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Background: The longitudinal population-based study Gesundheit 65+ aimed to close data gaps on health and well-being of older adults in Germany in times of the COVID-19 pandemic. Methods: The target population comprised persons 65 years and older permanently residing in Germany and with sufficient German language skills. Proxy interviews were possible and consent from legal representatives was obtained as necessary in order to enable participation of physically or cognitively impaired persons. A two-stage sampling process, was used to draw 128 primary sample points (PSUs) and within these PSUs sex- and age-stratified random samples were drawn from population registries. A mixed-mode design was applied to contact the study population and for data collection. Data were collected between June 2021 and April 2023. Participants were surveyed a total of four times at intervals of four months. At month 12 participants were offered a home visit including a non-invasive examination. Data on all-cause mortality and information on neighborhood social and built environment as well as health insurance data will be linked to primarily collected data at the individual level. Discussion: Results will inform health politicians and other stakeholders in the care system on health and health care needs of older people in Germany.

Between April 2019 and September 2020, 23,001 people aged 15 or over responded to questions about their health and living conditions for the German Health Update (GEDA 2019/2020-EHIS). The results are representative of the German resident population aged 15 or above. The response rate was 21.6%. The study used a questionnaire based on the third wave of the European Health Interview Survey (EHIS), which was carried out in all EU member states. EHIS consists of four modules on health status, health care provision, health determinants, and socioeconomic variables. The data are collected in a harmonised manner and therefore have a high degree of international comparability. They constitute an important source of information for European health policy and health reporting and are made available by the Statistical Office of the European Union (Eurostat). They also form the basis of the Federal Health Reporting undertaken in Germany. Data collection began in April 2019, just under a year before the beginning of the SARS-CoV-2 pandemic, and continued into its initial phase, as of March 2020. As such, data from the current GEDA wave can also be used to conduct research into the health impact of the SARS-CoV-2 pandemic.

Consuming large amounts of sugary beverages has been related to developing obesity, diabetes mellitus type II and other chronic diseases. KiGGS Wave 2 (2014-2017) provides data on the consumption of sugary soft drinks in the 3-17 year age group in Germany. Overall, 13.7% of girls and 17.6% of boys consume one to three times a day sugary soft drinks and 3.3% of girls and 4.7% of boys four or more times. Consumption frequency increases with age and is higher among children and adolescents with low socioeconomic status (SES) than for those of the same age with high SES. The share of adolescents who drink sugary soft drinks daily has decreased since the KiGGS baseline study (2003-2006).

In Germany, the provision of health services to people with mental disorders is an issue that is subject to controversial debate. On the one hand, regional differences exist in the distribution of psychotherapists in Germany. On the other hand, patients are often willing to accept the extra effort of having to travel further in order to access treatment even in case of a low supply. Thus, in addition to issues of access, an analysis of care provision also needs to take into account the actual level of services utilization. The present paper analyses the utilization of outpatient psychiatric and psychotherapeutic services and identifies individual and regional determinants. The German Health Update (GEDA) is a nationwide survey of the adult population that is conducted by the Robert Koch Institute in the context of its population-based health monitoring. The GEDA 2014/2015-EHIS study (n=24,016) is based on a two-stage stratified random sample drawn from the population registers of 301 local authorities in Germany. The main outcome is the utilization of psychotherapeutic or psychiatric services during the last 12 months. In addition to the consideration of individual factors, the survey data was combined with information describing the regional distribution of providers of outpatient psychotherapeutic and neurological care. The data was analysed using logistic multi-level regression. In Germany, 11.3% of women and 8.1% of men report that they have used psychotherapeutic or psychiatric treatment within the last 12 months. Among respondents with current depressive symptoms, these rates are 35.0% in women and 31.0% in men. This means that approximately two thirds of people with current depressive symptoms do not seek the services of these health professionals during this period. Apart from current depressive symptoms the utilization of psychiatric and psychotherapeutic services is associated with not living with a partner and with low levels of social support. Furthermore, in regions with a high density of care providers, the proportion of people with current depressive symptoms using such services is about 15 percentage points higher than in regions with a low density. The conditions for the utilization of the respective services should not only be improved by increasing the number of care providers, but also by implementing accompanying measures. Innovations in health care aiming at rapid and low-threshold access as well as approaches for a better cooperation between primary and specialist care should therefore be evaluated regarding their contribution to an improved early treatment.

