Anna-Kristin Brettschneider

Comparison of BMI Derived from Parent-Reported Height and Weight with Measured Values: Results from the German KiGGS Study

The use of parent-reported height and weight is a cost-efficient instrument to assess the prevalence of children’s weight status in large-scale surveys. This study aimed to examine the accuracy of BMI derived from parent-reported height and weight and to identify potential predictors of the validity of BMI derived from parent-reported data. A subsample of children aged 2–17 years (n = 9,187) was taken from the 2003–2006 cross-sectional German KiGGS study. Parent-reported and measured height and weight were collected and BMI was calculated. Besides descriptive analysis, linear regression models with BMI difference and logistic regression models with weight status misclassification as dependent variables were calculated. Height differences varied by gender and were generally small. Weight and BMI were under-reported in all age groups, the under-reporting getting stronger with increasing age. Overall, the proportion for overweight and obesity based on parental and measured reports differed slightly. In the youngest age group, the proportion of overweight children was overestimated, while it was underestimated for older children and adolescents. Main predictors of the difference between parent reported and measured values were age, gender, weight status and parents’ perception of the child’s weight. In summary, the exclusive use of uncorrected parental reports for assessment of prevalence rates of weight status is not recommended.

Does Breastfeeding Help to Reduce the Risk of Childhood Overweight and Obesity? A Propensity Score Analysis of Data from the KiGGS Study

Background Current studies suggest that the beneficial effect of breastfeeding on overweight and obesity may have been largely overestimated. We examined the relationship between >4 months of full breastfeeding and overweight/obesity in children living in Germany. Methods We analyzed retrospectively collected data on breastfeeding from children aged 3–17 years who participated in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS baseline study) between 2003 and 2006 (n = 13163). To minimize confounding, we applied propensity score matching and multivariate logistic regression analyses to estimate the effect of breastfeeding on childhood overweight and obesity. Results Adjusted analyses of the matched dataset (n = 8034) indicated that children who were breastfed for <4 months had a significant reduction in the odds of overweight (OR 0.81 [95% CI 0.71–0.92]) and obesity (OR 0.75 [95% CI 0.61–0.92]) compared to children who were not breastfed or who were breastfed for a shorter duration. Further analyses stratified by age group showed that the association was strongest in children aged 7–10 years (OR 0.67 [95% CI 0.53–0.84] for overweight and OR 0.56 [95% CI 0.39–0.81] for obesity), while no significant effect could be seen in other age groups. Discussion Our findings support the hypothesis that breastfeeding does have a beneficial effect on childhood overweight and obesity, although the effect seems to be strongest in children of primary school age.

Beteiligung von Menschen mit Migrationshintergrund an Gesundheitssurveys des Robert Koch-Instituts

People with migration background (PMB) make up a huge section of the population with specific health chances and risks. There are only limited data available on the health situation of PMB, since inclusion of PMB in surveys is hindered, e.g. due to language barriers. The present study has examined to what extent the population-based health surveys of the Robert Koch Institute have managed to include a representative extent of PMB, with the aim of deriving recommendations for analysis options and future recruitment strategies. The 2009 microcensus (MC) of the Federal Statistical Office was used as the basis to check whether the sample of KiGGS Wave 1 (2009-2012) and DEGS 1 (2008-2011) are representative regarding socio-demographic and migrant-specific characteristics. 1107 PMB participated in DEGS 1. In comparison to the MC, particular sub-groups are underrepresented in the sample: people who immigrated themselves (first-generation migrants), people with a low education and Turkish citizens. On the other hand, some age groups are overrepresented. In KiGGS Wave 1, 2021 children and adolescents with a migration background participated. Response was lower if parents had a low education. In total, the participation of children and adolescents with a migration background was lower in comparison to the KiGGS baseline survey. The data on PMB in DEGS 1 and KiGGS Wave 1 are appropriate for health analyses of this population group. However, analyses should be stratified according to characteristics like migrant generation, age or education level, or these characteristics should be adjusted for in statistical models. In order to achieve a representative inclusion of people with a migration background, in future surveys sub-group-specific activities to increase participation of PMB are recommended.

