Concept and methodology of the Health Behaviour in School-aged Children (HBSC) study - Insights into the current 2022 survey and trends in Germany

Background

Health Behaviour in School-aged Children (HBSC) is one of the largest international studies on child and adolescent health and cooperates with the World Health Organization (WHO). In Germany, adolescents aged 11, 13 and 15 are surveyed every four years about their health, health behaviour and social conditions. This article describes the HBSC study and in particular the methodology of the current 2022 survey and prior surveys conducted between 2009/10 and 2017/18.

Method

174 schools with a total of 6,475 students participated in the 2022 survey. The survey was conducted using questionnaires and covered a wide range of topics (including mental health, physical activity, bullying experiences, social determinants of health and experiences related to COVID-19). The 2022 survey was complemented by a school principal survey (N = 160). In addition to the current sample, the samples of the three previous surveys with representative data for Germany are presented: 2009/10 (N = 5,005), 2013/14 (N = 5,961) and 2017/18 (N = 4,347).

Discussion

The health of children and adolescents is of great public health importance. The HBSC study makes a substantial contribution by providing internationally comparable results, analysing trends, and providing stakeholders with comprehensive and representative health monitoring data.

Health literacy of students in Germany - Results of the HBSC study 2022

Background

Health literacy (HL) encompasses knowledge and skills for dealing critically and confidently with health information in individual and social contexts. Current studies show that a high proportion of children and adolescents have limited health literacy, depending on aspects of their social background. Health literacy is considered an important factor influencing health. Little is known about the development of health literacy over time and its connection with psychosomatic complaints in young people.

Methods

Based on the results of the Health Behaviour in School-aged Children (HBSC) study, this article focusses on the level of HL in 11-, 13-, and 15-year-old students (N = 6,475) over time and taking social differences into account. Finally, the relationship between HL and psychosomatic complaints is analysed. Univariate, bivariate, and multivariate analyses were carried out for this purpose.

Results

At 24.4 %, slightly more students have low HL in 2022 than in 2017/18 (21.4 %). There are differences in HL according to gender, age, type of school, and family affluence. Low HL is associated with a high psychosomatic burden.

Conclusions

The results highlight the need for target group-specific measures to promote young people's HL, which address individual and organisational aspects of HL.

Organizational health literacy and health promotion in health care settings: Results from Germany

Introduction

Health care organizations (HCO) are increasingly required to provide health literate structures and processes to strengthen organizational health literacy (OHL). So far, little is known about the extent of OHL in HCO in Germany. Aims are therefore 1) to examine the level of OHL in health care organizations, and 2) to investigate the impact of organizations level of health prevention and workplace health promotion on the level of OHL.

Methods

Analyses are based on a nationwide cross-sectional study (online survey) among management staff (N = 564) in HCO (hospitals, nursing homes, facilities for disabled people). OHL was measured by the German version of the ‘Health literate health care organization 10 item questionnaire’ (HLHO-10). Health prevention and workplace health promotion were operationalized by the “Worksite Health Promotion Capacity Instrument’ (WHPCI). Uni- and bivariate analyses were carried out, on an item-basis and as an index (median-split).

Results

Regarding OHL, 55.1 % of the health care organizations reported below-average levels of OHL. On an item-basis, the highest below-average levels were given for the standard ‘communication’ (59.1 %) and the ‘provision of information to patients/residents via various media’ (57.4 %). Regarding the level of health prevention (51.8 %) and the existence of workplace health promotion structures (55.7 %), more than half of HCO reported a below-average level. In addition, results showed that HCO that indicate a below-average level of prevention and few structures of workplace health promotion also revealed a below-average level of OHL.

Conclusions

There is need to strengthen OHL in German HCO.

Key messages

• HCO are required to strengthen HLO, particular in communication and participatory approaches.

• A higher level of prevention and workplace health promotion on HCO can contribute to the implementation of OHL initiatives.

Organizational health literacy in health care: Results from a participatory project in Germany

Background

Health care facilities (i.e., hospitals, care facilities and integration assistance) play an important role in providing health-related information and strengthening health literacy (HL) of patients/clients, staff and at the organizational level. The project “Development of Health Literacy in Health Care Facilities (EwiKo)’ aims at implementing tools to promote and strengthen organizational health literacy (OHL) in health care institutions in Germany. Objectives are 1) to assess needs for strengthening OHL in pilot facilities and 2) to examine factors that are beneficial to strengthen OHL in health care facilities.

Methods

N = 6 pilot institutions (n = 2 hospitals, n = 2 care homes for elderly people, n = 2 facilities for people with disabilities) and their members of the “working groups on HL” filled in a self-assessment tool to assess the level of OHL, accompanied by focus group interviews (n = 6-9 persons per pilot facility). Regarding conducive and obstructive factors when implementing tools to strengthen OHL, focus group interviews (n = 6-9 persons per pilot facility) and semi-structured interviews (n = 1 coordinator per organization) were conducted.

Results

Results of the self-assessment tool showed a need to strengthen OHL in all types of health care facilities, particularly in the fields of action ‘training of employees in HL tools’, “communication” and ‘participatory development and testing of documents, materials and services on HL’. Results of the focus group interviews showed a special need to strengthen OHL in the area ‘HL of employees’. Beneficial factors by implementing tools to strengthen OHL are, for instance a supporting management, resources, a participatory approach and trainings by the project team.

Conclusions

Due to the ongoing corona pandemic and accompanying challenges (e.g., personnel resources), it is comprehensible that health care facilities emphasize a need for strengthening HL of employees.

Digital health literacy and health behaviors of eighth and ninth graders from Germany

Background

Due to the high availability and use of digital media, health-related information is increasingly shifting into the digital space. While there are increasing empirical findings on general health literacy (HL), there is a lack of evidence on digital HL in adolescence and its association with health behavior.

