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BackgroundUltraviolet (UV) exposure during outdoor work increases the risk of developing skin cancer. Therefore, the uptake of recommended sun protection behaviors is important to prevent UV-related skin damage in the population of outdoor workers. To develop targeted prevention campaigns, information on the use of sun protection behaviors in different industries is needed.MethodsA total of 486 outdoor workers were surveyed on the use of several sun protection measures as part of the 7th wave of the National Cancer Aid Monitoring. Furthermore, details on job-related characteristics, sociodemographics, and skin type were assessed. Descriptive analyses stratified by sex were conducted.ResultsIn general, use of sun protection was insufficient (e.g. 38.4% used sunscreen on the face). Sun protection behavior differed between female and male outdoor workers with females being more likely to use sunscreen and males being more likely to wear sun protective clothes and headgear. For male outdoor workers, we revealed several associations with job-related characteristics. For instance, those who were employed full time were more likely to wear sun protective clothes (e.g. shoulder-covering shirt: 87.1% versus 50.0%, P < 0.001).DiscussionWe identified deficits in sun protection behavior in outdoor workers and differences by sex- and job-related characteristics. These differences offer starting points for targeted prevention measures. In addition, the findings may inspire qualitative research.

Several studies have shown that loneliness is prevalent in university students. However, up to now, it is less clear how transitions during this life stage are associated with loneliness. Therefore, we aimed to explore the association of loneliness with the transition from high school to university and the transition into the COVID-19 pandemic. Twenty students were interviewed in qualitative interviews based on a semi-structured guide that also included biographical mapping. In addition, the participants reported social and emotional loneliness based on the six-item De Jong Gierveld Loneliness Scale for three points in time: (1) at the time of the interview, (2) at the beginning of their studies at the university and (3) at the start of the COVID-19 pandemic. The qualitative data were analyzed using a structuring content analysis following Mayring. The quantitative data were analyzed using descriptive statistics. We found that emotional loneliness increased both during high school graduation and at the start of study at the university, as well as at the beginning of the COVID-19 pandemic. Social loneliness was higher during university studies than during the last years at high school and increased at the beginning of the pandemic. The results indicate that both transitions played an important role for perceived social and emotional loneliness. Further quantitative studies in larger samples will be relevant in the future to better target the responses to loneliness during transitions. Universities can actively counteract loneliness, especially during the transition from high school to university, by organizing events and meeting places where new students can network.

IntroductionHealth inequalities start early in life. The time of young adulthood, between late teens and early twenties, is especially interesting in this regard. This time of emerging adulthood, the transition from being a child to becoming an adult, is characterized by the detachment from parents and establishing of an own independent life. From a health inequality perspective, the question about the importance of the socio-economic background of parents is important. University students are an especially interesting group. Many students come from a privileged background and the question of health inequality among university students has not yet been properly studied.MethodsBased on the National Educational Panel Study (NEPS), we analyzed health inequalities among 9,000 students in Germany (∅ 20 years in the first year of their studies) over a period of 8 years.ResultsWe found that most university students (92%) in Germany reported a good and very good health. Yet, we still found substantial health inequalities. Students whose parents had a higher occupational status reported less health problems. Additionally, we observed that health inequalities had indirect impact on health via health behavior, psychosocial resources, and material conditions.DiscussionWe believe our study is an important contribution to the understudied subject of students' health. We see the impact of social inequality on health among such a privileged group like university students as an important sign of the importance of health inequality.

Distress is a widespread phenomenon in the general population, but also among university students, associated with poorer learning success and negative health consequences. A source of distress might be the experience of injustice. Theoretical and empirical work in the area of perceived fairness in the workplace (“organizational justice”) has shown that perceived unfairness is related to various stress indicators and health outcomes. Preliminary evidence indicates that unfairness matters not only in the work context but also in the university context. However, an adapted and validated tool to assess perceived unfairness in the university context is hitherto missing. The goal of the proposed project is therefore to adapt the construct of organizational justice to the university context and to develop a corresponding questionnaire by means of established scientific procedures. An exploratory sequential mixed-methods design is applied in which qualitative and quantitative methods are combined. A valid and practicable measurement instrument (“UFair” University Fairness Questionnaire) will be developed and tested, and the relationship with various health outcomes will be examined. The UFair questionnaire will be made available free of charge to other researchers.

Background At the end of secondary education, young people can either start vocational training, enter university, directly transition to employment or become unemployed. Research assumes that post-secondary pathways have immediate and/or long-term impacts on health and well-being, but empirical investigations on this are scarce and restricted to few countries. Therefore, this study traced the development of health and well-being throughout the highly institutionalised school-to-work transition (STWT) in Germany. Methods We used longitudinal data of the National Educational Panel Study (NEPS), a representative sample of 11,098 school-leavers (50.5% girls) repeatedly interviewed between 2011 and 2020. We estimated the effect of post-secondary transitions on self-rated health and subjective well-being by applying fixed-effects (FE) regression, eliminating bias resulting from time-constant confounding and self-selection into different pathways. A multiple-sample strategy was used to account for the increasing diversity of STWTs patterns. Models were controlled for age, as well as household and residential changes to minimise temporal heterogeneity. Results Findings indicate that leaving school was good for health and well-being. Compared with participants who did not find a training position after school, direct transitions to vocational training or university were linked to higher absolute levels of health and well-being, but also to a lower relative decline over time. Furthermore, upward transitions (e.g. to programs leading to better education or from unemployment to employment) were associated with improvements in health and well-being, while downward transitions were followed by deteriorations. Conclusion Findings suggest that school-leave is a sensitive period and that post-secondary pathways provide young people with different abilities to maintain health and well-being. Youth health interventions might benefit when setting a stronger focus on unsuccessful school-leavers.

