Associations between physical activity and potential influencing factors among adults with a history of migration in Germany - results of a nationwide cross-sectional survey

Associations between physical activity and potential influencing factors among adults with a history of migration in Germany - results of a nationwide cross-sectional survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Associations between physical activity and potential influencing factors among adults with a history of migration in Germany - results of a nationwide cross-sectional survey Hanwei Zhang, Carmen Koschollek, Claudia Hövener, Julika Loss, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6269892/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Promoting physical activity among the general population as well as among people with a history of migration is a crucial aspect of health promotion. However, we still lack a general understanding of physical activity levels and their potential determinants among adults with a history of migration living in Germany. Methods: The GEDA Fokus study, conducted by the Robert Koch Institute from 11/2021 to 05/2022, is a nationwide cross-sectional health interview survey of adults (18 – 79 years) with Croatian, Italian, Polish, Syrian or Turkish citizenship living throughout Germany (n = 6,038). The Aims of this study were (1) to assess the physical activity levels of adults with selected citizenships in Germany, and (2) to identify sociodemographic and migration-related factors associated with their physical activity behaviour. Results: Approximately 70% of the participants reported not achieving the World Health Organization (WHO) recommendations for aerobic physical activity and 75% did not achieve the recommendation for muscle strengthening. The physical activity levels among the participants were associated with a number of sociodemographic, migration-related and psychosocial factors. Multivariable regression analyses showed that men compared to women, adults with higher educational levels, higher subjective social status, better German language proficiency and a higher level of social support were more likely to achieve the WHO recommendations for physical activity. In addition, men compared to women and adults with higher educational levels were more likely to cycle for travel. Conclusions: Overall, the study found relatively low levels of physical activity among adults of Croatian, Italian, Polish, Syrian or Turkish citizenship living in Germany, and significant associations between their physical activity behaviour and a number of associated sociodemographic, migration-related and psychosocial factors. Further in-depth research is needed, both from a public health and health sociology perspective, to identify barriers to physical activity among people with a history of migration and to derive appropriate measures for intervention planning. movement behaviour sports health inequalities migration Background The substantial health benefits of physical activity are widely recognised, including benefits in preventing chronic diseases as well as cancer and reducing the risk of death [ 1 ]. In Germany, a significant proportion of the population is still physically inactive. According to the GEDA 2019/2020-EHIS study, only about half of the population meets the WHO recommendations for aerobic physical activity (51.2% of men and 44.8% of women)[ 2 ]. Previous studies have shown that the physical activity levels of people living in Germany vary significantly according to different socio-demographic factors (e.g., age, gender and educational level). For example, older people, women and those with lower educational levels are generally less active [ 2 ]. In addition, migration has been found to be associated with lower levels of physical activity, particularly among women with a migrant background [ 3 ]. Although there is a growing body of research on the physical activity levels of the general population, there are still significant gaps in knowledge about the physical activity behaviour and associated factors of people with a history of migration living in Germany. People with a history of migration are an important part of the demographic structure in Germany, as 24.3% of the population living in Germany had an own or parental history of migration in 2022 [ 4 ]. However, it is not well understood which factors related to migration actually affect physical activity. Qualitative studies of specific migrant groups have identified various barriers, such as language difficulties, or time constraints, which may also change with the length of time spent in the new country [ 5 , 6 ]. There is a lack of representative studies that help analyse determinants of physical activity in migrant populations, especially in Germany. Therefore, we used data from the nationwide GEDA Fokus study, which surveyed adults with Croatian, Italian, Polish, Turkish, or Syrian citizenship living in Germany. The objectives of this study are 1) to investigate the physical activity behaviour in this sample (aerobic physical activity, muscle-strengthening and active transport), and 2) to identify the factors associated with this physical activity behaviour, distinguishing between socio-demographic, migration-related and psychosocial determinants [ 7 ]. Methods The health interview survey GEDA Fokus For the current analyses, data of the health interview survey “Gesundheit in Deutschland aktuell: Fokus” (GEDA Fokus, German Health Update: Fokus) were used. GEDA Fokus is a multilingual, cross-sectional study with a sequential mixed-mode design. A total of 120 primary sampling units in 99 cities and municipalities were randomly selected from all cities and municipalities all over Germany based on, inter alia, the proportion of the population without German citizenship in the administrative districts. In the second stage, adults aged 18–79 years were randomly selected from the population registers of the local registration offices based on their citizenship (first, second, or third, including dual citizens) as Croatian, Italian, Polish, Syrian, or Turkish. The selection of the citizenship groups followed model calculations described elsewhere [ 8 ]. Self-administered online and paper-based questionnaires were sequentially offered during the data collection phase. In larger cities, personal interviews were conducted by partly bilingual interviewers, either face to face in participants’ homes or by telephone. Questionnaires were available in Arabic, Croatian, Italian, German, Polish, and Turkish. The study design is described in more detail elsewhere [ 8 ]. Definition of variables The physical activity behaviour was assessed using the European Health Interview Survey - Physical Activity Questionnaire EHIS-PAQ [ 9 ]. Three indicators of physical activity were selected as the dependent variables: (1) achieving the WHO recommendations for aerobic physical activity, (2) muscle strengthening, and in addition (3) regular cycling for travel (Table 1 ). The following independent variables were selected: (a) sociodemographic variables: sex, age group, educational level and subjective social status; (b) migration-related variables: duration of residence, and self-assessed German language proficiency; and (c) psychosocial variables: self-reported social support and sense of belonging to the society in Germany. A detailed overview of the dependent and independent variables is presented in Table 1 . Table 1 Definition of variables Dependent variable: Physical Activity Categorization Ÿ Achieving the WHO recommendations for aerobic physical activity Based on the sum of physical activity during leisure time and cycling for travel < 150min/ Week, ≥ 150min/ Week Ÿ Achieving the WHO recommendations for muscle strengthening Based on number of times reported by respondents <Twice/ Week ≥Twice/ Week Ÿ Cycling regularly for travel Based on number of times reported by respondents <Once/ Week ≥Once/ Week Independent variables : Socio-demographic variables Ÿ Sex: Based on biological sex assigned at birth Men Women Ÿ Age group: Age categorised into three groups 18–39 years 40–59 years 60–79 years Ÿ Educational level: Based on the ISCED-2011 [ 10 ] classification standard Low (ISCED 1–2) Medium (ISCED 3–4) High (ISCED 5–8) Ÿ Subjective social status: Based on the MacArthur Scale of Subjective Social Status [ 11 , 12 ] Low (values 1–4) Medium (values 5–6) High (values 7–10) Missing Migration-related variables Ÿ Duration of residence: Based on country of birth and year of moving to Germany for those born abroad < 5 years ≥ 5 years (but less than a lifetime) Since birth Missing Ÿ German language proficiency Based on questions on native language and the self-assessed German language proficiency of those not indicating German as their native language Native/ Very good Good/ Moderate Bad/ Very bad Missing Psychosocial variables Ÿ Social support Based on the Oslo 3-item Social Support Scale [ 13 ] Poor (values 3–8) Moderate (values 9–11) Strong (values 12–14) Missing Ÿ Sense of belonging to the society in Germany Based on the question ‘How much do you feel you belong to the society in Germany?” [ 14 ] Very strongly/ Strongly Partly Barely/ Not at all Missing Statistical analyses Statistical analyses were performed using Stata version 17.0 survey procedures for complex samples. Analyses were performed using a weighting factor to ensure that the sample was representative of the population with corresponding citizenships. Results are presented as prevalences with corresponding 95% confidence intervals (95% CI). A statistically significant difference is assumed at a p-value less than 0.05. For the bivariate analyses, Pearson’s Chi-square test was used to determine the associations between each physical activity indicator and the socio-demographic, migration-related and psychosocial variables. In addition, multivariable adjusted odds ratios (OR) with corresponding 95% CIs were calculated using logistic regression analyses, adjusting for socio-demographic (sex, age group, educational level, subjective social status) as well as the migration-related (duration of residence, German language proficiency) and psychosocial (social support, sense of belonging to the society in Germany) variables. The multivariable analyses were adjusted for citizenship according to registration offices to account for different response behaviour between citizenship groups [ 15 ]. Results Study sample A total of 6,038 participants took part in the survey, consisting of 53.8% men and 46.2% women (% weighted). The participants had a mean age of 41.6 years. Table 2 shows the sociodemographic, migration-related and psychosocial characteristics of the participants. Table 2 Description of the study sample according to sociodemographic, migration-related and psychosocial variables Variable: Categorization n % [95%CI] Sex Men Women 3055 2983 53.8 [51.0- 56.5] 46.2 [43.5–49.0] Age group 18–39 years 40–59 years 60–79 years 3024 2156 858 46.5 [43.7–49.4] 37.9 [35.9–39.9] 15.6 [13.4–18.0] Educational level Low Medium High Missing 1704 2260 2042 32 45.3 [42.4–48.3] 39.9 [37.7–42.2] 14.2 [12.5–16.1] 0.5 [0.3–0.9] Subjective social status Low Medium High Missing 1920 2266 1597 255 31.7 [28.9–34.6] 39.6 [36.8–42.5] 24.1 [22.0- 26.4] 4.5 [3.5–5.9] Duration of residence < 5 years ≥ 5 years Since birth Missing 2255 2507 1189 87 22.7 [19.3–26.5] 56.2 [53.0- 59.5] 19.5 [17.3–21.9] 1.5 [0.9–2.5] German language proficiency Native/ Very good Good/ Moderate Bad/ Very bad Missing 2570 2839 538 91 44.4 [42.3–46.6] 46.5 [44.4–48.6] 7.2 [6.2–8.2] 1.9 [1.4–2.6] Social support Poor Moderate Strong Missing 1561 3062 1356 59 25.7 [23.0- 28.5] 49.1 [46.6–51.5] 24.3 [21.5–27.2] 1.0 [0.6–1.5] Sense of belonging Very strongly/ Strongly Partly Barely/ Not at all Missing 3655 1824 548 11 63.0 [60.6–65.4] 28.7 [26.9–30.6] 7.9 [6.8–9.1] 0.3 [0.1–0.8] n = unweighted, % weighted Physical activity levels Of the participants, 28.5% achieved the recommended 150 minutes or more of aerobic physical activity per week, and 22.6% met the recommended level of at least two muscle-strengthening sessions per week. Of the participants, 22.0% cycled at least once