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Vorgelegt werden Ergebnisse einer 1998 in den alten (n=3939) und den neuen Bundesländern (n=904) durchgeführten Replikationsstudie zum Nationalen Gesundheitssurvey von 1984/85 bzw. zum Survey Ost von 1991/92. In einem ersten Teil wird das Freizeitverhalten der 45- bis 86jährigen Teilnehmer der Erhebung anhand von 14 ausgewählten Freizeitaktivitäten beschrieben. Hier zeigt sich eine Dominanz medienorientierter Freizeitaktivitäten. In einem zweiten Schritt werden Aspekte der subjektiven Gesundheit behandelt (Beurteilung und Beachtung der eigenen Gesundheit, Zahl der Erkrankungen und Beschwerden). Abschließend wird die Entwicklung von sportlicher Aktivität und subjektiver Gesundheit zwischen 1984 und 1998 dargestellt. (ICE2)

Background: Smoking behaviour among immigrants is assumed to converge to that of the host country's majority population with increasing duration of stay. We compared smoking prevalence among Turkish immigrants residing in two different countries (Germany (DE)/the Netherlands (NL)) between and within countries by time spent in Turkey and DE/NL. Methods: The German 2009 micro-census and the Dutch POLS database (national survey, 1997–2004) were analysed. An interaction variable with dichotomised length of stay (LOS) in Turkey (age: 0-17; 18+) and categorised LOS in the host country (immigration year: 1979 and earlier, 1980-1999, 2000-2009; the latter only for Germany) was generated. Age standardised smoking prevalences and sex-specific logistic regression models were calculated. Results: 6,517 Turkish participants were identified in Germany, 2,106 in the Netherlands. Age-standardised smoking prevalences were higher among Turkish immigrants in the Netherlands compared to those in Germany: 62.3% vs. 53.1% (men/lower education); 30.6% vs. 23.0% (women/lower education). A similar trend was observed for the majority population of both countries. The chance of being a smoker was lower among Turkish men with short LOS in Turkey and middle LOS in Germany/the Netherlands compared to those with short LOS in Turkey and long LOS in Germany/the Netherlands (NL: OR = 0.57[95% CI = 0.36-0.89]; DE: OR = 0.73[95% CI = 0.56-0.95]). Contrary to that, the chance of being a smoker was higher among Turkish men with long LOS in Turkey and middle LOS in Germany/the Netherlands compared to those with long LOS in Turkey and long LOS in Germany/the Netherlands (NL: OR = 1.35[95% CI = 0.79-2.33]; DE: OR = 1.44[95% CI = 1.03-2.02]). The effects for Turkish women were similar, but smaller and often non-significant. Conclusion: Turkish immigrants adapt their smoking behaviour towards that of the Dutch/German majority population with increasing duration of stay. This was particularly obvious among those who left Turkey before the age of 18 years - a group that needs tailored interventions to prevent further increases in smoking. Those who left Turkey as adults and spent a short time in the host countries show 'imported' smoking patterns. A limitation of this study is the use of cross-sectional data: a cohort effect cannot be ruled out. Our findings have to be confirmed with longitudinal data.

Zusammenfassung
Ziel der Studie Der Bedarf an medizinischen
Rehabilitationsmaßnahmen wird zukünftig durch die
Erhöhung des Rentenalters und den demographischen Wandel steigen. Der
Bedarf wird u. A. durch das Maß an Arbeitsbelastungen bestimmt. Ziel ist
es zu untersuchen, ob Erwerbstätige mit Migrationshintergrund (EmM)
häufiger hohen Arbeitsbelastungen ausgesetzt sind und häufiger
einen hohen Bedarf als Erwerbstätige ohne Migrationshintergrund (EoM)
haben. Ebenso wird geprüft, ob sich ein möglicherweise
höherer Bedarf bei EmM durch höhere Arbeitsbelastungen
erklären lässt.
Methodik Die lidA-Studie ist eine deutschlandweite, prospektive
Kohortenstudie zu Arbeit, Alter, Gesundheit und Erwerbsteilhabe. 4724
sozialversicherungspflichtig Beschäftigte (2443 weiblich, 2281
männlich) der Geburtsjahrgänge 1959 und 1965 wurden
computergestützt persönlich befragt. Daten der ersten
Studienwelle (2011) wurden mittels multipler logistischer Regressionsanalysen,
adjustiert für soziodemographische Faktoren (Alter, Geschlecht, Bildung
und Haushaltsäquivalenzeinkommen), analysiert. Der Einfluss des
Migrationshintergrundes, der Staatsangehörigkeit und hoher
Arbeitsbelastungen auf den medizinischen Rehabilitationsbedarf wurde
geschätzt.
Ergebnisse Besonders betroffen von hohen Arbeitsbelastungen sind in dieser
Stichprobe EmM der 1. Generation in Vergleich zu EoM. Die subjektiv erlebten
Arbeitsbelastungen bei EoM und EmM der 2. Generation liegen auf einem
vergleichbaren Niveau. Zwischen den EmM mit deutscher und ausländischer
Staatsangehörigkeit finden sich dagegen keine Unterschiede. Ein
höherer Rehabilitationsbedarf zeigt sich nach Adjustierung für
soziodemographische und arbeitsbelastungsbezogene Faktoren für die EmM
der 1. Generation (nicht signifikant) im Vergleich zu EoM und EmM der 2.
Generation, nicht aber für EmM mit ausländischer im Vergleich zu
EmM mit deutscher Staatsangehörigkeit.
Schlussfolgerungen EmM der 1. Generation sind häufiger hohen
Arbeitsbelastungen ausgesetzt und weisen häufiger einen hohen
Rehabilitationsbedarf auf als EoM und EmM der 2. Generation. Der
Migrationshintergrund selbst ist keine Determinante für einen
erhöhten Rehabilitationsbedarf. Der höhere Rehabilitationsbedarf
lässt sich vielmehr durch die bei EmM der 1. Generation häufiger
anzutreffenden arbeitsbedingten Belastungen sowie soziodemografische Merkmale
erklären. Differenzierte Betrachtungen der Untergruppen von EmM sind
wichtig, um besondere Bedarfe zu erkennen und eine Unterversorgung
(z. B. bedingt durch Zugangsbarrieren) zu vermeiden.