Development and Validation of Correction Formulas for Self-Reported Height and Weight to Estimate BMI in Adolescents. Results from the KiGGS Study

Objective: The use of reported instead of measured height and weight induces a bias in prevalence rates for overweight and obesity. Therefore, correction formulas are necessary. Methods: Self-reported and measured height and weight were available from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) baseline study (2003-2006) from 3,468 adolescents aged 11-17 years. With regression analyses, correction formulas for height and weight were developed. Cross-validation was conducted in order to validate and compare the formulas. Corrected BMI was calculated, and corrected prevalence rates were estimated. Sensitivity, specificity, and predictive values for overweight and obesity were calculated. Results: Through the correction procedure, the mean differences between reported and measured height and weight become remarkably smaller and thus the estimated prevalence rates more accurate. The corrected proportions for overweight and obesity are less under-reported, while the corrected proportions for underweight are less over-reported. Sensitivity for overweight and obesity increased after correction. Specificity remained high. Conclusion: The validation process showed that the correction formulas are an appropriate tool to correct self-reports on an individual level in order to estimate corrected prevalence rates of overweight and obesity in adolescents for studies which have collected self-reports only.

Applying a correction procedure to the prevalence estimates of overweight and obesity in the German part of the HBSC study

BackgroundPrevalence rates for overweight and obesity based on self-reported height and weight are underestimated, whereas the prevalence rate for underweight is slightly overestimated. Therefore a correction is needed. Aim of this study is to apply correction procedures to the prevalence rates developed on basis of (self-reported and measured) data from the representative German National Health Interview and Examination Survey for Children and Adolescents (KiGGS) to (self-reported) data from the German Health Behaviour in School Aged Children (HBSC) study to determine whether correction leads to higher prevalence estimates of overweight and obesity as well as lower prevalence rates for underweight.MethodsBMI classifications based on self-reported and measured height and weight from a subsample of the KiGGS study (2,565 adolescents aged 11–15) were used to estimate two different correction formulas. The first and the second correction function are described. Furthermore, the both formulas were applied to the prevalence rates from the HBSC study (7,274 adolescents aged 11–15) which are based on self-reports collected via self-administered questionnaires.ResultsAfter applying the first correction function to self-reported data of the HBSC study, the prevalence rates of overweight and obesity increased from 5.5% to 7.8% (compared to 10.4% in the KiGGS study) and 2.7% to 3.8% (compared to 7.8% in the KiGGS study), respectively, whereas the corrected prevalence rates of underweight and severe underweight decreased from 8.0% to 6.7% (compared to 5.7% in the KiGGS study) and from 5.5% to 3.3% (compared to 2.4% in the KiGGS study), respectively. Application of the second correction function, which additionally considers body image, led to further slight corrections with an increase of the prevalence rates for overweight to 7.9% and for obese to 3.9%.ConclusionSubjective BMI can be used to determine the prevalence of overweight and obesity among children and adolescents. Where there is evidence of bias, the prevalence estimates should be corrected using conditional probabilities that link measured and subjectively assessed BMI from a representative validation study. These corrections may be improved further by considering body image as an additional influential factor.

Einflussfaktoren auf Verbreitung und Dauer des Stillens in Deutschland

Breastfeeding is the natural way of feeding infants in the first months of their lives and has been proven to have health benefits for both infants and mothers. Breastfeeding initiation and duration are affected by social, demographic and health factors. The aim of this study was to describe the current rates of breastfeeding initiation and duration in Germany, and to identify potential factors that underline these rates. Additionally, results are compared with the KiGGS basic (2003-2006; birth cohorts 1996-2002) study in order to reveal the development in the trends of breastfeeding initiation and duration in Germany. The KiGGS wave 1 (2009-2012) includes data on the breastfeeding behavior of mothers of 4410 children aged between 0 and 6 years (birth cohorts 2002-2012). Altogether, 82% (95% confidence interval 79.8-84.2 %) of children were ever breastfed, and the average breastfeeding duration was 7.5 months (7.2-7.8). There was a slight increase in the breastfeeding initiation in Germany over the last several years. Breastfeeding initiation among children aged 0-6 years increased by 4% points compared to 0- to 6-year-olds (birth cohorts 1996-2002) from the KiGGS basic study. The breastfeeding duration stayed unchanged. The breastfeeding behavior was mainly related to the age of the mother at birth, the mothers education level, smoking during pregnancy, and multiple or premature birth. Despite the overall increasing trend in breastfeeding initiation, there is still a growing need for breastfeeding promotion and support for young and less educated mothers, mothers who smoke during pregnancy, and also for mothers with premature babies or multiple births.