a week for travel. Bivariate analyses Bivariate analyses showed that all selected variables were found to be significantly associated with the achievement of WHO recommendation for aerobic physical activity (Table 3 ). Except for the sense of belonging to the society in Germany, all selected variables were significantly associated with achieving the WHO recommendations for muscle strengthening as well. Sex and educational level were found to be significantly associated with cycling behaviour in the bivariate analyses. Table 3 Results of the bivariate analyses Result of the bivariate analyses Aerobic physical activity recommendation achieved Muscle strengthening recommendation achieved Cycling for travel at least once a week n % [95%CI] p -value n % [95%CI] p -value n % [95%CI] p -value Total Yes No 6038 1941 4032 28.5 [26.4–30.7] 70.0 [67.7–72.2] 6038 1551 4391 22.6 [20.5–24.8] 75.0 [72.5–24.6] 5924 1532 4392 22.0 [19.5–24.6] 75.4 [72.7–77.8] Missing 65 1.5 [1.0-2.2] 96 2.4 [1.7–3.3] 114 2.7 [2.1–3.4] Sex 5973 5942 5924 Men 3024 31.8 [28.9,34.8] 0.003 3013 26.5 [23.5–29.7] < 0.001 3002 26.5 [23.4–29.9] < 0.001 Women 2949 25.6 [22.8,28.7] 2929 19.2 [16.8–21.8] 2922 18.0 [15.0-21.4] Age group 5973 5942 5924 18–39 years 3014 33.5 [30.7,36.4] < 0.001 2994 28.4 [25.3–31.8] < 0.001 3001 24.4 [21.0-28.3] 0.187 40–59 years 2132 25.6 [22.2,29.5] 2120 19.4 [16.3–23.0] 2108 21.0 [17.6–25.0] 60–79 years 827 23.0 [18.7,27.9] 828 16.1 [13.3–19.3] 815 20.5 [16.8–24.8] Educational level 5943 5913 5895 Low 1667 19.2 [16.6,22.2] < 0.001 1658 17.8 [14.7–21.3] < 0.001 1649 16.8 [13.8–20.3] < 0.001 Medium 2239 36.1 [33.4,38.9] 2229 26.8 [24.2–29.5] 2225 26.8 [23.0–31.0] High 2037 40.2 [36.1,44.5] 2026 30.9 [27.2–34.8] 2021 28.8 [24.7–33.4] Subjective social status 5731 5709 5694 Low 1913 23.5 [20.2,27.3] < 0.001 1911 18.2 [14.7–22.2] 0.001 1908 20.6 [17.0-24.7] 0.256 Medium 2251 31.3 [28.0,34.7] 2236 24.9 [22.0–28.0] 2230 22.6 [19.3–26.3] High 1567 32.9 [28.8,37.2] 1562 27.0 [23.3–31.0] 1556 25.2 [20.6–30.5] Duration of residence 5887 5857 5842 < 5 years 2238 26.8 [23.3,30.6] < 0.001 2225 23.3 [19.5–27.6] 0.002 2225 25.7 [22.1–29.6] 0.181 ≥ 5 years 2462 26.9 [23.7,30.4] 2452 21.1 [18.4–24.2] 2432 21.9 [19.0-25.1] Since birth 1187 38.2 [33.5,43.3] 1180 29.8 [25.8–34.0] 1185 21.4 [17.1–26.5] German language proficiency 5895 5869 5851 Native/ very good 2556 37.4 [34.4,40.6] < 0.001 2548 27.5 [24.7,30.4] < 0.001 2547 23.8 [20.6,27.4] 0.473 Good/ moderate 2807 22.5 [19.4,25.9] 2790 20.5 [17.1,24.4] 2780 22.0 [18.8,25.5] Bad/ very bad 532 17.3 [12.1,24.2] 531 13.3 [9.0,19.2] 524 19.7 [13.5,27.8] Social Support Poor 1534 22.7 [18.8,27.1] 0.002 1526 16.5 [13.1–20.7] < 0.001 1513 20.5 [17.0-24.5] 0.264 Moderate 3036 30.0 [27.0,33.2] 3022 24.4 [21.6–27.3] 3016 23.6 [20.7–26.9] Strong 1349 33.2 [29.2,37.4] 1342 27.4 [23.6–31.6] 1343 22.5 [19.0-26.3] Sense of belonging 5965 5932 5916 Very strongly/ strongly 3617 31.0 [28.5,33.5] 0.011 3601 23.6 [21.1–26.4] 0.355 3603 23.4 [20.5–26.6] 0.207 Partly 1804 26.6 [22.9,30.7] 1796 23.4 [20.0-27.2] 1778 21.8 [18.1–26.0] Barely/ not at all 544 21.7 [16.5,27.9] 535 18.7 [13.2–25.7] 535 17.8 [13.2–23.5] % weighted; CI: confidence interval Multivariable logistic regression analyses A higher likelihood to achieve the WHO recommendation for aerobic physical activity as well as the recommendation for muscle-strengthening was observed among men, those with a higher educational level, those with a higher subjective social status, native/ very good German language proficiency, and a stronger social support compared to those in the respective reference categories. In addition, younger adults (18–39 years) were more likely to achieve the muscle-strengthening recommendation than older adults (60 years and older) (Table 4 ). A higher likelihood to cycle for travel at least once a week was found for men compared to women, for people with a higher level of education compared to those with a low educational level, and for people who have lived in Germany for less than five years, compared to those who were born in Germany (Table 4 ). Table 4 Results of the multivariable logistic regression analyses Results of the multivariable regression analyses Aerobic physical activity recommendation achieved Muscle strengthening recommendation achieved Cycling for travel at least once a week OR [95%CI] p -value OR [95%CI] p -value OR [95%CI] p -value Sex Men 1.34 [1.07–1.68] 0.012 1.55 [1.24–1.94] < 0.001 1.59 [1.27–1.99] < 0.001 Women 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) Age group 18–39 years 1.40 [0.98–2.01] 0.066 1.93 [1.32–2.83] 0.001 1.05 [0.72–1.53] 0.785 40–59 years 1.07 [0.75–1.53] 0.714 1.22 [0.85–1.73] 0.274 0.92 [0.68–1.26] 0.615 60–79 years 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) Educational level Low 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) Medium 1.95 [1.59–2.39] < 0.001 1.42 [1.08–1.87] 0.014 1.82 [1.37–2.43] < 0.001 High 2.34 [1.78–3.07] < 0.001 1.65 [1.23–2.22] 0.001 1.92 [1.40–2.61] < 0.001 Subjective social status Low 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) Medium 1.31 [1.05–1.63] 0.019 1.41 [1.09–1.83] 0.009 1.08 [0.79–1.48] 0.623 High 1.34 [1.01–1.78] 0.044 1.53 [1.14–2.06] 0.005 1.16 [0.82–1.63] 0.390 Duration of residence < 5 years 1.03 [0.73–1.46] 0.849 1.07 [0.73–1.58] 0.719 1.63 [1.12–2.38] 0.012 ≥ 5 years 0.98 [0.69–1.39] 0.891 1.02 [0.76–1.38] 0.885 1.34 [0.96–1.87] 0.089 Since birth 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) German language proficiency Native/ very good 2.25 [1.40–3.62] 0.001 2.23 [1.30–3.82] 0.004 1.41 [0.90–2.21] 0.135 Good/ moderate 1.35 [0.87–2.08] 0.175 1.82 [1.13–2.92] 0.014 1.27 [0.80–2.01] 0.308 Bad/ very bad 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) Social support Poor 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) Moderate 1.33 [1.00-1.76] 0.047 1.78 [1.33–2.38] < 0.001 1.18 [0.92–1.51] 0.201 Strong 1.40 [1.01–1.94] 0.045 1.96 [1.41–2.71] < 0.001 1.07 [0.80–1.43] 0.629 Sense of belonging Very strongly/ strongly 1.25 [0.87–1.78] 0.223 0.89 [0.58–1.36] 0.587 1.37 [0.93–2.01] 0.108 Partly 1.16 [0.80–1.67] 0.435 1.03 [0.69–1.54] 0.872 1.23 [0.83–1.81] 0.305 Barely/ not at all 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) OR: odds ratio CI: confidence interval ref.: reference category; adjusted for citizenship according to residents’ registration offices Discussion Our study showed that the overall level of physical activity among adults with a history of migration in Germany was comparatively low, with less than a third achieving the WHO recommendations for aerobic and muscle-strengthening physical activity. A higher likelihood of not achieving the physical activity recommendations was observed among women, those with a low educational level, a low subjective social status, a low level of social support and a lower level of German language proficiency. Factors associated with physical activity among respondents As in the general population, a wide range of associations between socio-demographic factors and physical activity were found among GEDA Fokus participants. Men in the sample were more likely than women to achieve the physical activity recommendations. These gender differences in physical activity are consistent with previous research findings among migrants as well as in the general population living in Germany [ 16 – 20 ]. One possible explanation for this finding is that men and women may have been socialised differently with men being more motivated and supported to engage in physical activity [ 21 ]. In our sample, age was found to be significantly associated with aerobic physical activity and muscle-strengthening, with younger participants being more likely to be physically active, while older participants were less active. A previous study has also shown that physical activity levels are lower in older age groups in Germany [ 2 ]. While biological factors such as decreasing health and fitness levels and frailty may contribute to lower levels of physical activity among older adults in the general population, other barriers may also be relevant for older adults with a history of migration, such as social isolation, discrimination, or low social participation [ 22 ]. We also found associations between higher levels of education and more frequent participation in physical activity. Individuals with higher levels of education are more likely to have better health literacy, and therefore may be more likely to understand the health benefits of physical activity and engage in such activities intentionally [ 23 ]. In contrast, those with lower levels of education are often more likely to be engaged in more physically demanding jobs [ 24 ]. This may further reduce their chances of engaging in beneficial physical activity in their leisure time. Advanced levels of physical activity are more common among those who report a higher subjective social status. This may be due to lower stress levels of individuals with a higher subjective social status and greater opportunities to engage in leisure-time physical activity, such as joining sports clubs or gyms [ 25 ]. In addition to socio-demographic factors, other determinants of health, particularly migration-related and psychosocial factors, were also found to be significantly associated with physical activity in this study: Those with better German language proficiency and higher levels of social support were more likely to meet the recommendations for physical activity. It is likely that there exists a complex interplay between these factors and physical activity. Improved language proficiency of the majority language offers people with a history of migration better chances for social integration [ 26 ]. This integration, in turn, enables them to access health information, communicate effectively with healthcare providers, and actively participate in public physical activities based on their individual needs [ 27 ]. Language difficulties can also prevent individuals from obtaining information about sports and exercise programs [ 6 ]. Additionally, strong social support provides adults with a history of migration with the necessary resources and decision-making assistance from their families and communities, fostering a supportive environment for sustained physical activity and long-term adherence [ 28 ]. In this study, regular cycling for travel was only found to be significantly associated with sex, education, and duration of residence in Germany in the multivariable regression analysis. Regarding sex, an earlier survey investigating cycling among a group of adults with personal migration experience in Germany (IntegRADtion) also found higher rates of cycling among men than women [ 29 ]. This gender difference in cycling behaviour is also found in the general population living in Germany: a nationwide study in 2021 showed that 40% of men cycled at least once a week for travel, but only 29% of women [ 30 ]. Furthermore, this observation is not unique to Germany. For example, our findings are consistent with those of Goel et al. who conducted a cross-national study in 13 countries, where women were generally less likely to cycle for travel than men. The authors stated that a lack of safe environments, cultural norms, and fear of harassment could explain women’s lower cycling rates. In contrast, gender differences in cycling are significantly reduced in societies with safe cycling infrastructure and relatively gender-equal societies [ 31 ]. The lower prevalence of cycling for travel among people with low levels of education compared to those with higher levels of education found in our study is also consistent with findings in the general population living in Germany [ 30 , 32 ]. One explanation may lie in different attitudes towards cycling as a mode of transport. People with low educational levels may avoid cycling as a mode of transport because it may be associated with a low social status [ 32 ]. In contrast, people with higher educational level often see cycling as fashionable and ethical because of its environmental and fitness benefits [ 32 ]. Duration of residence was negatively associated with the likelihood of cycling for travel. Newcomers