Zusammenfassung Ziel der Studie Studierende sind in den letzten Jahren immer mehr in den Fokus von Prävention und gesundheitswissenschaftlicher Forschung gerückt. Allerdings werden sie meist als homogene Gruppe wahrgenommen. Ziel des vorliegenden Beitrags war es, zu prüfen, ob in der Gruppe Studierender gesundheitliche Ungleichheit existiert. Methodik Zur Beantwortung der Frage wurde ein bundesweiter Studierendensurvey, die sogenannte NuPhA-Studie, herangezogen (n=689, 69,5% weiblich, Altersdurchschnitt: 22,69 Jahre). Ergebnisse und Schlussfolgerung Tatsächlich zeigten sich Zusammenhänge zwischen sozioökonomischen Indikatoren und Gesundheit sowie Gesundheitsverhalten. Beispielsweise war die Studienfinanzierung über ein Stipendium mit einer besseren allgemeinen, psychischen und physischen Gesundheit verbunden. Insbesondere der subjektive Sozialstatus war positiv mit einer besseren allgemeinen, psychischen und körperlichen Gesundheit sowie einer höheren Sportaktivität verknüpft. Die Ergebnisse sprechen für ein Vorliegen von gesundheitlicher Ungleichheit in der zunächst homogen erscheinenden Gruppe Studierender. Dies unterstreicht die Notwendigkeit einer differenzierten Betrachtung der Gruppe Studierender und die Wichtigkeit, gesundheitliche Ungleichheit unter Studierenden tiefergehend zu untersuchen, zu erklären und schließlich zu reduzieren.

Studienergebnisse weisen darauf hin, dass Menschen mit einer eingeschrankten Gesundheitskompetenz (GK) ein erhohtes Risiko fur einen schlechten Gesundheitszustand und ein ungunstiges Gesundheitsverhalten aufweisen. Wahrend der Fokus innerhalb der Forschung zur GK bislang auf der erwachsenen Allgemeinbevolkerung lag, wurde die Gruppe der Studierenden wenig berucksichtigt. Vor dem Hintergrund der besonderen Lebenslage von Studierenden erscheint eine gezielte Betrachtung der GK im Zusammenspiel mit Gesundheitsindikatoren bei dieser Zielgruppe relevant. Das Ziel dieser Arbeit ist die Uberprufung der Assoziation zwischen der GK und dem Gesundheitszustand sowie dem -verhalten bei Studierenden. Die Datenbasis stellt eine Onlinebefragung mit 996 Studierenden der Technischen Universitat Dortmund dar. Zur Erfassung der GK wurde der HLS-EU-Q16 genutzt. Als Indikatoren fur den Gesundheitsstatus fungierten der subjektive Gesundheitszustand, die allgemeine Lebenszufriedenheit sowie die psychosomatische Beschwerdelast. Das Gesundheitsverhalten wurde mittels des Ernahrungs- und Bewegungsverhaltens sowie des Tabak- und Alkoholkonsums operationalisiert. Zur Uberprufung der Assoziationen zwischen der GK und dem Gesundheitszustand sowie dem -verhalten wurden uni-, bi- und multivariate Analysen durchgefuhrt. Knapp 60 % der Studierenden gaben eine eingeschrankte GK an. Studierende mit eingeschrankter GK wiesen ein rund 2‑fach erhohtes Risiko fur einen geringen subjektiven Gesundheitszustand, eine geringe allgemeine Lebenszufriedenheit, eine hohe psychosomatische Beschwerdelast, ein ungesundes Ernahrungsverhalten und einen regelmasigen Tabakkonsum auf. Es zeigten sich keine Assoziationen zwischen der GK und dem Bewegungsverhalten sowie dem Alkoholkonsum. Studierende stellen in Bezug auf den Gesundheitsstatus und die GK eine vulnerable Bevolkerungsgruppe dar und sollten in die zukunftige Forschung zur GK sowie in die Gesundheitsberichterstattung starker einbezogen werden. Assoziationen zwischen der GK und dem Gesundheitsstatus sowie einzelnen Indikatoren des Gesundheitsverhaltens sprechen dafur, die GK in der Gesundheitsforschung sowie der Pravention und Gesundheitsforderung zu berucksichtigen. Zudem sollten die Rahmenbedingungen im Hochschulsetting die Gesundheit und das gesundheitsforderliche Verhalten der Studierenden ermoglichen und fordern.

