off site were more likely to report negative experiences for the scales communication & information (OR 1.2, 95% CI 1.0–1.5), rapport & participation (OR 1.4, 95% CI 1.1–1.7) and access (OR 1.3, 95% CI 0.9–1.4) than those who completed it on site. Those who chose a paper questionnaire were more likely to report negative experiences for all five scales compared to web responders. Conclusion Routine measurement of patient experience with factors contributing to the occurrence of PSEs can achieve high response rates by offering flexible participation options. Results gained from mixed-mode surveys need to take mode-effects into account when interpreting and using the results. Further research is needed in how to adequately assess number and type of experienced events in routine measurements.
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Affiliation(s)
- Katja Stahl
- Department Research & Innovation, OptiMedis AG, Hamburg, Germany
- * E-mail:
| | - Oliver Groene
- Department Research & Innovation, OptiMedis AG, Hamburg, Germany
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Allen J, Born S, Damerow S, Kuhnert R, Lemcke J, Müller A, Weihrauch T, Wetzstein M. German Health Update (GEDA 2019/2020-EHIS) - Background and methodology. JOURNAL OF HEALTH MONITORING 2021; 6:66-79. [PMID: 35146317 PMCID: PMC8734110 DOI: 10.25646/8559] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
Between April 2019 and September 2020, 23,001 people aged 15 or over responded to questions about their health and living conditions for the German Health Update (GEDA 2019/2020-EHIS). The results are representative of the German resident population aged 15 or above. The response rate was 21.6%. The study used a questionnaire based on the third wave of the European Health Interview Survey (EHIS), which was carried out in all EU member states. EHIS consists of four modules on health status, health care provision, health determinants, and socioeconomic variables. The data are collected in a harmonised manner and therefore have a high degree of international comparability. They constitute an important source of information for European health policy and health reporting and are made available by the Statistical Office of the European Union (Eurostat). They also form the basis of the Federal Health Reporting undertaken in Germany. Data collection began in April 2019, just under a year before the beginning of the SARS-CoV-2 pandemic, and continued into its initial phase, as of March 2020. As such, data from the current GEDA wave can also be used to conduct research into the health impact of the SARS-CoV-2 pandemic.
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Affiliation(s)
- Jennifer Allen
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
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Rosendahl Jensen HA, Thygesen LC, Møller SP, Dahl Nielsen MB, Ersbøll AK, Ekholm O. The Danish Health and Wellbeing Survey: Study design, response proportion and respondent characteristics. Scand J Public Health 2021; 50:959-967. [PMID: 34162289 DOI: 10.1177/14034948211022429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS This study aimed to describe the study design and respondent characteristics (including non-response analyses) of the Danish Health and Wellbeing Surveys in 2015 and 2019 and a follow-up survey that was carried out during the COVID-19 pandemic in 2020. METHODS The Danish Health and Wellbeing Survey is the Danish part of the European Health Interview Survey (EHIS). The samples in 2015 (N=12,000) and 2019 (N=14,000) were both based on a simple random selection of individuals aged ⩾15 years from the Danish Civil Registration System. All individuals from the sample in 2019 who were still alive and living in Denmark were reinvited for a follow-up survey in 2020 (N=13,474). Data in all surveys were collected via self-administered questionnaires (web or paper based). The questionnaires in 2015 and 2019 included the EHIS model questionnaire as well as national questions, whereas the questionnaire in 2020 mainly focused on physical and mental health, employment and working lives, and health behaviour. RESULTS The overall response proportion declined slightly between 2015 (48.4%) and 2019 (47.4%) but went up to 49.8% in the follow-up survey in 2020. Unit non-response was associated with, for example, male sex, younger age, being unmarried and lower educational level but not with degree of urbanisation. In all, 5000 individuals completed the questionnaire in both 2019 and 2020. CONCLUSIONS The results are in line with most previous research on non-response in health surveys. However, an association between degree of urbanisation and non-response has been suggested in previous studies. This association was not found in our study.
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Affiliation(s)
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Sanne Pagh Møller
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
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18
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A multi-state evaluation of the association between mental health and firearm storage practices. Prev Med 2021; 145:106389. [PMID: 33385422 PMCID: PMC7956108 DOI: 10.1016/j.ypmed.2020.106389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/19/2020] [Accepted: 12/24/2020] [Indexed: 01/28/2023]
Abstract
Firearm storage method is a potentially modifiable risk factor for suicide. Using data from a large, multi-state survey, we sought to determine whether there is an association between mental health and household firearm storage practices, and characterize that association by state of residence. Participants who endorsed the presence of a household firearm and answered the mental health questions in the 2016-2017 Behavioral Risk Factor Surveillance System from eight states were included (n=26,949). Exposures were recent poor mental health (≥14 vs. 0-13 days/past month), and diagnosis of depression. Outcomes were household firearm storage practices (loaded, and both loaded and unlocked). Using Poisson regression, we calculated adjusted prevalence ratios (aPR) overall and stratified by state of residence. Of adults endorsing a household firearm, 35.1% reported storing a firearm loaded, and of those, 53.4% reported that the firearm was both loaded and unlocked. Neither recent poor mental health nor depression was associated with loaded (aPR 1.14 [95% CI: 0.95-1.37] and aPR 0.94 [95% CI 0.80-1.09], respectively) or loaded and unlocked (aPR 1.08 [95% CI 0.88-1.42] and aPR 1.04 [95% CI 0.88-1.22], respectively) firearm storage. In the setting of highly prevalent loaded firearm storage, no differences in storage practices by mental health indicators were observed across eight states despite disparate firearm policies and local culture. The lack of difference in storage practices by mental health indicators across several states highlights an opportunity to improve means safety counseling practices, and the need for dedicated evaluation of state-level firearm storage policies.
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Christensen AI, Lau CJ, Kristensen PL, Johnsen SB, Wingstrand A, Friis K, Davidsen M, Andreasen AH. The Danish National Health Survey: Study design, response rate and respondent characteristics in 2010, 2013 and 2017. Scand J Public Health 2020; 50:180-188. [PMID: 33161874 DOI: 10.1177/1403494820966534] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aim: This article aims to describe the study design, including descriptive statistics on changes in response rates, characteristics associated with response and response mode distribution, in the Danish National Health Survey (DNHS) in 2010, 2013 and 2017. Methods: Each survey was based on five regional stratified random samples and one national random sample drawn from the Danish Civil Registration System. The subsamples were mutually exclusive. Around 300,000 individuals (aged ⩾16 years) were invited to participate in each survey using a mixed-mode approach (paper/web). A questionnaire with a minimum of 52 questions was used in all subsamples. In 2010 and 2013, invitations were sent via the regular postal service, whereas a secure electronical mail service was used to invite the majority (around 90%) in 2017. Weights accounted for survey design and non-response. Results: Participation decreased from 59.5% in 2010 to 54.0% in 2013 after which it increased to 58.7% in 2017. The proportion answering the web questionnaire increased from 31.0% to 77.4% between 2013 and 2017 and varied from 73.8% to 79.7% between the subsamples in 2017. Overall, the response rate was low among young men and old women and among individuals who were unmarried, had low sociodemographic status, were from ethnic minority backgrounds or were living in the eastern part of Denmark. Conclusions: The survey mode, response mode distribution as well as response rate have changed over time. Weights to handle non-response can be applied to accommodate possible problems in generalising the results. However, efforts should continuously be made to ensure that response is missing at random.