may choose cycling as their primary mode of travel due to unfamiliarity with the new environment, such as public transport routes and potential financial pressure [ 5 ]. However, in contrast to our results, the findings of the IntegRADtion study by Schaefer & Francke indicate that adults living in Germany who grew up abroad were less likely to choose cycling as a mode of transport than the group who grew up in Germany [ 29 ]. In addition, the IntegRADtion study found that the main barriers and motivators for cycling among adults with migration experience were barely different from those of the general population. Therefore, the various interactions between the duration of immigrants' residence and their characteristics still need to be further investigated in the future. Recommendations for policy and practice Based on the findings of this study, interventions to promote physical activity among adults with a history of migration should address several dimensions. First, they should consider the heterogeneity of different sub-populations with migration history. Previous research has demonstrated significant heterogeneity in physical activity among minority groups in the United States, including immigrants [ 33 ]. This heterogeneity is characterized by multiple dimensions of socioeconomic status, and community resources, and therefore presents different challenges to their physical activity participation. Homogenized perspectives may lead to inappropriate generalizations and potentially ineffective “one size fits all" interventions. This suggests that interventions should be tailored to the specific social, economic, and environmental needs of population groups, and also consider different lifestyles and gender roles, in order to provide needs-based support frameworks for physical activity. In order to establish successful approaches to promoting physical activity among people with a history of migration, the target group should be involved in the planning and delivery of these interventions. In addition, research is needed to better understand the barriers to physical activity and active travel of people with a migrant history, with a focus on women, people with a low social status and low German language proficiency. Furthermore, it should be investigated how sports facilities and public spaces can be adapted to meet the diverse needs of adults with a history of migration for physical activity [ 34 ]. Based on our finding that low proficiency in German language predicted significant physical inactivity, increasing the number of sports classes offered in different languages could increase the physical activity behaviour of people with low German language proficiency, in addition to appropriate ways of promoting these sports classes to the respective groups. Strengths This study has several strengths: First, it is the first to use nationwide cross-sectional survey data to examine the association between physical activity and social determinants, particularly psychosocial factors, among adults with selected citizenships in Germany. The study design was complex and used different methods to recruit individuals with a migration history, including home visits. This study fills a research gap in this area and provides a new source of data to study the physical activity of selected groups of adults with a history of migration in Germany, which is an important reference for the development and implementation of relevant policies. In addition, this study investigated the association between a wide range of factors, not only socio-demographic factors, but also migration-related and psychosocial factors, and physical activity. The findings of this study provide valuable insights for future research in terms of selecting directions for in-depth research. Limitations A limitation of this study may lie in the selection of variables. Despite efforts to include various socio-demographic, migration-related, and psychosocial factors in the selection of variables, further potential factors influencing the physical activity behaviour of the participants were not included in the questionnaire, such as physical literacy or environmental factors. Furthermore, occupational physical activity was not included in the statistical analysis due to its potential negative health effects [ 35 ]. These aspects remain a potential research area that should be carefully considered in future studies. In addition, the variables in this study were based on participants' self-reports, which may have biased the results on their physical activity levels due to recall and social desirability bias. Another issue that needs to be mentioned is that the generalizability of our findings is limited to people with the five selected citizenships, but not to all people with a history of migration living in Germany. Finally, although associations have been identified between various factors and physical activity among people with selected citizenships, causal relationships between these factors and physical activity remain inconclusive as is the nature of cross-sectional studies. Conclusions Overall, the study found relatively low levels of physical activity among adults with Croatian, Italian, Polish, Syrian or Turkish citizenship in Germany, and there were significant associations between their physical activity behaviour and a range of socio-demographic, migration-related and psychosocial factors. Further in-depth research is necessary and valuable from both a public health and health sociology perspective. It is necessary for policy and intervention planning to pay particular attention to addressing existing social inequalities in order to effectively promote physical activity among peoplee with a history of migration for their health and well-being. Abbreviations CI Confidence Interval GEDA Gesundheit in Deutschland aktuell ISCED International Standard Classification of Education (ISCED) OR Odds Ratio WHO World Health Organization Declarations Ethics approval and consent to participate The study was approved without concern by the local ethics committee at Charité – Universitätsmedizin Berlin (EA1/250/21) and by the Commissioner for Data Protection of the RKI. Participation was voluntary; all participants provided informed consent. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding The study was funded by the German Federal Ministry of Health (Grant Number: ZMVI1-2518FSB411). The funders had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript. Author Contribution All authors have made substantial contributions to the development of this manuscript. CK and CH developed the study design and the survey questions. HZ and KM conducted the data analysis. HZ drafted the manuscript, while HZ, KM, CK, JL, and CH contributed to the interpretation of the results and the writing of the manuscript. All authors critically revised the manuscript and approved the final version. Acknowledgement The authors would like to thank all participants who took their time to take part in the survey. Additionally, we thank all colleagues at RKI who supported conducting this study. Data Availability The dataset supporting the conclusions of this article cannot be made publicly available because informed consent from study participants did not cover public deposition of data. However, the minimal dataset underlying the findings is archived in the Research Data Centre at the Robert Koch Institute and can be accessed by researchers on reasonable request. On-site access to the data set is possible at the Secure Data Centre of the Robert Koch Institute’s Research Data Centre. Requests should be submitted by e-mail to [email protected] . References Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: The evidence. Can Med Assoc J. 2006;174:801–9. Richter A, Schienkiewitz A, Starker A, Krug S, Domanska O, Kuhnert R, et al. Health-promoting behaviour among adults in Germany - results from GEDA 2019/2020-EHIS. J Health Monit. 2021;6:26–44. Rommel A, Saß A-C, Born S, Ellert U. Die gesundheitliche Lage von Menschen mit Migrationshintergrund und die Bedeutung des sozioökonomischen Status. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2015;58:543–52. Federal Statistical Office. 24.3% of the population had a history of immigration in 2022. Fed Stat Office. 2023. https://www.destatis.de/EN/Press/2023/04/PE23_158_125.html Sauter A, Kikhia S, Loss J. Influences on the physical activity of Syrian migrants in Germany: results of a qualitative study. Health Promot Int. 2021;37:daab132. Frahsa A, Streber A, Wolff AR, Rütten A. Capabilities for physical activity by turkish- and russian-speaking immigrants aged 65 years and older in Germany: A qualitative study. J Aging Phys Act. 2020;28:567–79. Dahlgren G, Whitehead M. Policies and Strategies to Promote Social Equity in health. Background Document to the WHO Strategy Paper for Europe. Institute For Futures Studies; 1991. Koschollek C, Zeisler M-L, Houben RA, Geerlings J, Kajikhina K, Bug M, et al. German Health Update Fokus (GEDA Fokus): Study Protocol of a Multilingual Mixed-mode Interview Survey among Residents with Croatian, Italian, Polish, Syrian or Turkish Citizenship in Germany. JMIR Res Protoc. 2023;12:e43503. Finger JD, Tafforeau J, Gisle L, Oja L, Ziese T, Thelen J, et al. Development of the european health interview survey - physical activity questionnaire (EHIS-PAQ) to monitor physical activity in the european union. Arch Public Health. 2015;73:59. Eurostat. Glossary:International standard classification of education (ISCED). 2017. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Glossary:International_standard_classification_of_education_(ISCED)/de . Accessed 1 Jan 2023. Adler NE, Epel ES, Castellazzo G, Ickovics JR. Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy, White women. Health Psychol. 2000;19:586–92. Chen B, Covinsky KE, Cenzer IS, Adler N, Williams BA. Subjective Social Status and Functional Decline in Older Adults. J Gen Intern Med. 2012;27:693–9. Meltzer H. Development of a common instrument for mental health. In: Nosikov A, Gudex C, editors. EUROHIS: Developing Common Instruments for Health Surveys. IOS; 2003. pp. 35–47. Schumann M, Kajikhina K, Polizzi A, Sarma N, Hoebel J, Bug M, et al. Concepts migration-sensitive health Monit. 2019;4:49–65. Koschollek C, Gaertner B, Geerlings J, Kuhnert R, Mauz E, Hövener C. Recruiting people with selected citizenships for the health interview survey GEDA Fokus throughout Germany: Evaluation of recruitment efforts and recommendations for future research. BMC Med Res Methodol. 2024;24:200 (2024). Baek S-R, Moudon AV, Saelens BE, Kang B, Hurvitz PM, Bae C-HC. Comparisons of Physical Activity and Walking Between Korean Immigrant and White Women in King County, WA. J Immigr Minor Health. 2015;18:1541–6. Finger JD, Mensink G, Lange C, Manz K. Health-enhancing physical activity during leisure time among adults in Germany. J Health Monit. 2017;2:35–42. Morawa E, Erim Y. Health-Related Lifestyle Behavior and Religiosity among First-Generation Immigrants of Polish Origin in Germany. Int J Environ Res Public Health. 2018;15:2545. Krist L, Dornquast C, Reinhold T, Becher H, Icke K, Danquah I, et al. Physical Activity Trajectories among Persons of Turkish Descent Living in Germany—A Cohort Study. Int J Environ Res Public Health. 2020;17:6349. Mikell M, Snethen J, Kelber ST. Exploring Factors Associated with Physical Activity in Latino Immigrants. West J Nurs Res. 2020;42:680–9. Loss J, Blume M, Neuperdt L, Flerlage N, Weihrauch T, Manz K, et al. Wie steht es um die Gesundheit von Mädchen und Jungen in der COVID-19-Pandemie? Ausgewählte Ergebnisse der KIDA-Studie. J Health Monit. 2023;8:40–58. Tong H, Walsh CA, Bouchard N, Lai DWL. Social Inclusion and Immigrant Older Adults. In: Liamputtong P, editor. Handbook of Social Inclusion: Research and practices in health and social sciences. Cham: Springer; 2021. pp. 769–90. Jordan S. Gesundheitskompetenz/Health Literacy. In: Bundeszentrale für gesundheitliche Aufklärung (BZgA), editor. Leitbegriffe der Gesundheitsförderung und Prävention. Glossar zu Konzepten, Strategien und Methoden. 2023. Finger JD, Mensink G, Lange C, Manz K. Work-related physical activity among adults in Germany. PubMed. 