Sunscreen use is an important aspect of sun protective behavior. Previous studies revealed deficits in sunscreen use. Our aim was to quantify sunscreen use in a nationwide representative study in Germany as well as to develop and test an item battery on reasons for none use of sunscreen. We analyzed data of the National Cancer Aid Monitoring (NCAM; wave 4; n = 3000, aged 14–45). To describe those who only use sunscreen rarely or never, we used chi2 statistics and logistic regression analysis. In addition, we utilized a newly developed item battery on barriers to sunscreen use. Here, we used Cronbach’s alpha to investigate reliability. In total, 20.7% reported using sunscreen rarely or never. Infrequent or none use of sunscreen was associated with male sex, immigrant background, none or rare sunbathing in summer, and current or past use of sunbeds. Participants with higher skin cancer risk (e.g., pale skin) were less likely to use sunscreen infrequently or never. The major reasons for not using sunscreen were inconvenience and no perceived need for applying sunscreen. Overall, internal consistency of the item battery on potential barriers to sunscreen use was very good (Cronbach’s alpha = 0.865). We found deficits in sunscreen use especially in sunbed users, men, and individuals with immigrant background. Our results give important implications for future prevention and health promotion campaigns on sunscreen use.

Background The number of obese children is rising worldwide. Many studies have investigated single determinants of children’s body mass index (BMI), yet studies measuring determinants at different potential levels of influence are sparse. The aim of this study is to investigate the independent role of parental socioeconomic position (SEP), additional family factors at the micro level, as well as early childhood education and care (ECEC) centre characteristics at the meso level regarding BMI. Methods Analyses used the baseline data of the PReschool INtervention Study (PRINS) including up to 1,151 children from 53 ECEC centres. Multi-level models first estimated the associations of parental SEP indicators (parental school education, vocational training, and household income) with the children’s standard deviation scores for BMI (SDS BMI, standardised for age and gender). Second, structural (number of siblings), psychosocial (strained family relationships), and nutrition behavioural (soft-drink consumption, frequency of fast-food restaurant visits) family factors at the micro level were included. Third, characteristics of the ECEC centre at the meso level in terms of average group size, the ratio of overweight children in the group, ECEC centre type (all-day care), and the location of the ECEC centre (rural vs urban) were included. All analyses were stratified by gender and adjusted for age, migration background, and parental employment status. Results Estimates for boys and girls appeared to differ. In the full model, for boys the parental SEP indicators were not related to SDS BMI. Factors related to SDS BMI in boys were: two or more siblings; B = -.55; p = 0.045 [ref.: no sibling]), the characteristics of the ECEC centre in terms of average group size (20 – 25 children; B = -.54; p = 0.022 [ref.: p p = 0.027 [ref.: no sibling]) and average group size (> 25 children; B = -.52; p = 0.037 [ref.: Conclusions The BMI of preschool children appears to be associated with determinants at the micro and meso level, however with some gender differences. The identified factors at the micro and meso level appear largely modifiable and can inform about possible interventions to reduce obesity in preschool children.

Outdoor and indoor tanning are considered as risk factors for the development of skin cancer. The aims of this nationwide representative study were to quantify both behaviors in a sample with a wide age range, to identify those showing both behaviors and to explore and compare determinants of both behaviors. We used data from the fifth wave (2019) of the National Cancer Aid Monitoring (NCAM). We surveyed the representative sample including 4000 individuals, aged 16–65 years, living in Germany. Data were collected through telephone interviews. In addition to descriptive statistics, we used logistic regression analyses to identify determinants. The one-year-prevalence of tanning bed use was 7.5%, while 31.9% tanned (very) often intentionally outdoors in at least one situation (weekdays, holidays, and weekends). A total of 3.2% reported both risk behaviors. Regression analyses revealed that tanning bed use is associated with employment, an increased number of naevi, and lack of risk awareness. Intentional outdoor tanning was associated with male sex, younger age, past tobacco use, and low risk awareness of UV radiation. Our findings suggest that only a minority of subjects showed both risk behaviors. This implies that individuals seem to perform either one behavior or the other. In addition, the associated determinants differed between both behaviors, implying that specific preventive measures tailored to address to each tanning behavior are needed.

Zusammenfassung Adipogene Umwelten, engl. Obesogenic Environments, bezeichnen die Gesamtheit aller Umgebungseinflüsse auf die Entstehung von Übergewicht. Auf Mikroebene sind dies lokale Umwelten (sog. Settings) wie Kindergärten, Schulen, das Wohnumfeld und die eigene Familie, auf Makroebene Sektoren wie etwa Bildungs- und Gesundheitssystem, Industrie, Massenmedien und Politik. Sowohl Settings als auch Sektoren weisen physische, ökonomische, politische und soziokulturelle Aspekte mit adipogener Wirkung auf.

Characteristics of early childhood education and care (ECEC) centers might be relevant for children’s health. This scoping review aims to provide an overview of the association between meso-level characteristics (MLCs) of ECEC centers with children’s health, health behavior, and wellbeing. Five databases were searched for quantitative and qualitative research articles published in English or German since 1 January 2000 on health, health behavior, and wellbeing of children aged 0 to 6 years considering MLCs of ECEC centers. Two authors screened 10,396 potentially eligible manuscripts and identified 117 papers, including 3077 examinations of the association between MLCs and children’s health indicators (Kappas > 0.91). Five categories of MLCs were identified: (1) structural characteristics, (2) equipment/furnishings, (3) location, (4) facilities/environment, (5) culture/activities/policies/practices, and 6) staff. Only very few studies found an association of MLCs with body weight/obesity, and general health and wellbeing. Especially physical activity and mental health were related to MLCs. In general, the location (rural vs. urban, neighborhood status) seemed to be a relevant health aspect. MLCs of ECEC centers appeared relevant for child health indicators to different degrees. Future research should focus on these associations, in detail, to identify concrete ECEC indicators that can support health promotion in early childhood.

