Social differences in the utilization of medical services by children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study

Family structure, socioeconomic status, and mental health in childhood

The changing landscape of family structures over the last decades has led to a growing need to investigate its impact on children's well-being. This study examined differences in mental health among children from different family compositions and how these differences may be affected by familial socioeconomic status (SES). Data were collected within the LIFE Child study. Participants included 2828 children aged 3-17 years raised in traditional families, stepfamilies, or single-parent families. Mental health was measured using the Strengths and Difficulties Questionnaire (SDQ (behavioral strengths and difficulties)) and the KIDSCREEN-27 questionnaire (quality of life). Linear regression analyses were applied to examine associations between family structure, SES, and mental health outcomes. Children from single-parent families exhibited worse mental health outcomes than those from traditional families across all domains of the SDQ and the KIDSCREEN-27. Children from stepfamilies showed significantly higher Total Difficulties scores (B = 1.29 and 1.42), with 3- to 10-year-olds displaying higher scores in the Hyperactivity & Inattention (B = 0.61) and Peer Relationship Problems (B = 0.36) subscales, and 11- to 17-year-olds showing higher Conduct Problems (B = 0.31), Emotional Symptoms (B = 0.58), and a worse Parent Relationship scores (B = - 1.82) than children from traditional families (all p < 0.05). After controlling for SES, several associations between family structure and mental health lost significance, while others persisted, particularly among older children. To promote mental health in non-traditional families, interventions should address socioeconomic disparities while also investigating factors contributing to the direct impact of family structure on mental well-being.Trial registration The LIFE Child study is registered on clinicaltrials.gov (No. NCT02550236).

[Parental strain, inattention/hyperactivity symptoms and parent-reported ADHD in children and adolescents: results of the KiGGS study]

BACKGROUND

A child's attention deficit hyperactivity disorder (ADHD) is associated with strain for the parents. In turn, psychosocial parental strain is associated with higher probabilities for the occurrence of inattention/hyperactivity symptoms (IHS) in their children. The aim of this paper is to assess the association between parental strain, IHS, and a parent-reported ADHD diagnosis of the children.

METHODOLOGY

Based on data from n = 4596 participants of the KiGGS cohort (wave 2: 2014-2017), the type and extent of parental strain was set in relation to IHS and an ADHD diagnosis of the child in cross-sectional analysis. Frequencies, means, beta coefficients, and odds ratios adjusted for sex, age, socioeconomic status, and migration background are reported.

RESULTS

In individual consideration, a greater number of parental strains were associated with IHS than with an ADHD diagnosis. In a multivariate analysis, financial worries and parenting problems/conflicts with the children were significant predictors of IHS and an ADHD diagnosis, respectively. In addition, four or more types of parental strain were associated with a higher likelihood of both IHS and an ADHD diagnosis.

DISCUSSION

Financial and child-rearing strain are relevant to parents of children with IHS and an ADHD diagnosis. Interrelationships between parental stress and a child's IHS or an ADHD diagnosis can be assumed. To relieve their burden, prevention can either aim at improving the situation of ADHD-affected families or at improving the family's handling of the child's ADHD.

Relation between socioeconomic status and maternal serum lipids to infant lipid concentrations and anthropometry in the first year of life

PURPOSE

The physical health and development of an individual are influenced by multiple parameters and shaped by internal and external factors during pregnancy. However, it is unclear whether there is an association between maternal lipid concentrations in the third trimester of pregnancy and infant serum lipids as well as anthropometric growth, and whether these factors are influenced by the socioeconomic status (SES) of the mothers.

METHODS

Between 2011 and 2021, 982 mother-child pairs were recruited in the LIFE-Child study. To investigate the influence of prenatal factors, pregnant women at the 24th and 36th week of gestation as well as children at the age of 3, 6 and 12 months were examined and serum lipids determined. Socioeconomic status (SES) was assessed using the validated Winkler Index.

RESULTS

A higher maternal BMI was associated with a significantly lower Winkler score and a higher infant weight, height, head circumference and BMI from birth up to the 4th-5th week of life. In addition, the Winkler Index correlates with maternal HDL cholesterol and ApoA1 levels. There was no relation between the delivery mode and the maternal BMI or SES. For the maternal HDL cholesterol concentration in the third trimester, an inverse relation to children's height, weight, head circumference and BMI up to the first year of life as well as the chest and abdominal circumference to an age of 3 months was found. Children born to mothers with dyslipidemia in pregnancy tended to have a worse lipid profile than those born to normolipidemic mothers.