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Affiliation(s)
| | - Cathrine Juel Lau
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Denmark
| | | | | | | | | | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Anne Helms Andreasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Denmark
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20
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Braekman E, Charafeddine R, Demarest S, Drieskens S, Berete F, Gisle L, Van der Heyden J, Van Hal G. Comparing web-based versus face-to-face and paper-and-pencil questionnaire data collected through two Belgian health surveys. Int J Public Health 2020; 65:5-16. [PMID: 31993674 DOI: 10.1007/s00038-019-01327-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/10/2019] [Accepted: 12/30/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Using the European Health Interview Survey (EHIS) questionnaire, a web-based survey was organized alongside a face-to-face (F2F) survey including a paper-and-pencil (P&P) questionnaire for sensitive topics. Associated with these different modes, other design features varied too (e.g., recruitment, incentives, sampling). We assessed whether these whole data collection systems developed around the modes produced equivalent health estimates. METHODS Data were obtained from two population-based surveys: the EHISWEB (web-administered, n = 1010) and the Belgian Health Interview Survey 2018 (BHIS2018) (interviewer-administered, n = 2748). Logistic regression analyses were used to assess mode system differences while adjusting for socio-demographic differences in the net samples. RESULTS For the P&P mode of the BHIS, significant mode system differences were detected for 2 of the 9 health indicators. Among the indicators collected via the F2F mode, 9 of the 18 indicators showed significant differences. CONCLUSIONS Indicators collected via the web-based and P&P self-administered modes were generally more comparable than indicators collected via the web-based and F2F mode. Furthermore, fewer differences were detected for indicators based on simple and factual questions compared to indicators based on subjective or complex questions.
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Affiliation(s)
- Elise Braekman
- Department Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium.
- Unit of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium.
| | - Rana Charafeddine
- Department Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Stefaan Demarest
- Department Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Sabine Drieskens
- Department Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Finaba Berete
- Department Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Lydia Gisle
- Department Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Johan Van der Heyden
- Department Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Guido Van Hal
- Unit of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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Finger JD, Hoebel J, Kuntz B, Kuhnert R, Zeiher J, Mensink GBM, Lampert T. Educational differences in the prevalence of behavioural risk factors in Germany and the EU - Results from the European Health Interview Survey (EHIS) 2. JOURNAL OF HEALTH MONITORING 2019; 4:29-47. [PMID: 35146256 PMCID: PMC8790794 DOI: 10.25646/6225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Jonas D. Finger
- Formerly Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Jens Hoebel
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Benjamin Kuntz
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Ronny Kuhnert
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Johannes Zeiher
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Gert B. M. Mensink
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Thomas Lampert
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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Zeiher J, Finger JD, Kuntz B, Hoebel J, Lampert T, Starker A. [Trends in smoking among adults in Germany : Evidence from seven population-based health surveys from 1991-2015]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:1365-1376. [PMID: 30215104 DOI: 10.1007/s00103-018-2817-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite decreasing smoking prevalence, tobacco use remains a key public health problem in Germany. For planning, managing, and evaluating tobacco control measures, regular data collection on smoking behavior in the population is essential. The aim of this article is to present trends in adult tobacco use since the early 1990s based on data from the health monitoring of the Robert Koch-Institute (RKI). METHODS Analyses are based on data from 106,158 individuals aged 18 to 79 years, who participated in seven RKI health surveys from 1991-2015. Trends in tobacco consumption were analyzed using different indicators of smoking behavior, stratified by age, cohort, and gender. RESULTS An overall falling smoking prevalence can be attributed primarily to a significant decline in the younger age groups since the early 2000s. Trend analysis by cohort reveals a declining prevalence for almost all cohorts over time from 1991-2015. Historically there has been is a sharp increase in the prevalence of women who have ever smoked between the 1930-1934 and 1950-1959 cohorts. The proportion of men who have ever smoked slightly decreased between the 1930-1934 and 1980-1984 cohorts. DISCUSSION The shown overall decline happened concurrently with various tobacco prevention measures implemented during this period in Germany. If present trends related to continuous high smoking rates are sustained, it can be assumed that the tobacco consumption of the population will remain the source of adverse health outcomes. Accordingly, tobacco prevention measures and the promotion of smoking cessation in all age groups should be a public health priority.
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Affiliation(s)
- Johannes Zeiher
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Jonas David Finger
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Benjamin Kuntz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Jens Hoebel
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Thomas Lampert
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Anne Starker
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
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Christensen AI, Lynn P, Tolstrup JS. Can targeted cover letters improve participation in health surveys? Results from a randomized controlled trial. BMC Med Res Methodol 2019; 19:151. [PMID: 31315577 PMCID: PMC6635988 DOI: 10.1186/s12874-019-0799-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Improving response rates in epidemiologic studies is important for the generalizability of the outcome. The aim of this study was to examine whether it can be advantageous for participation to target different versions of the cover letters to different sample subgroups. Methods A randomized trial was incorporated in a cross-sectional health survey in Denmark (n = 25,000) where a motivational sentence in the cover letter intended to heighten perceptions of relevance of the survey was varied among 11 sample subgroups (treatment groups). Ten different versions of a sentence outlining questionnaire themes were tested: each mentioned three out of five themes: stress, alcohol, sex, sleep problems, and contact with family and friends. An eleventh group, the control group, omitted this sentence. Results On average, the additional motivational sentence resulted in a significantly lower response rate overall compared to the control group. However, the additional motivational sentence was found to have heterogeneous effects on survey response. Furthermore, the nature of the heterogeneity differed between the versions of the sentence. Specifically, the additional sentence tended to produce a higher response rate among the youngest age group and a lower response rate in the oldest age group compared to the generic letter. The use of alcohol in the motivational sentence tended to have a positive effect on response in the age group 16–24 years, and stress tended to have a positive effect in the age group ≥65 years. On the contrary, sex tended to have a negative effect in the age groups 45–64 years and ≥ 65 years. However, a significant interaction was only found between the use of stress and age group (p = < 0.0001). Conclusion The findings of significant and heterogeneous effects suggest that there is potential for a targeted approach to improve both response rates and sample composition. The uneven effect of the separate themes across age groups suggests that the selection of themes to be included in the motivational sentence is important for the use of targeted appeals to be successful and warrants further research to better identify which themes works in which contexts, in which subgroups and under which circumstances. Trial registration ClinicalTrials.gov ID: NCT03046368, retrospectively registered February 8th, 2017. Electronic supplementary material The online version of this article (10.1186/s12874-019-0799-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Illemann Christensen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.