Methods

A cross-sectional study of 490 secondary school students (grades eight and nine) from the federal state of Hesse was conducted from October 2019 to February 2020. Digital HL was assessed using five subscales of the Digital Health Literacy Instrument (DHLI), while consumption of fruits, vegetables, soft drinks, and weekly physical activity were used as indicators of health behavior. In addition to gender and grade level, subjective social status (SSS) was used as a social characteristic. Univariate, bivariate, and multivariate analyses were performed, with binary-logistic regression adjusted for gender and SSS.

Results

Across all items, the percentage of adolescents reporting difficulties in acquiring and dealing with digital health information ranges from 15.3 % to 37.5 %. Stratified by social characteristics, gender and socioeconomic differences were found with girls and respondents reporting a lower SSS more often showing a limited digital HL. Adolescents with moderate and low digital HL report higher levels of low physical activity, non-daily fruit and daily soft drink consumption. Depending on the health behavior, different relationship patterns can be observed for the dimensions of digital HL.

Conclusions

The findings suggest a need for interventions to promote digital HL among adolescents, particularly for those of low SSS. In this context, the differential relationship patterns with health behaviors provide an avenue for the development of specific interventions.

Digital health literacy and well-being in university students in Germany

Background

Digital communication technologies had a crucial role during the COVID-19 pandemic, with the internet and Social Media as highly frequented sources for retrieving health information. University student's health and well-being were highly affected and most interaction with peers and professionals migrated to the digital realm, which made digital health literacy (DHL) a key competence to navigate digital health environments. The main goal of the study was to explore DHL of students in Germany.

Methods

A cross-sectional online survey among students (N = 14916) from 130 universities in Germany was implemented as part of the global Covid-HL Network, collecting data on DHL, physical and mental health, SoC and sociodemographics. Data was analyzed using univariate, bivariate and regression analyses.

Results

Assessing the reliability of information (5964/14,103, 42.3%) and determining commercial interest of information posed the most difficult tasks (5489/14,097, 38.9%). Difficulties were revealed for finding information (4282/14,098, 30.4%). Female students reported lower DHL and social media use was associated with lower judgment skills. 38% of all students reported low and very low well-being and 29% reported at least two health complaints weekly, while health outcomes follow a social gradient (lower SES and gender). Regression analysis showed significant association between SoC and well-being (OR: 1.2-2.03) and health complaints (OR: 1.58-1.71). Higher future worries were with low well-being (OR: 2.83) and multiple health complaints (OR: 2.84).

Conclusions

There is an urgent need to enhance DHL and SoC of students and implement health promotion strategies, using target group specific intervention. Gender and socioeconomic differences must be taken into account and interventions could be delivered within the university. Measures should also address student mental health.

Measuring Health Literacy in Childhood and Adolescence with the Scale Health Literacy in School-Aged Children – German Version

Abstract. Health literacy can help explain health inequalities in childhood and adolescence. However, suitable instruments for assessing health literacy in this age group are rare, especially in the German-speaking countries. One economical measure is the 10-item Health Literacy in School-Aged Children (HLSAC) scale, developed and reviewed as part of the WHO Child and Adolescent Health Study (HBSC, Health Behavior in School-Aged Children). In the present study, we tested dimensionality, measurement invariance, and associations with health-related measures of the German version of the scale (HLSAC–German), using data from the 2018 national German HBSC study ( N = 4,347 students aged 11, 13, and 15 years). We also tested HLSAC–German with 11-year-olds, representing an expansion of the original scale. Exploratory and confirmatory factor analyses consistently demonstrated the unidimensionality of the scale (α = .88). Complete scalar measurement invariance was found for sex and partial scalar measurement invariance for age groups and school type, allowing for the comparison of means. Associations with indicators of health and health behavior further demonstrate the construct validity of the scale. The analyses show that the scale is suitable for the economic measurement of a general factor of health literacy in 11- as well as in 13- and 15-year-olds.

Infodemic Preparedness and COVID-19: Searching about Public Health and Social Measures Is Associated with Digital Health Literacy in University Students

We aimed to evaluate the associations between information searching about public health and social measures (PHSM) and university students' digital health literacy (DHL) related to the new coronavirus (SARS-CoV-2) and COVID-19.

METHODS

This cross-sectional study included 3,084 Portuguese university students (75.7% females), with an average age of 24.2 (SD = 7.5). Sociodemographic data, DHL questionnaire and online information concerning PHSM were gathered. Cox proportional hazards models were performed.

RESULTS

Students who searched for personal protective measures achieved in shorter time sufficient "evaluating reliability" (HR = 1.4; 95% CI = 1.1; 1.7) and "determining relevance" (HR = 1.5; 95% CI = 1.2; 1.8). Searching for surveillance and response measures was associated with sufficient "determining relevance" (HR = 1.4; 95% CI = 1.1; 1.9). Finally, those students who searched for environmental, economic and psychosocial measures achieved in shorter time "determining relevance" (HR = 1.2; 95% CI = 1.0; 1.4).

CONCLUSIONS

Searching for PHSM was significantly associated with an increased likelihood of achieving sufficient DHL subscales in a shorter time. Further studies are needed, including developing strategies to increase the availability of high-quality information concerning public health and social measures and to improve (digital) health literacy.

Selbsthilfe und Gesundheitskompetenz während der Corona-Pandemie: Ergebnisse der qualitativen GeMSeHeCo-Studie

Hintergrund

Die Pandemie stellt Menschen mit Beeinträchtigung vor vielfältige Herausforderungen, insbesondere auch beim Umgang mit Gesundheitsinformationen. Bislang ist nur wenig über die Rolle der Selbsthilfe bei der Förderung der Gesundheitskompetenz ihrer Mitglieder während der Pandemie bekannt.