Pharmacists and pharmaceutical technicians play an important role in counselling customers regarding sunscreen use and sun protection measures. A potentially helpful tool that can be used during counselling is the ultraviolet index (UVI), which informs individuals when and what sun protection measures are needed at a specific place and time. Our aim in this qualitative study was to explore awareness, knowledge, and use of the UVI during counselling in pharmacies. We used semi-structured interviews with pharmacists and pharmaceutical technicians (n = 20) to answer our research questions. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. During the interviews pharmacists and pharmaceutical technicians revealed a lot of uncertainty and lack of knowledge regarding the UVI. Eight professionals were able to give a correct definition of UVI. Amongst others, the UVI was confused with sun protection factor. Overall, the UVI was hardly used during the counselling of customers. The UVI was developed to provide guidance when which type of sun protection is required to avoid detrimental effects of ultraviolet radiation. For effective implementation, both the general population and health professionals (e.g., pharmacists) have to increase their knowledge about the UVI. This would strengthen its use during professional counselling in pharmacies and may help to reduce the incidence of skin cancer over the long term.

Background School-to-work transition is a sensitive period that can have a substantial impact on health over the life course. Previous studies suggest pronounced health inequalities during this period but little is known about the determinants at the individual, meso- and macro-levels. We aim to further elucidate possible health inequalities during school-to-work transitions with a focus on multilevel determinants, e.g. evidence on potential effects of contextual and compositional factors of specific institutions involved. Methods We are currently conducting a scoping review (funded by the German Research Foundation) to map the evidence on the above mentioned topic among young adults (aged 16-24 years), following the methodological framework proposed by Arksey and ÓMalley and PRISMA. The literature search was performed in Ovid MEDLINE, Web of Science, ILO and NIOSH, using sensitive search strategy developed by text-analysis. Only articles published between January 2000 - February 2020 and written in English or German are considered. The selection process is conducted following a two-step approach:1) screening of titles and abstracts 2) screening of full-texts by two independent reviewers. Any discrepancies in the selection process are resolved by a third researcher. Preliminary Results Following the five stages of the methodological framework, the scoping review is currently in stage 3 (study selection-screening phase). We found 25,069 potentially relevant articles in our primary search. 15,508 articles remained after the duplicates were removed. Up to now, 8,825 papers were screened of which 7,629 were excluded and 1,176 included which qualified for full-text reading. Complete results of the scoping review will be presented at the conference. Conclusions This scoping review will improve our knowledge about the emergence and development of health inequalities during school-to-work transitions by examining health of individuals in different institutional contexts. Key messages Improving our knowledge of health inequalities during school-to-work transitions. the role of determinants at the individual, meso- and macro-levels during this stage will also be examined.

Indoor tanning is an important risk factor for the development of melanoma and non-melanoma skin cancer. With our nationally representative monitoring, we aimed at describing tanning bed use, user characteristics, reasons for use, and risk awareness over time. In the framework of the National Cancer Aid Monitoring (NCAM), we collected representative data on 12,000 individuals aged 14 to 45 years in annual waves of n = 3,000 participants in Germany between 2015 and 2018. We used descriptive statistics and chi&sup2, tests to uncover group differences. To compare data from the different waves, we calculated confidence intervals. The use of tanning beds decreased from 2015 (11.0%, 95%-CI: 9.9%&ndash, 12.1%) to 2018 (8.8%, 95%-CI: 7.8%&ndash, 9.8%). However, this decrease did not affect all subgroups. For instance, there was an (non-significant) increase in minors and the prevalence remained stable for individuals with immigrant background and males. Attractiveness was an important reason for tanning bed use in each wave. Over time, there was an increase in medical-related reasons for use. Furthermore, monitoring showed a decrease in risk awareness regarding tanning bed use and ultraviolet (UV) radiation. While it is a positive development that the overall use of tanning beds in Germany has decreased over time, the increasing use by minors despite the legal ban is alarming. Due to the declining risk awareness it is necessary to implement prevention and education campaigns specifically targeted at this group.

