Trends in health inequalities in childhood and adolescence in Germany: Results of the HBSC study 2009/10 - 2022.

Background: Many studies have identified health inequalities in childhood and adolescence. However, it is unclear how these have developed in recent years, particularly since the COVID-19 pandemic. Methods: Analyses are based on the German data from the international Health Behaviour in School-aged Children (HBSC) study from 2009/10 (n = 5,005), 2013/14 (n = 5,961), 2017/18 (n = 4,347), and 2022 (n = 6,475). A total of 21,788 students aged approximately between 11 and 15 years were included. Socioeconomic status (SES) was assessed using the Family Affluence Scale (FAS). Several health indicators were analysed stratified by gender using bivariate and multivariate analysis methods. Results: In 2022, there are clear socioeconomic inequalities in life satisfaction, self-rated health, fruit and vegetable consumption, and physical activity. These inequalities remained largely constant or increased between 2009/10 and 2022. Between 2017/18 and 2022, no significant changes in inequalities were found. Conclusions: Health inequalities are persistent and reduce the chances of growing up healthy. There is no evidence that inequalities in the analysed outcomes have changed during the pandemic period (between 2017/18 and 2022). Rather, the changes in the health indicators seem to affect all adolescents in a similar way.

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.

Impact of Low-Dose Dronabinol Therapy on Cognitive Function in Cancer Patients Receiving Palliative Care: A Case-Series Intervention Study.

Background: Cannabis may offer therapeutic benefits to patients with advanced cancer not responding adequately to conventional palliative treatment. However, tolerability is a major concern. Cognitive function is a potential adverse reaction to tetrahydrocannabinol containing regimens. The aim of this study was to test cognitive function in patients being prescribed dronabinol as an adjuvant palliative therapy. Methods: Adult patients with advanced cancer and severe related pain refractory to conventional palliative treatment were included in this case-series study. Patients were examined at baseline in conjunction with initiation of dronabinol therapy and at a two-week follow-up using three selected Wechsler's adult intelligence scale III neurocognitive tests: Processing Speed Index (PSI), Perceptual Organization Index (POI), and Working Memory Index (WMI). Patients were also assessed using pain visual analog scale, Major Depression Inventory, and Brief Fatigue Inventory. Results: Eight patients consented to take part in the study. Two patients discontinued dronabinol therapy, one due to a complaint of dizziness and another critical progression of cancer disease, respectively. The remaining six patients were successfully treated with a daily dosage of 12.5 mg dronabinol (p = 0.039). PSI (p = 0.020), POI (p = 0.034.), and WMI (p = 0.039). Conclusions: Cognitive function improved in this group of patients with advanced cancer in conjunction with low-dose dronabinol therapy. The cause is likely multifactorial including reported relief of cancer-associated symptoms. Further clinical investigation is required.

The effects of lineup size on the processes underlying eyewitness decisions.

Here we apply the two-high threshold eyewitness identification model to identify the effects of lineup size on the detection-based and non-detection-based processes underlying eyewitness decisions. In Experiment 1, lineup size was manipulated by showing participants simultaneous or sequential lineups that contained either three or six persons. In Experiment 2, the lineups contained either two or five persons. In both experiments, the culprit was better detected in smaller than in larger lineups. Furthermore, participants made fewer guessing-based selections in smaller than in larger lineups. However, guessing-based selection in larger lineups was not increased to a level sufficient to offset the effect of increased protection of suspects in larger lineups due to the fact that the guessing-based selections that occur are distributed across more persons. The results show that increasing the lineup size causes several changes in the detection-based and non-detection-based processes underlying eyewitness decisions.

Measuring lineup fairness from eyewitness identification data using a multinomial processing tree model.

The mock-witness task is typically used to evaluate the fairness of lineups. However, the validity of this task has been questioned because there are substantial differences between the tasks for mock witnesses and eyewitnesses. Unlike eyewitnesses, mock witnesses must select a person from the lineup and are alerted to the fact that one lineup member might stand out from the others. It therefore seems desirable to base conclusions about lineup fairness directly on eyewitness data rather than on mock-witness data. To test the importance of direct measurements of biased suspect selection in eyewitness identification decisions, we assessed the fairness of lineups containing either morphed or non-morphed fillers using both mock witnesses and eyewitnesses. We used Tredoux's E and the proportion of suspect selections to measure lineup fairness from mock-witness choices and the two-high threshold eyewitness identification model to measure the biased selection of the suspects directly from eyewitness identification decisions. Results obtained in the mock-witness task and the model-based analysis of data obtained in the eyewitness task converged in showing that simultaneous lineups with morphed fillers were significantly more unfair than simultaneous lineups with non-morphed fillers. However, mock-witness and eyewitness data converged only when the eyewitness task mimicked the mock-witness task by including pre-lineup instructions that (1) discouraged eyewitnesses to reject the lineups and (2) alerted eyewitnesses that a photograph might stand out from the other photographs in the lineup. When a typical eyewitness task was created by removing these two features from the pre-lineup instructions, the morphed fillers no longer lead to unfair lineups. These findings highlight the differences in the cognitive processes of mock witnesses and eyewitnesses and they demonstrate the importance of measuring lineup fairness directly from eyewitness identification decisions rather than indirectly using the mock-witness task.