Methodik

Der Studie „Gesundheitskompetenz von Mitgliedern der Selbsthilfe: Herausforderungen durch die Corona-Pandemie (GeMSe^HeCo)“ liegt ein qualitatives Studiendesign zugrunde. Der Feldzugang erfolgte deutschlandweit über die Selbsthilfegruppen. Von Juli bis Oktober 2020 wurden N = 19 Telefoninterviews mit Vertreter*innen von Selbsthilfegruppen durchgeführt, transkribiert und inhaltsanalytisch ausgewertet.

Ergebnisse

Vertreter*innen der Selbsthilfe berichteten über Stärken und Schwächen der Mitglieder im Umgang mit Gesundheitsinformationen während der Corona-Pandemie. Schwächen wurden v. a. bei älteren Mitgliedern, Menschen mit niedrigem Bildungsniveau und mit Migrationshintergrund berichtet. Stärken beobachteten die Vertreter*innen bei langjährigen Mitgliedern und bei Mitgliedern, die sich zu ihrer Krankheit kontinuierlich weiterbilden.

Diskussion

Die Selbsthilfe wird während der Pandemie als wichtige Unterstützung der Mitglieder im Umgang mit Gesundheitsinformationen wahrgenommen. Ein Vorteil für die Mitglieder besteht insbesondere in der Prüfung und Zusammenstellung von Gesundheitsinformationen nach individuellen Bedarfen durch die Selbsthilfe. Herausforderungen können aufgrund von Sprach- und Verständnisschwierigkeiten entstehen, bspw. durch einen Migrationshintergrund. Der Ausbau von digitalen Angeboten hat sich in dieser Zeit als hilfreich erwiesen. Dabei sollte die Unterstützung vermehrt Ältere und Mitglieder mit geringen finanziellen Möglichkeiten berücksichtigen, da diese während der Pandemie weniger Zugang zu digitalen Angeboten aufweisen.

[Digital health literacy of pupils. Level and associations with physical activity and dietary behavior]

Hintergrund

Während vermehrt Studienbefunde zur allgemeinen Gesundheitskompetenz (GK) vorliegen, mangelt es an Erkenntnissen zur digitalen GK im Jugendalter und deren Assoziationen mit Indikatoren des Gesundheitsverhaltens.

Methodik

Empirische Basis bildet eine von Oktober 2019 bis Februar 2020 im Bundesland Hessen durchgeführte Querschnittstudie mit 490 Schülerinnen und Schülern der Klassenstufe 8 und 9. Die digitale GK wurde mithilfe von 5 Subskalen des Digital Health Literacy Instrument (DHLI) erfasst, während der Verzehr von Obst, Gemüse und Softdrinks sowie die körperliche Aktivität als Indikatoren des Gesundheitsverhaltens herangezogen wurden. Als soziales Merkmal wurde neben dem Geschlecht und der Klassenstufe der subjektive Sozialstatus (SSS) berücksichtigt. Die Datenauswertung erfolgte uni-, bi- und multivariat, wobei binärlogistische Regressionen für das Geschlecht und den SSS adjustiert wurden.

Ergebnisse

Über alle Items hinweg berichten 15,3–37,5 % der befragten Jugendlichen Schwierigkeiten bei der Beschaffung von und im Umgang mit digitalen Informationen. Differenziert nach sozialen Merkmalen finden sich für 2 Dimensionen der digitalen GK Unterschiede zuungunsten der Mädchen sowie durchgehend ein sozialer Gradient zuungunsten von Befragten mit niedrigem SSS. Jugendliche mit mittlerer und geringer digitaler GK weisen ein höheres Maß an geringer körperlicher Aktivität, nichttäglichem Obstverzehr und täglichem Konsum von zuckerhaltigen Getränken auf.

Diskussion

Die Befunde weisen auf einen Interventionsbedarf zur Förderung der digitalen GK insbesondere bei Jugendlichen mit geringem SSS hin. Die differenziellen Zusammenhangsmuster mit dem Gesundheitsverhalten bieten Ansatzpunkte für die Entwicklung spezifischer Interventionen. Als Lehr- und Lernort stellt die Schule u. a. aufgrund der Passung mit verpflichtenden Strategien der schulischen Medienkompetenzbildung ein geeignetes Setting dar.

[Tools to strengthen organizational health literacy in the health care sector]

BACKGROUND

The National Action Plan to Improve Health Literacy calls for user-friendly and health-competent development of health care at all levels. After the first years of focusing on individual health literacy, the focus is increasingly on organizational health literacy. Organizational health literacy addresses different standards (e. g., management, communication, staff, users or patients) and levels in the organization (i.e., organizational, staff and user level). Numerous tools already exist to strengthen health literacy in hospitals. However, previous studies have rarely focused on a differentiated overview of tools to strengthen organizational health literacy by health literacy standards and differentiated by level of organization, staff and users. The article has two goals, one of which is to search for and review existing tools to strengthen organizational health literacy in health care institutions. In addition, selected tools for strengthening organizational health literacy for health care institutions, differentiated according to the eight fields of action and the three organizational levels (i.e., institution, staff, users), will be presented.

METHOD

A search was carried out to identify tools on strengthening health literacy in facilities of health care. All the tools identified were reviewed, selected according to previously defined inclusion and exclusion criteria and assigned to the level (institution, employees or patients/clients and their relatives) as well as the eight fields of action of organizational health literacy.

RESULTS

We found a total of N=191 tools for health care facilities. After taking into account the inclusion and exclusion criteria, a total of n=60 tools were selected and differentiated according to the level and standard of organizational health literacy. Some of these tools could be assigned to more than one field of action. Most tools (n=37) were found for Standard 5 "Health-competent communication users", while the lowest number of tools were identified for Standard 7 "Promoting the health literacy of employees" (n=4). Differentiation by level (i. e., organizational, staff, patients or clients) shows that there is a smaller number of tools for employees (n=43) compared to the level of the organization (n=76) or users (n=65).