| | - Peter Lynn
- Institute for Social and Economic Research, University of Essex, Colchester, CO4 3SQ, UK
| | - Janne Schurmann Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
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Waldhauer J, Kuntz B, Mauz E, Lampert T. Intergenerational Educational Pathways and Self-Rated Health in Adolescence and Young Adulthood: Results of the German KiGGS Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E684. [PMID: 30813568 PMCID: PMC6427741 DOI: 10.3390/ijerph16050684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/19/2022]
Abstract
Health differences in social mobility are often analysed by income differences or different occupational positions. However, in early adulthood many young people still have very diffuse income situations and are not always fully integrated into the labour market despite many having finished school. This article focusses on the link between intergenerational educational pathways and self-rated health (SRH) among young adults considering their SRH in adolescence. The data source used is the German KiGGS cohort study. The analysis sample comprises 2175 young people at baseline (t0: 2003⁻2006 age 14⁻17) and first follow-up (t1: 2009⁻2012 age 19⁻24). Combining parent's and young people's highest school degree, the data can trace patterns of intergenerational educational pathways (constant high level of education, upward mobility, downward mobility, constant low level of education). Young people's SRH was recorded at t0 and t1. During adolescence and young adulthood, participants were less likely to report poor SRH if they had a constant high intergenerational education or if they were upwardly mobile. The differences were particularly striking among young adults: average marginal effects (AME) for poor SRH showed much higher risk among downwardly mobile compared to peers with an intergenerational constant high education (AME: 0.175 [0.099; 0.251]), while the upwardly mobile had a significantly lower risk for less than good SRH than peers with an intergenerational constant low level of education (AME: -0.058 [-0.113; -0.004]). In the context of great societal demands and personal developmental needs, educational differences in health tend to increase in young adulthood. Public Health should pay more attention to educational and health inequalities in young adulthood.
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Affiliation(s)
- Julia Waldhauer
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany.
| | - Benjamin Kuntz
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany.
| | - Elvira Mauz
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany.
| | - Thomas Lampert
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany.
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25
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Lampert T, Schmidtke C, Borgmann LS, Poethko-Müller C, Kuntz B. The subjective health of adults in Germany. JOURNAL OF HEALTH MONITORING 2018; 3:61-68. [PMID: 35586373 PMCID: PMC8848780 DOI: 10.17886/rki-gbe-2018-073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The term 'subjective health' reflects not only existing illnesses and health complaints, but particularly emphasizes the personal well-being. Studies often collect data on subjective health by asking participants to provide self-assessments of their general state of health. This was also the case with GEDA 2014/2015-EHIS, which employed the internationally renowned Minimum European Health Module (MEHM) as part of the study. Its results demonstrate that 68.2% of adults in Germany rate their general health as very good or good, with the remaining 31.8% rating it as fair, poor or very poor. The proportion of women who rate their general health as very good or good is slightly lower than the proportion of men who do so (66.6% compared to 69.9%). With increasing age, women and men view the condition of their general health as worsening. The study also identified educational differences which showed that men and women with low levels of education tend to rate their health worse compared to self-assessments provided by women and men with higher levels of education, and in some cases also regional differences.
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Affiliation(s)
- Thomas Lampert
- Robert Koch Institute, Department of Epidemiology and Health Monitoring
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Braekman E, Berete F, Charafeddine R, Demarest S, Drieskens S, Gisle L, Molenberghs G, Tafforeau J, Van der Heyden J, Van Hal G. Measurement agreement of the self-administered questionnaire of the Belgian Health Interview Survey: Paper-and-pencil versus web-based mode. PLoS One 2018; 13:e0197434. [PMID: 29782504 PMCID: PMC5962098 DOI: 10.1371/journal.pone.0197434] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/02/2018] [Indexed: 11/18/2022] Open
Abstract
Before organizing mixed-mode data collection for the self-administered questionnaire of the Belgian Health Interview Survey, measurement effects between the paper-and-pencil and the web-based questionnaire were evaluated. A two-period cross-over study was organized with a sample of 149 employees of two Belgian research institutes (age range 22–62 years, 72% female). Measurement agreement was assessed for a diverse range of health indicators related to general health, mental and psychosocial health, health behaviors and prevention with kappa coefficients and intraclass correlation (ICC). The quality of the data collected by both modes was evaluated by quantifying the missing, ‘don’t know’ and inconsistent values and data entry mistakes. Good to very good agreement was found for all categorical indicators with kappa coefficients superior to 0.60, except for two mental and psychosocial health indicators namely the presence of a sleeping disorder and of a depressive disorder (kappa≥0.50). For the continuous indicators high to acceptable agreement was observed with ICC superior to 0.70. Inconsistent answers and data-entry mistakes were only occurring in the paper-and-pencil mode. There were no less missing values in the web-based mode compared to the paper-and-pencil mode. The study supports the idea that web-based modes provide, in general, equal responses to paper-and-pencil modes. However, health indicators based upon factual and objective items tend to have higher measurement agreement than indicators requiring an assessment of personal subjective feelings. A web-based mode greatly facilitates the data-entry process and guides the completing of a questionnaire. However, item non-response was not positively affected.
