Trends of socioeconomic inequalities in overweight and obesity in children and adolescents in Germany

Abstract Background Overweight and obesity in early life are risk factors for chronic health conditions in the later life course. Children and adolescents from socioeconomically disadvantaged families are more likely to be overweight or obese than their better-off peers. This study examined post-millennial trends of socioeconomic inequalities in the prevalence of overweight and obesity among young people in Germany. Methods Repeated cross-sectional data were used from the German health interview and examination survey for children and adolescents (KiGGS). Overweight and obesity were assessed by body mass index, based on measured height and weight of 3- to 17-year-old participants in KiGGS baseline (2003-06) and KiGGS wave 2 (2014-17). Socioeconomic position (SEP) was measured using a composite index of parental education, occupation and income. The regression-based slope index of inequality (SII) and relative index of inequality (RII) were calculated to estimate the extent of absolute and relative inequalities in the prevalence of overweight and obesity. Results The overall prevalence of overweight and obesity among 3- to 17-year-olds in Germany did not change over time and was recently 15.4% and 5.9%, respectively. In both survey waves, overweight and obesity were more prevalent in lower SEP-groups. From 2003-06 to 2014-17, overweight increased in the low-SES group, whereas it tended to decrease in those with higher SES. This trend was concomitant with increasing socioeconomic inequalities in overweight over the observation period (SII from 0.11 to 0.19, p = 0.054; RII from 2.1 to 3.7, p = 0.021). No such trend was found for obesity. Conclusions Socioeconomic inequalities in overweight have widened among the young in Germany since the early 2000s. Structural interventions that are effective in preventing and reducing overweight in young people from socially disadvantaged backgrounds are still needed. Key messages Overweight increased among young people from socioeconomically disadvantaged families. Socioeconomic inequalities in overweight increased among children and adolescents.

The increase in heavy rainfall in recent years shows the need to consider disaster preparedness also for persons in need of assistance and care who are cared for at home or in old people's and nursing homes. Evacuation concepts in the event of a heavy rainfall event lasting several days with simultaneous power failure are hardly available for the vulnerable group so far. As part of the LifeGRID project funded by the Federal Ministry of Education and Research, the question is being investigated as to what regional challenges and requirements arise in the event of flooding and a prolonged power blackout in the Wesermarsch district. In addition, the question will be addressed as to how the current care situation of patients referred to electricity presents itself in such a situation. Within the framework of a qualitative design, expert interviews were conducted with care service managers in winter 2022. The four guided interviews were transcribed and their content analysed. In coping with the assumed catastrophic events, the interviewees see problem areas in the organisation, communication, form of care and target group, in addition to the regional characteristics. It became clear that there are not only unanswered questions regarding responsibilities in the event of a crisis, but also that the diversity of forms of care (e.g. private households) poses a particular challenge. The interviewees do not see any viable alternatives to secure communication in the event of a power failure and also see that respiratory patients, for example, have a special need for care (e.g. due to the limited battery life of the respiratory equipment). The results also show that the nursing experts have different views on how they should prepare for such a scenario. These range from passivity to proactivity. A clear need for action becomes visible for cooperation and networking of the relevant actors, promotion of disaster literacy as well as the necessity to adapt the training curricula.

Key messages:
Climate change is exacerbating the demands for concepts that sustainably contribute to increasing disaster literacy. The results of the study underline this. Patients receiving outpatient care and residents of nursing homes for the elderly who depend on a continuous power supply have not yet been the focus of disaster management.

Methods:
Repeated cross-sectional data were used from the German health interview and examination survey for children and adolescents (KiGGS). Overweight and obesity were assessed by body mass index, based on measured height and weight of 3to 17-year-old participants in KiGGS baseline (2003-06) and KiGGS wave 2 (2014-17). Socioeconomic position (SEP) was measured using a composite index of parental education, occupation and income. The regression-based slope index of inequality (SII) and relative index of inequality (RII) were calculated to estimate the extent of absolute and relative inequalities in the prevalence of overweight and obesity.