Die elektrische Zigarette (E-Zigarette) ist eine Produktinnovation, die sich derzeit weltweit mit rasantem Tempo verbreitet. Mittlerweile liegen erste systematische Uberblicksarbeiten zum Risikopotenzial von E-Zigaretten (Ubelkeit, Schwindel, Atemwegsreizungen, allergische Reaktionen, Hirn- und Herz-Kreislauf-Schaden, eine nikotinbedingte Abhangigkeit und ein erschwerter Rauchstopp fur Zigarettenraucher) vor. Dieser Beitrag untersucht als einer der ersten den E-Zigaretten-Konsum und die Risikowahrnehmung unter Jugendlichen. Zwischen Oktober 2014 und Marz 2015 wurden 840 Schulerinnen und Schuler der siebten und achten Klassen in der Metropolregion Rhein-Neckar anonym und standardisiert befragt. Nahezu alle befragten Schuler kannten die E-Zigarette (98,0 %) und 16,2 % aller Jugendlichen hatten schon mindestens einmal eine E‑Zigarette benutzt. Dabei war die weit uberwiegende Mehrheit (namlich 83 % der E-Zigarettennutzer) Nichtraucher von Tabakzigaretten. Die befragten Jugendlichen schrieben nikotinhaltigen E-Zigaretten am ehesten das Risiko eines Abhangigkeitspotenzials (Zustimmungsquote: 88 %) zu. Mittels Clusteranalysen liesen sich bezuglich der Risikowahrnehmung drei unterschiedliche Cluster identifizieren: die „umfassend Besorgten“ (25 % aller Jugendlichen), die „wegen langfristiger Folgen Besorgten“ (59 % aller Jugendlichen) und die „insgesamt eher Sorglosen“ (17 % aller Jugendlichen). Dieses letzte Cluster war durch hohere Anteile mannlicher Jugendlicher, Real- bzw. Hauptschuler und Jugendlicher mit Migrationshintergrund gekennzeichnet. Analysen wie die vorliegende erlauben ein fruhes Monitoring und die Ableitung datenbasierter Praventionsmasnahmen.

Zusammenfassung. Zielsetzung: E–Zigaretten erfreuen sich weltweit zunehmender Beliebtheit. In der vorliegenden Studie haben wir ein vergleichsweise junges Kollektiv deutscher Schülerinnen und Schüler nach Bekanntheit, Konsum und Konsummustern befragt, typische Nutzergruppen identifiziert und Motive der Nutzung untersucht. Methodik: Im Rahmen der hier erstmals vorgestellten PrevEND study II wurden zwischen 10/2014 und 03/2015 insgesamt 840 Schülerinnen und Schüler aus siebten und achten Klassen der Metropolregion Rhein-Neckar anonym mittels eines standardisierten Fragebogens zu E–Zigaretten (einschließlich E–Shishas) befragt. Ergebnisse: Nahezu alle befragten Schülerinnen und Schüler kannten die E–Zigarette (98 %) und 16 % hatten schon mindestens einmal eine E–Zigarette benutzt. Es zeigt sich ein sozialer Gradient, wonach 9 % aller Gymnasiasten und Gesamtschüler und 17 % aller Real- und 33 % aller Werkreal- und Hauptschüler schon einmal E–Zigaretten konsumiert hatten (p

OBJECTIVE The aim of the National Cancer Aid Monitoring (NCAM) was to investigate which occupational groups (1) show higher sun exposure time, (2) suffer from sunburn, and (3) use recommended protective measures. METHODS In 2016, a total of 485 individuals were classified as outdoor workers in accordance with ISCO-08 and asked about exposure time, prevalence of sunburn, and personal sun-protective measures on a sunny summer day. RESULTS Outdoor workers were exposed to ultraviolet (UV) radiation for a mean time of 23.6 ± 15.3 hours per week. The 12-month prevalence of getting sunburnt at work was 19%. Only one-third of outdoor workers reported using five of the most important protective measures "often" or "always." CONCLUSION The NCAM revealed a number of high-risk groups, whose sun-protective behavior has scarcely been studied up to now.

Although psychosocial stress has been associated with adverse health parameters, little is known about this topic among the variety of university students. We thus examined associations of psychosocial stress due to academic education with self-rated health, and symptoms of depression and anxiety among students from various study disciplines. We used data from the Nutrition and Physical Activity (NuPhA) Study, a cross-sectional online survey among students enrolled across German universities (n = 698). Academic stress was assessed by a newly developed and validated student version of the Effort–Reward Imbalance (ERI-Student) Questionnaire. Depressive and anxiety symptoms were measured by applying the Patient Health Questionnaire-4 (PHQ-4) and using validated cut-offs. Separate multivariate logistic regression analyses run for the different ERI components, the ERI-ratio revealed that high effort, low reward, high over-commitment, and a high ERI-ratio were associated with poor self-rated health, and depressive and anxiety symptoms (odds ratios ≥ 2.43). Separate analyses for medical students and non-medical students largely confirmed these findings for both groups. Associations between all ERI components, the ERI ratio, and both mental health measures were, however, more pronounced among medical students. We were able to show consistent associations between the ERI-Student Questionnaire and self-rated health and mental health across students from different study disciplines. Further research on associations between academic stress and health parameters is necessary to develop effective strategies that prevent students from adverse health outcomes during their academic education.