Psychische Gesundheit von Jugendlichen in Deutschland

ZusammenfassungViele Kinder und Jugendliche in Deutschland wachsen in Familien mit Migrationshintergrund auf. Unterschiedliche kulturelle, religiöse und sprachliche Hintergründe beeinflussen ihr Verhalten in vielerlei Hinsicht. Der Zusammenhang zwischen Gesundheit und Migrationshintergrund kann sowohl positiv als auch negativ sein. Ziel der vorliegenden Arbeit war es, Zusammenhänge zwischen selbstberichteten psychischen Problemen und Migrationshintergrund sowie verschiedenen Herkunftsländern bei Jugendlichen in Deutschland zu beschreiben. Die Basiserhebung (2003–2006) des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS) bietet durch ihr migrantensensitives Zugangsdesign gute Voraussetzungen für migrantenspezifische Auswertungen. Selbstberichtete Verhaltensauffälligkeiten sowie Stärken wurden mit dem Strengths and Difficulties Questionnaire (SDQ) bei 6719 Jugendlichen im Alter von 11 bis 17 Jahren erfasst. Jugendliche mit beidseitigem Migrationshintergrund berichteten häufiger psychische Probleme (SDQ-Gesamtproblemwert) als Jugendliche ohne Migrationshintergrund (16,9 vs. 11,5 %) oder Jugendliche mit einseitigem Migrationshintergrund (16,9 vs. 11,3 %). Der Vergleich nach Herkunftsländern zeigte, dass türkeistämmige Jugendliche ein erhöhtes Risiko für psychische Probleme im SDQ-Gesamtproblemwert hatten (Jungen: OR 2,0; 95 %-KI 1,3–3,2; Mädchen: OR 2,0; 95 %-KI 1,2–3,4) als Jugendliche ohne Migrationshintergrund. Auch für Mädchen aus Westeuropa, den USA und Kanada bestand laut Selbstauskunft ein erhöhtes Risiko für psychische Probleme (OR 2,2; 95 %-KI 1,3–3,6). Nach Adjustierung für den Sozialstatus wurde der Effekt der Herkunftsländer jedoch in einigen Fällen insignifikant. Die Ergebnisse weisen auf die Bedeutung einer migrantensensiblen und kultursensitiven Prävention von psychischen Problemen hin, die die Lebenswelt und kulturspezifischen Besonderheiten der Betroffenen mit einbezieht.AbstractMany children and adolescents in Germany grow up in families with a migration background. Different cultural, religious, and linguistic backgrounds have an influence on their behavior in various ways. Health status can be affected both negatively and positively by a migration background. The aim of this study was to analyze associations between migration background and self-reported psychological problems. In addition, it was tested whether country of origin had a differential effect on the associations found. Because of its migration-specific approach, the baseline survey (2003–2006) of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) offers a solid basis for migrant-specific analyses. Self-reported mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), which was completed by 6,719 adolescents aged 11–17 years. Adolescents with a two-sided migration background (i.e., both parents) reported higher SDQ total difficulties scores compared with adolescents without a migration background (16.9 vs 11.5 %) or those with a one-sided migration background (16.9 vs 11.3 %). Adolescents with a Turkish background had higher odds (boys: OR 2.0; 95 %CI 1.3–3.2; girls: OR 2.0; 95 %CI 1.2–3.4) of reporting mental health problems than adolescents without a migration background. Also, girls with a migration background from Western Europe, the USA or Canada had higher odds (OR 2.2; 95 %CI 1.3–3.6). In some cases, adjusting for socioeconomic status led to insignificant associations with regard to the country of origin. The findings underline the importance of migrant-specific and culture-sensitive prevention, which also takes the environment and culture-specific characteristics into account.Many children and adolescents in Germany grow up in families with a migration background. Different cultural, religious, and linguistic backgrounds have an influence on their behavior in various ways. Health status can be affected both negatively and positively by a migration background. The aim of this study was to analyze associations between migration background and self-reported psychological problems. In addition, it was tested whether country of origin had a differential effect on the associations found. Because of its migration-specific approach, the baseline survey (2003-2006) of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) offers a solid basis for migrant-specific analyses. Self-reported mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), which was completed by 6,719 adolescents aged 11-17 years. Adolescents with a two-sided migration background (i.e., both parents) reported higher SDQ total difficulties scores compared with adolescents without a migration background (16.9 vs 11.5%) or those with a one-sided migration background (16.9 vs 11.3%). Adolescents with a Turkish background had higher odds (boys: OR 2.0; 95%CI 1.3-3.2; girls: OR 2.0; 95%CI 1.2-3.4) of reporting mental health problems than adolescents without a migration background. Also, girls with a migration background from Western Europe, the USA or Canada had higher odds (OR 2.2; 95%CI 1.3-3.6). In some cases, adjusting for socioeconomic status led to insignificant associations with regard to the country of origin. The findings underline the importance of migrant-specific and culture-sensitive prevention, which also takes the environment and culture-specific characteristics into account.