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Affiliation(s)
- Elise Braekman
- Department Epidemiology and public health, Sciensano, Brussels, Belgium
- Unit of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Finaba Berete
- Department Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Rana Charafeddine
- Department Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Stefaan Demarest
- Department Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Sabine Drieskens
- Department Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Lydia Gisle
- Department Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, University of Leuven, Leuven, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, University of Hasselt, Diepenbeek, Belgium
| | - Jean Tafforeau
- Department Epidemiology and public health, Sciensano, Brussels, Belgium
| | | | - Guido Van Hal
- Unit of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
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Mauz E, Hoffmann R, Houben R, Krause L, Kamtsiuris P, Gößwald A. Mode Equivalence of Health Indicators Between Data Collection Modes and Mixed-Mode Survey Designs in Population-Based Health Interview Surveys for Children and Adolescents: Methodological Study. J Med Internet Res 2018; 20:e64. [PMID: 29506967 PMCID: PMC5859740 DOI: 10.2196/jmir.7802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/14/2017] [Accepted: 11/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The implementation of an Internet option in an existing public health interview survey using a mixed-mode design is attractive because of lower costs and faster data availability. Additionally, mixed-mode surveys can increase response rates and improve sample composition. However, mixed-mode designs can increase the risk of measurement error (mode effects). OBJECTIVE This study aimed to determine whether the prevalence rates or mean values of self- and parent-reported health indicators for children and adolescents aged 0-17 years differ between self-administered paper-based questionnaires (SAQ-paper) and self-administered Web-based questionnaires (SAQ-Web), as well as between a single-mode control group and different mixed-mode groups. METHODS Data were collected for a methodological pilot of the third wave of the "German Health Interview and Examination Survey for Children and Adolescents". Questionnaires were completed by parents or adolescents. A population-based sample of 11,140 children and adolescents aged 0-17 years was randomly allocated to 4 survey designs-a single-mode control group with paper-and-pencil questionnaires only (n=970 parents, n=343 adolescents)-and 3 mixed-mode designs, all of which offered Web-based questionnaire options. In the concurrent mixed-mode design, both questionnaires were offered at the same time (n=946 parents, n=290 adolescents); in the sequential mixed-mode design, the SAQ-Web was sent first, followed by the paper questionnaire along with a reminder (n=854 parents, n=269 adolescents); and in the preselect mixed-mode design, both options were offered and the respondents were asked to request the desired type of questionnaire (n=698 parents, n=292 adolescents). In total, 3468 questionnaires of parents of children aged 0-17 years (SAQ-Web: n=708; SAQ-paper: n=2760) and 1194 questionnaires of adolescents aged 11-17 years (SAQ-Web: n=299; SAQ-paper: n=895) were analyzed. Sociodemographic characteristics and a broad range of health indicators for children and adolescents were compared by survey design and data collection mode by calculating predictive margins from regression models. RESULTS There were no statistically significant differences in sociodemographic characteristics or health indicators between the single-mode control group and any of the mixed-mode survey designs. Differences in sociodemographic characteristics between SAQ-Web and SAQ-paper were found. Web respondents were more likely to be male, have higher levels of education, and higher household income compared with paper respondents. After adjusting for sociodemographic characteristics, only one of the 38 analyzed health indicators showed different prevalence rates between the data collection modes, with a higher prevalence rate for lifetime alcohol consumption among the online-responding adolescents (P<.001). CONCLUSIONS These results suggest that mode bias is limited in health interview surveys for children and adolescents using a mixed-mode design with Web-based and paper questionnaires.
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Affiliation(s)
- Elvira Mauz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Robert Hoffmann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Robin Houben
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Laura Krause
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Panagiotis Kamtsiuris
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Antje Gößwald
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Kjerulff KH, Brubaker LH. New mothers' feelings of disappointment and failure after cesarean delivery. Birth 2018; 45:19-27. [PMID: 29052265 PMCID: PMC6366841 DOI: 10.1111/birt.12315] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childbirth is an important life event and how women feel in retrospect about their first childbirth may have long-term effects on the mother, child, and family. In this study, we investigated the association between mode of delivery at first childbirth and birth experience, using a new scale developed specifically to measure women's affective response. METHODS This was a prospective cohort study of 3006 women who were interviewed during pregnancy and 1-month postpartum. The First Baby Study Birth Experience Scale was used to measure the association between mode of delivery and women's postpartum feelings about their childbirth, taking into account relevant confounders, including maternal age, race, education, pregnancy intendedness, depression, social support, and maternal and newborn complications by way of linear and logistic regression models. RESULTS Women who had unplanned cesarean delivery had the least positive feelings overall about their first childbirth, in comparison to those whose deliveries were spontaneous vaginal (P < .001), instrumental vaginal (P = .001), and planned cesarean (P < .001). In addition, those who delivered by unplanned cesarean were more likely to feel disappointed (adjusted odds ratio [OR] 6.21 [95% confidence interval (CI) 4.62-8.35]) and like a failure (adjusted OR 5.09 [95% CI 3.65-7.09]) in comparison to women who had spontaneous vaginal delivery; and less likely to feel extremely or quite a bit proud of themselves (adjusted OR 2.70 [95% CI 2.20-3.30]). CONCLUSIONS Delivering by unplanned cesarean delivery adversely affects how women feel about their first childbirth in retrospect, and their self-esteem.
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Affiliation(s)
- Kristen H Kjerulff
- Departments of Public Health Sciences and Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA, USA
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Mauz E, von der Lippe E, Allen J, Schilling R, Müters S, Hoebel J, Schmich P, Wetzstein M, Kamtsiuris P, Lange C. Mixing modes in a population-based interview survey: comparison of a sequential and a concurrent mixed-mode design for public health research. ACTA ACUST UNITED AC 2018; 76:8. [PMID: 29423220 PMCID: PMC5791202 DOI: 10.1186/s13690-017-0237-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 10/20/2017] [Indexed: 11/10/2022]
Abstract
Background Population-based surveys currently face the problem of decreasing response rates. Mixed-mode designs are now being implemented more often to account for this, to improve sample composition and to reduce overall costs. This study examines whether a concurrent or sequential mixed-mode design achieves better results on a number of indicators of survey quality. Methods Data were obtained from a population-based health interview survey of adults in Germany that was conducted as a methodological pilot study as part of the German Health Update (GEDA). Participants were randomly allocated to one of two surveys; each of the surveys had a different design. In the concurrent mixed-mode design (n = 617) two types of self-administered questionnaires (SAQ-Web and SAQ-Paper) and computer-assisted telephone interviewing were offered simultaneously to the respondents along with the invitation to participate. In the sequential mixed-mode design (n = 561), SAQ-Web was initially provided, followed by SAQ-Paper, with an option for a telephone interview being sent out together with the reminders at a later date. Finally, this study compared the response rates, sample composition, health indicators, item non-response, the scope of fieldwork and the costs of both designs. Results No systematic differences were identified between the two mixed-mode designs in terms of response rates, the socio-demographic characteristics of the achieved samples, or the prevalence rates of the health indicators under study. The sequential design gained a higher rate of online respondents. Very few telephone interviews were conducted for either design. With regard to data quality, the sequential design (which had more online respondents) showed less item non-response. There were minor differences between the designs in terms of their costs. Postage and printing costs were lower in the concurrent design, but labour costs were lower in the sequential design. No differences in health indicators were found between the two designs. Modelling these results for higher response rates and larger net sample sizes indicated that the sequential design was more cost and time-effective. Conclusions This study contributes to the research available on implementing mixed-mode designs as part of public health surveys. Our findings show that SAQ-Paper and SAQ-Web questionnaires can be combined effectively. Sequential mixed-mode designs with higher rates of online respondents may be of greater benefit to studies with larger net sample sizes than concurrent mixed-mode designs.
