Scientific Concept of the National Cohort (status ... - Nationale Kohorte

A.2
A.2. Scientific background and rationale for study elements
behavior 278-282 , whereas conscientiousness seems to be inversely associated with smoking,
alcohol consumption, risky sexual behavior, and overweight 278-282, 296, 297 and has been found
to be accompanied by healthy habits such as exercising, healthy nutrition, or enough sleep.
Work-related stress is an important psychosocial factor that can be captured by different
models, such as the effort–reward imbalance (ERI) model 298 , or the demand–control
model 299 . The ERI model, an internationally applied model to analyze psychosocial work
stress that has been developed in Germany, highlights distress arising from inadequately
low rewards in spite of high external efforts. ERI has been found to be associated with poor
self-rated health across Western and Eastern European countries 300 and to be predictive of
chronic disease such as CVD, depression, and other adverse health outcomes 301, 302 . Differences
in the association of work-related psychosocial factors with CVD 303-307 and diabetes
272, 273 have been observed by gender, mostly with stronger effects in men than women.
Within the National Cohort, the ERI model will be used to analyze psychosocial work stress
(see Sect. A.3.2.2).
Social networks and social support: The social network of a person refers mainly to the
quantitative aspects of social contacts. It was shown that persons who are well connected
with others and were engaged, for example, in political parties, sport clubs, or unions
are healthier than people with smaller networks308 and have a lower mortality309, 310 . Social
support refers to a social network’s provision of psychological and material resources in
instrumental, informational, and emotional domains. It can help individuals to cope with
stress308 , which may reduce disease risk. Social support has been found to be associated
with cardiovascular outcomes 269, 270 , but results differ among gender or CVD outcome
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304, 306,
307 . Information about the social network and social support will be obtained in the National
Cohort using standardized instruments developed by Berkman and Syme 309 that have been
modified and validated for use in German studies 311 .
Adverse life events, especially during early life, have an important impact on adult biological
stress reactivity 312 and have been found to be associated with risk of type 2 diabetes 313
and the metabolic syndrome 314-316 in most, but not in all studies 317 . In the National Cohort, a
history of adverse life events will be obtained.
By prospectively assessing different domains of psychocosocial factors in conjunction with
a wide range of behavioral and biological measurements and disease outcomes we can
elucidate potential causal pathways to adverse health effects.
Assessment of psychosocial factors:
Examinations & questionnaires (at baseline and during reassessment)
Level 1: Questionnaires
A.2.4.5 Socioeconomic status
"Socio-economic status" (SES) expresses the relative social and economic position of a
person or of an entire household as compared to the other members of society. Measures
of SES are income, education, and occupation, or combined indices, but also material possessions
(such as house and car ownership) or self-rated subjective status that can be used
to reflect the social status of a person318 . Social epidemiologic research has shown consistently
that lower SES is associated with higher mortality and morbidity for the majority of
chronic diseases319-324 . This inverse social gradient can be found to a different extent in most
industrialized countries and is well documented for the US and European countries
307, 325-
330 . However, results concerning the inverse social gradient differ considerably between the
type of disease or health outcome analyzed and between the measurements of SES that