@misc{BammertSchuettigNovellietal., author = {Bammert, Philip and Sch{\"u}ttig, Wiebke and Novelli, Anna and Iashchenko, Iryna and Spallek, Jacob and Blume, Miriam and Diehl, Katharina and Moor, Irene and Dragano, Nico and Sundmacher, Leonie}, title = {The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review}, series = {International Journal for Equity in Health}, volume = {23}, journal = {International Journal for Equity in Health}, number = {1}, issn = {1475-9276}, doi = {10.1186/s12939-024-02122-6}, abstract = {Background: Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. Methods: We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. Results: Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. Conclusions: Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.}, language = {en} } @misc{HerrDeBockDiehletal., author = {Herr, Raphael and De Bock, Freia and Diehl, Katharina and Wiedemann, Eva and Sterdt, Elena and Blume, Miriam and Hoffmann, Stephanie and Herke, Max and Reuter, Marvin and Iashchenko, Iryna and Schneider, Sven}, title = {Associations of individual factors and early childhood education and care (ECEC) centres characteristics with preschoolers' BMI in Germany}, series = {BMC Public Health}, volume = {22}, journal = {BMC Public Health}, issn = {1471-2458}, doi = {10.1186/s12889-022-13814-5}, pages = {1 -- 13}, abstract = {Background The number of obese children is rising worldwide. Many studies have investigated single determinants of children's body mass index (BMI), yet studies measuring determinants at different potential levels of influence are sparse. The aim of this study is to investigate the independent role of parental socioeconomic position (SEP), additional family factors at the micro level, as well as early childhood education and care (ECEC) centre characteristics at the meso level regarding BMI. Methods Analyses used the baseline data of the PReschool INtervention Study (PRINS) including up to 1,151 children from 53 ECEC centres. Multi-level models first estimated the associations of parental SEP indicators (parental school education, vocational training, and household income) with the children's standard deviation scores for BMI (SDS BMI, standardised for age and gender). Second, structural (number of siblings), psychosocial (strained family relationships), and nutrition behavioural (soft-drink consumption, frequency of fast-food restaurant visits) family factors at the micro level were included. Third, characteristics of the ECEC centre at the meso level in terms of average group size, the ratio of overweight children in the group, ECEC centre type (all-day care), and the location of the ECEC centre (rural vs urban) were included. All analyses were stratified by gender and adjusted for age, migration background, and parental employment status. Results Estimates for boys and girls appeared to differ. In the full model, for boys the parental SEP indicators were not related to SDS BMI. Factors related to SDS BMI in boys were: two or more siblings; B = -.55; p = 0.045 [ref.: no sibling]), the characteristics of the ECEC centre in terms of average group size (20 - 25 children; B = -.54; p = 0.022 [ref.: < 20 children]), and the ratio of overweight children (more overweight children B = -1.39; p < 0.001 [ref.: few overweight children]). For girls the number of siblings (two and more siblings; B = .67; p = 0.027 [ref.: no sibling]) and average group size (> 25 children; B = -.52; p = 0.037 [ref.: < 20 children]) were related to SDS BMI. Conclusions The BMI of preschool children appears to be associated with determinants at the micro and meso level, however with some gender differences. The identified factors at the micro and meso level appear largely modifiable and can inform about possible interventions to reduce obesity in preschool children.}, language = {en} } @misc{BlumeRattayHoffmannetal., author = {Blume, Miriam and Rattay, Petra and Hoffmann, Stephanie and Spallek, Jacob and Sander, Lydia and Herr, Raphael and Moor, Irene and Pischke, Claudia R. and Iashchenko, Iryna and H{\"o}vener, Claudia}, title = {Zusammenhang zwischen der sozio{\"o}konomischen Position der Familie und Adipositas bei Jugendlichen in Deutschland - welche Rolle hat die Familie?