Diabetes mellitus is a metabolic disease involving chronic dysfunction of blood sugar regulation; if left untreated, it can result in serious secondary illnesses. In 2014 and 2015, a total of 7.0% of women and 8.6% of men in Germany with an age of 18 and over reported having diabetes mellitus in the past 12 months (these figures do not include gestational diabetes). There are significant differences in the 12-month prevalence among adults: the prevalence of known diabetes increases significantly with age, and is particularly high among people with a low educational status and those living in Saxony-Anhalt or Brandenburg. The Robert Koch Institute is currently developing a diabetes surveillance system in order to establish a data-based fundament for guiding health policy decisions in Germany.

GEDA 2014/2015-EHIS is an up-to-date health survey of the adult population undertaken within the framework of the Robert Koch Institute’s (RKI) health monitoring system. It uses the EHIS (European Health Interview Survey) Wave 2 questionnaire and includes four modules covering health status, health care, health determinants, and socio-economic variables. Data on nationally relevant issues is also collected. The study employs a mixed-mode design, using both online and paper-based questionnaires to gather data from 24,016 people aged 18 and above: the response rate was 26.9%. The Statistical Office of the European Union (Eurostat) provides prepared data from 28 European Union (EU) member states (plus Norway and Iceland) on the Eurostat website. National analyses for Germany are published as Fact sheets on health reporting in the Journal of Health Monitoring.

People adopt a vegetarian diet for various reasons. A largely plant-based diet not only has advantages for health, it also has positive social and environmental aspects. The aim of this analysis is to provide a description of the people in Germany who follow a predominantly vegetarian diet and to compare their food consumption with those of non-vegetarians. As part of DEGS1 (2008–2011), a validated questionnaire was used within a representative sample of 6,933 persons aged 18 to 79 to study how often and how much of 53 different food groups was consumed during a four-week period. The questionnaire also included a question about a vegetarian diet. The data were analysed descriptively and with a binary-logistical regression model. In Germany, 4.3% of the population (6.1% of women and 2.5% of men) aged 18 to 79 usually follows a vegetarian diet. The highest proportion of vegetarians is found among 18- to 29-year-olds (women 9.2% and men 5.0%) and among women aged 60 to 69 (7.3%). People with a higher level of education are more likely to usually follow a vegetarian diet. The same applies to people who live in large cities and those who conduct more than four hours of sports per week. In addition, women and men who usually follow a vegetarian diet not only consume significantly less meat compared with non-vegetarians, they also drink less energy-reduced drinks, and less beer and wine; they also drink more tea and eat more fruit and vegetables. A vegetarian lifestyle is often associated with positive socio-political impacts. It can, among others, contribute to a reduction in factory farming, which means it can help preserve the environment. A reduction in meat consumption in Germany would also be beneficial from a public health perspective, since meat consumption is currently considerably higher than the amounts recommended by the German Nutrition Society. The benefits linked to a vegetarian diet would be further strengthened, if, in addition to the relatively small group of people who completely refrain from eating meat, a larger section of the population would reduce their meat consumption.

A continuous breastfeeding monitoring is essential as it enables reports on changes in breastfeeding behaviour. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is conducted by the Robert Koch Institute, periodically collects data about the health of children and young people living in Germany, including data on breastfeeding. Moreover, KiGGS is mentioned within the approach developed by the National Breastfeeding Committee as a possible source of data for breastfeeding monitoring. The data from KiGGS can be used to develop retrospective indicators on breastfeeding for particular birth cohorts. The data demonstrate that the prevalence of children who were ever breastfed tended to rise between the 2001/2002 and 2007/2008 cohorts; however, no significant changes were identified for the 2001–2008 cohorts with respect to breastfeeding duration. Breastfeeding monitoring relies on reports about current trends in the field; due to the periodicity with which the KiGGS study waves are conducted, data on current birth cohorts cannot be provided. Therefore, data on breastfeeding needs to be collected throughout Germany in relation to direct environmental and other factors. This data should be collected during health screenings and regular check-ups so that it can be used as a further measure in breastfeeding monitoring

For many years, a high sodium intake has been discussed as a potential risk factor in the development of hypertension and, consequently, cardiovascular diseases. As part of the German Health Interview and Examination Survey for Adults (DEGS1), which was conducted between 2008 and 2011, sodium excretion in casual urine samples was used as a biomarker to measure sodium intake. DEGS1 observed that the median daily sodium intake of women (3.4 g) as well as men (4.0 g) exceeds the levels recommended by German and international organisations. Among other factors, men’s higher sodium intake could be explained by their higher energy intake. In addition, DEGS1 demonstrates an association between women’s sodium intake and age; however, no equivalent correlation was identified for men. Furthermore, although high socio-economic status is associated with lower sodium intake in men, no comparable correlation was observed among women.