CONCLUSION

Serum lipid concentrations and anthropometric parameters of children in the first year of life are affected by multiple factors like maternal BMI, lipid levels and SES.

Perceived social support and characteristics of social networks of families with children with special healthcare needs following the COVID-19 pandemic

Background

Children with special healthcare needs (CSHCN) require more support than the average of their peers. Support systems for CSHCN were particularly affected by pandemic control measures. Perceived social support is a resource for health and wellbeing for CSHCN and their families. Associations of social support, mental health and socioeconomic status (SES) have been described. This study aims to (1) assess perceived social support in families with and without CSHCN; (2) describe structure and types of social networks of families with and without CSHCN; and (3) explore associations between perceived social support, disease complexity, child and caregiver mental health, and SES.

Methods

This is the third of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤ 18 years in Germany since the beginning of the COVID-19 pandemic, administered between 1st December 2022 and 10 March 2023. The Brief Social Support Scale (BS6) assessed perceived social support. Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire (SDQ) and WHO-5 Wellbeing index. The CSHCN-Screener identified CSHCN. Descriptive statistics and linear regression modeling assessed associations between perceived social support, parent-reported child mental health problems, disease complexity, caregiver mental wellbeing and SES.

Results

The final sample included 381 participants, among them 76.6% (n = 292) CSHCN. 46.2% (n = 176) of caregivers reported moderate, i.e., at least occasional social support. Social support was largely provided by informal social networks consisting of partners, relatives and neighbors/friends. Linear regression modeling revealed associations of lower perceived social support with higher disease complexity of the child, lower caregiver mental wellbeing, lower SES and increasing caregiver age.

Conclusion

The results of this study describe inequalities in perceived social support according to disease complexity of the child, caregiver mental health and socioeconomic status. They highlight the importance of social support and support networks as a resource for wellbeing of caregivers and CSHCN. Moving on from the COVID-19 pandemic, recovery strategies should focus on low-threshold interventions based in the community to improve social support for families with CSHCN and actively involve caregivers in identifying needs and co-creating new approaches.

Parent-perceived recurrent pain in children: associations with maternal pain, depressiveness, socioeconomic status, and children's behavioural difficulties

Objectives

The current study aimed to examine the potential transgenerational associations between maternal pain and depressiveness and childhood pain, and to explore the associations between the children's difficulties and recurrent pain (defined as pain occurring at least once a month in the previous 6 month) in healthy children aged 3-13 years.

Methods

We collected Data between 2015 and 2019 as part of the LIFE Child study in Germany and investigated associations of maternal pain and depressiveness, child age, sex, pubertal stage, emotional difficulties, conduct difficulties, hyperactivity/inattention, peer group difficulties, and prosocial skills, and family socioeconomic status with the frequency of parent-perceived headache, backache, and stomachache in a sample of 1,850 children (4,819 documented visits) using logistic and ordinal regression analyses.

Results

Overall, 10.4%, 24.4%, and 45.2% of parents reported their children had recurrent backache, headache, and stomachache, respectively, with 5.5% of children were reported to experience all three types of pain simultaneously. Higher age, female sex, puberty, emotional difficulties, low family socioeconomic status, as well as higher maternal impairment due to pain and maternal depressiveness were significantly associated with more frequent pain.

Conclusions

Our study suggests that maternal pain, maternal depressiveness, and lower family socioeconomic status as well as child's emotional difficulties are significantly associated with a higher frequency of recurrent pain in children perceived by their parents.

Screening for affective dysregulation in school-aged children: relationship with comprehensive measures of affective dysregulation and related mental disorders

Affective dysregulation (AD) is characterized by irritability, severe temper outbursts, anger, and unpredictable mood swings, and is typically classified as a transdiagnostic entity. A reliable and valid measure is needed to adequately identify children at risk of AD. This study sought to validate a parent-rated screening questionnaire, which is part of the comprehensive Diagnostic Tool for Affective Dysregulation in Children (DADYS-Screen), by analyzing relationships with comprehensive measures of AD and related mental disorders in a community sample of children with and without AD. The sample comprised 1114 children aged 8-12 years and their parents. We used clinical, parent, and child ratings for our analyses. Across all raters, the DADYS-Screen showed large correlations with comprehensive measures of AD. As expected, correlations were stronger for measures of externalizing symptoms than for measures of internalizing symptoms. Moreover, we found negative associations with emotion regulation strategies and health-related quality of life. In receiver operating characteristic (ROC) analyses, the DADYS-Screen adequately identified children with AD and provided an optimal cut-off. We conclude that the DADYS-Screen appears to be a reliable and valid measure to identify school-aged children at risk of AD.

