Social, health-related, and environmental factors influencing sleep problems of children, adolescents and young adults

Sleep is a relevant factor for functioning and well-being of young people. The paper provides a differentiated description of sleep difficulties in this population group including social, health-related, and environmental factors. The analyses included n=6,728 11- to 17-year-olds of the KiGGS baseline study (2003-2006) and 6,072 young adults (age 18-31), who provided information relating sleep in the survey KiGGS Wave 2 (2014-2017). Information from 3,567 people was evaluated at two survey points. 22.0% of the 11- to 17-year-olds reported sleep difficulties. A significant impact for the sex (female), living with a single parent, and with siblings is reflected in the logistic regression. The risk for sleep difficulties increases significantly in the case of mental problems and pain. Among the 18- to 31-year-olds, 19.6% complained of difficulties falling asleep and sleeping through the night. In addition to sex, noise exposure, a low level of education, the professional situation, and living with children were reflected as important influencing factors in the logistic regressions. Over one third of those, who suffered from sleep problems as children and adolescents, also indicated sleep difficulties almost ten years later. The high prevalence of sleep problems and the associated health risks illustrate the high public health relevance of the topic. In addition to sex, health-related and environmental variables also turned out to be significant and need to be considered in the development of interventions.

Toothache, tooth brushing frequency and dental check-ups in children and adolescents with and without disabilities

According to international studies, children and adolescents with disabilities have more tooth decay, brush their teeth less often twice a day and use preventive dental services less often than children and adolescents without disabilities. With data from the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), toothache, tooth brushing frequency and dental check-ups are examined in children and adolescents with and without disabilities. It was found that children and adolescents with disabilities had more toothache in the three months before the survey (23.5% and 15.9%, respectively) and brushed or got their teeth brushed twice a day less often (33.5% and 22.2%, respectively) than children and adolescents without disabilities. Differences in the utilisation of dental check-ups could not be determined. Overall, the results point to the importance of measures to promote tooth brushing frequency in order to improve the oral health of children and adolescents with disabilities. In addition, further opportunities should be created to collect data on the oral health of people with disabilities at the population level in health or participation studies.

Individual trajectories of asthma, obesity and ADHD during the transition from childhood and adolescence to young adulthood

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) provides comprehensive and reliable data on the health situation of the upcoming generation. The KiGGS cohort accompanies participants from the KiGGS baseline study (2003-2006) into adulthood. Until now, two follow-up surveys of the cohort have been implemented with KiGGS Wave 1 (2009-2012) and KiGGS Wave 2 (2014-2017). In KiGGS Wave 2, the cohort was supplemented by the in-depth study 'Family and care-specific factors influencing the development, trajectories and effects of mental disorders (especially ADHD), obesity and allergic diseases (especially asthma)'. One aim of the study was to identify individual trajectories of these health disorders. For this purpose, probabilities for typical transitions from the KiGGS baseline study to KiGGS Wave 2 were calculated. An important result is that many participants who had asthma, obesity or ADHD at KiGGS baseline still had the disease more than ten years later: Over a third still had asthma (35%) or ADHD (37%), and almost half were still affected by obesity (47%). The results point to the need for early preventive measures to stop these potentially chronic diseases from developing in childhood and adolescence.

Individual trajectories of asthma, obesity and ADHD during the transition from childhood and adolescence to young adulthood

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) provides comprehensive and reliable data on the health situation of the upcoming generation. The KiGGS cohort accompanies participants from the KiGGS baseline study (2003-2006) into adulthood. Until now, two follow-up surveys of the cohort have been implemented with KiGGS Wave 1 (2009-2012) and KiGGS Wave 2 (2014-2017). In KiGGS Wave 2, the cohort was supplemented by the in-depth study 'Family and care-specific factors influencing the development, trajectories and effects of mental disorders (especially ADHD), obesity and allergic diseases (especially asthma)'. One aim of the study was to identify individual trajectories of these health disorders. For this purpose, probabilities for typical transitions from the KiGGS baseline study to KiGGS Wave 2 were calculated. An important result is that many participants who had asthma, obesity or ADHD at KiGGS baseline still had the disease more than ten years later: Over a third still had asthma (35%) or ADHD (37%), and almost half were still affected by obesity (47%). The results point to the need for early preventive measures to stop these potentially chronic diseases from developing in childhood and adolescence.