2017;2:28–34. Ghaed SG, Gallo LC. Subjective social status, objective socioeconomic status, and cardiovascular risk in women. Health Psychol. 2007;26:668–74. Haug S. Sprachliche Integration von Migranten in Deutschland. Nürnberg: Bundesamt für Migration und Flüchtlinge (BAMF); 2008. Joshi S, Jatrana S, Paradies Y. Are Immigrants More Physically Active Than Native-Born Australians and Does it Changes Over Time? Evidence From a Nationally Representative Longitudinal Survey. J Phys Act Health. 2017;14:145–54. Vonneilich N, Franzkowiak P. Soziale Unterstützung. In: Bundeszentrale für gesundheitliche Aufklärung (BZgA), editor. Leitbegriffe der Gesundheitsförderung und Prävention. Glossar zu Konzepten, Strategien und Methoden. 2022. Schaefer L-M, Francke A. IntegRADtion Radfahren für Alle Informationsbroschüre über Migration und Radfahren. Technische Universität Dresden; 2021. Moosburger R, Manz K, Richter A, Gert BM, Mensink, Loss J. Climate protection, health and other motives for active transport – results of a cross-sectional survey in Germany. BMC Public Health. 2024;24:1505. Goel R, Oyebode O, Foley L, Tatah L, Millett C, Woodcock J. Gender differences in active travel in major cities across the world. Transportation. 2022;50:733–49. Hudde A. Educational differences in cycling: Evidence from German cities. Sociology. 2022;56:909–29. Bantham A, Taverno Ross SE, Sebastião E, Hall G. Overcoming barriers to physical activity in underserved populations. Prog Cardiovasc Dis. 2020;64:64–71. Wieland ML, Tiedje K, Meiers SJ, Mohamed AA, Formea CM, Ridgeway JL, et al. Perspectives on Physical Activity Among Immigrants and Refugees to a Small Urban Community in Minnesota. J Immigr Minor Health. 2013;17:263–75. Holtermann A, Krause N, van der Beek AJ, Straker L. The physical activity paradox: Six reasons why occupational physical activity (OPA) does not confer the cardiovascular health benefits that leisure time physical activity does. Br J Sports Med. 2017;52:149–50. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6269892","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463476668,"identity":"41c7bbde-2456-40b4-aeb4-3a8b78228acf","order_by":0,"name":"Hanwei Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYBACgwP8z0C0HMMBHiB1gIGBD0hJ4NfCkAaijeFa2IjVkthAipZjD37uqE3vO3/28AeGMzZybNINjDc+4NFif4Cx3bD3zPHcmTfy0iQYbqQZs8kcYLacgdcWZjYJ3rZjuRtu8Jgx//lwOLFNIoFNmgevFjY2yb9tx9INzp8x/sDw4XA9WMsfvFp42KR522oSDA7kGAAddjiBDaQFr/cPA7XIth0wnHkjx0yC4UyaYZtEYrNlDz4tx/ufSb5tq5PnAzvsmI08v0TywRs/8FnDDCYPIwsxNuDTAAN1xCgaBaNgFIyCkQoAmbpRvz1lIWkAAAAASUVORK5CYII=","orcid":"","institution":"Robert Koch Institute","correspondingAuthor":true,"prefix":"","firstName":"Hanwei","middleName":"","lastName":"Zhang","suffix":""},{"id":463476676,"identity":"9293a2eb-6835-4687-9fc4-948f19824bc1","order_by":1,"name":"Carmen Koschollek","email":"","orcid":"","institution":"Robert Koch Institute","correspondingAuthor":false,"prefix":"","firstName":"Carmen","middleName":"","lastName":"Koschollek","suffix":""},{"id":463476678,"identity":"797b4dff-da0e-452d-ad4c-0690c0a0f04f","order_by":2,"name":"Claudia Hövener","email":"","orcid":"","institution":"Robert Koch Institute","correspondingAuthor":false,"prefix":"","firstName":"Claudia","middleName":"","lastName":"Hövener","suffix":""},{"id":463476680,"identity":"dc47182c-2cb2-4b29-a273-d6e1ba2c1452","order_by":3,"name":"Julika Loss","email":"","orcid":"","institution":"Robert Koch Institute","correspondingAuthor":false,"prefix":"","firstName":"Julika","middleName":"","lastName":"Loss","suffix":""},{"id":463476682,"identity":"777cd963-cfb0-4d4d-a9df-ba018c0d5013","order_by":4,"name":"Kristin Manz","email":"","orcid":"","institution":"Robert Koch Institute","correspondingAuthor":false,"prefix":"","firstName":"Kristin","middleName":"","lastName":"Manz","suffix":""}],"badges":[],"createdAt":"2025-03-20 13:08:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6269892/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6269892/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83669155,"identity":"4cfe3788-3a71-4440-8c5a-f8e53932d7ab","added_by":"auto","created_at":"2025-05-30 12:47:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1219525,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6269892/v1/0a482e47-8a8d-4544-886a-c0b19f85bf24.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Associations between physical activity and potential influencing factors among adults with a history of migration in Germany - results of a nationwide cross-sectional survey","fulltext":[{"header":"Background","content":"\u003cp\u003eThe substantial health benefits of physical activity are widely recognised, including benefits in preventing chronic diseases as well as cancer and reducing the risk of death [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Germany, a significant proportion of the population is still physically inactive. According to the GEDA 2019/2020-EHIS study, only about half of the population meets the WHO recommendations for aerobic physical activity (51.2% of men and 44.8% of women)[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies have shown that the physical activity levels of people living in Germany vary significantly according to different socio-demographic factors (e.g., age, gender and educational level). For example, older people, women and those with lower educational levels are generally less active [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In addition, migration has been found to be associated with lower levels of physical activity, particularly among women with a migrant background [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough there is a growing body of research on the physical activity levels of the general population, there are still significant gaps in knowledge about the physical activity behaviour and associated factors of people with a history of migration living in Germany. People with a history of migration are an important part of the demographic structure in Germany, as 24.3% of the population living in Germany had an own or parental history of migration in 2022 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, it is not well understood which factors related to migration actually affect physical activity. Qualitative studies of specific migrant groups have identified various barriers, such as language difficulties, or time constraints, which may also change with the length of time spent in the new country [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. There is a lack of representative studies that help analyse determinants of physical activity in migrant populations, especially in Germany.\u003c/p\u003e \u003cp\u003eTherefore, we used data from the nationwide GEDA Fokus study, which surveyed adults with Croatian, Italian, Polish, Turkish, or Syrian citizenship living in Germany. The objectives of this study are 1) to investigate the physical activity behaviour in this sample (aerobic physical activity, muscle-strengthening and active transport), and 2) to identify the factors associated with this physical activity behaviour, distinguishing between socio-demographic, migration-related and psychosocial determinants [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe health interview survey GEDA Fokus\u003c/h2\u003e \u003cp\u003eFor the current analyses, data of the health interview survey \u0026ldquo;Gesundheit in Deutschland aktuell: Fokus\u0026rdquo; (GEDA Fokus, German Health Update: Fokus) were used.\u003c/p\u003e \u003cp\u003eGEDA Fokus is a multilingual, cross-sectional study with a sequential mixed-mode design. A total of 120 primary sampling units in 99 cities and municipalities were randomly selected from all cities and municipalities all over Germany based on, inter alia, the proportion of the population without German citizenship in the administrative districts. In the second stage, adults aged 18\u0026ndash;79 years were randomly selected from the population registers of the local registration offices based on their citizenship (first, second, or third, including dual citizens) as Croatian, Italian, Polish, Syrian, or Turkish. The selection of the citizenship groups followed model calculations described elsewhere [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Self-administered online and paper-based questionnaires were sequentially offered during the data collection phase. In larger cities, personal interviews were conducted by partly bilingual interviewers, either face to face in participants\u0026rsquo; homes or by telephone. Questionnaires were available in Arabic, Croatian, Italian, German, Polish, and Turkish. The study design is described in more detail elsewhere [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDefinition of variables\u003c/h3\u003e\n\u003cp\u003eThe physical activity behaviour was assessed using the European Health Interview Survey - Physical Activity Questionnaire EHIS-PAQ [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Three indicators of physical activity were selected as the dependent variables: (1) achieving the WHO recommendations for aerobic physical activity, (2) muscle strengthening, and in addition (3) regular cycling for travel (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe following independent variables were selected: (a) sociodemographic variables: sex, age group, educational level and subjective social status; (b) migration-related variables: duration of residence, and self-assessed German language proficiency; and (c) psychosocial variables: self-reported social support and sense of belonging to the society in Germany. A detailed overview of the dependent and independent variables is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDefinition of variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent variable: Physical Activity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategorization\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; Achieving the WHO recommendations for aerobic physical activity\u003c/p\u003e \u003cp\u003eBased on the sum of physical activity during leisure time and cycling for travel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;150min/ Week,\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;150min/ Week\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; Achieving the WHO recommendations for muscle strengthening\u003c/p\u003e \u003cp\u003eBased on number of times reported by respondents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;Twice/ Week\u003c/p\u003e \u003cp\u003e\u0026ge;Twice/ Week\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; Cycling regularly for travel\u003c/p\u003e \u003cp\u003eBased on number of times reported by respondents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;Once/ Week\u003c/p\u003e \u003cp\u003e\u0026ge;Once/ Week\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndependent variables\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocio-demographic variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; Sex:\u003c/p\u003e \u003cp\u003eBased on biological sex assigned at birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; Age group:\u003c/p\u003e \u003cp\u003eAge categorised into three groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;39 years\u003c/p\u003e \u003cp\u003e40\u0026ndash;59 years\u003c/p\u003e \u003cp\u003e60\u0026ndash;79 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; Educational level:\u003c/p\u003e \u003cp\u003eBased on the ISCED-2011 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] classification standard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow (ISCED 1\u0026ndash;2)\u003c/p\u003e \u003cp\u003eMedium (ISCED 3\u0026ndash;4)\u003c/p\u003e \u003cp\u003eHigh (ISCED 5\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; Subjective social status:\u003c/p\u003e \u003cp\u003eBased on the MacArthur Scale of Subjective Social Status [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow (values 1\u0026ndash;4)\u003c/p\u003e \u003cp\u003eMedium (values 5\u0026ndash;6)\u003c/p\u003e \u003cp\u003eHigh (values 7\u0026ndash;10)\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMigration-related variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; Duration of residence:\u003c/p\u003e \u003cp\u003eBased on country of birth and year of moving to Germany for those born abroad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5 years (but less than a lifetime)\u003c/p\u003e \u003cp\u003eSince birth\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; German language proficiency\u003c/p\u003e \u003cp\u003eBased on questions on native language and the self-assessed German language proficiency of those not indicating German as their native language\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNative/ Very good\u003c/p\u003e \u003cp\u003eGood/ Moderate\u003c/p\u003e \u003cp\u003eBad/ Very bad\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychosocial variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; Social support\u003c/p\u003e \u003cp\u003eBased on the Oslo 3-item Social Support Scale [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor (values 3\u0026ndash;8)\u003c/p\u003e \u003cp\u003eModerate (values 9\u0026ndash;11)\u003c/p\u003e \u003cp\u003eStrong (values 12\u0026ndash;14)\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026#159; Sense of belonging to the society in Germany\u003c/p\u003e \u003cp\u003eBased on the question \u0026lsquo;How much do you feel you belong to the society in Germany?