DISCUSSION

Overall, the study shows that numerous tools already exist to strengthen organizational health literacy for hospitals, in particular, and for health care settings, in general. In the future, however, it will be necessary to develop and test tools for individual standards of health literate organizations in health care facilities. Further, internationally provided and tested tools have to be adapted and piloted for the German-speaking countries and health care settings in order to address the health literacy of staff, users and their relatives in a sustainable manner.

CONCLUSION

The development of health literate settings requires effort from health care organizations. Thus, tools for strengthening organizational health literacy should be provided and implemented by also focusing on the level of organization, staff and users so that the individual health literacy of users can be addressed and improved in the long-run.

[Health Literacy of People with and without Disabilities and Chronic Diseases in Germany: Results of the Study "German Health Update" 2014/2015-EHIS]

BACKGROUND

People with disabilities and chronic diseases represent a population group in vulnerable circumstances, and often have difficulty finding, understanding, assessing, and applying health information. The aim of this study was to examine the health literacy of people doubly burdened with both disabilities and chronic diseases in comparison to two other groups, namely people with either disabilities or chronic diseases and people without impairment.

MATERIAL AND METHODS

Our data is based on the representative survey "German Health Update" 2014/2015-EHIS. The sample consists of n=21,647 people, including 2,875 (13.3%) people with disabilities and chronic diseases, 7,598 people (35.1%) with disability or chronic diseases and 11,174 (51.6%) people without impairment. Health literacy was measured using the short form of the questionnaire of the European Health Literacy Survey (HLS-EU-Q16). Uni, bi- and multivariate analyses were conducted.

RESULTS

43.7% of respondents with both disabilities and chronic diseases had quite a lot difficulties in dealing with health information in comparison to people with disabilities or chronic diseases (37.7%) or those with no impairment (33.0%). People with double burdens had a 1.22-fold (CI: 1.10-1.35; p<0.001) and people with a single burden had a 1.08-fold (CI: 1.01-1.16; p=0.031) increased likelihood to find it difficult or very difficult to find, understand, evaluate and apply health-related information compared to people without impairment.

CONCLUSION

The results show a gradient to the disadvantage of people with disabilities and/or chronic diseases. Health literacy among people with disabilities and/or chronic diseases should be adequately promoted in order to support their health, their participation as well as the quality and efficiency of and the reduction of barriers to access health care.

COVID-HL: A cross-sectional study on digital health literacy in university students in Germany

Background

Digital communication technologies are playing an important role in the health communication strategies of university students during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and digital health literacy is a key competence to navigate web-based COVID-19 information. This study aimed to investigate university students' digital health literacy during the early stages of the COVID-19 pandemic in Germany.

Methods

A cross-sectional study among 14,916 university students from 130 universities in Germany was conducted using a web-based survey. Along with sociodemographics, the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Data were analyzed using univariate and bivariate analyses.

Results

Across DHL dimensions, the greatest difficulty was assessing the reliability of information and to determine whether it had commercial interest. Students indicated that they have problems finding the information they are looking for. Females achieved significant lower scores for information searching and evaluating reliability. Search engines, news portals, and websites of public bodies were most often used by the respondents to inform about COVID-19. Females were found to use social media and health portals more frequently, while male students used Wikipedia as well as YouTube more often. Social media use was associated with a low ability to critically evaluate information.

Conclusions

Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key.

University students' sense of coherence, future worries and mental health: findings from the German COVID-HL-survey

Early-on in the COVID-19 pandemic when universities were closed as part of the nation-wide public health response to the COVID-19 outbreak, studying and student life significantly changed. Based on limited evidence the aim of this study was to explore the relationship between sense of coherence (SoC), future worries and mental health outcomes among German university students during the early phase of the pandemic. A cross-sectional online survey with n = 14 916 participants was carried out by inviting all private and public universities in Germany. All data were analysed using univariate, bivariate and multivariate statistics. Findings indicate a low and very low wellbeing for 38% of university students. Moreover, 29% reported being affected by at least two health complaints more than once week. Both health outcomes follow a social gradient and could be more frequently observed for respondents with lower subjective social status and female students. Regression analysis revealed significant association between the SoC dimensions and wellbeing (OR: 1.2−2.03) as well as health complaints (OR: 1.58−1.71). A high level of future worries was associated with low/very low wellbeing (OR: 2.83) and multiple health complaints (OR: 2.84). Based on the results, the public health response to the pandemic and university health promotion should therefore consider student mental health as an important target within their policy and action frameworks.

[Mental Health of Children and Adolescents with and without Disabilities and Health-related Impairment: Results of the Representative German Child and Adolescent Health Survey (KiGGS Wave 2)]

BACKGROUND AND OBJECTIVE

Children and adolescents with disabilities and health-related impairment belong to a vulnerable population group. There are only few German findings on mental health that distinguish between children and adolescents with and without disabilities and health-related impairment.

MATERIALS AND METHODS

Data were used from the German KiGGS Wave 2 of the Robert Koch-Institute from 2014-2017. A total of 11,830 children and adolescents aged 3-17 years were included using the parent perspective and 5,222 children and adolescents between 11-17 years using their self-assessments. Mental health outcomes were mental health problems (SDQ, parental assessment) and health-related quality of life (kidscreen, self-assessment). Univariate and bivariate analyses were conducted using cross-tables with Chi square tests and multivariate analyses using binary logistic regression models.