}, series = {Gesundheitswesen}, volume = {84}, journal = {Gesundheitswesen}, number = {08/09}, doi = {10.1055/s-0042-1753866}, pages = {826}, abstract = {Einleitung Die gesundheitlichen Folgen von Adipositas f{\"u}r junge Menschen k{\"o}nnen schwerwiegend sein. Bei der Entwicklung verschiedener Gesundheitsoutcomes wie Adipositas spielt f{\"u}r junge Menschen die Familie als auch ihre sozio{\"o}konomische Position (SEP) eine große Rolle. In dieser Analyse wird untersucht, welche famili{\"a}re Determinanten den Zusammenhang zwischen SEP der Familie und Adipositas bei Jugendlichen erkl{\"a}ren. Methoden Die vorliegende Analyse wurde mit Daten der "Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland" (KiGGS) (Basiserhebung, Welle 1 und 2) durchgef{\"u}hrt (1301 weibliche und 1232 m{\"a}nnliche 11- bis 17-J{\"a}hrige). Mittels logistischer Regressionsmodelle (KHB-Methode) wurden f{\"u}r den Zusammenhang zwischen der SEP der Familie (Einkommen, berufliche Stellung, Bildung, SES-Index) und Adipositas (Ja/Nein) bei Jugendlichen die mediierenden Effekte von famili{\"a}ren Determinanten (elterliches Rauchen, elterliche sportliche Aktivit{\"a}ten, elterliches {\"U}bergewicht, famili{\"a}rer Stress und famili{\"a}rer Zusammenhalt) analysiert. Ergebnisse Die Pr{\"a}valenz von Adipositas betrug 7,9 \% bei den weiblichen und 8,4 \% bei den m{\"a}nnlichen Jugendlichen. Es zeigen sich signifikante Zusammenh{\"a}nge zwischen Adipositas und SEP zu Ungunsten von jenen mit niedriger sozio{\"o}konomischer Position. Famili{\"a}re Determinanten erkl{\"a}ren teilweise oder vollst{\"a}ndig den Zusammenhang zwischen SEP und Adipositas bei Jugendlichen. Es wurden geschlechtsspezifische Unterschiede im Ausmaß der Mediation der Familie gefunden. Bei Jungen erkl{\"a}ren famili{\"a}re Determinanten vollst{\"a}ndig den Zusammenhang zwischen Adipositas und Einkommen sowie zwischen Adipositas und der beruflichen Stellung der Eltern. Bei m{\"a}nnlichen Jugendlichen l{\"a}sst sich der indirekte Effekt abh{\"a}ngig von der jeweiligen SEP-Variable zu 20,8 - 27,9 \% auf das elterliche Rauchen, zu 14,8 - 26,3 \% auf die elterliche sportliche Aktivit{\"a}t und zu 42,6 - 63,6 \% auf das elterliche {\"U}bergewicht zur{\"u}ckf{\"u}hren. Bei M{\"a}dchen wurde der Zusammenhang zwischen der SEP und Adipositas teilweise durch famili{\"a}re Determinanten erkl{\"a}rt. Bei weiblichen Jugendlichen l{\"a}sst sich der indirekte Effekt abh{\"a}ngig von der jeweiligen SEP-Variable zu 26,0 - 52,2 \% auf das elterliche Rauchen und zu 41,6 - 67,6 \% auf das elterliche {\"U}bergewicht zur{\"u}ckf{\"u}hren. Schlussfolgerung Die Adipositas-Pr{\"a}valenz von Jugendlichen variiert nach dem SEP. Famili{\"a}re Determinanten sind wichtige mediierende Faktoren f{\"u}r gesundheitliche Ungleichheiten bei Adipositas von Jugendlichen. Es zeigt sich, dass sich Unterschiede in der Adipositas nach SEP insbesondere durch das elterliche Gesundheitsverhalten (v.a. elterliches Rauchen, elterliches {\"U}bergewicht und elterliche sportliche Aktivit{\"a}t) erkl{\"a}ren lassen. Die Ber{\"u}cksichtigung und Einbindung der Familie bei der Planung und Umsetzung von Gesundheitsf{\"o}rderungs- und Pr{\"a}ventionsprogrammen f{\"u}r gesundheitliche Chancengleichheit bei Jugendlichen ist essentiell.}, language = {de} } @misc{IashchenkoSchuettigBammertetal., author = {Iashchenko, Iryna and Sch{\"u}ttig, Wiebke and Bammert, Philip and Spallek, Jacob and Rattay, Petra and Schneider, Sven and Moor, Irene and Pischke, Claudia R. and Sundmacher, Leonie}, title = {The role of regional health policy for socioeconomic inequality in health services utilization}, series = {European Journal of Public Health}, volume = {32}, journal = {European Journal of Public Health}, number = {Supplement_3}, issn = {1101-1262}, doi = {10.1093/eurpub/ckac129.584}, pages = {1}, abstract = {Background "J1" is a preventative routine examination in Germany recommended for adolescents at the age of 12-14 years. In contrast to the well-established U1-U9 examinations for younger children, with participation rates above 90\%, the attendance of the J1 examination is approximately only 40\%. The most frequent reason for not attending J1 is the unawareness of this examination. "Ticket to J1" is an intervention including an information leaflet introduced in Bavaria in 2017 to inform adolescents about J1. The aims of the present analysis are to investigate (1) if the regional policy was effective in increasing the attendance in J1, (2) if the effects vary by family socioeconomic status (SES), and (3) which meso-level characteristics of the healthcare system correlate with attendance rates in J1. Methods We used anonymised data of a large statutory health insurance in Germany for the timeframe of 2016-2018. To investigate the effect of the policy, a difference-in-differences design at the individual level was used. Assuming a parallel trend at the level of federal states, the likelihood of attendance in J1 of 13- and 14-year-olds was compared between Bavaria and other federal German states before and after policy introduction. All analyses were additionally stratified by SES. Results The introduction of "Ticket to J1" increased participation in J1 by 1\% after controlling for all confounders. Furthermore, the effect was stronger for children from families with lower SES (an increase of 5\%). Density of pediatricians was positively significantly correlated with participation in J1. Discussion Regional health policy intervention had a significant positive impact on attendance of J1 and appears to have the potential to reduce socioeconomic inequalities in healthcare utilization. Informing adolescents about J1 seems to increase the attendance, in particular for children from families with lower SES.