Klassischerweise wird der sozioökonomische Status (SES) in der Gesundheitsforschung mit objektiven Indikatoren (Bildung, Beruf, Einkommen) bestimmt. Ergänzend wird seit einigen Jahren zunehmend auch der subjektive soziale Status (SSS) erfasst, meist mithilfe der MacArthur Scale. In diesem Beitrag wird die Konstruktvalidität einer deutschsprachigen Version dieses Instruments untersucht. Zudem wird der Frage nachgegangen, ob der SSS über den objektiven SES hinaus mit der gesundheitlichen Lage zusammenhängt. Für die Analysen werden Daten einer bevölkerungsbasierten Pilotstudie herangezogen, die im Rahmen der Studie „Gesundheit in Deutschland aktuell“ (GEDA) vom Robert Koch-Institut durchgeführt wurde (n = 1571; Alter: 18−79 Jahre). Der SSS wurde mit der 10-stufigen MacArthur Scale erfasst. Dabei konnten sich die Befragten selbst auf der „sozialen Stufenleiter“ platzieren. Am stärksten korrelierte der SSS mit konstruktverwandten Indikatoren wie einem mehrdimensionalen SES-Index und den objektiven SES-Einzelindikatoren Einkommen, berufliche Stellung und Bildungsgrad (r = 0,32−0,60; p < 0,001). Schwächere Korrelationen waren zwischen dem SSS und den konstruktfremden Indikatoren soziale Unterstützung, seelisches Wohlbefinden, Depressivität und Body-Mass-Index festzustellen (r = − 0,29−0,30; p < 0,001). Faktorenanalysen ließen keine nennenswerten Fremdladungen des SSS auf die Faktoren Wohlbefinden und Depressivität erkennen. Nach Kontrolle für Alter, Bildung, Beruf und Einkommen blieb ein niedrigerer SSS signifikant mit einem schlechteren Gesundheitszustand assoziiert (p < 0,05). Die Ergebnisse sprechen für die konvergente und diskriminante Validität des Instruments und weisen darauf hin, dass der Selbstwahrnehmung von sozialer Benachteiligung eine eigenständige Bedeutung für die gesundheitliche Lage zukommt. In health research, socio-economic status (SES) is traditionally assessed using objective indicators (education, occupation, income). For a couple of years, there has been a growing body of studies that additionally assess the subjective social status (SSS) of respondents, mostly using the MacArthur Scale. The aim of this study was to examine the construct validity of a German-language version of this instrument and to investigate whether SSS is associated with health over and above objective SES. Analyses were based on data from a population-based pilot study carried out within the ‘German Health Update’ (GEDA) study conducted by the Robert Koch Institute (n = 1,571; age: 18−79 years). SSS was measured with the MacArthur scale asking respondents to place themselves on a 10-rung “social ladder”. The strongest correlations to SSS were found with measures of similar constructs such as a multidimensional index of objective SES, income level, occupational position and educational attainment (r = 0.32−0.60; p < 0.001). Weaker correlations were found between SSS and measures of dissimilar constructs such as social support, mental well-being, depressiveness, and body-mass-index (r = − 0.29−0.30; p < 0.001). Factor analysis did not show considerable loadings of SSS on factors of mental well-being and depressiveness. After adjusting for age, education, occupation, and income, lower SSS remained significantly associated with higher odds of adverse health (p < 0.05). The findings of this study provide support for the convergent and discriminant validity of the MacArthur Scale and indicate that self-perceptions of social disadvantage may have health implications beyond the impact of objective SES.

Children who are exposed to secondhand smoke (SHS) have an increased risk of a wide range of health problems and illnesses. Smoke-free legislation aims to improve indoor air quality and in this way protect the health of people who do not smoke. This paper examines trends in SHS exposure at home among children in Germany since the introduction of smoking bans in public places. Special focus is placed on the importance of the family of origin’s socioeconomic status (SES) and on parental smoking behaviour. The analyses are based on two waves of the “German Health Interview and Examination Survey for Children and Adolescents” (KiGGS)—one of which was conducted immediately before the introduction of central smoke-free legislation in the 2003-2006 period, the other approximately 6 years later from 2009 to 2012. A comparison is made between the answers given by the parents of children aged between 0 to 6 (KiGGS baseline study, n = 6680; KiGGS Wave 1, n = 4455). Domestic SHS exposure is covered in the parent interviews by asking whether anyone is allowed to smoke at home in the presence of their child. Parental smoking behaviour is determined separately for mothers and fathers. SES is determined on the basis of the parents’ education, occupational status and income. The percentage of 0- to 6-year-old children exposed to SHS in the parental home fell from 23.9 to 6.6 % in the period from 2003-2006 to 2009-2012. At the same time, the percentage of children with at least one parent who smokes decreased from 49.8 to 41.8 %. While relative social inequalities in parental smoking behaviour have tended to increase over time, inequalities in domestic SHS exposure have persisted. Children whose parents smoke and children from low-SES families are still most likely to be exposed to tobacco smoke. In both study periods and after statistical adjustment for parental smoking behaviour, children with a low SES had a 6.6-fold higher risk for SHS exposure in the parental home than children from high-SES households. The results of the KiGGS study show that the proportion of children in Germany who are exposed to SHS at home has declined significantly over the last few years. There is much to suggest that the smoke-free legislation that has been introduced in Germany has led to a heightened awareness of the health risks of SHS both in public and in the private sphere, as well as to a denormalization of smoking. Children whose parents smoke, and among them particularly children from socially disadvantaged families, should be recognised as key target groups when implementing future tobacco-control measures.