Background: An ageing and a shrinking labour force implies that the prevention of a premature exit from work due to poor health will become more relevant in the future. Medical rehabilitation is a health service that aims at active participation in working life. The provision of this service will be relevant for an increasing part of the ageing labour force, namely, employees with a migrant background and their different subgroups. Thus, this study examines whether first- and second-generation employees with migrant background differ from non-migrants in their utilisation of rehabilitation services and whether within the subsample of migrant employees, those persons with foreign nationality differ from those with German nationality. Methods: Socially insured employees born in 1959 or 1965 were surveyed nationwide in 2011 as part of the lidA cohort study (n=6303). Survey data of the first study wave were used to identify the dependent variable of the utilisation of rehabilitation (in- and outpatient), the independent variable of migrant status and the covariates of sociodemographic, work- and non-work-related factors. Applying bivariate statistics with tests of independence and block-wise logistic regressions, differences between the groups were investigated. Additionally, average marginal effects were computed to directly compare the adjusted models. Results: The study showed that first-generation migrants had a significantly lower likelihood of utilising outpatient rehabilitation than non-migrants (fully adj. OR 0.42, 95% CI 0.22-0.82) and that average marginal effects indicated higher differences in the full model than in the null model. No significant differences were found between the first- or second-generation migrants and non-migrants when comparing the utilisation of inpatient rehabilitation or any rehabilitation or when analysing German and foreign employees with migrant background (n=1148). Conclusions: Significant differences in the utilisation of outpatient rehabilitation between first-generation migrants and non-migrants were found, which could not be explained by sociodemographic, work- and non-work-related factors. Thus, further factors might play a role. The second-generation migrants resemble the non-migrants rather than their parent generation (first-generation migrants). This detailed investigation shows the heterogeneity in the utilisation of health services such as medical rehabilitation, which is why service sensitive to diversity should be considered.

In Germany, an ageing population is affected by societal and political changes due to demographic transition, e.g. by a prolonged working life for older employees. Demographic change also influences persons of higher working age with a migrant background. In 2018, 25% of all employees in Germany had a migrant background. Those affected by poor health at a higher working age can benefit from medical rehabilitation services, which aim to prevent early retirement and disabilities. So far, the utilisation of medical rehabilitation has been lower among persons of foreign nationality (often the only available proxy for migrant background), compared to that of Germans. The aim of this scoping review is to assess the utilisation of medical rehabilitation services by those with migrant background (PMB) and those without (non-PMB) and to identify the differences between these groups. We included 25 studies in our analysis, which were mainly secondary analyses of routine data and also a small number of primary studies. The results were inconsistent: studies published before 2018 showed a lower use of rehabilitation services for persons of foreign nationality compared to Germans. However, no differences were found between PMB and non-PMB in studies published in 2018 or later. PMB, as well as foreign nationals, showed poorer health before medical rehabilitation utilisation and had a higher chance of occupational disease and a lower education level. We identified a lower work-related performance, as well as barriers (e.g. information deficits) in the utilisation of rehabilitation services for groups of PMB. Our review is limited in that we cannot generalise our results to all PMB living in Germany. This is because of the heterogeneity, the limited number of studies and lack of representativeness in some studies. In many cases, studies only analyse the nationality, but they lack information about the second generation PMB. Future studies should survey the utilisation of medical rehabilitation services by migrant background ...