RESULTS

In 16.5% of children aged 3-17 years, parents reported mental health problems; 48.4% of the interviewed children and adolescents aged 11-17 years reported a low health-related quality of life. Children with disabilities and health-related impairment had a significantly higher probability of mental health problems (OR: 5.11) and a low health-related quality of life (OR: 1.50).

CONCLUSION

The findings suggest a need for action to strengthen mental health in children and adolescents with disabilities and/or health-related impairment. In this context, the educational settings of kindergarten and school are of great importance.

Health literacy and mental health of school principals. Results from a German cross-sectional survey

Purpose

School principals are generally seen as key facilitators for the delivery and long-term implementation of activities on school health promotion, including health literacy. However, there is little evidence on the health literacy and health status of this occupational group. The purpose of this paper is to investigate the health literacy of school principals and its association with mental health indicators.

Design/methodology/approach

A cross-sectional online survey with German school principals and members of the management board (vice principals) was conducted (n = 680, 68.3% female). Demographic (gender, age) and work characteristics (type of school, professional role) as well as health literacy served as independent variables. Mental health as a dependent variable included well-being, emotional exhaustion and psychosomatic complaints. Next to uni- and bivariate analysis, a series of binary logistic regression models was performed.

Findings

Of the respondents, 29.2% showed a limited health literacy with significant differences to the disadvantage of male principals. With regard to mental health, respondents aged over 60 years and those from schools for children with special educational needs were less often affected by low well-being as well as frequent emotional exhaustion and psychosomatic complaints. Taking into account demographic and work characteristics, regression models revealed significant associations between a low level of health literacy and poor mental health across all indicators.

Research limitations/implications

The cross-sectional nature of this study does not allow to draw conclusions about the causal pathways between health literacy and mental health. Although the sample has been weighted, the results cannot be generalized to the whole population of school principals. There is a need for evidence-based interventions aiming at promoting health literacy and mental health tailored to the needs of school principals.

Originality/value

This is the first study to investigate health literacy and its association with health indicators among school principals.

Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study

Background

Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19–related information and service environments.

Objective

This study aimed to investigate university students’ digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany.

Methods

A cross-sectional study among 14,916 university students aged ≥18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses.

Results

Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of “information searching” and “evaluating reliability.” Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more frequently, while male students used Wikipedia and other web-based encyclopedias as well as YouTube more often. The use of social media was associated with a low ability to critically evaluate information, while the opposite was observed for the use of public websites.

Conclusions

Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key.

Trajectories of students' well-being in secondary education in Germany and differences by social background

BACKGROUND

Subjective well-being (SWB) is an important indicator of quality of life, but prior research mostly analyzed adolescents' subjective well-being in cross-sectional studies. There is a lack of studies examining changes in subjective well-being throughout adolescence using longitudinal panel data. This study examined trajectories of subjective well-being of adolescents in Germany throughout secondary education and differences by socioeconomic position, gender and family structure.

METHODS

We use the German National Educational Panel Study and combine data from annual survey waves of two of its cohorts. These were first surveyed in 2010 and cover 5th to 10th and 9th to 12th grade level. Using growth curve modelling based on multilevel models, differences in levels and trajectories of subjective well-being overall and differentiated by school type, parental education, household income, gender and family structure were identified. The analyses include 34 504 observations of 12 564 students.

RESULTS

Subjective well-being decreased from 5th to 12th grade. Students attending lower track schools showed lower subjective well-being, but also a lesser decrease over time. Students living in low-income households or in single-parent or step-families showed lower subjective well-being. Female students showed higher subjective well-being than males in 5th grade, but also a higher decrease over time, leading to lower subjective well-being than males by 12th grade.

CONCLUSION

This study provides a comprehensive picture of subjective well-being throughout secondary education. Adolescents' subjective well-being is linked to social factors regarding family and living conditions as well as school features. Overall, disadvantaged adolescents experience longer periods of lower subjective well-being, thus accumulating the effects of worse psychosocial health opportunities over time.

Alcohol, tobacco and cannabis use in adolescence - Cross-sectional results of the 2017/18 HBSC study

Tobacco, alcohol and cannabis are psychoactive substances that is often tried for the first time during adolescence and further continued in later life. Regular tobacco and cannabis use as well as alcohol abuse are associated with serious health consequences. According to the importance of health reporting, this article describes current prevalence of adolescent substance use and the associations between psychoactive substance use and specific social determinants. Representative data for Germany from the 2017/18 Health Behaviour in School-Aged Children (HBSC) study among schoolchildren aged 11, 13 and 15 years are used. The article analyses both, the lifetime and 30-day prevalence of tobacco, alcohol and cannabis use (in the latter case, data were only available for 15-year-olds) among adolescents as well as their experiences of alcohol-related misuse (binge drinking). Tobacco and alcohol are used comparatively rarely by 11- and 13-year-olds. However, the prevalence increases significantly among 15-year-olds. In addition, cannabis use is also quite common among this age group. Schoolchildren who do not attend grammar schools are at greater risk of smoking and those with high family affluence are at a greater risk of alcohol use, this applies particularly to girls. Finally, adolescents with a migration background are less at risk of regular alcohol use or binge drinking, but face an increased risk of cannabis use (girls with one-sided migration background). The results indicate that prevention measures should start early, as the prevalence of substance use is significantly higher among older schoolchildren. Depending on the substance, different risk groups can be identified that require particular consideration when drawing up preventive measures.

[Gradients in Mental Health and Health Consciousness by the Degree of Disabilities - Results from representative GEDA-Survey in Germany]

PURPOSE

People with disabilities belong to a vulnerable population group, especially with regard to their economic and health situation. In the social-epidemiological research, hardly any studies on mental health and health awareness among people with disabilities are available using representative data, in particular not differentiated according to their degree of disability (DoD). Therefore, the aim of this study is to investigate 1) differences in mental health and health awareness between people with disabilities compared to people without disabilities. In addition, the study 2) shows differences mental health outcomes and health awareness, differentiated according to the DoD.