Results:
The overall prevalence of overweight and obesity among 3-to 17-year-olds in Germany did not change over time and was recently 15.4% and 5.9%, respectively. In both survey waves, overweight and obesity were more prevalent in lower SEPgroups. From 2003-06 to 2014-17, overweight increased in the low-SES group, whereas it tended to decrease in those with higher SES. This trend was concomitant with increasing socioeconomic inequalities in overweight over the observation period (SII from 0.11 to 0.19, p = 0.054; RII from 2.1 to 3.7, p = 0.021). No such trend was found for obesity.

Conclusions:
Socioeconomic inequalities in overweight have widened among the young in Germany since the early 2000s. Structural interventions that are effective in preventing and reducing overweight in young people from socially disadvantaged backgrounds are still needed. Key messages: Overweight increased among young people from socioeconomically disadvantaged families. Socioeconomic inequalities in overweight increased among children and adolescents.

Introduction:
Socioeconomic conditions affect the dynamics of the COVID-19 pandemic. We analysed the association between area-level socioeconomic deprivation, proportion of non-nationals, and Covid-19 incidence in Germany.

Methods:
Using nationally representative data at the level of 401 German districts from three waves of infection (January-2020 to May-2021), we fitted Bayesian spatiotemporal models to assess the association between socioeconomic deprivation, proportion of non-nationals, and Covid-19 incidence, controlling for age, sex, vaccination coverage, settlement structure, spatial and temporal effects. We estimated risk ratios (RR) and corresponding 95% credible intervals (95%-CrI) for deprivation quintiles. We further examined the deprivation domains (education, income, occupation), interactions between deprivation, sex and the proportion of non-nationals, and explored potential pathways from deprivation to Covid-19 incidence.

Conclusions:
Socioeconomic deprivation and proportion of non-nationals are independently associated with Covid-19 incidence. Regional planning of non-pharmaceutical interventions and vaccination strategies would benefit from consideration of area-level deprivation and non-national residency. Key messages: Area-level socioeconomic deprivation and proportion of non-nationals are independently associated with higher risk of Covid-19 incidence across 401 German districts. Tailored non-pharmaceutical interventions and immunisation strategies are needed, which properly consider arealevel socioeconomic deprivation and non-national residents.

Background:
Electronic cigarettes (e-cigarettes) are often advertised as a healthier option to combustible cigarettes and as smoking cessation aid. However, e-cigarettes are a growing health concern and their addictive potential remains to be fully understood. Within the EValuation of the Addictive Potential of E-cigarettes (EVAPE) project, we studied subjective and objective measures of addiction in relation to e-cigarette use.

Methods:
This cross-sectional analysis was based on 832 participants of the first wave (2016) of England from the ITC Four Country Smoking and Vaping (4CV) Survey, who were using ecigarettes daily or weekly for at least four months. Perceived addiction to e-cigarettes was categorised as very vs. not/ somewhat addicted, and perceived addictiveness of e-cigarettes relative to combustible cigarettes as equally/more addictive vs. less addictive. Objective measures of addiction included urge to vape, time to first vape after waking, frequency of use, and used nicotine strength. We examined associations between these objective and subjective measures of addiction using multivariate logistic regression, adjusted for age, gender, education, and cigarette smoking.

Results:
17.8% of participants reported feeling very addicted to ecigarettes and 42.3% considered e-cigarettes equally/more addictive than combustible cigarettes. Those who felt very addicted had higher odds of regarding e-cigarettes as more addictive (OR 3.43 (95%-CI 2.29-5.19)). All objective measures of addiction were associated with higher perceived addiction, whereas only a shorter time to first vape was associated with perceived product addictiveness.

Conclusions:
Subjective measures of addiction to e-cigarettes, in particular perceived addiction, correspond with objective measures.
Understanding the addictive potential of e-cigarettes is the 15th European Public Health Conference 2022