The growing range of ready-to-cook and ready-to-eat foods (convenience foods) and opportunities to eat outside of the home is tending to reduce the number of fresh meals that people prepare themselves. However, people continue to place great importance on preparing their own meals from fresh foods, as this provides them with greater influence over the quality and composition of the food they eat. The German Health Interview and Examination Survey for Adults (DEGS1, 2008–2011) observed that 50.8% of adults aged between 18 and 79 (61.4% of all women and 40.2% of all men) prepare their meals daily or almost daily from fresh food. Moreover, women report less often that they never cook (2.9%) than men (16.1%) and older participants report far more often to cook daily or almost daily than younger participants. Finally, among both genders is a low level of employment associated with an increased cooking frequency.

Vitamin D plays an important role in the body as part of bone metabolism. Blood serum concentrations demonstrate that 30.2% of adults (29.7% of women and 30.8% of men) have a deficient vitamin D status. In total, 38.4% of adults (38.6% of women, 38.3% of men) have an adequate status. Although there is little variation among men between the various age groups, the proportion of women with deficient vitamin D status increases with age, while the proportion of women with an adequate status decreases. Furthermore, adults with a low socio-economic status are significantly more likely to have a deficient vitamin D status than adults with a higher socio-economic status. Vitamin D status is subject to strong seasonal fluctuations. In order to ensure adequate concentrations of serum vitamin D, it is recommended to expose the face, hands and arms to the sun two to three times a week between March and October without using sun protection; however, sunburn should be strictly avoided.

Folate is important for cell division and thus for growth and physical development. Serum folate concentrations can be used to assess a population’s folate status. In Germany, the median serum folate level of adults aged 18 to 79 is 7.5 ng/ml (women: 7.9 ng/ml, and men: 7.2 ng/ml). Approximately 86% of the adult population in Germany has adequate folate levels. Higher folate concentrations are observed among older age groups and individuals with a higher socio-economic status. However, the World Health Organization recommends that women of reproductive age should, at the population level, have significantly higher folate levels in order to reduce the risk for neural tube defects. However, the majority of women in this age group do not achieve these concentrations.

Harmful alcohol consumption is one of the five essential risk factors for disease, impairments and premature death around the world. It is considered to be a contributory cause for more than 200 diseases and is co-responsible for causing many intentional and unintentional injuries. In order to reduce harmful alcohol consumption, the health target “Reduce alcohol consumption” has been currently elaborated in Germany and focuses on a policy mix of behavioural and situational preventive measures to include as far as possible all relevant players for the development of overarching objectives. The data from the recurrent health surveys by the Robert Koch Institute (RKI) allow an evaluation of trends of harmful alcohol consumption in the population aged 25 to 69 between 1990/1992, 1997/1999, and 2008/2011. Harmful alcohol consumption is defined as a daily consumption of pure alcohol of more than 10g for women and more than 20g for men. For the years 2008-2011 harmful alcohol consumption for the age group 18 to 79 years is calculated based on the “German Health Interview and Examination Survey for Adults” (DEGS1) and examined in connection with socio-demographic and health-related factors. The results of DEGS1 show that 13.1% of women and 18.5% of men consume alcohol in harmful quantities. For men harmful alcohol consumption rises with the age; for women the lowest prevalence is found in those aged 30-39 years and the highest in the age group 50-59 years. Women with a high socio-economic status drink a harmful quantity of alcohol to a higher extent than women from medium or low status groups. For men there are no corresponding differences. Mainly smoking is associated with harmful alcohol consumption. Between 1990 and 1992 as well as between 2008 and 2011 harmful alcohol consumption has strongly declined, for women from 50.9% to 13.6%, for men from 52.6% to 18.3% (age group 25 to 69 years). Even if harmful alcohol consumption in the population has strongly declined, the per capita consumption of pure alcohol is above the average of the EU Member States in Germany. For that reason, preventive measures for specific target groups are required.