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Affiliation(s)
- Elvira Mauz
- 1Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.,3FG 23 Monitoring Studies and Survey Methods, Robert Koch Institute, P.O. Box 650261, G-13302 Berlin, Germany
| | - Elena von der Lippe
- 1Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jennifer Allen
- 1Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Stephan Müters
- 1Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jens Hoebel
- 1Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Patrick Schmich
- 1Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Matthias Wetzstein
- 1Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Panagiotis Kamtsiuris
- 1Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Cornelia Lange
- 1Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Hoebel J, Rommel A, Schröder SL, Fuchs J, Nowossadeck E, Lampert T. Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1127. [PMID: 28954436 PMCID: PMC5664628 DOI: 10.3390/ijerph14101127] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 11/24/2022]
Abstract
Research into health inequalities in the elderly population of Germany is relatively scarce. This study examines socioeconomic inequalities in health and perceived unmet needs for healthcare and explores the dynamics of health inequalities with age among elderly people in Germany. Data were derived from the Robert Koch Institute's cross-sectional German Health Update study. The sample was restricted to participants aged 50-85 years (n = 11,811). Socioeconomic status (SES) was measured based on education, (former) occupation, and income. Odds ratios and prevalence differences were estimated using logistic regression and linear probability models, respectively. Our results show that self-reported health problems were more prevalent among men and women with lower SES. The extent of SES-related health inequalities decreased at older ages, predominantly among men. Although the prevalence of perceived unmet needs for healthcare was low overall, low SES was associated with higher perceptions of unmet needs in both sexes and for several kinds of health services. In conclusion, socioeconomic inequalities in health exist in a late working age and early retirement but may narrow at older ages, particularly among men. Socially disadvantaged elderly people perceive greater barriers to accessing healthcare services than those who are better off.
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Affiliation(s)
- Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
| | - Alexander Rommel
- Division of Health Reporting, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
| | - Sara Lena Schröder
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle, Germany.
| | - Judith Fuchs
- Division of Physical Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
| | - Enno Nowossadeck
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
| | - Thomas Lampert
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
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Lange C, Finger JD, Allen J, Born S, Hoebel J, Kuhnert R, Müters S, Thelen J, Schmich P, Varga M, von der Lippe E, Wetzstein M, Ziese T. Implementation of the European health interview survey (EHIS) into the German health update (GEDA). ACTA ACUST UNITED AC 2017; 75:40. [PMID: 28936356 PMCID: PMC5603169 DOI: 10.1186/s13690-017-0208-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/15/2017] [Indexed: 11/10/2022]
Abstract
Background This methodological paper describes the integration of the ‘European Health Interview Survey wave 2’ (EHIS 2) into the ‘German Health Update’ 2014/2015 (GEDA 2014/2015-EHIS). Methods GEDA 2014/2015-EHIS is a cross-sectional health survey. A two-stage stratified cluster sampling approach was used to recruit persons aged 15 years and older with permanent residence in Germany. Two different modes of data collection were used, self-administered web questionnaire and self-administered paper questionnaire. The survey instrument implemented the EHIS 2 modules on health status, health care use, health determinants and social background variables and additional national questions. Data processing was conducted according to the quality and validation rules specified by Eurostat. Results In total, 24,824 questionnaires were completed. The response rate was 27.6%. The two-stage cluster sample method seems to have been successful in achieving a sample with high representativeness. The final micro data file was inspected, approved and certified by Eurostat. Access to micro data of the EHIS 2 can be provided by Eurostat via research contract and to the GEDA 2014/2015-EHIS public use file by the Research Data Centre of the Robert Koch Institute. First EHIS 2 results are available at the Eurostat website. Conclusions Integrating a multinational health survey into an existing national health monitoring system was a challenge in Germany. The national survey methodology for conducting the survey had to be further developed in order to meet the overarching goal of harmonizing the health information from national statistical offices and public health research institutes across the European Union. The harmonized EHIS 2 data source will profoundly impact international public health research in the near future. The next EHIS wave 3 will be conducted around 2019.
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Affiliation(s)
- C Lange
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - J D Finger
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - J Allen
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - S Born
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - J Hoebel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - R Kuhnert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - S Müters
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - J Thelen
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - P Schmich
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - M Varga
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - E von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - M Wetzstein
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - T Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, D-12101 Berlin, Germany
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Hagan TL, Belcher SM, Donovan HS. Mind the Mode: Differences in Paper vs. Web-Based Survey Modes Among Women With Cancer. J Pain Symptom Manage 2017; 54:368-375. [PMID: 28711752 PMCID: PMC5610085 DOI: 10.1016/j.jpainsymman.2017.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/06/2017] [Accepted: 07/07/2017] [Indexed: 11/18/2022]
Abstract
CONTEXT Researchers administering surveys seek to balance data quality, sources of error, and practical concerns when selecting an administration mode. Rarely are decisions about survey administration based on the background of study participants, although socio-demographic characteristics like age, education, and race may contribute to participants' (non)responses. OBJECTIVES In this study, we describe differences in paper- and web-based surveys administered in a national cancer survivor study of women with a history of cancer to compare the ability of each survey administrative mode to provide quality, generalizable data. METHODS We compared paper- and web-based survey data by socio-demographic characteristics of respondents, missing data rates, scores on primary outcome measure, and administrative costs and time using descriptive statistics, tests of mean group differences, and linear regression. RESULTS Our findings indicate that more potentially vulnerable patients preferred paper questionnaires and that data quality, responses, and costs significantly varied by mode and participants' demographic information. We provide targeted suggestions for researchers conducting survey research to reduce survey error and increase generalizability of study results to the patient population of interest. CONCLUSION Researchers must carefully weigh the pros and cons of survey administration modes to ensure a representative sample and high-quality data.
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Affiliation(s)
- Teresa L Hagan
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| | - Sarah M Belcher
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Heidi S Donovan
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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Abstract
BACKGROUND The London Health Sciences Centre Home Safety Program (HSP) provides safety devices, education, a safety video, and home safety checklist to all first-time parents for the reduction of childhood home injuries. The objective of this study was to evaluate the HSP for the prevention of home injuries in children up to 2 years of age. METHODS A program evaluation was performed with follow-up survey, along with an interrupted time series analysis of emergency department (ED) visits for home injuries 5 years before (2007-2013) and 2 years after (2013-2015) implementation. Spatial analysis of ED visits was undertaken to assess differences in home injury rates by dissemination areas controlling differences in socioeconomic status (i.e., income, education, and lone-parent status) at the neighborhood level. RESULTS A total of 3,458 first-time parents participated in the HSP (a 74% compliance rate). Of these, 20% (n = 696) of parents responded to our questionnaire, with 94% reporting the program to be useful (median, 6; interquartile range, 2 on a 7-point Likert scale) and 81% learning new strategies for preventing home injuries. The median age of the respondent's babies were 12 months (interquartile range, 1). The home safety check list was used by 87% of respondents to identify hazards in their home, with 95% taking action to minimize the risk. The time series analysis demonstrated a significant decline in ED visits for home injuries in toddlers younger than2 years of age after HSP implementation. The declines in ED visits for home injuries remained significant over and above each socioeconomic status covariate. CONCLUSION Removing hazards, supervision, and installing safety devices are key facilitators in the reduction of home injuries. Parents found the HSP useful to identify hazards, learn new strategies, build confidence, and provide safety products. Initial finding suggests that the program is effective in reducing home injuries in children up to 2 years of age. LEVEL OF EVIDENCE Therapeutic/care management study, level V.