Health-related quality of life in children and adolescents with overweight and obesity: results from the German KIGGS survey

BACKGROUND

The well-being of persons with overweight and obesity, in particular of children and adolescents, may be impaired. The present study investigates the health-related quality of life (HRQoL) of girls and boys with overweight and obesity living in Germany as compared to those of normal-weight, while taking a selection of relevant determinants of HRQoL into account.

METHODS

The sample comprises 1771 children and adolescents aged 11 to 17 years that took part in the cross-sectional German Health Interview and Examination Survey for Children and Adolescents (KIGGS Wave 2, 2014-2017). Sex-and age-specific BMI (kg/m2) percentiles were utilized to classify overweight and obesity. HRQoL was measured with the KIDSCREEN-27 questionnaire, which gathers detailed information about the five dimensions physical and psychological well-being, well-being regarding peers (i.e., social acceptance), parents (i.e., autonomy) and within the school environment. Multiple regression analyses were performed with HRQoL dimensions as outcomes to test for differences between children and adolescents with normal-weight vs. those with overweight and vs. those with obesity, separately for girls and boys. In a next step, age, physical activity, media consumption, social support and self-efficacy were considered as potential confounders in the analyses.

RESULTS

18.7% of the children and adolescents under study were affected by overweight and among them 8.0% by obesity. After adjusting for potential confounders, overweight and obesity were associated with lower physical well-being as compared to normal weight in both sexes (boys with overweight: standardized beta [β] = -.14, standard error [SE] = .03, p < .001, and obesity: β = -.16, SE = .03, p < .001; girls with overweight: β = -.09, SE = .04, p = .011, and obesity: β = -.11, SE = .03, p = .003). Results moreover suggest lower levels of psychological (β = -.10, SE = .04, p = .002) and parent-related well-being (β = -.08, SE = .04, p = .036) of boys with obesity as compared to normal-weight peers.

CONCLUSION

HRQoL of German children and adolescents with overweight and obesity is impaired according to physical well-being in general, while psychological and parent-related well-being is particularly affected in boys. Public health approaches should therefore promote children and adolescents with overweight and obesity by improving diverse facets of HRQoL as well as relevant associated factors (i.e., media consumption, self-efficacy) in general and in boys in particular.

The health of children and adolescents with a migration background in Germany - Results of the cross-sectional KiGGS Wave 2 study

Over a third (36.5%) of young people living in Germany have a migration background. Based on the data of the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), the health situation of 11- to 17-year-olds with and without a migration background is described using selected indicators. In order to account for the diversity among children and adolescents with a migration background, the health indicators used in this study are stratified by migration background but also by additional migration-related characteristics. In addition, the results from the various subgroups are also stratified by sociodemographic characteristics. No differences in self-assessed general health or the outpatient utilisation of paediatric and general medical services were identified between 11- to 17-year-olds with and without a migration background. However, migration-related differences were identified in health behaviour: whereas children and adolescents with a one- or two-sided migration background are more frequently overweight (including obesity), they consume risky amounts of alcohol less often than those of the same age without a migration background. Finally, the outcomes of the indicators also vary according to migration-related and sociodemographic characteristics.

Uptake of orthodontic treatment by children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

For patients with considerable malfunctions, or where these could potentially develop, statutory health insurers completely cover the cost of correcting malpositionings of the teeth and jaws through orthodontic treatment in Germany. Based on the self-reported information from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), the uptake of orthodontic treatment was analysed. A total of 25.8% of the girls and 21.1% of the boys aged 3 to 17 years are receiving regular orthodontic treatment. Uptake of treatment is very much dependent on age. The highest rates are found among 13-year-old girls (55.0%) and 14-year-old boys (50.8%). Compared to the data from previous KiGGS waves, the trend over approximately ten years has seen a significant increase of orthodontic treatment across all age groups. More health services research and a broader discourse on current treatment practices and their benefits are desirable.