The effect of early skin-to-skin contact after cesarean section on breastfeeding duration and development of atopic-allergic diseases

INTRODUCTION

Breastfeeding to strengthen the immune system suggests allergy prevention as a possible option. The connection between breastfeeding and the development of atopic-allergic diseases is being discussed. The primary aim of this work was to investigate an association of the first early skin-to-skin contact following cesarean section with the development of atopic diseases within the 1st year of life.

METHODS

The present study was conducted as a bicentric prospective cohort study in central Germany with a 15-month recruitment period. Data collection was by telephone interviews with a follow-up of 12 months. The statistical evaluation procedure was based on a hierarchical test of the association of early skin-to-skin contact between mother and child with the two main outcome measures. The primary outcome is the duration of breastfeeding. The second outcome is the onset of atopic-allergic disease within the 1st year of life.

RESULTS

Mothers breastfed longer if they had skin-to-skin contact within the first 30 minutes postpartum [χ²(df=5) = 19.020, p=0.002], if they breastfed their newborns early immediately after birth (p<0.001), and if the first skin-to-skin contact lasted more than one hour [χ²(df=4) = 19.617, p<0.001]. Regarding atopic-allergic diseases, no significant effects of skin-to-skin contact were found in relation to disease development. Regarding breastfeeding, no significant effects of atopic-allergic diseases could be detected either.

CONCLUSIONS

The results of this study reflect the benefits of skin-to-skin contact in the context of breastfeeding and atopic disease. The current scientific knowledge regarding skin contact and the development of atopic-allergic diseases should be extended and deepened.

Hepatitis A seroprevalence, vaccination status and demographic determinants in children and adolescents in Germany, 2014-2017, a population-based study

Children play an important role in hepatitis A virus (HAV) transmission but, due to frequent asymptomatic or mild courses, these infections are underrecognized in routine surveillance. Here, we analyzed hepatitis A (HA) seroprevalence, vaccination status and demographic determinants and estimated previous HAV infections in a cross-sectional population-based study of children and adolescents with residence in Germany 2014-2017, performing weighted univariable and multivariable logistic regression. Of 3567 participants aged 3-17 years, serological results were available for 3013 (84.5%), vaccination records for 3214 (90.1%) and both for 2721 (76.3%). Of 2721 with complete results, 467 (17.2%) were seropositive, thereof 412 (15.1%) with and 55 (2.0%) without previous HA vaccination, indicating previous HAV infection. Seropositivity was associated with age, residence in Eastern states, high socioeconomic status and migration background with personal migration experience. Participants with migration background and personal migration experience also had the highest odds ratios for previous HAV infection. Germany remains a country with very low HA endemicity. The current vaccination recommendations focusing on individuals with a high risk for HAV exposure (e.g. travelers to endemic countries) or severe disease appear appropriate. Migration and travel patterns as well as the endemicity in other countries influence the domestic situation, warranting further monitoring.

[The Importance of Socioeconomic Status in the Occurrence of Mental Health Problems in 11- to 17-Year-Old Girls and Boys in Germany: Results of KiGGS Wave 2 (2014-2017)]

AIM OF THE STUDY

The aim of the study was to investigate the distribution pattern of mental health problems (emotional problems, conduct problems, peer problems, hyperactivity) among different socioeconomic groups of 11- to 17-year-old girls and boys.

METHODS

Data for this study were obtained from the "German Health Interview and Examination Survey for Children and Adolescents KiGGS Wave 2" (2012-2014, n=15,023). The data on 11- to 17-year-old girls and boys (n=6599) was analyzed overall and separately for two age groups. The dependent variable was the parental version of the "Strengths and Difficulties Questionnaire" (SDQ). As non-dependent variable, a multidimensional index was used, which indicates the socioeconomic status (SES) of the family. Prevalence and odds ratios (ORs) based on logistic regressions are shown.

RESULTS

The prevalence of reporting mental health problems in those aged 11 to 17 was 15.7%. Girls were more likely to show internalizing problems whilst boys were more likely to show externalizing problems. The 11- to 17-year-old adolescents with a low SES were about two times (aOR: 2.32; 95%-CI: 1.81-2.97; p<0.001) more likely to report mental health problems. Adolescent girls with a low SES were at a twofold (aOR: 2.06; 95%-CI: 1.49-2.98; p<0.001) increased risk of showing a specific mental health problem such as "emotional problems".Conclusion Mental health problems in adolescents are distributed unequally. 11- to 17-year-old boys are generally more likely to show mental health problems, while girls' SES differences in mental health are more pronounced.