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Hoebel J, Finger JD, Kuntz B, Kroll LE, Manz K, Lange C, Lampert T. Changing educational inequalities in sporting inactivity among adults in Germany: a trend study from 2003 to 2012. BMC Public Health 2017; 17:547. [PMID: 28587641 PMCID: PMC5461755 DOI: 10.1186/s12889-017-4478-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social inequalities in health can be explained in part by the social patterning of leisure-time physical activity, such as non-participation in sports. This study is the first to explore whether absolute and relative educational inequalities in sporting inactivity among adults have changed in Germany since the early 2000s. METHODS Data from four cross-sectional national health surveys conducted in 2003 (n = 6890), 2009 (n = 16,418), 2010 (n = 17,145) and 2012 (n = 13,744) were analysed. The study population was aged 25-69 years in each survey. Sporting inactivity was defined as no sports participation during the preceding 3 months. The regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in sporting inactivity, respectively. RESULTS Sporting inactivity was consistently more prevalent in less-educated groups. The overall prevalence of sporting inactivity declined significantly over time. However, the decline was observed only in the high and medium education groups, while no change was observed in the low education group. Both absolute and relative educational inequalities in sporting inactivity were found to have widened significantly between 2003 (SII = 0.30, 95% CI = 0.25-0.35; RII = 2.08, 95% CI = 1.83-2.38) and 2012 (SII = 0.41, 95% CI = 0.37-0.45; RII = 3.44, 95% CI = 3.03-3.91). Interaction analysis showed that these increases in inequalities were larger in the younger population under the age of 50 than among the elderly. CONCLUSIONS The findings suggest that the gap in sports participation between adults with high and low educational attainment has widened in both absolute and relative terms because of an increase in sports participation among the better educated. Health-enhancing physical activity interventions specifically targeted to less-educated younger adults are needed to prevent future increases in social inequalities in health.
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Affiliation(s)
- Jens Hoebel
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany.
| | - Jonas D Finger
- Unit of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Benjamin Kuntz
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Lars E Kroll
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Kristin Manz
- Unit of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Cornelia Lange
- Unit of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Thomas Lampert
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
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Algren MH, Ekholm O, van Lenthe F, Mackenbach J, Bak CK, Andersen PT. Health-risk behaviour among residents in deprived neighbourhoods compared with those of the general population in Denmark: A cross-sectional study. Health Place 2017; 45:189-198. [PMID: 28412595 DOI: 10.1016/j.healthplace.2017.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
This study compares health-risk behaviours (including the co-occurrence of health-risk behaviours) of residents in the deprived neighbourhoods with those of the general population of Denmark. It also examines associations between sociodemographic and socioeconomic characteristics and health-risk behaviours in deprived neighbourhoods in Denmark. Even after adjustment for socioeconomic characteristics there were large differences in health-risk behaviours between residents in deprived neighbourhoods and the general population. In the deprived neighbourhoods large sociodemographic and socioeconomic differences in health-risk behaviours were found among the residents. Our findings highlight the need for health promotion programmes targeting residents in deprived neighbourhoods.
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Affiliation(s)
- Maria Holst Algren
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark.
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, 1353 Copenhagen, Denmark
| | - Frank van Lenthe
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Johan Mackenbach
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Carsten Kronborg Bak
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
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Hoebel J, Maske UE, Zeeb H, Lampert T. Social Inequalities and Depressive Symptoms in Adults: The Role of Objective and Subjective Socioeconomic Status. PLoS One 2017; 12:e0169764. [PMID: 28107456 PMCID: PMC5249164 DOI: 10.1371/journal.pone.0169764] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 12/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is substantial evidence that lower objective socioeconomic status (SES)-as measured by education, occupation, and income-is associated with a higher risk of depression. Less is known, however, about associations between perceptions of social status and the prevalence of depression. This study investigated associations of both objective SES and subjective social status (SSS) with depressive symptoms among adults in Germany. METHODS Data were obtained from the 2013 special wave of the German Health Update study, a national health survey of the adult population in Germany. Objective SES was determined using a composite index based on education, occupation, and income. The three single dimensions of the index were also used individually. SSS was measured using the MacArthur Scale, which asks respondents to place themselves on a 10-rung 'social ladder'. Regression models were employed to examine associations of objective SES and SSS with current depressive symptoms, as assessed with the eight-item Patient Health Questionnaire depression scale (PHQ-8 sum score ≥10). RESULTS After mutual adjustment, lower objective SES and lower SSS were independently associated with current depressive symptoms. The associations were found in both sexes and persisted after further adjustment for sociodemographic factors, long-term chronic conditions, and functional limitations. Mediation analyses revealed a significant indirect relationship between objective SES and depressive symptoms through SSS. When the three individual dimensions of objective SES were mutually adjusted, occupation and income were independently associated with depressive symptoms. After additional adjustment for SSS, these associations attenuated but remained significant. CONCLUSIONS The findings suggest that perceptions of low social status in adults may be involved in the pathogenesis of depression and play a mediating role in the relationship between objective SES and depressive symptoms. Prospective studies are needed to establish the direction of effects and to address questions of causality.
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Affiliation(s)
- Jens Hoebel
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ulrike E. Maske
- Unit of Mental Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Thomas Lampert
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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McGrath BM, Norris CM, Hardwicke-Brown E, Welsh RC, Bainey KR. Quality of life following coronary artery bypass graft surgery vs. percutaneous coronary intervention in diabetics with multivessel disease: a five-year registry study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 3:216-223. [DOI: 10.1093/ehjqcco/qcw055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/16/2017] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
The aim of this study is to investigate the long-term relationship between revascularization technique and health status in diabetics with multivessel disease.