Oral health behaviour of children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Oral health behaviour plays a key role in the prevention of caries and periodontitis. This article describes the prevalence, determinants and trends of tooth brushing frequency and utilization of dental check-ups. The analyses are based on the data from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). The results show that around 80% of children and adolescents meet the recommended tooth brushing frequency and utilization of dental check-ups. Around one fifth of children and adolescents do not meet the recommendations. 14- to 17-year-old adolescents, as well as those with low socioeconomic status and a migration background are groups which are particularly at risk. Compared to the KiGGS baseline study (2003-2006), tooth brushing frequency and utilization of dental check-ups has improved. While this positive development is apparent for nearly all the population groups analysed, the same risk groups that were identified by the baseline study are also evident in the KiGGS Wave 2 results. Targeted measures directed at specific target groups to promote oral health behaviour at younger ages should therefore be maintained and expanded, respectively.

Human papillomavirus (HPV) vaccination of girls in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Since 2007, the Standing Committee on Vaccination (STIKO) has recommended that all girls receive vaccinations against the human papillomavirus (HPV) in order to reduce the disease burden of cervical cancer. Persistent infections with high-risk HPV subtypes increase a woman's risk of developing cancer. In the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), 42% of 2,958 11- to 17-year-old girls reported that they had received at least one HPV vaccination, and 31.4% reported a full HPV vaccination. 45.3% of 14- to 17-year-old girls reported a complete series of HPV vaccinations. Compared to the figures reported in KiGGS Wave 1 five years ago, HPV vaccination coverage has therefore remained stable. A vaccination coverage below 50% in girls is too low to exploit the potential of HPV vaccination to reduce cervical cancer rates in Germany.

Utilization of early detection examinations by children in Germany. Results of the cross-sectional KiGGS Wave 2 study

Examinations for early detection of diseases (called U-Untersuchungen in Germany) are among the most important prevention measures at childhood age. According to KiGGS Wave 2 data, participation rates are over 95% for most of these examinations. 99.7% and 99.6% of children, respectively, who had reached the recommended age for these examinations participated in the U1 and U2 examinations, 98.0% and 98.1%, respectively, the U8 and U9 examinations. Participation rates for children from families with low socioeconomic status and those with a two-sided migration background are slightly lower. A comparison with previous KiGGS waves shows that the utilization of early detection examinations has increased significantly over the last ten years. During this time, social differences which were previously pronounced have decreased.

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

Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) enable conclusions about the utilization of outpatient and inpatient medical services by children and adolescents accounting the family's socioeconomic status (SES). Results from the second follow-up to the KiGGS survey (KiGGS Wave 2), which covers the years 2014 to 2017, clearly demonstrate that children and adolescents from families with a low SES visit specialists in general medicine, gynaecologists and psychiatrists, as well as child and adolescent psychiatrists, psychotherapists and psychologists more frequently. In contrast, children and adolescents from families with a high SES visit paediatric, dermatological, dental and orthodontic practices more often. No statistically significant differences between the status groups with regard to the utilization of outpatient medical services in hospitals were identified. However, children and adolescents from the low status group received inpatient hospital treatment more frequently and, on average, spent more nights in hospital. These results reflect status-specific differences both in disease prevalence and care, as well as in patterns related to the utilization of medical services.

Utilization of physical therapy, speech therapy and occupational therapy by children and adolescents in Germany.Results of the cross-sectional KiGGS Wave 2 study and trends

Allied health services such as physical therapy, speech therapy and occupational therapy contribute to the early treatment of health disorders in children and adolescents and promote a healthy development. This article describes the utilization of these allied health services by children and adolescents in Germany and analyses its association with demographic and social factors. The analyses are based on the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) including 15,023 participants. Trends are calculated in comparison with the KiGGS baseline study (2003-2006). Within one year, 9.6% of children and adolescents in Germany use physical therapy, 6.1% speech therapy and 4.0% occupational therapy. Speech therapy and occupational therapy are used more frequently by boys than by girls. The utilization of speech therapy is highest among 3- to 6-year-olds with 15.0%. Occupational therapy (8.3%) is most frequently used by 7- to 10-year-olds and physical therapy (16.9%) by 14- to 17-year-olds. Social differences are evident mainly in the higher utilization of occupational therapy and speech therapy and a lower utilization of physical therapy by socially disadvantaged children and adolescents. Over the last ten years, the utilization of speech therapy and physical therapy in children and adolescents has increased significantly.