Ziel: Derzeit existieren in den landlichen Regionen Deutschlands Engpasse in der (haus)arztlichen Versorgung. Ob sich diese regionale Ungleichheit auch im Angebot einer Lebensstilberatung im Rahmen der kardiovaskularen Pravention in der Hausarztpraxis niederschlagt, war Untersuchungsgegenstand dieser Arbeit. Methodik: Im Rahmen der bundesweiten Studie nahmen insgesamt 4 074 Allgemeinmediziner, Praktische Arzte und hausarztlich tatige Internisten in den Jahren 2011/2012 an der schriftlichen Erhebung teil (Response: 33,9%). Sie wurden zu ihrer personlichen Einstellung gegenuber Lebensstilberatung sowie deren Angebot und Barrieren in der Praxis befragt. Ergebnisse: Hausarzte aus landlichen Regionen (Landarzte) boten ihren Patienten seltener routinemasig eine Beratung zu verhaltensbezogenen Risikofaktoren fur kardiovaskulare Erkrankungen an. Landarzte fuhlten sich im Vergleich zu Befragten aus Ballungsgebieten weniger gut auf die Lebensstilberatung vorbereitet und hatten eher das Gefuhl, weniger erfolgreich dabei zu sein. Als Hindernisse fur das Angebot an Lebensstilberatung nannten Landarzte im Vergleich zu Arzten aus stadtischen Regionen haufiger eine geringe Adharenz der Patienten (65 vs. 57%), eine unzureichende Vernetzung mit anderen Leistungsanbietern im Bereich der kardiovaskularen Pravention (62 vs. 55%) und Zeitmangel (66 vs. 52%; alle p Schlussfolgerung: Angesichts der zu erwartenden Verschlechterung der Versorgungssituation im hausarztlichen Bereich in landlichen Regionen weisen die Studienergebnisse bereits jetzt auf einen Bedarf an zielgruppenspezifischen Ansatzen zur Forderung der Lebensstilberatung in Hausarztpraxen auf dem Land hin.

Background Little is known about the relationship between socioeconomic status (SES) and health in late adolescence. As it is difficult to measure SES in this age group directly, we used two subjective social status (SSS) scales with different reference groups for social comparison in the relatively homogeneous group of university students and analyzed the relationship with health and health behaviors. Methods We used two 10-rung ladders, a societal and a university one, to measure SSS in students (n = 689, 16–29 years). We compared the scales’ ratings and analyzed relationships with sociodemographic factors, health outcomes and behaviors. Results On average, students rated their individual SSS higher on the university scale (6.87) than on the societal one (6.41). Regarding health outcomes and behaviors, we found similar results for both scales, while sociodemographic variables were more likely to be associated with the societal scale. Conclusion SSS seems to be a useful measure besides the objective SES. Our data suggest that both SSS scales are helpful in the framework of health inequality but differ slightly in what they measure. More detailed research may help to determine which scale is appropriate for individual study context.

Zielsetzung: Die Hausarztpraxis gilt als ideales Setting für die Tabakentwöhnung. Die bundesweite „ÄSP-kardio-Studie“ liefert aktuelle Daten zum Status quo der Tabakentwöhnung nach der „5 A-Strategie“ in deutschen Hausarztpraxen. Methodik: Zwischen 10/2011 und 03/2012 wurden über 4.000 Hausärzte repräsentativ befragt. Der Fragebogen wurde vorab einem Expert Review unterzogen, durch kognitive Interviews validiert und in einer Pilotstudie getestet. Ergebnisse: Routinemäßig erfassten 89 % der Hausärzte etwaigen Tabakkonsum („Assess“), 82 % rieten Rauchern zu einem Rauchstopp („Advise“) und 12 % vereinbarten schriftliche Ziele einer Entwöhnung („Agree“). Hilfestellungen („Assist“) in Form einer Kurzintervention fanden mit 72 % deutlich häufiger statt als in Form von Informationsmaterial (33 %) oder einer Entwöhnungstherapie (27 %). Etwa die Hälfte (54 %) vereinbarte Folgetermine zur Überprüfung des Rauchstopps („Arrange“). Das Angebot war von arzt-, praxis- sowie patientenspezifischen Faktoren abhängig und in den nordöstlichen Bundesländern unterdurchschnittlich. Acht von 10 Hausärzten (77 %) bewerteten ihre Maßnahmen als nicht erfolgreich. Schlussfolgerungen: Deutlich wird die suboptimale und ungleich verteilte Versorgung von Rauchern mit angemessenen Entwöhnungsmaßnahmen in deutschen Hausarztpraxen.

Aim Sunbed use can have severe health consequences, e.g. skin cancer, especially for children and adolescents. Therefore, our aim was to quantify how many adolescents use tanning beds despite a legal ban in Germany. In addition, we aimed at identifying characteristics of users and at analyzing reasons for use and user behavior.