Analysiert wird der Tabak- und Alkoholkonsum von Jugendlichen in Deutschland. Neben der aktuellen Situation werden auch zeitliche Entwicklungen und Trends berichtet. Als Datenbasis dient die erste Folgebefragung der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS Welle 1), die in den Jahren 2009 bis 2012 durchgeführt wurde. Einbezogen wurden alle Mädchen und Jungen im Alter von 11 bis 17 Jahren (n = 5258). Die Ergebnisse zeigen, dass aktuell 12,0 % der 11- bis 17-jährigen Jugendlichen in Deutschland rauchen. Darin eingeschlossen sind 5,4 % der Jugendlichen, die täglich rauchen. Ein riskanter Alkoholkonsum (AUDIT-C-Gesamtwert) ist bei 15,8 % der Heranwachsenden festzustellen, regelmäßiges Rauschtrinken (mindestens einmal im Monat 6 oder mehr alkoholische Getränke bei einer Gelegenheit) bei 11,5 %. Zwischen den Geschlechtern sind in Bezug auf die meisten Indikatoren keine signifikanten Unterschiede festzustellen. Lediglich bei den 14- bis 17-Jährigen zeigt sich, dass Jungen häufiger als Mädchen zu regelmäßigem Rauschtrinken neigen (23,1 vs. 16,5 %, p In this paper, tobacco and alcohol consumption among adolescents in Germany was analyzed. In addition to the current situation, we report temporal developments and trends. Data were obtained from the first follow-up of the KiGGS study (KiGGS Wave 1) conducted from 2009 to 2012. All girls and boys aged 11–17 years (n = 5,258) were included. The results show that currently 12.0 % of 11- to 17-year-old adolescents in Germany smoke, 5.4 % of them on a daily basis. At-risk drinking (AUDIT-C total score) was prevalent among 15.8 % of adolescents, heavy episodic drinking (six or more alcoholic standard drinks on a single occasion at least once a month) among 11.5 %. No significant gender differences were found for most indicators. However, among adolescents aged 14–17 years, boys revealed a greater inclination toward heavy episodic drinking than girls did (23.1 vs. 16.5 %, p

In the Western industrialized nations, the proportion of people who are overweight has increased continuously during the past few decades (1). One particularly clear sign of this development is the prevalence of severe overweight, which is why the...

Social inequalities in health can be explained in part by the social patterning of leisure-time physical activity, such as non-participation in sports. This study is the first to explore whether absolute and relative educational inequalities in sporting inactivity among adults have changed in Germany since the early 2000s. Data from four cross-sectional national health surveys conducted in 2003 (n = 6890), 2009 (n = 16,418), 2010 (n = 17,145) and 2012 (n = 13,744) were analysed. The study population was aged 25–69 years in each survey. Sporting inactivity was defined as no sports participation during the preceding 3 months. The regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in sporting inactivity, respectively. Sporting inactivity was consistently more prevalent in less-educated groups. The overall prevalence of sporting inactivity declined significantly over time. However, the decline was observed only in the high and medium education groups, while no change was observed in the low education group. Both absolute and relative educational inequalities in sporting inactivity were found to have widened significantly between 2003 (SII = 0.30, 95% CI = 0.25–0.35; RII = 2.08, 95% CI = 1.83–2.38) and 2012 (SII = 0.41, 95% CI = 0.37–0.45; RII = 3.44, 95% CI = 3.03–3.91). Interaction analysis showed that these increases in inequalities were larger in the younger population under the age of 50 than among the elderly. The findings suggest that the gap in sports participation between adults with high and low educational attainment has widened in both absolute and relative terms because of an increase in sports participation among the better educated. Health-enhancing physical activity interventions specifically targeted to less-educated younger adults are needed to prevent future increases in social inequalities in health.

Background: Adolescence is the period in which smoking onset usually occurs and the course for future socioeconomic status (SES) is set. However, because of the transitional nature of adolescence, it is questionable whether health inequalities are best measured by indicators of parental SES or rather by indicators of the adolescents’ own developing SES. We examine the independent effects of parental and adolescent education and intergenerational educational mobility on adolescent smoking behaviour while controlling for differences in parental and close friends’ smoking behaviour. Methods: The study is based on data from a subsample (12–17 years, n = 5,053) of the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Participants reported their education level as well as their personal and close friends’ smoking behaviour. Information on parental education and smoking behaviour was obtained via parent interviews. Adolescent and parental education data were dichotomized (low/high), leading to four categories of intergenerational educational mobility: stable high, potentially upwardly mobile, potentially downwardly mobile, and stable low. Results: After adjustment for parental and close friends’ smoking behaviour, adolescent smoking habits were strongly related to their personal education level, but not that of their parents. Among boys, both stable low and downwardly mobile adolescents had a 2.7-fold increased risk of being a smoker compared with peers with a stable high education. Among girls, only those with a stable low education had a 2.2-fold increased risk of smoking. Among both genders, educational upward mobility was associated with significantly lower smoking rates compared with peers with a stable low education (boys: OR 0.32; 95% CI 0.20–0.53; girls: OR 0.52; 95% CI 0.37–0.73). Conclusions: Our results show that the risk of an adolescent smoking is influenced by their own education level rather than that of their parents. Educational upward mobility seems to be protective against becoming a smoker in youth. Boys who experience downward mobility tend to have a significantly higher inclination to smoke than their peers with a stable high education. These findings illustrate the potential public health benefits of investments in education and help identify high-risk groups for smoking onset.