Evaluating the impact of first-yes-counts instructions on eyewitness performance using the two-high threshold eyewitness identification model.

In eyewitness research, multiple identification decisions in sequential lineups are typically prevented by telling participants that only their first identification decision counts. These first-yes-counts instructions are incompatible with standard police protocols prescribing that witnesses shall see the entire lineup. Horry et al. were the first to experimentally test how this discrepancy between eyewitness research and standard police protocols affects eyewitness identification decisions. Here, the two-high threshold eyewitness identification model was used to disentangle the effect of the first-yes-counts instructions on the detection and guessing processes underlying eyewitness identification decisions. We report both a reanalysis of Horry et al.'s data and a conceptual replication. Both the reanalysis and the results of the conceptual replication confirm that first-yes-counts instructions do not affect the detection of the culprit but decrease the probability of guessing-based selections. To improve the ecological validity, research on sequential lineups should avoid first-yes-counts instructions.

Experimental validation of a multinomial processing tree model for analyzing eyewitness identification decisions.

To improve police protocols for lineup procedures, it is helpful to understand the processes underlying eyewitness identification performance. The two-high threshold (2-HT) eyewitness identification model is a multinomial processing tree model that measures four latent cognitive processes on which eyewitness identification decisions are based: two detection-based processes (the detection of culprit presence and absence) and two non-detection-based processes (biased and guessing-based selection). The model takes into account the full 2 × 3 data structure of lineup procedures, that is, suspect identifications, filler identifications and rejections in both culprit-present and culprit-absent lineups. Here the model is introduced and the results of four large validation experiments are reported, one for each of the processes specified by the model. The validation experiments served to test whether the model's parameters sensitively reflect manipulations of the processes they were designed to measure. The results show that manipulations of exposure duration of the culprit's face at encoding, lineup fairness, pre-lineup instructions and ease of rejection of culprit-absent lineups were sensitively reflected in the parameters representing culprit-presence detection, biased suspect selection, guessing-based selection and culprit-absence detection, respectively. The results of the experiments thus validate the interpretations of the parameters of the 2-HT eyewitness identification model.

A validation of the two-high threshold eyewitness identification model by reanalyzing published data.

The two-high threshold (2-HT) eyewitness identification model serves as a new measurement tool to measure the latent cognitive processes underlying eyewitness identification performance. By simultaneously taking into account correct culprit identifications, false innocent-suspect identifications, false filler identifications in culprit-present and culprit-absent lineups as well as correct and false lineup rejections, the model capitalizes on the full range of data categories that are observed when measuring eyewitness identification performance. Thereby, the model is able to shed light on detection-based and non-detection-based processes underlying eyewitness identification performance. Specifically, the model incorporates parameters for the detection of culprit presence and absence, biased selection of the suspect and guessing-based selection among the lineup members. Here, we provide evidence of the validity of each of the four model parameters by applying the model to eight published data sets. The data sets come from studies with experimental manipulations that target one of the underlying processes specified by the model. Manipulations of encoding difficulty, lineup fairness and pre-lineup instructions were sensitively reflected in the parameters reflecting culprit-presence detection, biased selection and guessing-based selection, respectively. Manipulations designed to facilitate the rejection of culprit-absent lineups affected the parameter for culprit-absence detection. The reanalyses of published results thus suggest that the parameters sensitively reflect the manipulations of the processes they were designed to measure, providing support of the validity of the 2-HT eyewitness identification model.

[The role of health promoting schools for increasing health equity]. / Die Bedeutung schulischer Gesundheitsförderung für die Erhöhung gesundheitlicher Chancengleichheit.