Long-term changes in serum levels of lipoproteins in children and adolescents with attention-deficit/hyperactivity disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of children worldwide. The causal mechanisms of ADHD remain unclear as the aetiology of this disorder seems to be multifactorial. One research field addresses the impact on lipid metabolism and particularly serum lipid fractions on the development of ADHD symptoms. This post hoc analysis aimed to investigate long-term changes in serum levels of lipoproteins in children and adolescents with ADHD and controls. Data of German children and adolescents from the nationwide and representative "Kinder- und Jugendgesundheitssurvey (KiGGS)" study were analysed at baseline and at a ten-year follow-up. At the two time points, participants in the control group were compared with those in the ADHD group, both before and after propensity score matching. Differences in total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides were assessed between matched children with and without ADHD. In addition, subgroups with versus without methylphenidate use were compared at both time points. At baseline before matching, there were no significant differences for lipid parameters between participants in the ADHD group (n = 1,219) and the control group (n = 9,741): total cholesterol (Exp(ß) = 0.999, 95%-CI 0.911-1.094, p = .979), LDL (Exp(ß) = 0.967, 95%-CI 0.872-1.071, p = .525), HDL (Exp(ß) = 1.095, 95%-CI 0.899-1.331, p = .366) and triglycerides (Exp(ß) = 1.038, 95%-CI 0.948-1.133, p = .412). Propensity score matching confirmed the non-significant differences between the ADHD and non-ADHD group at baseline. At the 10-year follow-up, n = 571 participants fulfilled complete inclusion criteria, among them 268 subjects were classified as ADHD. The two groups did not significantly differ in lipid fractions, neither cross-sectionally nor with regard to long-term changes. There was also no significant difference between methylphenidate subgroups. In this sample of children and adolescents we could not reveal any significant associations between serum lipid fractions and the diagnosis of ADHD, neither cross-sectionally nor longitudinally; even when methylphenidate use was considered. Thus, further studies using larger sample sizes are required to investigate putative long-term changes in serum lipid fractions related to ADHD.

The Effects of a Mindfulness-Based Training in an Elementary School in Germany

Objectives

The primary goal of this study was to investigate the influence of the Mindfulness Education Workbook, a 6-week mindfulness-based tool, on emotion regulation, inhibition, physical self-concept, resources, and connectedness to nature. Furthermore, we explored whether a difference in number of hours of mindfulness practice would affect the outcomes.

Method

Ninety-one children from a public elementary school (M age = 9.74 years, SD = 0.76) participated in the study and were divided into three groups according to their respective school classes. The intervention group was divided into two groups that varied by number of hours of mindfulness practice: (a) mindfulness-plus and (b) mindfulness. In addition to biweekly training, the mindfulness-plus group also repeated a daily exercise. The passive control group received the standard school day instruction. The five concepts of emotion regulation, inhibition, physical self-concept, resources, and connectedness to nature were measured before and after the mindfulness intervention.

Results

For the measurement of emotion regulation, there was a significant effect in favor of the two mindfulness groups compared with the control group for the adaptive strategies in total as well as for their comprising emotions, anger, fear, and sadness, separately. Solely for the subscale mood elevation, the mindfulness-plus group showed significantly higher scores compared to the control group. Both mindfulness-plus and mindfulness groups varied from the control group on the measure of emotion regulation strategies, however not on the other four domains that were assessed (self-reports of resources, physical self-concept, and connectedness to nature as well as a mental task assessing inhibition). There was no evidence that the additional practice in the mindfulness-plus group significantly added to the intervention's effectiveness.

Conclusions

The Mindfulness Education Workbook is a promising tool for elementary schools. Follow-up studies may provide further insights into the various effects of offering mindfulness training in schools. Further research with objective markers may also allow individual aspects under the umbrella term mindfulness to be investigated in more detail.

Preregistration

This study was not preregistered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-023-02084-w.

[Personal Resources of Adolescents in Eastern and Western Germany - Results of the KiGGS Study 15 and 25 years after the German Reunification]

QUESTIONS

More than 15 years after the German reunification, were there differences in the personal resources among adolescents born around 1989 between East and West? How did the differences of this generation develop?