Übergewicht und Adipositas im Kindes- und Jugendalter in Deutschland – Querschnittergebnisse aus KiGGS Welle 2 und Trends

Seit einiger Zeit gibt es Hinweise darauf, dass sich die Übergewichtsund Adipositasprävalenzen bei Heranwachsenden in Deutschland auf hohem Niveau stabilisiert haben. Mit Daten aus der zweiten Folgeerhebung der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS Welle 2, 2014 – 2017) liegen nun erneut Messwerte zu Körpergröße und -gewicht von Kindern und Jugendlichen im Alter von 3 bis 17 Jahren vor, die dies bestätigen. Die Prävalenz der daraus abgeleiteten Indikatoren beträgt für Übergewicht 15,4 % und für Adipositas 5,9 %. Es gibt keine Unterschiede zwischen Mädchen und Jungen. Übergewichtsund Adipositasprävalenzen steigen mit zunehmendem Alter an. Kinder und Jugendliche mit niedrigem sozioökonomischen Status (SES) sind deutlich häufiger von Übergewicht und Adipositas betroffen als Gleichaltrige mit hohem SES. Im Vergleich zur KiGGS-Basiserhebung (2003 – 2006) ist insgesamt und in allen Altersgruppen kein weiterer Anstieg der Übergewichtsund Adipositasprävalenzen zu beobachten. ÜBERGEWICHT · ADIPOSITAS · UNTERSUCHUNGSSURVEY · GESUNDHEITSMONITORING · KIGGS Hintergrund Die hohen Prävalenzen von Übergewicht und Adipositas im Kindesund Jugendalter stellen ein weltweites Gesundheitsproblem sowie eine bedeutende Herausforderung für Public Health im 21. Jahrhundert dar. Die Prävention von übermäßiger Gewichtszunahme bei Kindern und Jugendlichen hat aus unterschiedlichen Gründen eine hohe Relevanz: Kinder mit Übergewicht und Adipositas weisen im Vergleich zu normalgewichtigen Gleichaltrigen häufiger Risikofaktoren für Herz-Kreislauf-Erkrankungen wie einen erhöhten Blutdruck, Fettstoffwechselstörungen und Störungen des Glukosestoffwechsels auf [1]. Darüber hinaus ist ein hoher Body Mass Index (BMI) im Kindesund Jugendalter mit einer höheren Wahrscheinlichkeit für Typ-2-Diabetes, Bluthochdruck und Herz-Kreislauf-Erkrankungen im Erwachsenenalter assoziiert [2]. Außerdem sind Übergewicht und Adipositas bei Kindern und Jugendlichen mit einer erheblichen Reduktion der Lebensqualität [3] sowie mit einem höheren Risiko für Mobbing [4] verbunden. Seit Mitte der 1970er-Jahre wurde weltweit ein Anstieg der Prävalenzen von Übergewicht und Adipositas im Kindesund Jugendalter beobachtet [5]. Ungefähr seit Beginn der 2000er-Jahre zeigt sich jedoch für viele Länder mit hohem Einkommensniveau, dass sich der Trend zunehmender Übergewichtsund Adipositasprävalenzen nicht weiter fortsetzt [6, 7]. Auch für Deutschland gibt es Hinweise darauf, dass die Prävalenzen nicht weiter ansteigen beziehungsweise dass sich der Trend verlangsamt oder sogar stagniert [8–13]. Journal of Health Monitoring · 2018 3(1) DOI 10.17886/RKI-GBE-2018-005 Robert Koch-Institut, Berlin Anja Schienkiewitz, Anna-Kristin Brettschneider, Stefan Damerow, Angelika Schaffrath Rosario Robert Koch-Institut, Berlin Abteilung für Epidemiologie und Gesundheits-