\u0026rdquo; [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery strongly/ Strongly\u003c/p\u003e \u003cp\u003ePartly\u003c/p\u003e \u003cp\u003eBarely/ Not at all\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eStatistical analyses were performed using Stata version 17.0 survey procedures for complex samples. Analyses were performed using a weighting factor to ensure that the sample was representative of the population with corresponding citizenships. Results are presented as prevalences with corresponding 95% confidence intervals (95% CI). A statistically significant difference is assumed at a p-value less than 0.05.\u003c/p\u003e \u003cp\u003eFor the bivariate analyses, Pearson\u0026rsquo;s Chi-square test was used to determine the associations between each physical activity indicator and the socio-demographic, migration-related and psychosocial variables. In addition, multivariable adjusted odds ratios (OR) with corresponding 95% CIs were calculated using logistic regression analyses, adjusting for socio-demographic (sex, age group, educational level, subjective social status) as well as the migration-related (duration of residence, German language proficiency) and psychosocial (social support, sense of belonging to the society in Germany) variables. The multivariable analyses were adjusted for citizenship according to registration offices to account for different response behaviour between citizenship groups [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy sample\u003c/h2\u003e\n \u003cp\u003eA total of 6,038 participants took part in the survey, consisting of 53.8% men and 46.2% women (% weighted). The participants had a mean age of 41.6 years. Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows the sociodemographic, migration-related and psychosocial characteristics of the participants.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescription of the study sample according to sociodemographic, migration-related and psychosocial variables\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable:\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategorization\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% [95%CI]\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3055\u003c/p\u003e\n \u003cp\u003e2983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.8 [51.0- 56.5]\u003c/p\u003e\n \u003cp\u003e46.2 [43.5\u0026ndash;49.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;39 years\u003c/p\u003e\n \u003cp\u003e40\u0026ndash;59 years\u003c/p\u003e\n \u003cp\u003e60\u0026ndash;79 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3024\u003c/p\u003e\n \u003cp\u003e2156\u003c/p\u003e\n \u003cp\u003e858\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.5 [43.7\u0026ndash;49.4]\u003c/p\u003e\n \u003cp\u003e37.9 [35.9\u0026ndash;39.9]\u003c/p\u003e\n \u003cp\u003e15.6 [13.4\u0026ndash;18.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1704\u003c/p\u003e\n \u003cp\u003e2260\u003c/p\u003e\n \u003cp\u003e2042\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.3 [42.4\u0026ndash;48.3]\u003c/p\u003e\n \u003cp\u003e39.9 [37.7\u0026ndash;42.2]\u003c/p\u003e\n \u003cp\u003e14.2 [12.5\u0026ndash;16.1]\u003c/p\u003e\n \u003cp\u003e0.5 [0.3\u0026ndash;0.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubjective social status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1920\u003c/p\u003e\n \u003cp\u003e2266\u003c/p\u003e\n \u003cp\u003e1597\u003c/p\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.7 [28.9\u0026ndash;34.6]\u003c/p\u003e\n \u003cp\u003e39.6 [36.8\u0026ndash;42.5]\u003c/p\u003e\n \u003cp\u003e24.1 [22.0- 26.4]\u003c/p\u003e\n \u003cp\u003e4.5 [3.5\u0026ndash;5.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;5 years\u003c/p\u003e\n \u003cp\u003eSince birth\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2255\u003c/p\u003e\n \u003cp\u003e2507\u003c/p\u003e\n \u003cp\u003e1189\u003c/p\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.7 [19.3\u0026ndash;26.5]\u003c/p\u003e\n \u003cp\u003e56.2 [53.0- 59.5]\u003c/p\u003e\n \u003cp\u003e19.5 [17.3\u0026ndash;21.9]\u003c/p\u003e\n \u003cp\u003e1.5 [0.9\u0026ndash;2.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGerman language proficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNative/ Very good\u003c/p\u003e\n \u003cp\u003eGood/ Moderate\u003c/p\u003e\n \u003cp\u003eBad/ Very bad\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2570\u003c/p\u003e\n \u003cp\u003e2839\u003c/p\u003e\n \u003cp\u003e538\u003c/p\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.4 [42.3\u0026ndash;46.6]\u003c/p\u003e\n \u003cp\u003e46.5 [44.4\u0026ndash;48.6]\u003c/p\u003e\n \u003cp\u003e7.2 [6.2\u0026ndash;8.2]\u003c/p\u003e\n \u003cp\u003e1.9 [1.4\u0026ndash;2.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003cp\u003eStrong\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1561\u003c/p\u003e\n \u003cp\u003e3062\u003c/p\u003e\n \u003cp\u003e1356\u003c/p\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.7 [23.0- 28.5]\u003c/p\u003e\n \u003cp\u003e49.1 [46.6\u0026ndash;51.5]\u003c/p\u003e\n \u003cp\u003e24.3 [21.5\u0026ndash;27.2]\u003c/p\u003e\n \u003cp\u003e1.0 [0.6\u0026ndash;1.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSense of belonging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery strongly/ Strongly\u003c/p\u003e\n \u003cp\u003ePartly\u003c/p\u003e\n \u003cp\u003eBarely/ Not at all\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3655\u003c/p\u003e\n \u003cp\u003e1824\u003c/p\u003e\n \u003cp\u003e548\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.0 [60.6\u0026ndash;65.4]\u003c/p\u003e\n \u003cp\u003e28.7 [26.9\u0026ndash;30.6]\u003c/p\u003e\n \u003cp\u003e7.9 [6.8\u0026ndash;9.1]\u003c/p\u003e\n \u003cp\u003e0.3 [0.1\u0026ndash;0.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;unweighted, % weighted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003ePhysical activity levels\u003c/h2\u003e\n \u003cp\u003eOf the participants, 28.5% achieved the recommended 150 minutes or more of aerobic physical activity per week, and 22.6% met the recommended level of at least two muscle-strengthening sessions per week. Of the participants, 22.0% cycled at least once a week for travel.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eBivariate analyses\u003c/h3\u003e\n\u003cp\u003eBivariate analyses showed that all selected variables were found to be significantly associated with the achievement of WHO recommendation for aerobic physical activity (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eExcept for the sense of belonging to the society in Germany, all selected variables were significantly associated with achieving the WHO recommendations for muscle strengthening as well.\u003c/p\u003e\n\u003cp\u003eSex and educational level were found to be significantly associated with cycling behaviour in the bivariate analyses.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of the bivariate analyses\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003eResult of the bivariate analyses\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAerobic physical activity\u003c/p\u003e\n \u003cp\u003erecommendation achieved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eMuscle strengthening\u003c/p\u003e\n \u003cp\u003erecommendation achieved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCycling for travel\u003c/p\u003e\n \u003cp\u003eat least once a week\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e% [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e% [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e% [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6038\u003c/p\u003e\n \u003cp\u003e1941\u003c/p\u003e\n \u003cp\u003e4032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.5 [26.4\u0026ndash;30.7]\u003c/p\u003e\n \u003cp\u003e70.0 [67.7\u0026ndash;72.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6038\u003c/p\u003e\n \u003cp\u003e1551\u003c/p\u003e\n \u003cp\u003e4391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.6 [20.5\u0026ndash;24.8]\u003c/p\u003e\n \u003cp\u003e75.0 [72.5\u0026ndash;24.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5924\u003c/p\u003e\n \u003cp\u003e1532\u003c/p\u003e\n \u003cp\u003e4392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.0 [19.5\u0026ndash;24.6]\u003c/p\u003e\n \u003cp\u003e75.4 [72.7\u0026ndash;77.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5 [1.0-2.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4 [1.7\u0026ndash;3.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7 [2.1\u0026ndash;3.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5942\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.8 [28.9,34.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.5 [23.5\u0026ndash;29.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.5 [23.4\u0026ndash;29.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.6 [22.8,28.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.2 [16.8\u0026ndash;21.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.0 [15.0-21.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5942\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.5 [30.7,36.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2994\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.4 [25.3\u0026ndash;31.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.4 [21.0-28.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.6 [22.2,29.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.4 [16.3\u0026ndash;23.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.0 [17.6\u0026ndash;25.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026ndash;79 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.0 [18.7,27.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e828\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.1 [13.3\u0026ndash;19.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.5 [16.8\u0026ndash;24.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5943\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.2 [16.6,22.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.8 [14.7\u0026ndash;21.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.8 [13.8\u0026ndash;20.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.1 [33.4,38.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.8 [24.2\u0026ndash;29.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.8 [23.0\u0026ndash;31.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.2 [36.1,44.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.9 [27.2\u0026ndash;34.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.8 [24.7\u0026ndash;33.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubjective social status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.5 [20.2,27.