METHODS

Data from the study on the health of children, adolescents and young adults in Germany (KiGGS study) from the years 2003-2006 and 2014-2017 are used to determine the prevalence of low personal resources in 14-17-year-old adolescents in Eastern and Western Germany. Cross-sectional data at both time periods are compared between East and West, and longitudinal data are used to follow the cohort over the course of age RESULTS: Around 15 years after the German reunification, 14- to 17-year-olds from East Germany more frequently show fewer personal resources and have lower self-efficacy expectations than adolescents of the same age in West Germany. 10 years later, these differences are barely visible and have partially reversed. The east-west differences found cannot be explained by the different socio-economic situations of the families in East and West.

DISCUSSION

The results show that in the 2000s, adolescents born around 1989 from families living in Eastern Germany, showed a higher risk of having fewer personal resources than adolescents from families living in Western Germany. 25 years after the German reunification this is no longer recognizable. While the differences between East and West decrease over time, the importance of the socio-economic situation of the family for the personal resources of adolescents as a whole increases, to the detriment of those with a lower socioeconomic status. The results indicate the need for targeted interventions to strengthen psychosocial resources especially for children and adolescents in phases of transformation and biographical breaks.

Impact of the COVID-19 pandemic on children with and without affective dysregulation and their families

Analyzing COVID-19-related stress in children with affective dysregulation (AD) seems especially interesting, as these children typically show heightened reactivity to potential stressors and an increased use of maladaptive emotion regulation strategies. Children in out-of-home care often show similar characteristics to those with AD. Since COVID-19 has led to interruptions in psychotherapy for children with mental health problems and to potentially reduced resources to implement treatment strategies in daily life in families or in out-of-home care, these children might show a particularly strong increase in stress levels. In this study, 512 families of children without AD and 269 families of children with AD reported on COVID-19-related stress. The sample comprised screened community, clinical, and out-of-home care samples. Sociodemographic factors, characteristics of child and caregiver before the pandemic, and perceived change in external conditions due to the pandemic were examined as potential risk or protective factors. Interestingly, only small differences emerged between families of children with and without AD or between subsamples: families of children with AD and families in out-of-home care were affected slightly more, but in few domains. Improvements and deteriorations in treatment-related effects balanced each other out. Overall, the most stable and strongest risk factor for COVID-19-related stress was perceived negative change in external conditions-particularly family conditions and leisure options. Additionally, caregiver characteristics emerged as risk factors across most models. Actions to support families during the pandemic should, therefore, facilitate external conditions and focus on caregiver characteristic to reduce familial COVID-19-related stress. Trial registration: German Clinical Trials Register (DRKS), ADOPT Online: DRKS00014963 registered 27 June 2018, ADOPT Treatment: DRKS00013317 registered 27 September 2018, ADOPT Institution: DRKS00014581 registered 04 July 2018.

Feasibility of a Social Network-Based Physical Activity Intervention Targeting Vocational School Students: A Pilot Study

Globally, four out of five adolescents do not meet the recommendations for physical activity (PA). Moving large segments of young adults from inactivity to activity is essential to reach the global target of a 15% relative reduction in inactivity by 2030 worldwide. This study aimed to examine the feasibility of a social network-based PA intervention (WALK2gether) in vocational school students. Fourteen students from one vocational school in the city of Duesseldorf were instructed to walk ten thousand steps per day over six weeks. Applied behavior change techniques were self-monitoring of steps and social comparison via a pedometer app and a Facebook group. Indicators of feasibility were documented. The intervention was minimally resource intensive, with a total of 92 h spent by the research staff. The recruitment rate was 19.2% and loss-to-follow up 28.6%. Our data revealed no significant change in the target behavior PA from baseline to follow-up. The target population did not interact in the Facebook group, while a moderate use of the pedometer app was noted. Although the results ought to be interpreted with caution due to the small sample size, the findings suggest that the WALK2gether intervention was partially feasible, but not appropriate for the target group.

Associations between problematic smartphone use and behavioural difficulties, quality of life, and school performance among children and adolescents

BACKGROUND

European studies on determinants and factors associated with problematic smartphone use (PSU) in children and adolescents are still sparse. This study reports the current amount of PSU symptoms and the presence of (clinically relevant) PSU in German children and adolescents. We also investigated associations between socio-demographic factors, different smartphone usage patterns, and daily smartphone usage time and the amount of PSU symptoms in this group. In addition, associations of PSU symptoms and high smartphone usage times (> 2 h/day) with behavioural problems, quality of life (QoL), and school performance were investigated.