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

Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) enable conclusions about the utilization of outpatient and inpatient medical services by children and adolescents accounting the family's socioeconomic status (SES). Results from the second follow-up to the KiGGS survey (KiGGS Wave 2), which covers the years 2014 to 2017, clearly demonstrate that children and adolescents from families with a low SES visit specialists in general medicine, gynaecologists and psychiatrists, as well as child and adolescent psychiatrists, psychotherapists and psychologists more frequently. In contrast, children and adolescents from families with a high SES visit paediatric, dermatological, dental and orthodontic practices more often. No statistically significant differences between the status groups with regard to the utilization of outpatient medical services in hospitals were identified. However, children and adolescents from the low status group received inpatient hospital treatment more frequently and, on average, spent more nights in hospital. These results reflect status-specific differences both in disease prevalence and care, as well as in patterns related to the utilization of medical services.

Social inequalities in health of children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study

The close link between socioeconomic status (SES) and health can already be observed in childhood and adolescence. Although the vast majority of children and adolescents grow up healthily in Germany, social inequalities in health exist. The results of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2) demonstrate that children and adolescents with a low SES have a poorer level of general health and face health constraints more frequently than their peers with a higher SES. Social inequalities in mental health are significantly more profound than in the 12-month prevalence of bronchial asthma and allergic rhinitis. The odds of being affected by mental health problems or attention-deficit/hyperactivity disorder (ADHD) were 2.8 to 4.4 times higher for children and adolescents with a low SES compared to their peers with a high SES. Therefore, in order to enable all children and adolescents to grow up healthily, health promotion and disease prevention measures need to be put in place early in a child's life and need to be tailored to the needs of particular target groups.

Accident injuries of children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

For children and adolescents, accidents represent an important health risk. Despite decreasing mortality rates, accidental (unintended) injuries remain the most common cause of death for children over the age of one in Germany. Accident injuries can cause considerable and lasting damage on health and development. The possible major implications as well as the potential to prevent accident injuries underline the importance of accident prevention. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) collects data on unintentional child injuries at regular intervals. Results of the second follow-up survey (KiGGS Wave 2, 2014-2017) show that during the past twelve months 16.5% of children and adolescents aged between 1 and 17 received medical treatment following an accident. Boys suffer injuries from accidents significantly more often than girls (18.6% vs. 14.3%). While the prevalences for older children and adolescents tend to be higher, age generally has little impact on accident rates. Compared to the two previous waves of KiGGS, the prevalences of accident injuries have remained stable.

Mental health problems in children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Mental health problems in children and adolescents are associated with individual and family-related constraints as well as social costs. 20.0% of children and adolescents showed mental health problems at the KiGGS baseline study (2003-2006). This study investigates the current prevalence for KiGGS Wave 2 (2014-2017) as well as time trends in comparison with the KiGGS baseline study. Mental health problems were assessed for 3- to 17-year-old children and adolescents by using the parent-based version of the Strengths and Difficulties Questionnaire (SDQ). For KiGGS Wave 2, the prevalence of mental health problems was 16.9%. A decreasing trend is pronounced particularly among boys between 9 and 17 years of age. Mental health problems are displayed more frequently by girls and boys from families with a low socioeconomic status compared to their peers from families with a medium or high socioeconomic status. These findings are discussed in the light of various measures and actions in health promotion and health care.

ADHD in children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood and adolescence and is associated with functional, psychosocial and cognitive impairment. As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (2014-2017), parents of children and adolescents aged between 3 and 17 years reported whether their child was diagnosed with ADHD by a physician or psychologist. Overall, 4.4% of children and adolescents have been diagnosed with ADHD in Germany. In comparison, the KiGGS baseline study (2003-2006) showed a reduction of lifetime ADHD diagnoses of almost one percentage point over a period of ten years. The reduction of parent-reported ADHD diagnoses primarily occurred among 3- to 8-year old children and boys. The results are discussed in terms of health promotion and the introduction of health care measures.

