["My Home, my Car, my Boat" - Satisfaction with One's Own Standard of Living as a Predictor of Gender-Specific Mortality]. / "Mein Haus, mein Auto, mein Boot". Zufriedenheit mit dem Lebensstandard als geschlechtsspezifischer Mortalitätsprädiktor.

BACKGROUND: Men have a higher risk of mortality than women and react much more sensitively to status-related stressors. The relationship between hierarchical rank and health, mediated on the HPA axis, delivers possible explanations for the more pronounced male sensitivity. In this context, the construct of status unease has attracted a lot of attention in recent years. It links social comparison with a reduced general wellbeing and considers it to be a major risk factor for various diseases. METHODS: An analysis of secondary data from the Socio-Economic Panel (SOEP) was used to analyze the extent to which subjective dissatisfaction with one's own standard of living is associated with an increased gender-related mortality risk. The statistical modeling of the question was carried out by performing gender-disaggregated Cox proportional hazard models. The unbalanced sub-sample consisted of 6 454 men (685 deaths) and 6 908 women (618 deaths). RESULTS: Dissatisfaction with one's standard of living has a significant influence on the mortality risk of men but not women: Men with low satisfaction have nearly a twice as high risk of mortality than the reference group (HR=1,95, 95% CI 1,48-2,58), men with moderate satisfaction a 25% higher mortality risk (HR=1,26, 95% CI 1,08-1,49). Furthermore, subjective status shows stronger dose-response relationships than objective status parameters. CONCLUSION: Dissatisfaction with one's standard of living turns out to be a clear predictor for male mortality. Stress reactions due to disparaging social comparison processes triggered by the HPA-axis could be a central cause. The results indicate that the standardized inclusion of subjective status indicators should be considered in social-epidemiological analysis. The distinctive gender difference also points out that gender-sensitive epidemiological data analysis is reasonable.

[Males and rank--the role of competition for men's health]. / Mann und Rang--die Rolle von Konkurrenz für die Männergesundheit.

There exists a consistent, continuous, and partly strong gender-specific association between social status and health: Men react more sensitively than women to their social status, e.g., concerning mortality. A gender-difference becomes apparent especially concerning partly psycho-socially determined diseases with a conspicuous role of subjective social status. Status-induced psycho-social strain seems to be even more relevant for men than for women. A chronic over-activation of the HPA axis plays a central role in the neurophysiology of status-induced psychic stress. The strongest HPA activity is triggered by competitive situations. On the one hand men are more competitive than women; on the other hand they show a stronger stress response to social-evaluative situations. Chronic HPA over-activation is a risk factor for many widespread diseases and is particularly associated with depressive disorders. Therefore, a high grade of competition and a hierarchy-oriented self-image is considered to be a salient societal hazard factor. So far human rank behaviour has attracted relatively little scientific attention and competition-specific health-related approaches are rare until now. One currently and broadly discussed approach to influence the degree of competition focuses on societal egalitarianism. Approaches that are founded on culturally established competition-decreasing strategies may be more sophisticated, for example, humility-inducing approaches. Setting approaches in particular could represent a promising template to focus on competition as an important topic in health promotion and prevention in formative environments. Attention should be paid to the conflict of objectives between competitiveness as a risk-inducing health determinant and its role as a growth engine for our society and economy.

["Are you ok?" Self-rated health of boys and girls with externalising behavior problems]. / "Na? Geht's gut?" Zum gesundheitlichen Wohlbefinden (self-rated health) von Jungen und Mädchen mit externalisierenden Verhaltensproblemen.

BACKGROUND: Externalising behavior problems involve a huge developmental risk potential as they can substantially interface with the parallel process of establishing and forming identity in peer groups during adolescence while simultaneously coping with expectations regarding academic achievement and behaviour. Therefore adolescents with externalising behavior constitute a potential target audience for health promotion. AIM OF THE STUDY: The purpose of this paper is to clarify in what kind of social contexts externalising behavior problems are associated with decreased subjective health in adolescence. METHOD: An analysis of secondary data from the KiGGS study (Robert Koch-Institute, 2009) was undertaken. Calculations of logistic regression models for boys and girls were performed on the basis of preceding stratifications using the indicator subjective health and including relevant social demographic factors. OUTCOME: Externalising adolescents face a higher risk of decreased subjective health than inconspicuous adolescents of the same age group, while there is a gender-specific difference (boys OR 2.76; girls OR 1.48). The gender-specific differences in subjective health appraisal found in inconspicuous adolescents cannot be verified in adolescents with externalising behaviour. Related to social demographic predictors a classic social gradient for girls is verified whereas externalising behaviour in boys is predominantly associated from high social class and decreased subjective health. In multivariate procedures a higher odds ratio for decreased subjective health becomes apparent for adolescents who ascend or descend in relation to their education level as well as for adolescents from higher social classes who had to repeat a school year. CONCLUSION: Adolescents with externalising behavior frequently rate their health situation as being bad. The fact that it is primarily boys with behavior problems and boys who are intergenerational mobile educationwise who exhibit decreased psychosocial well-being, indicates that an increased context related exclusion risk (ostracism) is an essential health risk factor. Micro-groups of adolescents facing risk of being ostracised appear to be an essential target group for prevention and health promotion which so far is not being taken into consideration on the basis of school type related recommendations.