METHODS

Within the framework of the LIFE Child study, 564 children and adolescents aged 10-18 years provided information on PSU symptoms (using the Smartphone Addiction Proneness Scale), daily smartphone usage time, smartphone activities, behavioural strengths and difficulties (using the Strengths and Difficulties Questionnaire), QoL (using the KIDSCREEN-27), and school performance. Multiple regression analyses were applied to assess associations.

RESULTS

In the present sample, PSU was present in 13 children (2.3%). Older age, female gender, high daily smartphone usage time of > 2 h, and intensive smartphone use for social networking, gaming, or watching video clips were significantly associated with more PSU symptoms. Children and adolescents reporting more PSU symptoms also showed lower QoL, more behavioural difficulties, and poorer school performance, independently of age, gender, socio-economic status, and daily smartphone usage time. In contrast, daily smartphone usage time per se showed only weak or non-significant associations with these aspects of health and behaviour.

CONCLUSION

Intensive smartphone use for entertainment may increase the risk of developing PSU symptoms. Furthermore, the results indicate that PSU symptoms (more than long smartphone usage times per se) are associated with more behavioural difficulties and poorer QoL.

Changes of Self-Rated Health Status, Overweight and Physical Activity During Childhood and Adolescence-The Ratchet Effect of High Parental Socioeconomic Status

Childhood and adolescence are important life periods for the development of health status and physical activity (PA) behaviours. This study analyses the stability and potential changes of self-rated health status, overweight and PA behaviour over time, specifically focusing on the age and the socioeconomic status of children and adolescents. We employ representative longitudinal data for German children and adolescents from the Motorik-Modul Study and the German Health Interview and Examination Survey. Using four different dichotomous health status and PA indicators (self-rated health status [SRHS]; overweight; moderate-to-vigorous PA; and leisure sports engagement), we report within-person transition rates across the panel waves when the survey was taken (2003-2006, 2009-2012, and 2014-2017). Additionally, we report results of logistic regressions estimating the impact of children's age, gender, migration background, and their parents' socioeconomic status on these transition rates. The transition rates show mixed results. While children and adolescents from highly problematic states reporting bad SRHS and no leisure sports engagement at an early stage tend to improve later on, overweight children mostly stay overweight. Age and social inequality indicators correlate with some of the chances of improving or worsening the health and PA states. Most clearly, high parental status prevents the health status and PA from worsening over all transitions, particularly becoming overweight, representing a ratchet effect. The results of the present study underline that health policy needs to target specific groups to reduce social inequality in the health status and PA of children and adolescents.

Association of Oral Health Conditions in Adolescents with Social Factors and Obesity

This study aimed to investigate associations between psychosocial factors, obesity, and oral health in a study population of 10- to 18-year-old adolescents who participated in the LIFE Child study. Psychosocial information (socioeconomic status (SES) based on parents’ education, occupation and household income, Strengths and Difficulties Questionnaire (SDQ), health-related quality of life) and physical activity behavior were obtained. Nutritional status was classified based on age- and sex-adjusted body mass index into underweight, overweight, normal weight and obese. Clinical dental examinations were performed and scored with respect to caries experience (CE), oral hygiene (OH), and periodontal status (periodontal health score: PERIO-S). Age-adjusted regression analysis under the assumption of a double Poisson distribution was performed with and without adjusting for SES (α = 5%). A total of 1158 study participants (590 girls, 568 boys; mean age 13.2 ± 2.3 years) were included (17.2% were classified as obese). CE was 20% higher for moderate and 60% higher for low SES compared to high SES (p < 0.05). PERIO-S was 10% higher for moderate and 30% higher for low compared to high SES (p < 0.05). Poor OH was associated with higher CE (Ratio R = 2.3, p < 0.0001) and PERIO-S (R = 3.1, p < 0.0001). Physical activity in a sports club was associated with lower CE-S and PERIO-S (R = 0.85, p < 0.001). Obesity was associated with increased CE (R = 1.3, p < 0.001) compared to normal weight. For low but not high SES, more reported difficulties were associated with higher CE. In conclusion, low SES, poor OH, and obesity are associated with unfavorable oral health conditions, whereas physical activity and high SES are potentially protective.

Substance use in childhood and adolescence and its associations with quality of life and behavioral strengths and difficulties

BACKGROUND

Substance use in childhood and adolescence continues to be a current health concern. The aims of the present study were to identify trends in the use of alcohol, cigarettes, and cannabis in children and adolescents in the last 10 years and to assess associations between substance use and quality of life and behavioral strengths and difficulties.