Tobacco and alcohol use among 11- to 17-year-olds in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Tobacco and alcohol use are among the leading preventable risk factors associated with premature mortality and a variety of diseases that have long-term effects. Although tobacco and alcohol use among adults is widespread in Germany, there is a trend towards lower levels of consumption. The foundations for health-related behaviour in adulthood are set at an early age: young people who use alcohol and tobacco also tend to do so regularly when they reach adulthood. With this in mind, health policies should focus on preventing young people from smoking, and encouraging them to adopt a responsible, low-risk approach to alcohol. This article analyses patterns of tobacco and alcohol use among children and adolescents (aged between 11 and 17 years). It describes the prevalences of tobacco and alcohol use, as well as trends and correlates. The data used in this article was sourced from the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2). The survey's results show that 7.2% of 11- to 17-year-old children and adolescents smoke at least occasionally, with 3.7% doing so daily. The survey also demonstrates that a good half (51.0%) of 11- to 17-year-olds have ever drunk alcohol; at-risk drinking was prevalent among 12.1%, and heavy episodic drinking among 7.0%. The consumption of tobacco and alcohol increases considerably with age. Patterns of at-risk drinking and heavy episodic drinking show gender-associated differences: While more girls than boys practice at-risk drinking, more boys than girls practice heavy episodic drinking. Nevertheless, the KiGGS survey waves demonstrate a highly significant trend towards a decline in tobacco use (KiGGS baseline study 21.4%, KiGGS Wave 1 12.4%). The proportion of 11- to 17-year-olds who have ever drunk alcohol is also declining (KiGGS baseline study 63.9%, KiGGS Wave 1 55.6%). The proportions of at-risk drinking (KiGGS Wave 1 16.5%) and heavy episodic drinking (KiGGS Wave 1 12.0%) decreased as well. The results presented here are in line with findings from other studies that have surveyed adolescent tobacco and alcohol use in Germany, and they underscore the success of preventive measures.

Sports and dietary behaviour among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

This article focuses on selected indicators related to sports and dietary behaviour - two important factors that influence the development of obesity. The analyses are based on data collected for the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), which was conducted between 2014 and 2017. These data were collected, using a questionnaire, from 6,810 girls and 6,758 boys aged between 3 and 17. The analyses also compare the data collected for wave 2 with those from the KiGGS baseline study (2003-2006). More than 70% of 3- to 17-year-olds state that they participated in sports. However, boys do so significantly more often than girls, and 11- to 17-year-olds do so more frequently than 3- to 10-year-olds. In addition, there is a correlation between children's and adolescents' sports participation and those of their parents, and with an activity-friendly living environment. Younger children and girls have healthier diets than older children and boys. However, although the consumption of confectionery and sugary drinks by 3- to 17-year-olds has declined significantly since the KiGGS baseline study was conducted, 11- to 17-year-olds, in particular, eat significantly smaller amounts of vegetables than they did about ten years ago. Significantly more 3- to 10-year-olds currently eat at least five servings of fruit and vegetables per day than ten years ago, although the proportion of the children who reach this recommendation continues to remain very low at 14% overall. It is important to set an example by following a healthy lifestyle within families and other settings in early life. Furthermore, the living environments also need to be made more health-oriented to support children and adolescents in reaching the national recommendations on physical activity and healthy eating.

Socioeconomic differences in the health behaviour of children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study

Childhood and adolescence are key determining stages for health behaviour in the life course. Frequently, health-related attitudes and patterns of behaviour that develop at young age are also maintained at adult age. As studies show, already during childhood and adolescence, patterns of health risk behaviour are more common in certain population groups. KiGGS Wave 2 results confirm that 3- to 17-year-old children and adolescents from families with low socioeconomic status (SES) eat a less healthy diet, do fewer sports and are more often overweight or obese than their peers from more affluent backgrounds. Whereas socioeconomic differences appear to have little effect on levels of alcohol consumption among 11- to 17 year-olds, girls and boys with low SES smoke more frequently than their peers with high SES. Prevention and health promotion encourage children and adolescents to adopt healthy lifestyles, and aim to drive structural changes to stimulate behaviour which promotes good health. Combining measures that target individual behaviour and a settings-based approach appears to be the most promising preventative approach to reduce health inequalities among young people. Due to the clear impacts of socioeconomic differences on health behaviour already at young age measures for disadvantaged children and adolescents and their living conditions should be given an even stronger focus in the future.

Smoking behaviour among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Smoking behaviour during adolescence is particularly important because the pattern of a person's tobacco consumption in later life usually is established in this period. According to recent data from KiGGS Wave 2, 7.4% of 11 to 17 year-old girls and 7.0% of boys of the same age smoke at least occasionally. The proportion of children and adolescents who smoke increases with age. Adolescents with high socioeconomic status smoke less frequently than their peers with medium or low socioeconomic status. Since the beginning of the first KiGGS study (2003-2006), the proportion of 11 to 17 year-olds who smoke fell from 21.4% to 12.4% (2009-2012) and has recently dropped to 7.2% (2014-2017). Despite considerable progress, however, there is still potential to improve tobacco prevention policy in Germany for example using taxation and advertising bans.