[Mental health in adolescents in Germany: A comparison with regard to migration background and country of origin].

ZusammenfassungViele Kinder und Jugendliche in Deutschland wachsen in Familien mit Migrationshintergrund auf. Unterschiedliche kulturelle, religiöse und sprachliche Hintergründe beeinflussen ihr Verhalten in vielerlei Hinsicht. Der Zusammenhang zwischen Gesundheit und Migrationshintergrund kann sowohl positiv als auch negativ sein. Ziel der vorliegenden Arbeit war es, Zusammenhänge zwischen selbstberichteten psychischen Problemen und Migrationshintergrund sowie verschiedenen Herkunftsländern bei Jugendlichen in Deutschland zu beschreiben. Die Basiserhebung (2003–2006) des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS) bietet durch ihr migrantensensitives Zugangsdesign gute Voraussetzungen für migrantenspezifische Auswertungen. Selbstberichtete Verhaltensauffälligkeiten sowie Stärken wurden mit dem Strengths and Difficulties Questionnaire (SDQ) bei 6719 Jugendlichen im Alter von 11 bis 17 Jahren erfasst. Jugendliche mit beidseitigem Migrationshintergrund berichteten häufiger psychische Probleme (SDQ-Gesamtproblemwert) als Jugendliche ohne Migrationshintergrund (16,9 vs. 11,5 %) oder Jugendliche mit einseitigem Migrationshintergrund (16,9 vs. 11,3 %). Der Vergleich nach Herkunftsländern zeigte, dass türkeistämmige Jugendliche ein erhöhtes Risiko für psychische Probleme im SDQ-Gesamtproblemwert hatten (Jungen: OR 2,0; 95 %-KI 1,3–3,2; Mädchen: OR 2,0; 95 %-KI 1,2–3,4) als Jugendliche ohne Migrationshintergrund. Auch für Mädchen aus Westeuropa, den USA und Kanada bestand laut Selbstauskunft ein erhöhtes Risiko für psychische Probleme (OR 2,2; 95 %-KI 1,3–3,6). Nach Adjustierung für den Sozialstatus wurde der Effekt der Herkunftsländer jedoch in einigen Fällen insignifikant. Die Ergebnisse weisen auf die Bedeutung einer migrantensensiblen und kultursensitiven Prävention von psychischen Problemen hin, die die Lebenswelt und kulturspezifischen Besonderheiten der Betroffenen mit einbezieht.AbstractMany children and adolescents in Germany grow up in families with a migration background. Different cultural, religious, and linguistic backgrounds have an influence on their behavior in various ways. Health status can be affected both negatively and positively by a migration background. The aim of this study was to analyze associations between migration background and self-reported psychological problems. In addition, it was tested whether country of origin had a differential effect on the associations found. Because of its migration-specific approach, the baseline survey (2003–2006) of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) offers a solid basis for migrant-specific analyses. Self-reported mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), which was completed by 6,719 adolescents aged 11–17 years. Adolescents with a two-sided migration background (i.e., both parents) reported higher SDQ total difficulties scores compared with adolescents without a migration background (16.9 vs 11.5 %) or those with a one-sided migration background (16.9 vs 11.3 %). Adolescents with a Turkish background had higher odds (boys: OR 2.0; 95 %CI 1.3–3.2; girls: OR 2.0; 95 %CI 1.2–3.4) of reporting mental health problems than adolescents without a migration background. Also, girls with a migration background from Western Europe, the USA or Canada had higher odds (OR 2.2; 95 %CI 1.3–3.6). In some cases, adjusting for socioeconomic status led to insignificant associations with regard to the country of origin. The findings underline the importance of migrant-specific and culture-sensitive prevention, which also takes the environment and culture-specific characteristics into account.Many children and adolescents in Germany grow up in families with a migration background. Different cultural, religious, and linguistic backgrounds have an influence on their behavior in various ways. Health status can be affected both negatively and positively by a migration background. The aim of this study was to analyze associations between migration background and self-reported psychological problems. In addition, it was tested whether country of origin had a differential effect on the associations found. Because of its migration-specific approach, the baseline survey (2003-2006) of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) offers a solid basis for migrant-specific analyses. Self-reported mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), which was completed by 6,719 adolescents aged 11-17 years. Adolescents with a two-sided migration background (i.e., both parents) reported higher SDQ total difficulties scores compared with adolescents without a migration background (16.9 vs 11.5%) or those with a one-sided migration background (16.9 vs 11.3%). Adolescents with a Turkish background had higher odds (boys: OR 2.0; 95%CI 1.3-3.2; girls: OR 2.0; 95%CI 1.2-3.4) of reporting mental health problems than adolescents without a migration background. Also, girls with a migration background from Western Europe, the USA or Canada had higher odds (OR 2.2; 95%CI 1.3-3.6). In some cases, adjusting for socioeconomic status led to insignificant associations with regard to the country of origin. The findings underline the importance of migrant-specific and culture-sensitive prevention, which also takes the environment and culture-specific characteristics into account.