Einleitung: Die Neuerkrankungsrate an Hautkrebs steigt in Deutschland seit Jahrzehnten an. Dabei ist ultraviolette (UV) Strahlung der Hauptrisikofaktor fur die Hautkrebsentstehung. Zur Vermeidung von UV-bedingten Hautschaden empfehlen nationale und internationale Organisationen, in der Sonne geeignete Kleidung, Kopfbedeckung bzw. Sonnenbrille zu tragen, Sonnenschutzmittel zu nutzen sowie Sonne in der Mittagszeit zu meiden. Ziel der Fragestellung: Das Ziel dieser Arbeit war es, das Sonnenschutzverhalten der deutschen Bevolkerung zu analysieren. Methoden: Ausgewertet wurden die Daten des bundesweit reprasentativen National Cancer Aid Monitoring on Sunbed Use (NCAM), das von der Deutschen Krebshilfe gefordert wird. Im Zeitraum zwischen Oktober und Dezember 2015 wurden 3.000 Personen (14 – 45 Jahre) zur Anwendung folgender Masnahmen an einem typischen sonnigen Sommertag telefonisch befragt: Nutzung von Sonnencreme im Gesicht bzw. am Korper, Tragen von Oberbekleidung mit Armeln, Tragen von Kopfbedeckung bzw. Sonnenbrille, Schatten aufsuchen. Neben deskriptiver Statistik wurden Chi2-Tests zur Identifikation moglicher geschlechts- und altersspezifischer Unterschiede durchgefuhrt. Ergebnisse: Frauen und jungere Befragte (14 bis 25 Jahre) gaben signifikant haufiger an, sich im Sommer intentional der Sonne auszusetzen. Auch bei der Anwendung empfohlener Sonnenschutzmasnahmen zeigten sich signifikante geschlechts- und altersspezifische Unterschiede: Frauen gaben eher an, an einem sonnigen Sommertag Sonnenschutzmittel zu nutzen (32,8% vs. 55,2%), den Schatten aufzusuchen (43,3% vs. 50,3%) und eine Sonnenbrille zu tragen (45,9% vs. 58,9%, alle p < 0,001). Bei Befragten unter 25 Jahren zeigten sich fur alle betrachteten Schutzmasnahmen geringere Anwendungshaufigkeiten (z.B. Schatten aufsuchen, 51,9% vs. 36,4%, p < 0,001). Auserdem waren jungere Befragten sich des Risikos der UV-Strahlung weniger bewusst (Zustimmung zur Aussage „Jeder Sonnenbrand hinterlasst in der Haut einen bleibenden Schaden“; 74,8% vs. 83,6%, p < 0,001). Diskussion: Unsere Studie berichtet erstmals reprasentative Daten zum individuellen Sonnenschutzverhalten der deutschen Bevolkerung zwischen 14 und 45 Jahren. Die Ergebnisse zeigen, dass Frauen sich zwar haufiger intentional der Sonne aussetzten, im Alltag aber auch haufiger die meisten der betrachteten Sonnenschutzmasnahmen anwendeten. Bei Befragten unter 25 Jahren waren das Risikobewusstsein und die Pravalenz der individuellen Sonnenschutzmasnahmen geringer als bei alteren Befragten. Schlussfolgerung: Da insbesondere die Sonnenbrandhaufigkeit und die kumulative UV-Exposition im Lebenslauf fur die Entstehung von Hautkrebs entscheidend sind, erscheint die Altersgruppe der 14- bis 25-Jahrigen als eine wichtige Zielgruppe fur primarpraventive Masnahmen.

Although sunbed use is common in many developed countries, little is known about the characteristics of sunbed users.The SUN-Study 2008 (Sunbed-Use: Needs for Action-Study 2008) contains data on indoor tanning practices. It has a net sample size of 500 randomly selected 18-45-year-old adults living in Mannheim, Germany.In this sample, current sunbed users were predominantly females, employed, had completed vocational school (or an equivalent certification), were smokers, participated primarily in individual sports and had skin types III or IV. The mean overall prevalence of sun bed use was 21.0%.Our results highlight specific potential risk factors for intervention that should be examined in other settings among different populations.

INTRODUCTION The popularity of electronic cigarettes (e-cigarettes) among adolescents is growing worldwide. A more accurate model than the much discussed but inadequate Gateway Hypothesis is needed to explain some adolescents' initial preference for e-cigarettes over tobacco cigarettes, as well as any transition from e-cigarettes to tobacco smoking. Our aim was to summarize the diffuse fear that adolescents will be indirectly encouraged to begin smoking tobacco via the use of e-cigarettes and to systematize the disparate causal hypotheses used thus far in relevant literature. METHODS We summarized the vague and fragmented hypotheses formulated thus far in literature on both trajectories from abstinence to e-cigarette use and from there to tobacco smoking into a set of empirically testable hypotheses and organized them into a comprehensive model. RESULTS Our results indicate that the perceived health risks, specific product characteristics (such as taste, price and inconspicuous use), and higher levels of acceptance among peers and others potentially make e-cigarettes initially more attractive to adolescents than tobacco cigarettes. Later, increasing familiarity with nicotine could lead to the reevaluation of both electronic and tobacco cigarettes and subsequently to a potential transition to tobacco smoking. The suggested "catalyst model" takes variations in the nicotine content of e-cigarettes as well as the dual use of different substances into account. CONCLUSION Our model provides causal hypotheses for the initiation of e-cigarette use and for the potential transition to tobacco smoking which, after being tested in empirical studies, could lead to the formulation of concrete recommendations for healthcare intervention and prevention measures. IMPLICATIONS We developed a model that provides causal hypotheses for the initiation of e-cigarette use and for the potential transition to tobacco smoking.