Smoking during pregnancy. Results of the cross-sectional KiGGS Wave 2 study and trends

Maternal smoking during pregnancy poses a significant risk to the development of unborn children. Data from KiGGS Wave 2 shows that 10.9% of mothers of 0 to 6 year-old children smoked during pregnancy. Mothers who were under 25 when giving birth smoked about two to three times more often than older mothers. Furthermore, there is a distinct social gradient in maternal smoking: a higher socioeconomic status is associated with a lower proportion of children with a mother who smoked during pregnancy. A comparison with data from the KiGGS baseline study shows that the proportion of mothers who smoked during pregnancy fell from to 19.9% to 10.9% between the two study periods. Thus, the KiGGS results are in line with those from the perinatal survey, which also found that the proportion of pregnant women who smoke has declined significantly since the mid-1990s.

Improving the inclusion and participation of children and adolescents with a migration background in KiGGS Wave 2

In the context of health monitoring at the Robert Koch Institute, the baseline study of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) surveyed a sample of children and adolescents with a migration background according to their share within the general population through extensive measures. Owing to less comprehensive efforts, this was not accomplished in the follow-up KiGGS Wave 1 study. For KiGGS Wave 2, the objective therefore was, through targeted measures, to increase the willingness of children and adolescents with a migration background to participate in the survey. This article describes the approaches to include children and adolescents with a migration background, the operationalisation of migration-specific variables and the effectiveness of field visits prior to the actual survey as a tool to increase the willingness of these groups to participate in the survey. Furthermore, data on participation and the sample of children and adolescents with a migration background in the cross-sectional KiGGS Wave 2 study is presented. Overall, 2,994 children with a migration background aged 0 to 17 years took part in KiGGS Wave 2. In the weighted sample this corresponds to 11.8% (n=1,436) with a one-sided and 17.0% (n=1,558) with a two-sided migration background. In sum, the share of children and adolescents surveyed with a migration background (28.8%) is almost that of their share in Microcensus 2013 (31.2%). Compared to children and adolescents without a migration background, barely any differences exist in age and gender distribution, while differences are seen regarding social status; children with a two-sided migration background are significantly more often found in the low social status group. In the sample, the most often represented countries of origin were the countries of Central and South Europe, of the former Soviet Union and Turkey. Regarding the length of time parents had lived in Germany, around 40.1% of migrant families have been living in the country for over 20 years, whereas nearly one in five families has been in Germany for less than five years. A total of 12.2% of children and adolescents with a migration background migrated themselves. By implementing a comprehensive set of measures, the degree after weighting to which children and adolescents with a migration background were included in KiGGS Wave 2 is nearly commensurate to their share in the overall population.

Socioeconomic status and subjective social status measurement in KiGGS Wave 2

This article describes the method applied to measure socioeconomic status (SES) and subjective social status (SSS) in the current wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), which was conducted over three years between 2014 and 2017. The composite multidimensional SES index was calculated as a sum of point scores for the parents' education level, occupational status and equivalised disposable income. SSS was assessed in the 11 to 17 year age group using a German version of the MacArthur Scale for children and adolescents. To demonstrate the use of both instruments, we present examples that highlight the association between SES and SSS with the general health of children and adolescents in the 3 to 17 and/or 11 to 17 age groups. Over 95% of parents rated the general health of their children as 'very good' or 'good'. However, the analyses clearly reveal that children and adolescents from families with low SES and SSS have poorer general health than their better-off peers. Even when mutually adjusted, both low SES and SSS are independently associated with poorer general health. In addition to the SES index, studies on the health of children and adolescents should therefore also consider SSS. In this way, additional aspects of the socioeconomic conditions of families can be taken into account.