Background: The longitudinal population-based study Gesundheit 65+ aimed to close data gaps on health and well-being of older adults in Germany in times of the COVID-19 pandemic., Methods: The target population comprised persons 65 years and older permanently residing in Germany and with sufficient German language skills. Proxy interviews were possible and consent from legal representatives was obtained as necessary in order to enable participation of physically or cognitively impaired persons. A two-stage sampling process, was used to draw 128 primary sample points (PSUs) and within these PSUs sex- and age-stratified random samples were drawn from population registries. A mixed-mode design was applied to contact the study population and for data collection. Data were collected between June 2021 and April 2023. Participants were surveyed a total of four times at intervals of four months. At month 12 participants were offered a home visit including a non-invasive examination. Data on all-cause mortality and information on neighborhood social and built environment as well as health insurance data will be linked to primarily collected data at the individual level., Discussion: Results will inform health politicians and other stakeholders in the care system on health and health care needs of older people in Germany., Competing Interests: Conflicts of interest The authors declare that there is no conflict of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Between April 2019 and September 2020, 23,001 people aged 15 or over responded to questions about their health and living conditions for the German Health Update (GEDA 2019/2020-EHIS). The results are representative of the German resident population aged 15 or above. The response rate was 21.6%. The study used a questionnaire based on the third wave of the European Health Interview Survey (EHIS), which was carried out in all EU member states. EHIS consists of four modules on health status, health care provision, health determinants, and socioeconomic variables. The data are collected in a harmonised manner and therefore have a high degree of international comparability. They constitute an important source of information for European health policy and health reporting and are made available by the Statistical Office of the European Union (Eurostat). They also form the basis of the Federal Health Reporting undertaken in Germany. Data collection began in April 2019, just under a year before the beginning of the SARS-CoV-2 pandemic, and continued into its initial phase, as of March 2020. As such, data from the current GEDA wave can also be used to conduct research into the health impact of the SARS-CoV-2 pandemic., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Consuming large amounts of sugary beverages has been related to developing obesity, diabetes mellitus type II and other chronic diseases. KiGGS Wave 2 (2014-2017) provides data on the consumption of sugary soft drinks in the 3-17 year age group in Germany. Overall, 13.7% of girls and 17.6% of boys consume one to three times a day sugary soft drinks and 3.3% of girls and 4.7% of boys four or more times. Consumption frequency increases with age and is higher among children and adolescents with low socioeconomic status (SES) than for those of the same age with high SES. The share of adolescents who drink sugary soft drinks daily has decreased since the KiGGS baseline study (2003-2006)., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

In Germany, the provision of health services to people with mental disorders is an issue that is subject to controversial debate. On the one hand, regional differences exist in the distribution of psychotherapists in Germany. On the other hand, patients are often willing to accept the extra effort of having to travel further in order to access treatment even in case of a low supply. Thus, in addition to issues of access, an analysis of care provision also needs to take into account the actual level of services utilization. The present paper analyses the utilization of outpatient psychiatric and psychotherapeutic services and identifies individual and regional determinants. The German Health Update (GEDA) is a nationwide survey of the adult population that is conducted by the Robert Koch Institute in the context of its population-based health monitoring. The GEDA 2014/2015-EHIS study (n=24,016) is based on a two-stage stratified random sample drawn from the population registers of 301 local authorities in Germany. The main outcome is the utilization of psychotherapeutic or psychiatric services during the last 12 months. In addition to the consideration of individual factors, the survey data was combined with information describing the regional distribution of providers of outpatient psychotherapeutic and neurological care. The data was analysed using logistic multi-level regression. In Germany, 11.3% of women and 8.1% of men report that they have used psychotherapeutic or psychiatric treatment within the last 12 months. Among respondents with current depressive symptoms, these rates are 35.0% in women and 31.0% in men. This means that approximately two thirds of people with current depressive symptoms do not seek the services of these health professionals during this period. Apart from current depressive symptoms the utilization of psychiatric and psychotherapeutic services is associated with not living with a partner and with low levels of social support. Furthermore, in regions with a high density of care providers, the proportion of people with current depressive symptoms using such services is about 15 percentage points higher than in regions with a low density. The conditions for the utilization of the respective services should not only be improved by increasing the number of care providers, but also by implementing accompanying measures. Innovations in health care aiming at rapid and low-threshold access as well as approaches for a better cooperation between primary and specialist care should therefore be evaluated regarding their contribution to an improved early treatment., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