METHODS

Substance use was examined in 1829 9- to 18-year-old German children and adolescents participating in the LIFE Child cohort study between 2011 and 2020. Quality of life was investigated using the KIDSCREEN-27 questionnaire. The Strength and Difficulties Questionnaire was used to assess behavioral strengths and difficulties. Associations were assessed using linear regression analyses. All effects were adjusted for age, gender, and family socio-economic status.

RESULTS

38.44% of participants reported drinking alcohol at least sometimes. Smoking (6.23%) and the use of cannabis (3.94%) were less frequent. While we observed no significant changes in smoking between 2011 and 2021, the consumption of cannabis and the frequent consumption of alcohol has increased in this time period. Cigarette and cannabis use were associated with additional symptoms of hyperactivity/inattention and reduced prosocial behavior. For all three substances, usage was associated with more conduct problems. We also found significant associations between substance use and a lower quality of life in the areas of physical wellbeing, psychological wellbeing, parent relation and autonomy, and school environment. One noteworthy finding was that cigarette consumption and frequent alcohol use were associated with higher quality of life in terms of social support/peer group relations. Some significant interactions between substance use and child age indicated that associations between substance use and quality of life or behavioral difficulties were stronger in younger than in older children.

CONCLUSIONS

The results show that quality of life and behavioral difficulties are associated with substance use and should be considered when developing or implementing preventive measures to counter substance use. Furthermore, the findings indicate that substance use can be accompanied by improved peer relations. Therefore, the influence of peers, especially of peers who use these substances, should not be underestimated.

Impact of the COVID-19 Pandemic on Mental Health Outcomes of Healthy Children, Children With Special Health Care Needs and Their Caregivers-Results of a Cross-Sectional Study

BACKGROUND

Several studies have described widening inequalities as a result of the COVID-19 pandemic, mostly for adult populations. Children and adolescents are particularly impacted by the indirect effects of the pandemic and lockdown measures, such as reduced access to or delays in health care and school closures. National surveys in several countries also show a rising mental health burden in children and adolescents during the COVID-19 pandemic. Children with special health care needs are a particularly vulnerable group in this context as they rely on a wide range of services, which were mostly suspended during the first wave of the pandemic. This study aims: (1) to describe the mental health outcomes of children with and without special healthcare needs and of their caregivers following the first national lockdown in Germany; (2) to investigate variations in mental health outcomes and measures of pandemic burden according to socioeconomic status; (3) to assess the impact of socioeconomic status, disease complexity and psychosocial burden on parent-reported child mental health problems.

METHODS

We conducted an online survey among 1,619 caregivers of children aged 1-18 years from August 11th until October 5th 2020. Participants were recruited both from families of children with special healthcare needs and of healthy children. Inequalities were analysed by descriptive statistics, simple and hierarchical logistic regression modelling to explore the association between socioeconomic status and psychological outcome measures, disease complexity and general burden related to COVID-19.

RESULTS

There was a high prevalence of 57.4% of parent-reported mental health problems in children and of a positive screening score for depression in 30.9% of parents. Parent-reported mental health problems were more likely to affect children with low socioeconomic status, with complex chronic disease and those whose parents screened positive for depression.

CONCLUSIONS

This study highlights inequalities in parent-reported child mental health outcomes by socioeconomic status and disease complexity in a large sample of German families with and without children with special health care needs. Political measures should put children at the centre and aim to mitigate the unequal impact of the COVID-19 pandemic, particularly on the mental health of vulnerable children.

The Effect of Teacher Autonomy Support on Leisure-Time Physical Activity via Cognitive Appraisals and Achievement Emotions: A Mediation Analysis Based on the Control-Value Theory

Analyzing students’ emotional experience in physical education (PE) is of crucial importance as it may fill an important gap in research examining the role of PE for students’ leisure-time physical activity (PA). Based on the control-value theory of achievement emotions, the purpose of this study was to test the assumption that multi-dimensional autonomy support of the PE teacher may affect students’ leisure-time PA via their appraisals of control and value and achievement emotions experienced in PE. Variance-based structural equation modelling was used to test the proposed model in a sample of 1030 students aged between 11 and 18 years (M = 13.4, SD = 1.48) stemming from schools with the lowest educational level among secondary schools in Germany. The results indicated that in particular cognitive autonomy support positively predicted students’ self-efficacy and intrinsic value. Whereas appraisals of self-efficacy were negatively related to the experience of anxiety, intrinsic value was a major positive predictor of enjoyment. Enjoyment, in turn, was of substantial relevance for leisure-time PA. The findings offer a meaningful contribution in understanding students’ emotional experiences and remind PE teachers of their opportunity to adopt an autonomy-supportive teaching style to positively influence the emotions of their students.

