title: Health-related quality of life in rural children living in four European countries: the GABRIEL study.
abstract: OBJECTIVE
  Measuring children's health-related quality of life (HRQOL) is of growing importance given increasing chronic diseases. By integrating HRQOL questions into the European GABRIEL study, we assessed differences in HRQOL between rural farm and non-farm children from Germany, Austria, Switzerland and Poland to relate it to common childhood health problems and to compare it to a representative, mostly urban German population sample (KIGGS).
  
  
  METHODS
  The parents of 10,400 school-aged children answered comprehensive questionnaires including health-related questions and the KINDL-R questions assessing HRQOL.
  
  
  RESULTS
  Austrian children reported highest KINDL-R scores (mean: 80.9; 95 % CI [80.4, 81.4]) and Polish children the lowest (74.5; [73.9, 75.0]). Farm children reported higher KINDL-R scores than non-farm children (p = 0.002). Significantly lower scores were observed in children with allergic diseases (p < 0.001), with sleeping difficulties (p < 0.001) and in overweight children (p = 0.04). The German GABRIEL sample reported higher mean scores (age 7-10 years: 80.1, [79.9, 80.4]; age 11-13 years: 77.1, [74.9, 79.2]) compared to the urban KIGGS study (age 7-10 years: 79.0, [78.7-79.3]; age 11-13 years: 75.1 [74.6-75.6]). Socio-demographic or health-related factors could not explain differences in HRQOL between countries.
  
  
  CONCLUSIONS
  Future increases in chronic diseases may negatively impact children's HRQOL.
authors.affiliation: Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box 4002, Basel, Switzerland. laura.stoecklin@gmail.ch
authors.forename: Laura
authors.initials: L
authors.lastname: Stöcklin
authors.forename: Georg
authors.initials: G
authors.lastname: Loss
authors.forename: Erika
authors.initials: E
authors.lastname: von Mutius
authors.forename: Juliane
authors.initials: J
authors.lastname: Weber
authors.forename: Jon
authors.initials: J
authors.lastname: Genuneit
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Horak
authors.forename: Barbara
authors.initials: B
authors.lastname: Sozanska
authors.forename: Hanna
authors.initials: H
authors.lastname: Danielewicz
authors.forename: Paul
authors.initials: P
authors.lastname: Cullinan
authors.forename: Dick
authors.initials: D
authors.lastname: Heederick
authors.forename: Charlotte
authors.initials: C
authors.lastname: Braun-Fahrländer
mesh_terms: D000293:Adolescent; D001317:Austria; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D011044:Poland; D011788:Quality of Life; D012423:Rural Health / Q000592:standards*; D012424:Rural Population; D011795:Surveys and Questionnaires; D013557:Switzerland