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.2 [14.7\u0026ndash;22.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.6 [17.0-24.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.3 [28.0,34.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.9 [22.0\u0026ndash;28.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.6 [19.3\u0026ndash;26.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.9 [28.8,37.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.0 [23.3\u0026ndash;31.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.2 [20.6\u0026ndash;30.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5887\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.8 [23.3,30.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.3 [19.5\u0026ndash;27.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.7 [22.1\u0026ndash;29.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.9 [23.7,30.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.1 [18.4\u0026ndash;24.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2432\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.9 [19.0-25.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSince birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.2 [33.5,43.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.8 [25.8\u0026ndash;34.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.4 [17.1\u0026ndash;26.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGerman language proficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5851\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNative/ very good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.4 [34.4,40.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.5 [24.7,30.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.8 [20.6,27.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.473\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood/ moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.5 [19.4,25.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.5 [17.1,24.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.0 [18.8,25.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBad/ very bad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.3 [12.1,24.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.3 [9.0,19.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.7 [13.5,27.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.7 [18.8,27.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.5 [13.1\u0026ndash;20.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.5 [17.0-24.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.0 [27.0,33.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.4 [21.6\u0026ndash;27.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.6 [20.7\u0026ndash;26.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStrong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1349\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.2 [29.2,37.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.4 [23.6\u0026ndash;31.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.5 [19.0-26.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSense of belonging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5916\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery strongly/ strongly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.0 [28.5,33.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.6 [21.1\u0026ndash;26.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.4 [20.5\u0026ndash;26.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1804\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.6 [22.9,30.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.4 [20.0-27.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.8 [18.1\u0026ndash;26.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBarely/ not at all\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.7 [16.5,27.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.7 [13.2\u0026ndash;25.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.8 [13.2\u0026ndash;23.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e% weighted; CI: confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cbr\u003e\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cem\u003eMultivariable logistic regression analyses\u003c/em\u003e\u003c/div\u003e\n\u003cp\u003eA higher likelihood to achieve the WHO recommendation for aerobic physical activity as well as the recommendation for muscle-strengthening was observed among men, those with a higher educational level, those with a higher subjective social status, native/ very good German language proficiency, and a stronger social support compared to those in the respective reference categories. In addition, younger adults (18\u0026ndash;39 years) were more likely to achieve the muscle-strengthening recommendation than older adults (60 years and older) (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eA higher likelihood to cycle for travel at least once a week was found for men compared to women, for people with a higher level of education compared to those with a low educational level, and for people who have lived in Germany for less than five years, compared to those who were born in Germany (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of the multivariable logistic regression analyses\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eResults of the multivariable regression analyses\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAerobic physical activity\u003c/p\u003e\n \u003cp\u003erecommendation achieved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMuscle strengthening\u003c/p\u003e\n \u003cp\u003erecommendation achieved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCycling for travel\u003c/p\u003e\n \u003cp\u003eat least once a week\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOR [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOR [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOR [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.34 [1.07\u0026ndash;1.68]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.55 [1.24\u0026ndash;1.94]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.59 [1.27\u0026ndash;1.99]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.40 [0.98\u0026ndash;2.01]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.93 [1.32\u0026ndash;2.83]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.05 [0.72\u0026ndash;1.53]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.785\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07 [0.75\u0026ndash;1.53]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.22 [0.85\u0026ndash;1.73]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92 [0.68\u0026ndash;1.26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026ndash;79 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.95 [1.59\u0026ndash;2.39]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.42 [1.08\u0026ndash;1.87]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.82 [1.37\u0026ndash;2.43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.34 [1.78\u0026ndash;3.07]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.65 [1.23\u0026ndash;2.22]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.92 [1.40\u0026ndash;2.61]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubjective social status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.31 [1.05\u0026ndash;1.63]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.41 [1.09\u0026ndash;1.83]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.08 [0.79\u0026ndash;1.48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.623\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.34 [1.01\u0026ndash;1.78]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.044\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.53 [1.14\u0026ndash;2.06]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.16 [0.82\u0026ndash;1.63]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.390\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 [0.73\u0026ndash;1.46]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07 [0.73\u0026ndash;1.58]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.63 [1.12\u0026ndash;2.38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98 [0.69\u0026ndash;1.39]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02 [0.76\u0026ndash;1.38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.885\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.34 [0.96\u0026ndash;1.87]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSince birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGerman language proficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNative/ very good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.25 [1.40\u0026ndash;3.62]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.23 [1.30\u0026ndash;3.82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.41 [0.90\u0026ndash;2.21]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood/ moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.35 [0.87\u0026ndash;2.08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.82 [1.13\u0026ndash;2.92]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27 [0.80\u0026ndash;2.01]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBad/ very bad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.33 [1.00-1.76]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.78 [1.33\u0026ndash;2.38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.18 [0.92\u0026ndash;1.51]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStrong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.40 [1.01\u0026ndash;1.94]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.045\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.96 [1.41\u0026ndash;2.71]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07 [0.80\u0026ndash;1.43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSense of belonging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery strongly/ strongly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.25 [0.87\u0026ndash;1.78]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.89 [0.58\u0026ndash;1.36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.37 [0.93\u0026ndash;2.01]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.16 [0.80\u0026ndash;1.67]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 [0.69\u0026ndash;1.54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.23 [0.83\u0026ndash;1.81]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBarely/ not at all\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (ref.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eOR: odds ratio CI: confidence interval ref.: reference category; adjusted for citizenship according to residents\u0026rsquo; registration offices\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study showed that the overall level of physical activity among adults with a history of migration in Germany was comparatively low, with less than a third achieving the WHO recommendations for aerobic and muscle-strengthening physical activity. A higher likelihood of not achieving the physical activity recommendations was observed among women, those with a low educational level, a low subjective social status, a low level of social support and a lower level of German language proficiency.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with physical activity among respondents\u003c/h2\u003e \u003cp\u003eAs in the general population, a wide range of associations between socio-demographic factors and physical activity were found among GEDA Fokus participants.