Socioeconomic health inequalities are a major field of action in public health and tackling them is one of its main goals. However, there has been little success in reducing these health inequalities. This points to a large research deficit. Inequalities in health are already evident in childhood and adolescence, showing that those with a low socioeconomic background have more risk factors and at the same time fewer resources than their socially more privileged peers. Although health promotion aims at achieving equity in health, interventions rarely consider the socioeconomic status and can therefore provide only little evidence regarding socioeconomically differentiated intervention effects. How can we ensure that all children and young people have equal chances to grow up healthy?In order to come closer to answering this question, it is the aim of this article to give an overview of health inequalities in childhood and adolescence and to highlight the contribution of school and school-based health promotion interventions for tackling health inequalities and increasing equity in health. School is not only a place where adolescents can always be reached, regardless of their socioeconomic background, it has the potential to both exacerbate and reduce health inequalities.

Perception of Patients with Cancer Enquiring About Adjuvant Therapy with Cannabis Medicine for Palliation of Symptoms: An Interview Study among Danish Health Care Professionals.

Background: A medicinal cannabis pilot program was launched in Denmark in 2018 to support patients as countermeasure against self-medication by use of cannabis products from the illicit market. The aim was to facilitate patient access to adjuvate therapy using medicinal cannabis under the guidance of physicians. Objective: The aim of this interview study was to elucidate how health care professionals (HCPs) perceive cancer patients enquiring about cannabis medicine (CM), including medicinal cannabis and cannabis-based medicine, for adjuvant palliative therapy. Design: The program used semistructured qualitative research interviews with thematic analysis. Setting/Participants: Fifty HCPs took part in the study with 10 informants in each of the following 5 groups: oncologists, palliative care specialists, general practitioners, registered nurses in oncology, and in palliative care. Results: The informants reported that optional CM as adjuvant therapy was only discussed when initiated by the patient or relatives. Reluctance by HCPs to enter into a dialogue about CM with their patients was mainly explained by the lack of clinical evidence for the use of CM in palliative care of patients with cancer. None of the oncologists had ever prescribed CM, while three palliative care specialists and two general practitioners had issued prescriptions on rare occasions. Conclusion: HCPs involved in cancer treatment and palliative care are in general reluctant to discuss optional adjuvant CM therapy with their patients. The Danish health care authorities need to address this barrier to ensure that patients eligible for CM therapy are given this option as intended by the launch of the national pilot program.

Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: a scoping review.

OBJECTIVES: To synthesise the evidence on the role of compositional or contextual characteristics of schools in the association between students' socioeconomic position and their health in primary and secondary education in developed economies. DESIGN: Scoping review. We included studies examining the role of at least one school or class characteristic on students' health inequalities and was published since 1 January 2000, in English or German. We searched PubMed/Medline, Web of Science and Education Resources Information Center. We provided a narrative synthesis and an overview of findings. School characteristics were grouped into five broad categories: school composition, school climate, school policies and organisation, food environment and facilities. RESULTS: Of 8520 records identified, 26 studies were included. Twelve studies found a moderating and 3 a mediating effect. The strongest evidence came from studies examining the moderating effect of school composition, that is, the negative impact of a low individual socioeconomic position on mental health and well-being was aggravated by a low average socioeconomic position of schools. Evidence concerning the role of school climate, school stratification (eg, performance base tracking) and sponsorship, food environment and sport facilities and equipment was generally weak or very weak and mostly based on singular findings. Overall, favourable meso-level characteristics mitigated the negative impact of low individual socioeconomic position on health outcomes. CONCLUSIONS: School characteristics affect health inequalities in children and adolescents to some degree, but future research is necessary to strengthen the existing evidence and address under-represented aspects in school characteristics and health outcomes.

[The association between school tobacco policies and the perceived smoking prevalence of adolescents]. / Der Zusammenhang zwischen schulischer Tabakkontrolle und der wahrgenommenen Raucherprävalenz Jugendlicher.

BACKGROUND: In the German context, there is hardly any quantitative data about the implementation of school tobacco polices that include the perspective of both teachers and students. The aim of the study is to investigate the associations between implemented school tobacco policies and the perceived prevalence of smoking at the level of school staff and adolescents. METHODS: The repeated cross-sectional study (2013 and 2017) is based on pooled responses of 13- to 17-year-old adolescents (N = 2393) and school staff (N = 85) from 25 schools located in the West German metropolitan region of Hanover. In linear regression models, average marginal effects (AMEs) with 95% confidence intervals (CI95%) and robust standard errors for perceived tobacco prevalence are reported separately for school tobacco policies assessed by teachers and students (scale 0-6). All models were controlled for sociodemographic, school-, and smoking-specific covariates. RESULTS: On average, adolescents perceive a smoking prevalence of 30% ([Formula: see text]; s: 24.0) for their school. A comprehensive school tobacco policy is consistently associated with lower school smoking prevalence both from the point of view of teachers (AME: -3.54 CI95% -6.49 to -0.58) and students (AME: -1.69 CI95% -2.52 to -0.86). The number of smoking friends (e.g., "most of them are smokers" +14%: AME: 14.13 CI95% 10.46 to 17.80) and the type of school are the most relevant determinants of a high school smoking prevalence. School types with a nonacademic track report a 15% (AME: 15.03 CI95% 10.13 to 19.93) higher prevalence compared to grammar schools. DISCUSSION: Progressive school tobacco control policies should focus more on school types with nonacademic tracks, certain groups at risk, and those schools that do not strictly enforce school tobacco policies.

Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: protocol for a scoping review.

INTRODUCTION: Childhood and adolescence are crucial life stages for health trajectories and the development of health inequalities in later life. The relevance of schools for health and well-being of children and adolescents has long been recognised, and there is some research regarding the association of contextual and compositional characteristics of schools and classes with health, health behaviour and well-being in this population. Little is known about the role of meso-level characteristics in relation to health inequalities. The aim of this scoping review is to retrieve and synthesise evidence about the mediating or moderating role of compositional or contextual characteristics of schools for the association between students' socioeconomic position and health in primary and secondary education. METHODS AND ANALYSIS: We will conduct a systematic search of electronic databases in PubMed/Medline, Web of Science and Education Resources Information Center. Studies must meet the following inclusion criteria: (1) The population must be students attending primary or secondary schools in developed economies. (2) The outcomes must include at least one indicator for individual health, health behaviour or well-being. (3) The study must include at least one contextual or compositional characteristic of the school context and one individual determinant of socioeconomic position. (4) The study must also examine the mediating or moderating role of the contextual or compositional characteristic of the school context for the associations between socioeconomic position and health, health behaviour or well-being. (5) The study must be published since 1 January 2000 in English or German language. We will provide a narrative synthesis of findings. ETHICS AND DISSEMINATION: We will not collect primary data and only include secondary data derived from previously published studies. Therefore, ethical approval is not required. We intend to publish our findings in an international peer-reviewed journal and to present them at national and international conferences.

Traditional bullying and cyberbullying among children and adolescents in Germany - Cross-sectional results of the 2017/18 HBSC study and trends.

Bullying is a specific form of violence that can potentially lead to numerous and long-term negative health implications. Despite consistent coverage in the media, particularly on cyberbullying, as of yet there are only few representative findings on the frequency of (cyber)bullying in Germany. This article analyses how widespread bullying and cyberbullying were at schools in Germany in 2018, what differences exist between girls and boys, age groups and various types of schools, and changes in bullying trends between 2002 and 2018. Our findings are based on an analysis of the data provided by the 2017/18 cycle (N=4,347 students, 53.0% female) and previous cycles of the German Health Behaviour in School-aged Children (HBSC) study. In the 2018 cycle, boys reported having bullied other children more frequently than girls, but were bullied just as often. 15-year-olds reported having bullied other children more frequently than 11- to- 13-year-olds but reported being bullied less frequently. Students at grammar schools (Gymnasium) least frequently reported any involvement in bullying. Only few children and adolescents reported cases of cyberbullying. Compared to all previous survey years, 2018 saw the lowest number of children that reported having bullied others. However, reports of having been bullied have remained almost stable. The findings highlight the need for evidence-based prevention and intervention anti-bullying programmes and measures across all types of general education schools and age groups.

The 2017/18 Health Behaviour in School-aged Children (HBSC) study - Methodology of the World Health Organization's child and adolescent health study.

The Health Behaviour in School-aged Children (HBSC) study is an international research project in collaboration with the World Health Organization (WHO) for over 35 years. HBSC is the largest study on child and adolescent health and one of the most important sources of data for the WHO's international comparative health monitoring. Every four years, data on the health and health behaviour of students aged 11, 13 and 15, as well as the social contexts and conditions for growing up healthy, are collected. A total of 50 countries belong to the HBSC network, with 45 countries taking part in the 2017/18 survey. Germany has contributed to the HBSC surveys since 1993/94. For the most recent 2017/18 cycle, students at 146 schools in Germany were interviewed (response rate of schools: 15.6%). A net sample of n = 4,347 girls and boys was achieved for Germany (response rate: 52.7%). Participation was voluntary and the survey was conducted in German school years five, seven and nine (corresponding to ages 11, 13 and 15). A weighting procedure was applied to allow for representative findings on the health of children and adolescents in Germany. HBSC offers a valuable contribution to health monitoring and provides numerous starting points to identify needs, risk groups and fields of action to initiate targeted and actual needs-based measures of prevention and health promotion in the school setting.

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.