[Gender-specific health reporting in the Bodenseekreis: future theme of " health in boys and men"]. / Genderspezifische Gesundheitsberichterstattung im Bodenseekreis: Zukunftsthema "Gesundheit von Jungen und Männern".

Population prognoses predict a far over-proportional increase in the number of male seniors, entailing substantial implications for the planning of health supply and care, as well as various possibilities to intervene preventively by specific risk avoidance or boosting health responsibility. In the future men's health and male-specific health reporting will become eminently important. A gender-specific life table analysis for the years 1998 - 2002 shows which causes of death are more responsible for loss of life expectancy of men compared to women in both the Bodenseekreis and Baden-Württemberg. Baden-Württemberg and the Bodenseekreis are regions with a well above-average life expectancy compared to other regions in Germany. The average life expectancy in Baden-Württemberg in the year 2000 amounted to 82 years (Bodenseekreis: 82.2) in women, and 76.4 years (Bodenseekreis: 77.3) in men. Among the main causes for the 5.6 year difference in life expectancy are cardiovascular diseases, cancer illnesses, traffic accidents and suicide. These groups of causes of death explain the major part of the difference in average life expectancy. An analysis of death risks specific to age and gender shows some promising approaches for health promotion and prevention based on identification of critical phases of life. In this case, special attention should be paid to infancy, as examinations made within the scope of enrolment at schools identify considerable differences in the prevalence of various disturbances. However, early adulthood and old age also prove to be important periods concerning men-specific interventions. The presented results show first possible starting points which, however, should above all make a contribution to the establishment of the topic of men's health as a focus on gender-specific health reporting, health promotion and prevention. The described target group for health promotion and prevention is, on the one hand, sufficiently large, on the other hand, sufficiently disadvantaged in terms of health to demand more attention in the future.

[Prevention of diseases and health monitoring by the local public health services. Tasks and prospects]. / Prävention und Gesundheitsberichterstattung im OGD Bedingungen und Chancen.

For many years prevention of disease and health promotion have been central activities of the public health services in Germany. But especially within these areas of activity there have been difficulties in understanding "old"versus"new"in relation to public health. Previously it was not possible to generate common standards for the public health service for prevention, health promotion and health monitoring due to the regional diversity of legislation within the single provinces. However, these activities could demonstrate the strength of public health services in these fields. The forthcoming law on prevention provides a framework for strengthening the public health services through defining qualitative standards for eligible preventive measures and at the same time making clear the competences of public health services that should be available. Thus public health services could become one of the central players at the local level in the strengthening of prevention and health promotion in the future. The quality of planning and outcome of eligible preventive measures will strongly depend on the local health monitoring system. If the forthcoming law does not make use of the competence of public health services in identifying healthy and socially disadvantaged settings, a white-collar orientation of preventive and health promotion activities may be expected.

[Mortality due to road traffic in Baden-Württemberg--air pollution, accidents, noise]. / Mortalität durch den Strassenverkehr in Baden-Württemberg--Schadstoffemissionen, Unfälle, Lärm.

UNLABELLED: Aim of this study was to determine the influence of road traffic on mortality for the area of Baden-Württemberg (Germany) in 1997. Of special interest was the impact of air pollution and road traffic accidents on life expectancy. METHODS: Having the most pronounced effect on mortality particulate matter 10 (PM 10) was chosen for estimation of air pollution. Following the method described by Künzli et al. PM 10 concentration due to road traffic was estimated from total suspended particles to be 11.1 mg/m3 and relative risk (RR) of PM 10 on mortality be 1.044 (confidence interval 1.033-1.054) per 10 microg/m3 PM 10. RESULTS: 5216 (error range 3040-8892) premature deaths were calculated by life table analysis to be due to traffic. The vast majority (4325) were estimated to be a consequence of PM 10 pollution. The total influence on average life expectancy was 8.8 months (error range 6.0-13.7) with 5.5 months due to PM 10 and 3.3 months due to accidents. The effect of traffic accidents as well as PM 10 on mortality was higher for men than for women. CONCLUSION: Road traffic has a strong influence on mortality. The most important impact of traffic on premature mortality is due to air pollution. While the risk of traffic accidents can, to a certain degree, be controlled individually, prevention of deaths due to air pollution requires general guidelines for emission of deleterious substances.