GEDA 2014/2015-EHIS is an up-to-date health survey of the adult population undertaken within the framework of the Robert Koch Institute's (RKI) health monitoring system. It uses the EHIS (European Health Interview Survey) Wave 2 questionnaire and includes four modules covering health status, health care, health determinants, and socio-economic variables. Data on nationally relevant issues is also collected. The study employs a mixed-mode design, using both online and paper-based questionnaires to gather data from 24,016 people aged 18 and above: the response rate was 26.9%. The Statistical Office of the European Union (Eurostat) provides prepared data from 28 European Union (EU) member states (plus Norway and Iceland) on the Eurostat website. National analyses for Germany are published as Fact sheets on health reporting in the Journal of Health Monitoring., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Diabetes mellitus is a metabolic disease involving chronic dysfunction of blood sugar regulation; if left untreated, it can result in serious secondary illnesses. In 2014 and 2015, a total of 7.0% of women and 8.6% of men in Germany with an age of 18 and over reported having diabetes mellitus in the past 12 months (these figures do not include gestational diabetes). There are significant differences in the 12-month prevalence among adults: the prevalence of known diabetes increases significantly with age, and is particularly high among people with a low educational status and those living in Saxony-Anhalt or Brandenburg. The Robert Koch Institute is currently developing a diabetes surveillance system in order to establish a data-based fundament for guiding health policy decisions in Germany., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

A continuous breastfeeding monitoring is essential as it enables reports on changes in breastfeeding behaviour. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is conducted by the Robert Koch Institute, periodically collects data about the health of children and young people living in Germany, including data on breastfeeding. Moreover, KiGGS is mentioned within the approach developed by the National Breastfeeding Committee as a possible source of data for breastfeeding monitoring. The data from KiGGS can be used to develop retrospective indicators on breastfeeding for particular birth cohorts. The data demonstrate that the prevalence of children who were ever breastfed tended to rise between the 2001/2002 and 2007/2008 cohorts; however, no significant changes were identified for the 2001-2008 cohorts with respect to breastfeeding duration. Breastfeeding monitoring relies on reports about current trends in the field; due to the periodicity with which the KiGGS study waves are conducted, data on current birth cohorts cannot be provided. Therefore, data on breastfeeding needs to be collected throughout Germany in relation to direct environmental and other factors. This data should be collected during health screenings and regular check-ups so that it can be used as a further measure in breastfeeding monitoring., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Folate is important for cell division and thus for growth and physical development. Serum folate concentrations can be used to assess a population's folate status. In Germany, the median serum folate level of adults aged 18 to 79 is 7.5 ng/ml (women: 7.9 ng/ml, and men: 7.2 ng/ml). Approximately 86% of the adult population in Germany has adequate folate levels. Higher folate concentrations are observed among older age groups and individuals with a higher socio-economic status. However, the World Health Organization recommends that women of reproductive age should, at the population level, have significantly higher folate levels in order to reduce the risk for neural tube defects. However, the majority of women in this age group do not achieve these concentrations., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

For many years, a high sodium intake has been discussed as a potential risk factor in the development of hypertension and, consequently, cardiovascular diseases. As part of the German Health Interview and Examination Survey for Adults (DEGS1), which was conducted between 2008 and 2011, sodium excretion in casual urine samples was used as a biomarker to measure sodium intake. DEGS1 observed that the median daily sodium intake of women (3.4 g) as well as men (4.0 g) exceeds the levels recommended by German and international organisations. Among other factors, men's higher sodium intake could be explained by their higher energy intake. In addition, DEGS1 demonstrates an association between women's sodium intake and age; however, no equivalent correlation was identified for men. Furthermore, although high socio-economic status is associated with lower sodium intake in men, no comparable correlation was observed among women., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