Methods and results
Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry, we captured 1319 diabetics with multivessel disease requiring revascularization for an acute coronary syndrome (January 2009–December 2012) and reported health status using the Seattle Angina Questionnaire (SAQ) at baseline, 1, 3 and 5-years [599 underwent coronary artery bypass grafting (CABG); 720 underwent percutaneous coronary intervention (PCI)]. Adjusted analyses were performed using a propensity score-matching technique. After adjustment (including baseline SAQ domain scores), 1-year mean (95% CI) SAQ scores (range 0–100 with higher scores reflecting improved health status) were significantly greater in selected domains for CABG compared to PCI (exertional capacity: 81.7 [79.5–84.0] vs. 78.8 [76.5–81.0], P = 0.07; angina stability: 83.1 [80.4–85.9] vs. 75.0 [72.3–77.8], P < 0.001]; angina frequency 93.2 [91.6–95.0] vs. 90.0 [87.8–91.3], P = 0.003; treatment satisfaction: 93.6 [92.2–94.9] vs. 90.8 [89.2–92.0], P = 0.003; quality of life [QOL]: 83.8 [81.7–85.8] vs. 77.2 [75.2–79.2] P < 0.001). At 3-years, these benefits were attenuated (exertional capacity: 79.3 [76.9–81.7] vs. 78.7 [76.3–81.1], P = 0.734; angina stability 79.3 [76.3–82.3] vs. 75.5 [72.5–78.5], P = 0.080; angina frequency: 93.2 [91.3–95.1] vs. 90.9 [89.0–92.8], P = 0.095; treatment satisfaction: 92.5 [91.0–94.0] vs. 91.5 [90.0–93.0] P = 0.382; QOL: 83.2 [81.1–85.2] vs. 80.3 [78.2–82.4], P = 0.057). At 5-years, majority of domains were similar (exertional capacity: 77.8 [75.0–80.6] vs. 76.3 [73.2–79.3], P = 0.482; angina stability: 78.0 [74.8–81.2] vs. 74.8 [71.4–78.2], P = 0.175; angina frequency: 94.2 [92.3–96.0] vs. 90.9 [89.0–92.9], P = 0.018; treatment satisfaction: 93.7 [92.2–95.1] vs. 92.2 [90.6–93.7], P = 0.167; QOL: 84.1 [82.0–86.3] vs. 81.1 [78.8–83.4], P = 0.058). Majority in both groups remained angina-free at 5-years (75.0% vs. 70.3%, P = 0.15).
Conclusion
Improvements in health status with CABG compared with PCI were not sustained long-term. This temporal sequence should be considered when contemplating a revascularization strategy in diabetics with multivessel disease.
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Affiliation(s)
- Brent M. McGrath
- Division of Cardiology, 2C2 Walter Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
| | - Colleen M. Norris
- Division of Cardiology, 2C2 Walter Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
- Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Emeleigh Hardwicke-Brown
- Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease, Edmonton, AB, Canada
| | - Robert C. Welsh
- Division of Cardiology, 2C2 Walter Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
- The Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Kevin R. Bainey
- Division of Cardiology, 2C2 Walter Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
- The Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
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[Socioeconomic differences in physical activity in the middle-aged working population: The role of education, occupation, and income]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:188-96. [PMID: 26620205 DOI: 10.1007/s00103-015-2278-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Regular physical activity has positive effects on health at all ages. This study aims to investigate how far physical activity and regular sports engagement, as a more specific type of physical activity, are associated with socioeconomic factors in the middle-aged working population. METHODS Data were obtained from 21,699 working men and women aged between 30 and 64 years who participated in the 2009 and 2010 population-based national German Health Update (GEDA) surveys conducted by the Robert Koch Institute. Besides a multi-dimensional index of socioeconomic status (SES), three single dimensions of SES (education, occupation, and income) were used to analyse socioeconomic differences in total physical activity and regular sports engagement. RESULTS While the prevalence of total physical activity increased with lower SES, the proportion of people with regular sports engagement decreased with lower SES. These associations remained after adjusting for age in men and women. After mutual adjustment of the three single socioeconomic dimensions, physical activity was independently associated with lower education and lower occupational status. Regular sports engagement was observed to be independently associated with higher education, higher occupational status, as well as higher income after mutual adjustment. CONCLUSIONS This study demonstrates significant socioeconomic differences in physical and sports activity in the middle-aged working population. Education, occupation, and income show varying independent associations with physical activity behaviour. Such differences need to be considered when identifying target groups for health-enhancing physical activity interventions.
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Kuntz B, Lampert T. Smoking and Passive Smoke Exposure Among Adolescents in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 113:23-30. [PMID: 26857509 DOI: 10.3238/arztebl.2016.0023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 08/24/2015] [Accepted: 08/24/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Children and adolescents are the most important target group for smoking prevention and non-smoker protection measures (smoke-free legislation). In this article, we discuss trends over time and differences between social groups with regard to smoking and passive smoke exposure among adolescents in Germany. METHODS The data evaluated in this article were collected in two different study periods of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), namely, 2003-2006 and 2009-2012. Adolescents aged 11 to 17 were asked about their smoking behavior and passive smoke exposure (6812 and 5258 respondents in the two study periods, respectively). Their social status was rated with an index based on information supplied by the adolescents' parents about their level of education, occupation, and income. RESULTS The prevalence of smoking among adolescents fell in approximately six years from 20.4% to 12.0% (p< 0.001), and that of daily smoking from 13.3% to 5.4% (p<0.001). The percentage of non-smokers who spent time several days per week, or every day, in rooms where other persons were smoking declined from 35.1% to 18.8% (p<0.001). The lower the respondents' social status, the more likely they were to smoke daily and to have regular passive exposure to smoking. CONCLUSION The findings suggest that the measures implemented in recent years to protect adolescents from the health risks of active and passive smoking have been beneficial independently of the adolescents' social backgrounds.
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Affiliation(s)
- Benjamin Kuntz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin
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Jordan S, Hoebel J. [Health literacy of adults in Germany: Findings from the German Health Update (GEDA) study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:942-50. [PMID: 26227894 DOI: 10.1007/s00103-015-2200-z] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In today's information society, health literacy (HL) is considered important for health maintenance and disease management. In this context, dealing with health information is fundamental and requires different cognitive and social skills. OBJECTIVES The aim of this study was to investigate the distribution of HL levels in the adult population of Germany, and to identify associations with health behaviours and health status. MATERIALS AND METHODS The analyses were based on data from the German Health Update (GEDA) study, a cross-sectional survey of the German-speaking adult population of Germany, which was conducted from October 2013 to June 2014. Health literacy was assessed with the short form of the European Health Literacy Questionnaire (HLS EU-Q16), along with questions about socio-demographics, health behaviours, and health status. The HLS-EU-Q16 index could be calculated for 4845 respondents. RESULTS According to the criteria of the HLS-EU-Q16, more than half of the adults had "adequate" HL (55.8 %). Every third person (31.9 %) had "problematic" and almost every eighth person (12.3 %) had "inadequate" HL. We found significant differences in HL by educational level, but no differences in HL by sex and age group. Certain health behaviours were positively associated with health literacy. A low HL level was associated with poorer physical and mental health. CONCLUSION The results point to a need for action to improve HL in the adult population. The strengthening of health literacy should not solely aim at the promotion of individual skills, but also give high priority to the development of health-literate settings.