METHODS

Data is used from the representative study "Gesundheit in Deutschland Aktuell (GEDA) 2012" (N=19,294). Outcomes were self-reported health, health awareness, depression or depressive mood, mental discomfort, vitality and psychological well-being. The exposure variable used was the recognized disability (DoD≥50 vs. DoD<50 vs. no disability). Univariate and bivariate analyses were conducted using cross-tables and multivariate analyses using binary logistic regression models, controlled for socio-demographic, economic and health-related features.

RESULTS

People with disabilities often rate their mental health worse than people without disabilities. The bi- and multivariate analyses revealed a disability-specific gradient for all outcome measures according to the DoD (p<0,001). People with disabilities had a significantly higher likelihood of poor mental health compared to people without disabilities. People with severe disabilities (DoD≥50) had a more than 4,6-fold increased likelihood risk of poor self-reported health and 2,5-fold likelihood of depression or depressed mood compared to people without disabilities. A high level of health awareness was more prevalent in PWD than in those without disabilities.

CONCLUSION

The study highlights that People with disabilities more frequently reported mental health problems than people without disabilities. Targeted measures are necessary, which address in particular the target group of the people with disabilities. There is further need to strengthen access to health services and programs, assistive technologies and support services, and to make health of people with disabilities to the subject of research and health promotion in line with the WHO Action Plan on "Better health for all people with disabilities" (2014-2021).

Medizinische Versorgung in Medizinischen Behandlungszentren für Erwachsene mit geistiger und schwerst-mehrfacher Behinderung (MZEB): eine qualitative Studie zu aktuellen Herausforderungen aus Sicht der Behandler_innen

Hintergrund

Durch das GKV-Versorgungsstärkungsgesetz wurde die Grundlage zur medizinischen Versorgung von erwachsenen Menschen mit Behinderung (MmB) in Medizinischen Behandlungszentren für Erwachsene mit geistiger Behinderung oder schweren Mehrfachbehinderungen (MZEB) geschaffen, um die Versorgungslücke im Anschluss an die Versorgung in Sozialpädiatrischen Zentren (SPZ) für Minderjährige mit Behinderung zu schließen.

Fragestellung

Bislang fehlt Kenntnis darüber, a) wie sich Zugang zu und Inanspruchnahme medizinischer Versorgung im MZEB gestaltet und b) welche förderlichen oder hinderlichen Faktoren sich dabei beobachten lassen.

Material und Methode

Es wurden insgesamt acht leitfadengestützte Experteninterviews mit Behandler_innen im MZEB sowie einem Vertreter der Bundesarbeitsgemeinschaft (BAG) MZEB geführt. Anhand vorab festgelegter Kategorien wurde das Material mittels der strukturierenden und zusammenfassenden Inhaltsanalyse nach Mayring ausgewertet.

Ergebnisse

Die Ergebnisse verdeutlichen, dass organisatorisch strukturelle Faktoren (u. a. Definition der Zielgruppe) sowie die finanzielle Ressourcenausstattung derzeit den Zugang zu und die Inanspruchnahme medizinischer Leistungen hemmen. Als förderliche Faktoren im MZEB werden die multiprofessionelle Zusammenarbeit, die zeitlichen Ressourcen einer zielgruppenadäquaten Versorgung sowie die Unterstützung durch Angehörige oder Betreuungspersonal genannt.

Schlussfolgerungen

Organisatorische, strukturelle und finanzielle Faktoren erschweren den Zugang zum MZEB. Weitere Forschung ist erforderlich, um den Etablierungsprozess der MZEB in Deutschland zu untersuchen und um überdies die Perspektive der Zielgruppe selbst hinsichtlich des Zugangs und der Inanspruchnahme sowie förderlicher und hinderlicher Faktoren zu erfassen.

Psychosoziale Arbeitsbedingungen und Burnout-Symptome in der stationären somatischen und psychiatrischen Gesundheits- und Krankenpflege

Psychosocial working conditions and symptoms of burnout in somatic and psychiatric nursing Abstract. Background: While mental workload and stress among nurses are generally well-documented, differences within the nursing profession have hardly been investigated so far. Aim: This study aims to examine the differences and associations between psychosocial working conditions and symptoms of burnout of nurses working in somatic and psychiatric settings. Methods: A cross-sectional study has been conducted with employees in one somatic and one psychiatric hospital (n = 576). The Copenhagen Psychosocial Questionnaire and the Copenhagen Burnout Inventory were used to assess psychosocial workloads and burnout symptoms. The data analysis was carried out by univariate, bivariate and multivariate (regression) analyses. Results: About 50 % of respondents report at least a moderate level of symptoms of burnout with somatic nurses more frequently affected. While quantitative and physical demands are higher in somatic nursing, psychiatric nurses have a higher degree of emotional demands, socialβ = 0.33) in somatic nursing and emotional demands (β = 0.29) in psychiatric nursing serve as strongest predictors of burnout symptoms. Conclusions: Findings suggest specific profiles of psychosocial workload in somatic and psychiatric nursing as well as a high need for differentiated approaches for occupational health promotion.

[The Importance of the "Big Five" Personality Traits for Subjective Health and Life Satisfaction in Adolescence: Results of the National Educational Panel Study (NEPS)]

BACKGROUND

The role of personality traits in self-rated health and well-being of adolescents has barely been studied in Germany so far. The aim of this study was to analyze the association between the Big Five personality traits and self-reported health as well as life satisfaction of adolescents in Germany.

