Educational inequalities in risk perception, perceived effectiveness, trust and preventive behaviour in the onset of the COVID-19 pandemic in Germany.

OBJECTIVES: This study analysed educational inequalities in risk perception, perceived effectiveness, trust and adherence to preventive behaviours in the onset of the COVID-19 pandemic in Germany. STUDY DESIGN: This was a cross-sectional online survey. METHODS: Data were obtained from the GESIS Panel Special Survey on the coronavirus SARS-CoV-2 Outbreak in Germany, including 2949 participants. Stepwise linear regression was conducted to analyse educational inequalities in risk perception, perceived effectiveness, trust and adherence to preventive behaviours considering age, gender, family status and household size as covariates. RESULTS: We found lower levels in risk perception, trust towards scientists and adherence to preventive behaviour among individuals with lower education, a lower level of trust towards general practitioners among individuals with higher education and no (clear) educational inequalities in perceived effectiveness and trust towards local and governmental authorities. CONCLUSION: The results underline the relevance of a comprehensive and strategic management in communicating the risks of the pandemic and the benefits of preventive health behaviours by politics and public health. Risk and benefit communication must be adapted to the different needs of social groups in order to overcome educational inequalities in risk perception, trust and adherence to preventive behaviour.

Health inequalities in old age: the relative contribution of material, behavioral and psychosocial factors in a German sample.

Background: Whereas the association between education and health in later life is well described, investigations about the underlying mechanisms of these health inequalities are scarce. This study examines the relative contribution of material, behavioral and psychosocial factors to health inequalities in older Germans. Methods: Data were drawn from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). The analytic sample included 3246 participants aged 60-85 years. We examined the independent and indirect contribution of material, behavioral and psychosocial factors to the association between education and self-rated health based on logistic regression models. Results: Material factors were most important as they were additionally working through behavioral and psychosocial factors whereas the independent contribution of behavioral and psychosocial factors was much lower than suggested in the separate analyses of the three explanatory pathways. Conclusions: Policy interventions that focus on the improvement of material living conditions might reduce health inequalities in old age. In studies on the underlying mechanisms of health inequalities, material, behavioral and psychosocial factors should be modeled as inter-related predictors as the separate analysis does not reveal their actual contribution so that the relevance of single explanatory pathways might be overestimated.

[Contribution of Health Care Research to Establishing Social Equality in Health and Health Care Opportunities]. / Der Beitrag der Versorgungsforschung zur Chancengerechtigkeit in der Gesundheit und in der Versorgung.

Social inequalities in health and health care services represent issues of major concern. Findings in this area reveal inequalities in health and health care indicating disadvantages for individuals with a low socioeconomic background. Although the health care system plays a marginal role in the explanation of inequalities in health, health services research can be an important part in the development of equal health opportunities. The current article describes the causal associations between social inequalities, health inequalities and the health care service. Health services research can make a contribution to increasing equal opportunities in health and health care service. Against this background, we discuss the existing potential and need of research in the area of health services.

[Poverty, public transfers and health: An analysis on self-rated health of social benefit recipients in Germany]. / Armut, öffentliche Sozialtransfers und Gesundheit: Eine Analyse zur subjektiven Gesundheit von Sozialleistungsbeziehern in Deutschland.

BACKGROUND: Prevention and reduction of poverty are key elements of social welfare policy in Germany. This study is the first analysis of self-rated health of individuals that escape poverty by benefiting form public transfers. METHODS: Analyses are based on the German Socio-economic Panel (GSOEP) of 2010. Self-rated health was based on subjective assessment of general health status. Subjects were directly asked about receipt of public transfers. Income poverty was based on the equalized disposable income and is applied to a threshold of 60% of the median-based average income. We analyzed the association between self-rated health and pre- and post-transfer poverty by means of descriptive analyses and binary logistic regression. RESULTS: After adjusting for age, we found a significantly higher risk of poor self-rated health among those who escaped income poverty due to the receipt of social transfers compared to others (ORWomen: 1.85; 95%-CI: 1.27-2.69; ORMen: 2.57; 95%-CI: 1.63-4.05), in particular to those at risk of post-transfer poverty. These poverty-related inequalities in health were predominantly explained by nationality, occupational status, household type and long-term care within the household. CONCLUSION: This study provides first evidence that the receipt of public transfers is associated with increased risk of poor health in the light of impending income-poverty. This study adds to the current debate about the social and health implications of public transfers in the relationship between poverty and health.

[Poverty and Health: The Living Standard Approach as a Supplementary Concept to Measure Relative Poverty. Results from the German Socio-Economic Panel (GSOEP 2011)]. / Armut und Gesundheit: Der Lebensstandardansatz als ergänzendes Messinstrument relativer Armut. Ergebnisse aus dem Sozio-ökonomischen Panel (SOEP 2011).