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Affiliation(s)
- Susanne Jordan
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland,
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Social disparities in parental smoking and young children's exposure to secondhand smoke at home: a time-trend analysis of repeated cross-sectional data from the German KiGGS study between 2003-2006 and 2009-2012. BMC Public Health 2016; 16:485. [PMID: 27277721 PMCID: PMC4898452 DOI: 10.1186/s12889-016-3175-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022] Open
Abstract
Background Children who are exposed to secondhand smoke (SHS) have an increased risk of a wide range of health problems and illnesses. Smoke-free legislation aims to improve indoor air quality and in this way protect the health of people who do not smoke. This paper examines trends in SHS exposure at home among children in Germany since the introduction of smoking bans in public places. Special focus is placed on the importance of the family of origin’s socioeconomic status (SES) and on parental smoking behaviour. Methods The analyses are based on two waves of the “German Health Interview and Examination Survey for Children and Adolescents” (KiGGS)—one of which was conducted immediately before the introduction of central smoke-free legislation in the 2003-2006 period, the other approximately 6 years later from 2009 to 2012. A comparison is made between the answers given by the parents of children aged between 0 to 6 (KiGGS baseline study, n = 6680; KiGGS Wave 1, n = 4455). Domestic SHS exposure is covered in the parent interviews by asking whether anyone is allowed to smoke at home in the presence of their child. Parental smoking behaviour is determined separately for mothers and fathers. SES is determined on the basis of the parents’ education, occupational status and income. Results The percentage of 0- to 6-year-old children exposed to SHS in the parental home fell from 23.9 to 6.6 % in the period from 2003-2006 to 2009-2012. At the same time, the percentage of children with at least one parent who smokes decreased from 49.8 to 41.8 %. While relative social inequalities in parental smoking behaviour have tended to increase over time, inequalities in domestic SHS exposure have persisted. Children whose parents smoke and children from low-SES families are still most likely to be exposed to tobacco smoke. In both study periods and after statistical adjustment for parental smoking behaviour, children with a low SES had a 6.6-fold higher risk for SHS exposure in the parental home than children from high-SES households. Conclusions The results of the KiGGS study show that the proportion of children in Germany who are exposed to SHS at home has declined significantly over the last few years. There is much to suggest that the smoke-free legislation that has been introduced in Germany has led to a heightened awareness of the health risks of SHS both in public and in the private sphere, as well as to a denormalization of smoking. Children whose parents smoke, and among them particularly children from socially disadvantaged families, should be recognised as key target groups when implementing future tobacco-control measures.
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Kuntz B, Lampert T. Social Disparities in Maternal Smoking during Pregnancy: Comparison of Two Birth Cohorts (1996-2002 and 2003-2012) Based on Data from the German KiGGS Study. Geburtshilfe Frauenheilkd 2016; 76:239-247. [PMID: 27065485 DOI: 10.1055/s-0042-100207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Maternal smoking during pregnancy represents a significant developmental risk for the unborn child. This study investigated social differences in maternal smoking behavior during pregnancy in mothers living in Germany. The study focused on maternal age at delivery, social status and migration background. Method: The evaluation of data was based on two surveys carried out as part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) carried out in 2003-2006 and in 2009-2012. The study compared the information given by parents of children aged between 0 and 6 years who were born either in the period from 1996 to 2002 (KiGGS baseline study, n = 4818) or in the period from 2003 to 2012 (KiGGS Wave 1, n = 4434). Determination of social status was based on parental educational levels, occupational position and income. Children classified as having a two-sided migration background either had parents, both of whom had immigrated to Germany, or were born abroad and had one parent who had immigrated to Germany; children classified as having a one-sided migration background had been born in Germany but had one parent who had immigrated to Germany. Results: The percentage of children whose mothers had smoked during pregnancy was 19.9 % for the older birth cohort and 12.1 % for the younger birth cohort. In both birth cohorts, the probability of being exposed to tobacco smoke was twice as high for children whose mothers were aged < 25 years at delivery compared to the children of older mothers. Children from socially deprived families were most affected by smoking behavior, and the relative social differences were found to have even increased over time (KiGGS baseline study: OR = 6.34; 95 % CI = 4.53-8.86; KiGGS Wave 1: OR = 13.88; 95 % CI = 6.85-28.13). A two-sided migration background was associated with a lower risk of exposure to smoking. Conclusions: The KiGGS results are in accordance with the results of other national and international studies which have shown that the percentage of mothers who smoke during pregnancy is declining. Because of a change in the method how data are collected for the KiGGS survey (written questionnaire vs. telephone interview) the trend results must be interpreted with caution. Measures aimed at preventing smoking and weaning women off smoking should focus particularly on younger and socially deprived mothers.
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Affiliation(s)
- B Kuntz
- Department of Epidemiology and Health Monitoring, Unit "Social Determinants of Health", Robert Koch Institute, Berlin
| | - T Lampert
- Department of Epidemiology and Health Monitoring, Unit "Social Determinants of Health", Robert Koch Institute, Berlin
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Hollier L, Pettigrew S, Slevin T, Strickland M, Minto C. Comparing online and telephone survey results in the context of a skin cancer prevention campaign evaluation. J Public Health (Oxf) 2016; 39:193-201. [DOI: 10.1093/pubmed/fdw018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ander M, Grönqvist H, Cernvall M, Engvall G, Hedström M, Ljungman G, Lyhagen J, Mattsson E, von Essen L. Development of health-related quality of life and symptoms of anxiety and depression among persons diagnosed with cancer during adolescence: a 10-year follow-up study. Psychooncology 2015; 25:582-9. [PMID: 26361085 PMCID: PMC5049607 DOI: 10.1002/pon.3965] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The main aim was to investigate the development of health-related quality of life (HRQOL) and symptoms of anxiety and depression in a cohort diagnosed with cancer during adolescence from shortly after up to 10 years after diagnosis. METHODS Participants (n = 61) completed the SF-36 and the HADS shortly; six, 12, and 18 months; and two, three, four, and 10 years (n = 28) after diagnosis. Polynomial change trajectories were used to model development. RESULTS Polynomial change trajectories showed an initial increase which abated over time into a decrease which abated over time for the SF-36 subscales Mental Health and Vitality; an initial decline which abated over time into an increase for HADS anxiety; and an initial decline which abated over time into an increase which abated over time for HADS depression. The SF-36 mental component summary showed no change from two to 10 years after diagnosis whereas the SF-36 physical component summary showed an increase from two years after diagnosis which declined over time. Ten years after diagnosis 29% reported possible anxiety. CONCLUSIONS Development of HRQOL and symptoms of anxiety and depression appears to be non-linear among persons diagnosed with cancer during adolescence. Well into permanent survivorship an increase in symptoms of anxiety is shown and approximately a third of the participants report possible anxiety. The findings indicate the need for: studies designed to pinpoint the times of highest psychological risk, clinical follow-up focusing on psychological problems, and development of effective psychological interventions for survivors of adolescent cancer. © 2015 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.
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Affiliation(s)
- Malin Ander
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helena Grönqvist
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Cernvall
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunn Engvall
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Pediatrics, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mariann Hedström
- Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Pediatrics, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Johan Lyhagen
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Elisabet Mattsson
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Pediatrics, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Problem Gambling Associated with Violent and Criminal Behaviour: A Danish Population-Based Survey and Register Study. J Gambl Stud 2015; 32:25-34. [DOI: 10.1007/s10899-015-9536-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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