The transition from adolescence to adulthood is associated with many physical, social, and psychological changes. In addition, adolescents also have to deal with structural changes. An example of one such structural change is the transition from school to university or to other vocational establishments. Structural changes can also entail changes in overall framework conditions and daily life patterns and thus also in dietary habits and physical activity levels. The aim of the present paper was to draw attention to the research deficit in this area with the help of the results of our analyses. The results show that significant changes take place as a consequence of the transition from school to a vocational establishment. However, our analyses could not identify the exact catalysts and the time framework of these changes. In this respect, further research is urgently warranted.

This case-control study describes the health situation, internal and external resources, and utilisation of healthcare facilities by a marginalised population consisting of homeless people in Vienna, Austria, compared with a non-homeless control population. Among the homeless group, participants lived in halfway houses (70%) or permanent housing (30%) in Vienna. Personal interviews were conducted in July 2010 with 66 homeless individuals, and their data were compared with data from non-homeless subjects from the Austrian Health Interview Survey using conditional logistic regression. Compared with the control group, homeless persons suffered more often from chronic diseases (P < 0.001) and rated their health considerably lower than the comparison group (P < 0.001). Homeless people suffered significantly more often from psychiatric disorders, respiratory diseases, hypertension (P < 0.001), digestive system diseases (P = 0.002) and heart diseases (P = 0.015) in comparison with the control group. Additionally, among homeless and non-homeless individuals, the former more often consulted a general practitioner in a period of 28 days (P = 0.002). A significantly greater proportion of homeless people did not have any teeth (P = 0.024) and smoked significantly more (P = 0.002). The results demonstrate deficits in the areas of health, health behaviour, and individual and social resources of homeless people, even though homeless people seek medical care at a higher rate than controls. Continuing health promotion projects for this high-risk group and the strengthening of social resources are recommended.

Background In order to perform at top levels, elite athletes have to both protect and risk their health at the same time. Adolescent elite athletes have the additional challenge of coping with substantial physical, psychological and social transformations. The contradictory phenomenon of protecting and risking the adolescent athletes' health in sports challenges the development of health promotion and protection strategies. The GOAL Study (German Young Olympic Athletes' Lifestyle and Health Management Study) analyzes the individual and organizational management of health in adolescent elite sports. Methods/design We combine quantitative and qualitative approaches in a mixed-method study. This allows us to gather a broad range of representative information on squad athletes from all Olympic disciplines as well as in-depth information on four selected Olympic disciplines (artistic gymnastics, biathlon, handball and wrestling). Within the quantitative section we attempt to identify the young athletes' health and nutrition behavior, their subjective health state and their lay health representations, health-related social networks, and structures of medical attendance. 1138 national team level athletes born between 1992 and 1995 from 51 Olympic disciplines responded to the questionnaire (response rate: 61,75%). The qualitative section investigates the meaning and relevance of health and nutrition within the athletes' sports specific surroundings, the impact of biographic backgrounds on individual health behavior, and sports specific cultures of health, nutrition and risk. We interviewed 24 athletes and 28 coaching and medical experts, and carried out 14 multi-day participant observations at training sessions and competitions. Conclusions The studies' results will serve as the basis for developing tailored health promotion strategies to be in cooperation with German elite sports associations.

Background: Many prevention and intervention measures are still targeting isolated behaviours such as tobacco use or physical inactivity. Cluster analysis enables the aggregation of single health behaviours in order to identify distinctive behaviour patterns. The purpose of this study was to group a sample of the over-50 population into clusters that exhibit specific health behaviour patterns regarding regular tobacco use, excessive alcohol consumption, unhealthy diet and physical inactivity. Methods: From the total population of the federal state of Baden-Wuerttemberg, Germany, 982 men and 1020 women aged 50–70 were randomly selected. Subjects were asked by trained interviewers in computer-assisted telephone interviews (CATI) about health behaviour and sociodemographic characteristics. Cluster analysis was conducted to identify distinct health behaviour patterns. Multinomial logistic regression was used to characterize clusters by specific social attributes. Results: Five homogeneous health behaviour clusters were identified: ‘No Risk Behaviours’ (25.3%), ‘Physically Inactives’ (21.1%), ‘Fruit and Vegetable Avoiders’ (18.2%), ‘Smokers with Risk Behaviours’ (12.7%) and ‘Drinkers with Risk Behaviours’ (22.7%). Whereas the first cluster is the ideal in terms of risk and prevention, the latter two groups include regular users of tobacco and excessive consumers of alcohol, who also engage in other risk behaviours like inactivity and maintaining an unhealthy diet. These two risk groups also exhibit specific sociodemographic attributes (male, living alone, social class affiliation). Conclusion: Unhealthy behaviours evidently occur in typical combinations. An awareness of this clustering enables prevention and intervention measures to be planned so that multiple behaviours can be modified simultaneously.

Reprasentative Daten fur Deutschland zeigen, dass sich jahrlich 7,7% (95%-KI: 7,0–8,6%) der Kinder und Jugendlichen beim Sport verletzen. Ursachen waren meistens Kollisionen und Sturze. Die haufigsten Folgen waren Verletzungen des Muskel-Band-Apparates sowie Frakturen. Weder bei dem relativen Verletzungsrisiko noch bei dem Verletzungsmuster (Ursachen, arztliche Diagnosen und Schweregrad) bestanden – bis auf geringfugige Ausnahmen – signifikante Geschlechtsunterschiede.