Physical activity among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Self-reported data from wave 2 of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) provides the basis for assessing whether the levels of physical activity of children and adolescents in Germany meet the levels recommended by the World Health Organization (WHO). Merely 22.4% of girls and 29.4% of boys in the 3-17 age group are physically active for at least 60 minutes per day and therefore meet the WHO recommendations. Prevalence of recommended levels of physical activity decreases continuously with age, both for girls and boys. In KiGGS Wave 2, girls in the 3-10 age group met the levels of physical activity recommended by the World Health Organization significantly less often than in KiGGS Wave 1. Low levels of physical activity were highest amongst adolescent age girls, as well as among boys and girls of low socioeconomic status. The results indicate a great potential to promote physical activity.

Consumption of sugary soft drinks among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Consuming large amounts of sugary beverages has been related to developing obesity, diabetes mellitus type II and other chronic diseases. KiGGS Wave 2 (2014-2017) provides data on the consumption of sugary soft drinks in the 3-17 year age group in Germany. Overall, 13.7% of girls and 17.6% of boys consume one to three times a day sugary soft drinks and 3.3% of girls and 4.7% of boys four or more times. Consumption frequency increases with age and is higher among children and adolescents with low socioeconomic status (SES) than for those of the same age with high SES. The share of adolescents who drink sugary soft drinks daily has decreased since the KiGGS baseline study (2003-2006).

KiGGS Wave 2 cross-sectional study - participant acquisition, response rates and representativeness

For the third time, wave 2 of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is conducted in the context of health monitoring at the Robert Koch Institute, now provides representative cross-sectional data for Germany. Completed in 2017, data for the cross-sectional component of KiGGS Wave 2 was collected in the form of an interview and examination survey. Interview survey data was collected from 15,023 participants, meaning that the required number of participants has been reached. A randomly selected subgroup of 3,567 participants was also examined. The overall response rate was 40.1%. Differences in response rates were registered regarding certain sociodemographic characteristics. Weighting was applied to compensate for differences in willingness to participate related to age, gender, geographic region, nationality and education factors. Weighting ensures that assessments of the health of children and adolescents in Germany are representative for the population. The data serves to estimate prevalence rates and, through comparison with the results from previous survey waves, to analyse trends. A set of measures were taken to recruit a sufficiently large group of participants and ensure that the net sample reflects the composition of the overall population to the highest degree. For future surveys, further measures ought to be taken in order to improve the integration of hard-to-reach subgroups.

Overweight and obesity among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

For some time, there have been indications that the prevalence of overweight and obesity among children and adolescents in Germany has stabilised at a high level. The second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) once again provides nationwide measurements on height and weight of children and adolescents aged 3 to 17 years. The results are confirming this trend. The prevalence of overweight is 15.4% and 5.9% for obesity. There are no differences between girls and boys. Overweight and obesity prevalence increases with age. Children and adolescents with low socioeconomic status (SES) are more likely to be overweight and obese than those with high SES. Compared to the KiGGS baseline study (2003-2006), there was no further increase in overweight and obesity prevalence overall and in all age groups.

Motorik-Module (MoMo) - the KiGGS Wave 2 module to survey motor performance and physical activity

Initially, the Motorik-Module (MoMo) Longitudinal Study was surveyed between 2003 and 2006 using a sub-sample from the baseline German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The federal representative sub-sample of KiGGS consisted of 4,528 children and adolescents aged 4 to 17. To date, there have been two further survey waves: 2009-2012 (Wave 1) and 2015-2017 (Wave 2). MoMo Wave 2 consists of motor performance tests, anthropometric measurements, questionnaire-based information collection on activity habits and motion sensor data. Initial results of MoMo Wave 2 will be published in the second half of 2018. The total size of the Wave 2 sample is estimated to reach 5,200 participants. As its central goal, the MoMo longitudinal survey aims to contribute towards the long-term improvement of child and adolescent health in Germany. A focus will be on developmental (age-related) and periodic (over time) trends in motor performance and physical activity, underlying factors and the impacts on physical and mental health in the development of children and adolescents.