BACKGROUND: A common indicator of the measurement of relative poverty is the disposable income of a household. Current research introduces the living standard approach as an alternative concept for describing and measuring relative poverty. This study compares both approaches with regard to subjective health status of the German population, and provides theoretical implications for the utilisation of the income and living standard approach in health research. METHODS: Analyses are based on the German Socio-Economic Panel (GSOEP) from the year 2011 that includes 12 290 private households and 21106 survey members. Self-rated health was based on a subjective assessment of general health status. Income poverty is based on the equalised disposable income and is applied to a threshold of 60% of the median-based average income. A person will be denoted as deprived (inadequate living standard) if 3 or more out of 11 living standard items are lacking due to financial reasons. To calculate the discriminate power of both poverty indicators, descriptive analyses and stepwise logistic regression models were applied separately for men and women adjusted for age, residence, nationality, educational level, occupational status and marital status. RESULTS: The results of the stepwise regression revealed a stronger poverty-health relationship for the living standard indicator. After adjusting for all control variables and the respective poverty indicator, income poverty was statistically not significantly associated with a poor subjective health status among men (OR Men: 1.33; 95% CI: 1.00-1.77) and women (OR Women: 0.98; 95% CI: 0.78-1.22). In contrast, the association between deprivation and subjective health status was statistically significant for men (OR Men: 2.00; 95% CI: 1.57-2.52) and women (OR Women: 2.11; 95% CI: 1.76-2.64). CONCLUSIONS: The results of the present study indicate that the income and standard of living approach measure different dimensions of poverty. In comparison to the income approach, the living standard approach measures stronger shortages of wealth and is relatively robust towards gender differences. This study expands the current debate about complementary research on the association between poverty and health.

[Socioeconomic status and inflammatory biomarkers of cardiovascular diseases: How do education, occupation and income operate?]. / Sozioökonomischer Status und inflammatorische Biomarker für Herz-Kreislauf-Erkrankungen : Wie wirken Bildung, Beruf und Einkommen?

BACKGROUND: In light of the consistent SES gradient in cardiovascular diseases, current research is focusing on possible pathways through which the socioeconomic status (SES) may impact health. Inflammatory processes play a critical role in the development of cardiovascular diseases and are associated with stress. Therefore, they might be one psychobiological pathway explaining how the SES gets under the skin. Considering the different meanings of education, occupation and income, this article gives an overview of the association between inflammatory biomarkers and socioeconomic status. RESULTS: There is high evidence for associations between indicators of SES - education, occupation and income - and inflammatory biomarkers. Possible pathways are health status, health behavior and psychobiological processes as a result of increased exposure to psychosocial stress. CONCLUSIONS: The SES gradient in cardiovascular diseases reflects behavioral as well as physiological pathways and systemic inflammation seems to be involved. Low SES is associated with an increased exposure to adverse circumstances of life, which can trigger biological responses and result in an increased risk of cardiovascular diseases. Medical history taking in cardiology should focus on socio-structural exposures and thereby reflect the different meanings of education, occupation and income.

[Socioeconomic inequalities in subjective health among 11- to 15-year-olds in Germany. A trend analysis from 2002-2010]. / Sozioökonomische Ungleichheiten in der subjektiven Gesundheit bei 11- bis 15-Jährigen in Deutschland. Eine Trendanalyse von 2002-2010.

Health is strongly linked to social position. Several studies showed consistent or increasing health inequalities in the last decades. So far, few studies focused on trends in social inequalities in health among children and adolescents. The objective of this study was to determine changes in socioeconomic differences in subjective health between 2002 and 2010 of 11- to 15-year-old students in Germany.Data were obtained from the German part of the cross-sectional WHO "Health Behaviour in School-aged Children" survey in 2002 (n=5.221), 2006 (n=6.896) and 2010 (n=4.723). Log binomial regression models were used to assess the extent of inequalities in self-rated health across the survey years. Socioeconomic position was measured using the family affluence scale (FAS) and perceived family wealth.A relatively small improvement in good/excellent self-rated health was observed in both boys and girls from 2002 (85.2%) to 2010 (87%). Despite this improvement, inequalities in self-rated health could be identified for all survey years, regardless of which socioeconomic indicator was used (RR 1.4 up to 1.8). The level of these differences remained virtually unchanged in girls and boys in that time period.The same relationship of family affluence, family wealth and self-rated health has persisted for almost a decade in Germany. Recent strategies could not tackle existing inequalities in self-rated health which indicates an increasing need to develop and implement innovative measures and to intensify efforts of social and health policy.

[Changes in tobacco, alcohol and cannabis use by adolescents from 2002 to 2010 in Germany]. / Veränderungen im Tabak-, Alkohol- und Cannabiskonsum von Jugendlichen im Zeitraum von 2002 bis 2010 in Deutschland.

So far, little is known about long-term trends in the use of psychoactive substances by adolescents in Germany. However, these results are urgently required for a target-orientated prevention. The aim of the present study is to analyse age- and gender-specific prevalences and trends in tobacco, alcohol und cannabis use among young people in Germany from 2002 to 2010.Data were obtained from the German part of the WHO collaborative study "Health Behaviour in School-aged Children (HBSC)" conducted in 2002, 2006, and 2010. The analysis is based on 11 917 students aged 13 and 15 years. Age- and gender-specific trend analyses were done using log binomial regression models.The prevalences of regular tobacco and alcohol use among 13- and 15-year-olds decreased from 2002 to 2010, independent of gender. A similar effect was found for repeated drunkenness and for the 12-month prevalence of cannabis use. In 2010 about 15% of the 15-year-olds consumed tobacco and alcohol at least once a week, 30% reported 2 or more episodes of drunkenness and 11% used cannabis in the last 12 months. The corresponding values for 13-year-olds with a prevalence of 3-5% on average are considerably lower.Following an increase over the 1990s the HBSC data shows a strong decrease in the use of psychoactive substances over the last 8 years which can be interpreted as a success of recent preventive efforts. However, noticeable is a clear flattening of the decrease from 2006 to 2010. This underlines that preventive actions must continue play a central role in health policy and practice.