Overweight and obesity among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

For some time, there have been indications that the prevalence of overweight and obesity among children and adolescents in Germany has stabilised at a high level. The second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) once again provides nationwide measurements on height and weight of children and adolescents aged 3 to 17 years. The results are confirming this trend. The prevalence of overweight is 15.4% and 5.9% for obesity. There are no differences between girls and boys. Overweight and obesity prevalence increases with age. Children and adolescents with low socioeconomic status (SES) are more likely to be overweight and obese than those with high SES. Compared to the KiGGS baseline study (2003-2006), there was no further increase in overweight and obesity prevalence overall and in all age groups. OVERWEIGHT · OBESITY · EXAMINATION SURVEY · HEALTH MONITORING · KIGGS Background The high prevalence of overweight and obesity in childhood and adolescence is a global health problem and a major public health challenge in the 21st century. The prevention of excessive weight gain in children and adolescents has a high relevance for various reasons: Children with overweight and obesity are more likely to suffer from cardiovascular risk factors such as high blood pressure, as well as disorders in lipid and in glucose metabolism, when compared to their normal-weight peers [1]. In addition, a high body mass index (BMI) in childhood and adolescence is associated with a higher likelihood of type 2 diabetes, hypertension and cardiovascular disease in adulthood [2]. Furthermore, overweight and obesity in children and adolescents are associated with a significant reduction in quality of life [3] and a higher risk of bullying [4]. Since the mid-1970s, an increase in the prevalence of overweight and obesity among children and adolescents has been observed worldwide [5]. However, since the beginning of the 2000s, it has become apparent for many highincome countries that the trend of increasing overweight and obesity prevalences is not continuing [6, 7]. There are also indications for Germany that the prevalences are not increasing, or that the trend is slowing down, or even levelling off [8-13]. According to the results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS baseline study), which was conducted between 2003 and 2006, a total of 15% of children and adolescents aged 3 to 17 years were either overweight or obese. Obesity was observed in 6.3% of children and adolescents [14]. From the first follow-up survey (KiGGS Wave 1), which took This article has been corrected as of July 19, 2018 (see erratum, page 22) Journal of Health Monitoring · 2018 3(1) DOI 10.17886/RKI-GBE-2018-022.2 Robert Koch Institute, Berlin Anja Schienkiewitz, Anna-Kristin Brettschneider, Stefan Damerow, Angelika Schaffrath Rosario Robert Koch Institute, Berlin Department of Epidemiology and Health