Traumatic Events and Substance Use Disorders in Adolescents

OBJECTIVES

Adolescents with substance use disorders (SUD) frequently report traumatic events (TEs) and symptoms of post-traumatic stress disorder (PTSD). This study aimed to assess whether lifetime prevalence rates of TEs and PTSD are related to SUD severity in adolescent psychiatric patients.

METHODS

We analyzed N = 114 self-reports of treatment-seeking German adolescents aged 12 to 18 years, who visited a specialized SUD outpatient unit. Standardized questionnaires were applied to assess SUD severity, the number of TEs and DSM-IV PTSD criteria.

RESULTS

Patients fulfilling PTSD criteria (28% of the total sample) had a higher Drug Use Disorders Identification Test (DUDIT) score compared to non-PTSD patients with TEs (p <.001), and compared to adolescents without TEs or PTSD (p = .003). Additionally, SUD severity was positively associated with the number of TEs and the number of intrusion, hyperarousal, and avoidance symptoms (all r = .33 to.48, all p <.01).

DISCUSSION

Adolescent patients with SUD reported 3-times higher rates of TEs, and a 5-time higher prevalence of PTSD following TEs, than the general adolescent population. Adolescent SUD patients with PTSD reported more severe substance use problems than patients without PTSD-regardless of previous TEs. Longitudinal studies are needed in order to investigate the temporal relationship between TEs, PTSD and SUD.

[Headache, abdominal and back pain in children and adolescents in Germany : Results from KiGGS Wave 2 and trends]

BACKGROUND

Pain not only causes suffering in children and adolescents, but also leads to school absenteeism, medication intake, medical treatment, and an increased risk of recurrent pain in adulthood.

OBJECTIVES

Based on data from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), the 3‑month prevalence of recurrent headache, abdominal and back pain in girls and boys is reported, and is compared with the prevalence from the KiGGS baseline survey (2003-2006). The consequences of recurrent headache were also explored.

MATERIALS AND METHODS

Data from >11,000 participants (KiGGS Wave 2) and from >12,000 (KiGGS baseline) participants aged between 3 and 17 years were analyzed. For 3‑ to 10-year-olds, parents/guardians answered the questions, while 11- to 17-year-olds provided information themselves.

RESULTS

In 3‑ to 10-year-olds, recurrent abdominal pain was most prevalent, affecting one third of girls and one quarter of boys. Headache was the most frequent type of pain in 11- to 17-year-olds, affecting almost every second girl and about every third boy. The 3‑month prevalence of recurrent headache, abdominal and back pain has increased in girls and boys, especially in the age groups 7 to 10 years and 11 to 13 years. Among recurrent headache sufferers, adolescents take medication almost twice as often as children.

CONCLUSIONS

Headache, abdominal, and back pain are still and with increasing prevalence very common symptoms in children and adolescents in Germany. Their prevention requires a holistic view of children's health in the psychosocial living environment, and healthcare context.

Parents' Perception of Their 2⁻10-Year-Old Children's Contribution to The Dyadic Parent-Child Relationship in Terms of Positive and Negative Behaviors

Parent-child relationship is developed and changed through reciprocal interactions between a child and his/her parent, and these interactions can strongly influence the child's development across domains (e.g., emotional, physical, and intellectual). However, little is known about the parental perception of the child's contribution to the dyadic parent-child relationship in terms of positive and negative behaviors. We therefore aimed to develop and validate an economical parent-report instrument to assess these important aspects. The validation study included 1642 mothers (Mage = 37.1) and 1068 fathers (Mage = 40.4) of 1712 children aged 2⁻10 years (Mage = 6.6) who completed the new instrument, the Child Relationship Behavior Inventory (CRBI). Statistical results indicated that the CRBI is a reliable and valid measure. Mothers reported more positive child behaviors towards them, whereas fathers perceived fewer problems with problematic relationship behavior than mothers. In their parents' perception, girls showed more positive and less problematic relationship behaviors than boys. The frequency of problematic child relationship behavior significantly decreased with increasing child age while positive relationship behavior did not show any correlation with the child's age. To assess both positive and negative child relationship behaviors could be helpful to better understand the relevance of these different aspects for the development of the parent-child relationship.