METHODS

The study data are based on the National Educational Panel Study (NEPS), starting cohort 3 (wave 3, 2012). This sample includes (n=5,440) 7^th grade adolescents in regular schools. Personality traits were measured by the Big Five-Inventory (BFI-10): Extraversion, Agreeableness, Conscientiousness, Neuroticism, Openness. Statistical analyses were carried out using bivariate methods and binary-logistic multilevel models, taking into account individuals nested in school classes and schools.

RESULTS

Adolescents with pronounced neuroticism had a higher risk of both poor self-rated health (OR: 1.33) and low life satisfaction (OR: 1.46). In contrast, adolescents with high levels of conscientiousness had a reduced risk of poor health (OR: 0.72) and low life satisfaction (OR: 0.59). High levels of extraversion (OR: 0.78) and agreeableness (OR: 0.72) also correlated with higher life satisfaction, but not with better self-reported health. The characteristic of openness was not associated with either self-reported health or the life satisfaction of adolescents.

CONCLUSION

The results suggest that certain personality traits, namely the Big Five can be important indicators of health and life satisfaction of adolescents in early adolescence. However, further studies are needed to assess the link between the Big Five and its generalizability to other age groups.

[Trajectories of Self-rated Health in Secondary Education: Results from the German National Educational Panel Study]

AIM OF THE STUDY

Self-rated health is an important indicator of current and future health. However, panel data-based findings are lacking that take into consideration the background features of differentiated development of self-reported adolescent health. This paper examines the development of self- rated health through secondary education from grade 5-12 in Germany, analyzing differences according to indicators of socio-economic position and other background characteristics such as gender and family structure.

METHODOLOGY

5^th to 10^th grade data from the "Class 5" cohort and 9^th to 12^th grade data from the "9^th grade" cohort of the National Education Panel were combined. Growth curve models based on multi-level analysis were used to examine the level and course of self-rated health and to examine differences according to type of school, parenting, household income, gender and family structure. The final model contains 28,987 observations from 11,290 individuals over 8 time points.

RESULTS

Self-reported health declines slightly from 5^th to 12^th grade. Adolescents attending high school, living in higher-income households or parents with higher education status reported better health. Boys and adolescents growing up in nuclear families showed a more favorable course of self-rated health through secondary education.

CONCLUSION

This study provides a comprehensive overview of the development of self-rated health of adolescents in secondary education. In addition to the static differences according to background characteristics, girls and adolescents who do not live in nuclear families also had a worse prognosis for the development of self-rated health over the school career.

Inequalities in adolescent self-rated health and smoking in Europe: comparing different indicators of socioeconomic status

Background

Although there is evidence for socioeconomic inequalities in health and health behaviour in adolescents, different indicators of socioeconomic status (SES) have rarely been compared within one data sample. We examined associations of five SES indicators with self-rated health (SRH) and smoking (ie, a leading cause of health inequalities) in Europe.

Methods

Data of adolescents aged 14–17 years old were obtained from the 2013 SILNE survey (smoking inequalities: learning from natural experiments), carried out in 50 schools in 6 European cities (N=10 900). Capturing subjective perceptions of relative SES and objective measures of education and wealth, we measured adolescents’ own SES (academic performance, pocket money), parental SES (parental educational level) and family SES (Family Affluence Scale, subjective social status (SSS)). Logistic regression models with SRH and smoking as dependent variables included all SES indicators, age and gender.

Results

Correlations between SES indicators were weak to moderate. Low academic performance (OR=1.96, 95% CI 1.53 to 2.51) and low SSS (OR=2.75, 95% CI 2.12 to 3.55) were the strongest indicators of poor SRH after adjusting for other SES-indicators. Results for SSS were consistent across countries, while associations with academic performance varied. Low academic performance (OR=5.71, 95% CI 4.63 to 7.06) and more pocket money (OR=0.21, 95% CI 0.18 to 0.26) were most strongly associated with smoking in all countries.

Conclusions

Socioeconomic inequalities in adolescent health were largest according to SES indicators more closely related to the adolescent’s education as well as the adolescent’s perception of relative family SES, rather than objective indicators of parental education and material family affluence. For future studies on adolescent health inequalities, consideration of adolescent-related SES indicators was recommended.

[Trends in educational inequalities in smoking among adolescents in Germany : Evidence from four population-based studies]

BACKGROUND

In Germany, smoking prevalence among adolescents has significantly declined since the early 2000s. However, data show that adolescent smoking rates considerably differ between different types of secondary schools. The aim of our study was to examine how educational inequalities in adolescent smoking behaviour have developed over time.

METHODS

Data were used from four population-based studies (each consisting of repeated cross-sectional surveys from 2001-2015): the representative surveys of the Federal Centre for Health Education, the German Health Interview and Examination Survey for Children and Adolescents, the Health Behaviour in School-aged Children Study, and the European School Survey Project on Alcohol and Other Drugs. Each study comprised different age groups (within the age range of 11-17 years) and used different smoking measures. Adolescents' educational status was based on the attended type of secondary school. Absolute and relative educational inequalities were presented as prevalence differences and prevalence ratios, respectively.

RESULTS

Despite methodical differences, all four studies similarly reveal that adolescent smoking rates have significantly declined in all educational groups. However, lower smoking rates among secondary school students attending higher educational tracks could be observed. While absolute educational inequalities tended to decrease over time, relative inequalities between educational groups remained rather stable or even increased.

DISCUSSION

Declining adolescent smoking rates suggest that smoking may have lost some of its attractiveness for young people. Our findings further emphasize the importance of tobacco control measures such as raising cigarette taxes, smoking bans, and increasing minimum legal age for tobacco purchase. As relative educational inequalities in adolescent smoking rates did not diminish over time, setting- and target group-specific interventions should focus more on students in middle and lower secondary school tracks.