\u003c/p\u003e \u003cp\u003eMen in the sample were more likely than women to achieve the physical activity recommendations. These gender differences in physical activity are consistent with previous research findings among migrants as well as in the general population living in Germany [\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. One possible explanation for this finding is that men and women may have been socialised differently with men being more motivated and supported to engage in physical activity [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our sample, age was found to be significantly associated with aerobic physical activity and muscle-strengthening, with younger participants being more likely to be physically active, while older participants were less active. A previous study has also shown that physical activity levels are lower in older age groups in Germany [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While biological factors such as decreasing health and fitness levels and frailty may contribute to lower levels of physical activity among older adults in the general population, other barriers may also be relevant for older adults with a history of migration, such as social isolation, discrimination, or low social participation [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe also found associations between higher levels of education and more frequent participation in physical activity. Individuals with higher levels of education are more likely to have better health literacy, and therefore may be more likely to understand the health benefits of physical activity and engage in such activities intentionally [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In contrast, those with lower levels of education are often more likely to be engaged in more physically demanding jobs [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This may further reduce their chances of engaging in beneficial physical activity in their leisure time.\u003c/p\u003e \u003cp\u003eAdvanced levels of physical activity are more common among those who report a higher subjective social status. This may be due to lower stress levels of individuals with a higher subjective social status and greater opportunities to engage in leisure-time physical activity, such as joining sports clubs or gyms [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition to socio-demographic factors, other determinants of health, particularly migration-related and psychosocial factors, were also found to be significantly associated with physical activity in this study: Those with better German language proficiency and higher levels of social support were more likely to meet the recommendations for physical activity. It is likely that there exists a complex interplay between these factors and physical activity. Improved language proficiency of the majority language offers people with a history of migration better chances for social integration [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This integration, in turn, enables them to access health information, communicate effectively with healthcare providers, and actively participate in public physical activities based on their individual needs [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Language difficulties can also prevent individuals from obtaining information about sports and exercise programs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, strong social support provides adults with a history of migration with the necessary resources and decision-making assistance from their families and communities, fostering a supportive environment for sustained physical activity and long-term adherence [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, regular cycling for travel was only found to be significantly associated with sex, education, and duration of residence in Germany in the multivariable regression analysis.\u003c/p\u003e \u003cp\u003eRegarding sex, an earlier survey investigating cycling among a group of adults with personal migration experience in Germany (IntegRADtion) also found higher rates of cycling among men than women [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This gender difference in cycling behaviour is also found in the general population living in Germany: a nationwide study in 2021 showed that 40% of men cycled at least once a week for travel, but only 29% of women [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Furthermore, this observation is not unique to Germany. For example, our findings are consistent with those of Goel et al. who conducted a cross-national study in 13 countries, where women were generally less likely to cycle for travel than men. The authors stated that a lack of safe environments, cultural norms, and fear of harassment could explain women\u0026rsquo;s lower cycling rates. In contrast, gender differences in cycling are significantly reduced in societies with safe cycling infrastructure and relatively gender-equal societies [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe lower prevalence of cycling for travel among people with low levels of education compared to those with higher levels of education found in our study is also consistent with findings in the general population living in Germany [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. One explanation may lie in different attitudes towards cycling as a mode of transport. People with low educational levels may avoid cycling as a mode of transport because it may be associated with a low social status [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In contrast, people with higher educational level often see cycling as fashionable and ethical because of its environmental and fitness benefits [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDuration of residence was negatively associated with the likelihood of cycling for travel. Newcomers may choose cycling as their primary mode of travel due to unfamiliarity with the new environment, such as public transport routes and potential financial pressure [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, in contrast to our results, the findings of the IntegRADtion study by Schaefer \u0026amp; Francke indicate that adults living in Germany who grew up abroad were less likely to choose cycling as a mode of transport than the group who grew up in Germany [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In addition, the IntegRADtion study found that the main barriers and motivators for cycling among adults with migration experience were barely different from those of the general population. Therefore, the various interactions between the duration of immigrants' residence and their characteristics still need to be further investigated in the future.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations for policy and practice\u003c/h2\u003e \u003cp\u003eBased on the findings of this study, interventions to promote physical activity among adults with a history of migration should address several dimensions. First, they should consider the heterogeneity of different sub-populations with migration history. Previous research has demonstrated significant heterogeneity in physical activity among minority groups in the United States, including immigrants [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This heterogeneity is characterized by multiple dimensions of socioeconomic status, and community resources, and therefore presents different challenges to their physical activity participation. Homogenized perspectives may lead to inappropriate generalizations and potentially ineffective \u0026ldquo;one size fits all\" interventions. This suggests that interventions should be tailored to the specific social, economic, and environmental needs of population groups, and also consider different lifestyles and gender roles, in order to provide needs-based support frameworks for physical activity. In order to establish successful approaches to promoting physical activity among people with a history of migration, the target group should be involved in the planning and delivery of these interventions. In addition, research is needed to better understand the barriers to physical activity and active travel of people with a migrant history, with a focus on women, people with a low social status and low German language proficiency. Furthermore, it should be investigated how sports facilities and public spaces can be adapted to meet the diverse needs of adults with a history of migration for physical activity [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Based on our finding that low proficiency in German language predicted significant physical inactivity, increasing the number of sports classes offered in different languages could increase the physical activity behaviour of people with low German language proficiency, in addition to appropriate ways of promoting these sports classes to the respective groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths\u003c/h2\u003e \u003cp\u003eThis study has several strengths: First, it is the first to use nationwide cross-sectional survey data to examine the association between physical activity and social determinants, particularly psychosocial factors, among adults with selected citizenships in Germany. The study design was complex and used different methods to recruit individuals with a migration history, including home visits. This study fills a research gap in this area and provides a new source of data to study the physical activity of selected groups of adults with a history of migration in Germany, which is an important reference for the development and implementation of relevant policies. In addition, this study investigated the association between a wide range of factors, not only socio-demographic factors, but also migration-related and psychosocial factors, and physical activity. The findings of this study provide valuable insights for future research in terms of selecting directions for in-depth research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eA limitation of this study may lie in the selection of variables. Despite efforts to include various socio-demographic, migration-related, and psychosocial factors in the selection of variables, further potential factors influencing the physical activity behaviour of the participants were not included in the questionnaire, such as physical literacy or environmental factors. Furthermore, occupational physical activity was not included in the statistical analysis due to its potential negative health effects [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These aspects remain a potential research area that should be carefully considered in future studies.\u003c/p\u003e \u003cp\u003eIn addition, the variables in this study were based on participants' self-reports, which may have biased the results on their physical activity levels due to recall and social desirability bias.\u003c/p\u003e \u003cp\u003eAnother issue that needs to be mentioned is that the generalizability of our findings is limited to people with the five selected citizenships, but not to all people with a history of migration living in Germany.\u003c/p\u003e \u003cp\u003eFinally, although associations have been identified between various factors and physical activity among people with selected citizenships, causal relationships between these factors and physical activity remain inconclusive as is the nature of cross-sectional studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOverall, the study found relatively low levels of physical activity among adults with Croatian, Italian, Polish, Syrian or Turkish citizenship in Germany, and there were significant associations between their physical activity behaviour and a range of socio-demographic, migration-related and psychosocial factors.\u003c/p\u003e \u003cp\u003eFurther in-depth research is necessary and valuable from both a public health and health sociology perspective. It is necessary for policy and intervention planning to pay particular attention to addressing existing social inequalities in order to effectively promote physical activity among peoplee with a history of migration for their health and well-being.