People adopt a vegetarian diet for various reasons. A largely plant-based diet not only has advantages for health, it also has positive social and environmental aspects. The aim of this analysis is to provide a description of the people in Germany who follow a predominantly vegetarian diet and to compare their food consumption with those of non-vegetarians. As part of DEGS1 (2008-2011), a validated questionnaire was used within a representative sample of 6,933 persons aged 18 to 79 to study how often and how much of 53 different food groups was consumed during a four-week period. The questionnaire also included a question about a vegetarian diet. The data were analysed descriptively and with a binary-logistical regression model. In Germany, 4.3% of the population (6.1% of women and 2.5% of men) aged 18 to 79 usually follows a vegetarian diet. The highest proportion of vegetarians is found among 18- to 29-year-olds (women 9.2% and men 5.0%) and among women aged 60 to 69 (7.3%). People with a higher level of education are more likely to usually follow a vegetarian diet. The same applies to people who live in large cities and those who conduct more than four hours of sports per week. In addition, women and men who usually follow a vegetarian diet not only consume significantly less meat compared with non-vegetarians, they also drink less energy-reduced drinks, and less beer and wine; they also drink more tea and eat more fruit and vegetables. A vegetarian lifestyle is often associated with positive socio-political impacts. It can, among others, contribute to a reduction in factory farming, which means it can help preserve the environment. A reduction in meat consumption in Germany would also be beneficial from a public health perspective, since meat consumption is currently considerably higher than the amounts recommended by the German Nutrition Society. The benefits linked to a vegetarian diet would be further strengthened, if, in addition to the relatively small group of people who completely refrain from eating meat, a larger section of the population would reduce their meat consumption., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

The growing range of ready-to-cook and ready-to-eat foods (convenience foods) and opportunities to eat outside of the home is tending to reduce the number of fresh meals that people prepare themselves. However, people continue to place great importance on preparing their own meals from fresh foods, as this provides them with greater influence over the quality and composition of the food they eat. The German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011) observed that 50.8% of adults aged between 18 and 79 (61.4% of all women and 40.2% of all men) prepare their meals daily or almost daily from fresh food. Moreover, women report less often that they never cook (2.9%) than men (16.1%) and older participants report far more often to cook daily or almost daily than younger participants. Finally, among both genders is a low level of employment associated with an increased cooking frequency., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Vitamin D plays an important role in the body as part of bone metabolism. Blood serum concentrations demonstrate that 30.2% of adults (29.7% of women and 30.8% of men) have a deficient vitamin D status. In total, 38.4% of adults (38.6% of women, 38.3% of men) have an adequate status. Although there is little variation among men between the various age groups, the proportion of women with deficient vitamin D status increases with age, while the proportion of women with an adequate status decreases. Furthermore, adults with a low socio-economic status are significantly more likely to have a deficient vitamin D status than adults with a higher socio-economic status. Vitamin D status is subject to strong seasonal fluctuations. In order to ensure adequate concentrations of serum vitamin D, it is recommended to expose the face, hands and arms to the sun two to three times a week between March and October without using sun protection; however, sunburn should be strictly avoided., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Harmful alcohol consumption is one of the five essential risk factors for disease, impairments and premature death around the world. It is considered to be a contributory cause for more than 200 diseases and is co-responsible for causing many intentional and unintentional injuries. In order to reduce harmful alcohol consumption, the health target "Reduce alcohol consumption" has been currently elaborated in Germany and focuses on a policy mix of behavioural and situational preventive measures to include as far as possible all relevant players for the development of overarching objectives. The data from the recurrent health surveys by the Robert Koch Institute (RKI) allow an evaluation of trends of harmful alcohol consumption in the population aged 25 to 69 between 1990/1992, 1997/1999, and 2008/2011. Harmful alcohol consumption is defined as a daily consumption of pure alcohol of more than 10g for women and more than 20g for men. For the years 2008-2011 harmful alcohol consumption for the age group 18 to 79 years is calculated based on the "German Health Interview and Examination Survey for Adults" (DEGS1) and examined in connection with socio-demographic and health-related factors. The results of DEGS1 show that 13.1% of women and 18.5% of men consume alcohol in harmful quantities. For men harmful alcohol consumption rises with the age; for women the lowest prevalence is found in those aged 30-39 years and the highest in the age group 50-59 years. Women with a high socio-economic status drink a harmful quantity of alcohol to a higher extent than women from medium or low status groups. For men there are no corresponding differences. Mainly smoking is associated with harmful alcohol consumption. Between 1990 and 1992 as well as between 2008 and 2011 harmful alcohol consumption has strongly declined, for women from 50.9% to 13.6%, for men from 52.6% to 18.3% (age group 25 to 69 years). Even if harmful alcohol consumption in the population has strongly declined, the per capita consumption of pure alcohol is above the average of the EU Member States in Germany. For that reason, preventive measures for specific target groups are required., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)