Perceived school climate, academic well-being and school-aged children's self-rated health: a mediator analysis

Background

Schools are crucial settings for young people's development. Rare studies have examined the impact of perceived school-climate and academic well-being on young people's self-rated health in joint analyses. This study focuses on the role of perceived school-climate and academic well-being for young people's self-rated health and examines whether school climate is mediated by indicators of academic well-being.

Methods

Data were obtained from the German National Educational Panel Study, including seventh grade students (n = 6838) aged 11-12, nested in 710 classes within 277 schools. Indicators of school climate (teacher control, demands, autonomy, interaction, goal setting and orientation, teaching quality) and academic well-being (satisfaction with school, helplessness in major school subjects) were reported from students. Multilevel modelling was used to analyze the relative importance of perceived school-climate and academic well-being on school-aged children's self-rated health.

Results

Results showed that academic well-being is strongly related to self-rated health. The better students perceive their academic well-being, the lower the likelihood of poor self-rated health. In contrast, indicators of perceived school climate are only indirectly related to self-rated health, mediated by academic well-being or are not at all associated with self-rated health.

Conclusions

This study suggests that school climate is important for academic well-being but not as important for students' self-rated health as academic well-being. Health promotion initiatives in schools have to ensure that school climate serves to enhance students' academic well-being to avoid health problems in the long-run.

Self-rated health and wellbeing among school-aged children with and without special educational needs: Differences between mainstream and special schools

BACKGROUND

Studies among students with special educational needs (SEN) in separate special schools (SSS) and mainstream schools (MS) are particularly applicable to educational attainment and social participation. However, indicators of health and wellbeing have rarely been considered.

AIMS

This study investigates two related topics: first, health and wellbeing differences between students with SEN in special schools (SSS) and students without SEN in regular schools, and second, the rarely considered question whether health and wellbeing among students with SEN differ between school settings (i.e. MS vs. SSS).

METHODS AND PROCEDURES

Bivariate and multilevel analyses are applied with data from the German National Educational Panel Study (NEPS) with 5267 students (grade 7).

OUTCOMES AND RESULTS

After having controlled for background characteristics, students in SSS report higher likelihoods of poor self-rated health compared to students in higher track schools. Self-rated health of students with SEN does not significantly differ between MS vs. SSS. For life satisfaction, students with SEN show higher likelihoods of low life satisfaction when attending MS.

CONCLUSIONS AND IMPLICATIONS

Teachers in inclusive settings are encouraged to establish class work and teaching that support a real change from class placement to inclusive culture in order to suitably support students with SEN.

Is being a "small fish in a big pond" bad for students´ psychosomatic health? A multilevel study on the role of class-level school performance

Background

Features of schools and classes are closely related to students´ health and wellbeing. However, class composition (e.g. in terms of school performance) has rarely been examined in relation to students´ health and wellbeing. This study focuses on the so called Big-Fish-Little-Pond-Effect (BFLPE), by investigating whether the level of high-performing students in classroom is negatively associated with psychosomatic complaints of students who perceive themselves as poor performers.

Methods

Data were derived from the German sample of the WHO-Collaborative “Health Behaviour in School-aged Children (HBSC)” study 2013/2014. The sample included 5226 11-, 13- and 15-year-old students. Individual perceived school performance (PSP) was included (very good/good vs. average/below average PSP) at the individual student-level. At the class-level, school performance in class was generated by aggregating the share (in percentage) of students who report a very good/good PSP to the class-level, indicating the percentage of students with good/very good PSP in classroom. Using multilevel regression models, the association between class-level school performance (in percentage of students with very good/good PSP) and individual psychosomatic complaints were analyzed, stratified by students´ individual PSP.

Results

Students who report average/below average PSP showed higher likelihoods of psychosomatic complaints (Odds Ratio: 1.75; 95% Confidence Interval: 1.52–2.03) compared to counterparts with very good/good PSP. The aggregated class-level PSP was not significantly associated with psychosomatic complaints. However, in line with the BFLPE, results further revealed that students with average/below average PSP, who attend classes with a higher percentage of students who report very good/good PSP, had higher likelihoods of psychosomatic complaints (Odds Ratio: 1.91; 95% Confidence Interval: 1.01–4.01) compared to classmates with very good/good PSP.

Conclusions

This study revealed that class composition in terms of PSP was differentially associated with students´ psychosomatic complaints, depending on their individual PSP. Findings highlight the vulnerability of students with poor PSP placed in classes with a higher percentage of students with good PSP. Results of this study therefore indicate a need for initiatives for low performing students from teachers and school staff in class.

Nicotine dependence among adolescents in the European Union: How many and who are affected?

Background

Nicotine dependence during adolescence increases the risk of continuing smoking into adulthood. The magnitude of nicotine dependence among adolescents in the European Union (EU) has not been established. We aimed to estimate the number of nicotine dependent 15-year-old adolescents in the EU, and identify high-risk groups.

Methods

The number of nicotine dependent 15-year-olds in the EU was derived combining: (i) total number of 15-year-olds in the EU (2013 Eurostat), (ii) smoking prevalence among 15-year-olds (2013/2014 HBSC survey) and (iii) proportion of nicotine dependent 15-year-olds in six EU countries (2013 SILNE survey). Logistic regression analyses identified high-risk groups in the SILNE dataset.

Results

We estimated 172 636 15-year-olds were moderately to highly nicotine dependent (3.2% of all 15 years old; 35.3% of daily smokers). In the total population, risk of nicotine dependence was higher in males, adolescents with poor academic achievement, and those with smoking parents or friends. Among daily smokers, only lower academic achievement and younger age of smoking onset were associated with nicotine dependence.

Conclusion

According to our conservative estimates, more than 172 000 15-year-old EU adolescents were nicotine dependent in 2013. Prevention of smoking initiation, especially among adolescents with poor academic performance, is necessary to prevent a similar number of adolescents getting addicted to nicotine each consecutive year.