New data for action. Data collection for KiGGS Wave 2 has been completed

The fieldwork of the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was completed in August 2017. KiGGS is part of the Robert Koch Institute's Federal Health Monitoring. The study consists of the KiGGS cross-sectional component (a nationally representative, periodic cross-sectional survey of children and adolescents aged between 0 and 17) and the KiGGS cohort (the follow-up into adulthood of participants who took part in the KiGGS baseline study). KiGGS collects data on health status, health-related behaviour, psychosocial risk and protective factors, health care and the living conditions of children and adolescents in Germany. The first interview and examination survey (the KiGGS baseline study; undertaken between 2003 and 2006; n=17,641; age range: 0-17) was carried out in a total of 167 sample points in Germany. Physical examinations, laboratory analyses of blood and urine samples and various physical tests were conducted with the participants and, in addition, all parents and participants aged 11 or above were interviewed. The first follow-up was conducted via telephone-based interviews (KiGGS Wave 1 2009-2012; n=11,992; age range: 6-24) and an additional sample was included (n=4,455; age range: 0-6). KiGGS Wave 2 (2014-2017) was conducted as an interview and examination survey and consisted of a new, nationwide, representative cross-sectional sample of 0- to 17-year-old children and adolescents in Germany, and the second KiGGS cohort follow-up. The completion of the cross-sectional component of KiGGS Wave 2 means that the health of children and adolescents in Germany can now be assessed using representative data gained from three study waves. Trends can therefore be analysed over a period stretching to over ten years now. As the data collected from participants of the KiGGS cohort can be individually linked across the various surveys, in-depth analyses can be conducted for a period ranging from childhood to young adulthood and developmental processes associated with physical and mental health and the associated risk and protective factors can be explored. As such, KiGGS Wave 2 expands the resources available to health reporting, as well as policy planning and research, with regard to assessing the health of children and adolescents in Germany.

EsKiMo II - the Eating study as a KiGGS Module in KiGGS Wave 2

Nutrition plays an important role for health, in particular of children and adolescents. In addition to the baseline German Health Interview and Examination Survey for Children and Adolescents (KiGGS, 2003-2006), the nutrition survey EsKiMo (Eating study as a KiGGS Module) assessed the dietary habits of children and adolescents aged 6 to 17 in detail. In KiGGS Wave 2 (2014-2017) the corresponding module is EsKiMo II. Between June 2015 and September 2017, specially trained nutritionists will visit EsKiMo II participants at their homes. The parents of 6-to 11-year-olds are instructed on how to complete food records on four randomly chosen days - three consecutive days, followed later by an additional day. Participants aged 12 to 17 are interviewed personally on their food intake during the past four weeks with the dietary interview programme DISHES. Further information, for example, regarding dietary supplements is also recorded. EsKiMo II will provide an up-to-date and representative overview of the current nutrition status of 6-to 17-year-olds living in Germany, and it allows analysing changes in dietary behaviour over time. EsKiMo II can identify shortcomings in the nutrition of children and adolescents and thus may contribute with important information to nutrition and health policy.

KiESEL - the children's nutrition survey module in KiGGS Wave 2

Representative food consumption data for children are collected in KiESEL, the German nutrition survey for children aged 6 months up to five years conducted by the German Federal Institute for Risk Assessment (BfR). The data gained will update the consumption data for German children and will fill a data gap that existed for the age group of 5-year-old children. It will provide an actual and comprehensive data basis that will be used for exposure assessment, as part of risk assessment of Germany's youngest consumers. In the years 2014 to 2017, around 1,000 children will participate in the context of the KiESEL module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). During home visits, survey staff conducts a questionnaire-based interview, measures the children's height and weight and explains the weighing records for the family and the child care workers. The data will be used for risk assessments of the BfR and provided to national and international partners such as the World Health Organization. This article describes the background and objectives of the study as well as its methodology and survey instruments.

The BELLA study - the mental health module of KIGGS Wave 2

The BELLA study is the module on mental health and health-related quality of life within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Baseline data collection took place together with KiGGS baseline data collection between 2003 and 2006. This article discusses the fourth follow-up of the BELLA study (BELLA Wave 4), which was surveyed between 2014 and 2017. The aims of the BELLA Wave 4 are to enable longitudinal analyses of health-related quality of life and mental health problems. Dynamic measurement instruments were used to enable a user-friendly and precise assessment of mental health among children, adolescents and young adults. The study's participants were a sub-sample of around 3,500 KiGGS respondents aged 7 to 29 years. For the first time, in BELLA Wave 4 data were collected exclusively online. The BELLA study targeted both the parents of younger children (aged 7 to 13 years) and adolescents and young adults themselves (aged 11 years and above). Study instruments surveying mental health problems and the use of mental health care services were supplemented by a dynamic measurement tool in the form of a computer adaptive test (CAT) to record data on health-related quality of life.