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGEDA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGesundheit in Deutschland aktuell\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eISCED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Standard Classification of Education (ISCED)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThe study was approved without concern by the local ethics committee at Charit\u0026eacute; \u0026ndash; Universit\u0026auml;tsmedizin Berlin (EA1/250/21) and by the Commissioner for Data Protection of the RKI. Participation was voluntary; all participants provided informed consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe study was funded by the German Federal Ministry of Health (Grant Number: ZMVI1-2518FSB411). The funders had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors have made substantial contributions to the development of this manuscript. CK and CH developed the study design and the survey questions. HZ and KM conducted the data analysis. HZ drafted the manuscript, while HZ, KM, CK, JL, and CH contributed to the interpretation of the results and the writing of the manuscript. All authors critically revised the manuscript and approved the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank all participants who took their time to take part in the survey. Additionally, we thank all colleagues at RKI who supported conducting this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe dataset supporting the conclusions of this article cannot be made publicly available because informed consent from study participants did not cover public deposition of data. However, the minimal dataset underlying the findings is archived in the Research Data Centre at the Robert Koch Institute and can be accessed by researchers on reasonable request. On-site access to the data set is possible at the Secure Data Centre of the Robert Koch Institute\u0026rsquo;s Research Data Centre. Requests should be submitted by e-mail to [email protected].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWarburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: The evidence. Can Med Assoc J. 2006;174:801\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichter A, Schienkiewitz A, Starker A, Krug S, Domanska O, Kuhnert R, et al. Health-promoting behaviour among adults in Germany - results from GEDA 2019/2020-EHIS. J Health Monit. 2021;6:26\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRommel A, Sa\u0026szlig; A-C, Born S, Ellert U. Die gesundheitliche Lage von Menschen mit Migrationshintergrund und die Bedeutung des sozio\u0026ouml;konomischen Status. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2015;58:543\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFederal Statistical Office. 24.3% of the population had a history of immigration in 2022. Fed Stat Office. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.destatis.de/EN/Press/2023/04/PE23_158_125.html\u003c/span\u003e\u003cspan address=\"https://www.destatis.de/EN/Press/2023/04/PE23_158_125.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSauter A, Kikhia S, Loss J. Influences on the physical activity of Syrian migrants in Germany: results of a qualitative study. Health Promot Int. 2021;37:daab132.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrahsa A, Streber A, Wolff AR, R\u0026uuml;tten A. 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Concepts migration-sensitive health Monit. 2019;4:49\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoschollek C, Gaertner B, Geerlings J, Kuhnert R, Mauz E, H\u0026ouml;vener C. Recruiting people with selected citizenships for the health interview survey GEDA Fokus throughout Germany: Evaluation of recruitment efforts and recommendations for future research. BMC Med Res Methodol. 2024;24:200 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaek S-R, Moudon AV, Saelens BE, Kang B, Hurvitz PM, Bae C-HC. Comparisons of Physical Activity and Walking Between Korean Immigrant and White Women in King County, WA. J Immigr Minor Health. 2015;18:1541\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFinger JD, Mensink G, Lange C, Manz K. Health-enhancing physical activity during leisure time among adults in Germany. J Health Monit. 2017;2:35\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorawa E, Erim Y. Health-Related Lifestyle Behavior and Religiosity among First-Generation Immigrants of Polish Origin in Germany. Int J Environ Res Public Health. 2018;15:2545.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrist L, Dornquast C, Reinhold T, Becher H, Icke K, Danquah I, et al. Physical Activity Trajectories among Persons of Turkish Descent Living in Germany\u0026mdash;A Cohort Study. Int J Environ Res Public Health. 2020;17:6349.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMikell M, Snethen J, Kelber ST. Exploring Factors Associated with Physical Activity in Latino Immigrants. West J Nurs Res. 2020;42:680\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoss J, Blume M, Neuperdt L, Flerlage N, Weihrauch T, Manz K, et al. Wie steht es um die Gesundheit von M\u0026auml;dchen und Jungen in der COVID-19-Pandemie? Ausgew\u0026auml;hlte Ergebnisse der KIDA-Studie. J Health Monit. 2023;8:40\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTong H, Walsh CA, Bouchard N, Lai DWL. Social Inclusion and Immigrant Older Adults. In: Liamputtong P, editor. Handbook of Social Inclusion: Research and practices in health and social sciences. Cham: Springer; 2021. pp. 769\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJordan S. Gesundheitskompetenz/Health Literacy. In: Bundeszentrale f\u0026uuml;r gesundheitliche Aufkl\u0026auml;rung (BZgA), editor. Leitbegriffe der Gesundheitsf\u0026ouml;rderung und Pr\u0026auml;vention. Glossar zu Konzepten, Strategien und Methoden. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFinger JD, Mensink G, Lange C, Manz K. Work-related physical activity among adults in Germany. PubMed. 2017;2:28\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhaed SG, Gallo LC. Subjective social status, objective socioeconomic status, and cardiovascular risk in women. Health Psychol. 2007;26:668\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaug S. Sprachliche Integration von Migranten in Deutschland. N\u0026uuml;rnberg: Bundesamt f\u0026uuml;r Migration und Fl\u0026uuml;chtlinge (BAMF); 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoshi S, Jatrana S, Paradies Y. Are Immigrants More Physically Active Than Native-Born Australians and Does it Changes Over Time? Evidence From a Nationally Representative Longitudinal Survey. J Phys Act Health. 2017;14:145\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVonneilich N, Franzkowiak P. Soziale Unterst\u0026uuml;tzung. In: Bundeszentrale f\u0026uuml;r gesundheitliche Aufkl\u0026auml;rung (BZgA), editor. Leitbegriffe der Gesundheitsf\u0026ouml;rderung und Pr\u0026auml;vention. Glossar zu Konzepten, Strategien und Methoden. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchaefer L-M, Francke A. IntegRADtion Radfahren f\u0026uuml;r Alle Informationsbrosch\u0026uuml;re \u0026uuml;ber Migration und Radfahren. Technische Universit\u0026auml;t Dresden; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoosburger R, Manz K, Richter A, Gert BM, Mensink, Loss J. Climate protection, health and other motives for active transport \u0026ndash; results of a cross-sectional survey in Germany. BMC Public Health. 2024;24:1505.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoel R, Oyebode O, Foley L, Tatah L, Millett C, Woodcock J. Gender differences in active travel in major cities across the world. Transportation. 2022;50:733\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHudde A. Educational differences in cycling: Evidence from German cities. Sociology. 2022;56:909\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBantham A, Taverno Ross SE, Sebasti\u0026atilde;o E, Hall G. Overcoming barriers to physical activity in underserved populations. Prog Cardiovasc Dis. 2020;64:64\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWieland ML, Tiedje K, Meiers SJ, Mohamed AA, Formea CM, Ridgeway JL, et al. Perspectives on Physical Activity Among Immigrants and Refugees to a Small Urban Community in Minnesota. J Immigr Minor Health. 2013;17:263\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoltermann A, Krause N, van der Beek AJ, Straker L. The physical activity paradox: Six reasons why occupational physical activity (OPA) does not confer the cardiovascular health benefits that leisure time physical activity does. Br J Sports Med. 2017;52:149\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"movement behaviour, sports, health inequalities, migration","lastPublishedDoi":"10.21203/rs.3.rs-6269892/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6269892/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePromoting physical activity among the general population as well as among people with a history of migration is a crucial aspect of health promotion. However, we still lack a general understanding of physical activity levels and their potential determinants among adults with a history of migration living in Germany.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The GEDA Fokus study, conducted by the Robert Koch Institute from 11/2021 to 05/2022, is a nationwide cross-sectional health interview survey of adults (18 – 79 years) with Croatian, Italian, Polish, Syrian or Turkish citizenship living throughout Germany (n = 6,038). The Aims of this study were (1) to assess the physical activity levels of adults with selected citizenships in Germany, and (2) to identify sociodemographic and migration-related factors associated with their physical activity behaviour.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eApproximately 70% of the participants reported not achieving the World Health Organization (WHO) recommendations for aerobic physical activity and 75% did not achieve the recommendation for muscle strengthening. The physical activity levels among the participants were associated with a number of sociodemographic, migration-related and psychosocial factors. Multivariable regression analyses showed that men compared to women, adults with higher educational levels, higher subjective social status, better German language proficiency and a higher level of social support were more likely to achieve the WHO recommendations for physical activity. In addition, men compared to women and adults with higher educational levels were more likely to cycle for travel.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eOverall, the study found relatively low levels of physical activity among adults of Croatian, Italian, Polish, Syrian or Turkish citizenship living in Germany, and significant associations between their physical activity behaviour and a number of associated sociodemographic, migration-related and psychosocial factors. Further in-depth research is needed, both from a public health and health sociology perspective, to identify barriers to physical activity among people with a history of migration and to derive appropriate measures for intervention planning.\u003c/p\u003e","manuscriptTitle":"Associations between physical activity and potential influencing factors among adults with a history of migration in Germany - results of a nationwide cross-sectional survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-30 12:38:54","doi":"10.21203/rs.3.rs-6269892/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-05T10:38:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-27T11:02:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72998636467246547627469836962038814357","date":"2025-06-13T07:01:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-11T10:05:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114811586673116546494575423352914448449","date":"2025-06-02T08:09:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T12:18:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-27T12:58:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-24T07:38:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-24T07:36:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-03-20T13:01:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5e55577-8d24-4ce5-9338-365d57a66f6c","owner":[],"postedDate":"May 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-21T14:09:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-30 12:38:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6269892","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6269892","identity":"rs-6269892","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}