}, language = {en} } @misc{BammertSchuettigIashchenkoetal., author = {Bammert, Philip and Sch{\"u}ttig, Wiebke and Iashchenko, Iryna and Spallek, Jacob and Rattay, Petra and Schneider, Sven and Richter, Matthias and Pischke, Claudia R. and Dragano, Nico and Sundmacher, Leonie}, title = {The role of sociodemographic, psychosocial, and behavioral factors in the use of preventive healthcare services in children and adolescents: results of the KiGGS Wave 2 study}, series = {BMC Pediatrics}, volume = {24}, journal = {BMC Pediatrics}, issn = {1471-2431}, doi = {10.1186/s12887-024-04650-0}, abstract = {Background: In Germany, various preventive services are offered to children and adolescents. These include regular standardized examinations (so called U/J examinations) and several vaccinations. Although strongly recommended, most of them are not mandatory. Our aim is to identify factors associated with the use of U/J examinations and vaccination against diphtheria, hepatitis B, Hib, pertussis, polio, and tetanus. While previous research has focused on sociodemographic factors, we also include socioeconomic, behavioral, and psychosocial factors. Methods: We analyzed cross-sectional data from 15,023 participants (aged 0-17 years) of the nationwide representative KiGGS Wave 2 Survey. Participation in U/J examinations was assessed using a questionnaire, filled out by participants and/or their parents. Information on vaccination status was drawn from the participants' vaccination booklets. To identify relevant determinants for the use of preventive examinations and vaccinations, unadjusted and adjusted logistic regression models were employed with up to 16 different independent variables. Results: Various independent variables showed an association with the use of preventive services. Higher socioeconomic status, absence of migration background, and lower household size were associated with significantly higher utilization of U examinations. Parents' marital status, area of residence, behavioral and psychosocial factors yielded insignificant results for most U/J examinations. Higher vaccination rates were found for children with no migration background, with residence in eastern Germany, lower household size, and with married parents. Conclusion: This study attempted to depict the influence of sociodemographic, psychosocial, and behavioral factors on the use of several preventive services. Our results indicate that predominantly sociodemographic variables influence the use of preventive services. Further efforts should be made to investigate the interplay of different determinants of healthcare use in children and adolescents.}, language = {en} } @misc{BlumeRattayHoffmannetal., author = {Blume, Miriam and Rattay, Petra and Hoffmann, Stephanie and Spallek, Jacob and Sander, Lydia and Herr, Raphael and Richter, Matthias and Moor, Irene and Dragano, Nico and Pischke, Claudia R. and Iashchenko, Iryna and H{\"o}vener, Claudia and Wachtler, Benjamin}, title = {Health Inequalities in Children and Adolescents: A Scoping Review of the Mediating and Moderating Effects of Family Characteristics}, series = {International Journal of Environmental Research and Public Health}, volume = {18}, journal = {International Journal of Environmental Research and Public Health}, number = {15}, issn = {1660-4601}, doi = {10.3390/ijerph18157739}, pages = {33}, abstract = {This scoping review systematically mapped evidence of the mediating and moderating effects of family characteristics on health inequalities in school-aged children and adolescents (6-18 years) in countries with developed economies in Europe and North America. We conducted a systematic scoping review following the PRISMA extension for Scoping Reviews recommendations. We searched the PubMed, PsycINFO and Scopus databases. Two reviewers independently screened titles, abstracts and full texts. Evidence was synthesized narratively. Of the 12,403 records initially identified, 50 articles were included in the synthesis. The included studies were conducted in the United States (n = 27), Europe (n = 18), Canada (n = 3), or in multiple countries combined (n = 2). We found that mental health was the most frequently assessed health outcome. The included studies reported that different family characteristics mediated or moderated health inequalities. Parental mental health, parenting practices, and parent-child-relationships were most frequently examined, and were found to be important mediating or moderating factors. In addition, family conflict and distress were relevant family characteristics. Future research should integrate additional health outcomes besides mental health, and attempt to integrate the complexity of families. The family characteristics identified in this review represent potential starting points for reducing health inequalities in childhood and adolescence.}, language = {en} } @misc{IashchenkoSchuettigBammertetal., author = {Iashchenko, Iryna and Sch{\"u}ttig, Wiebke and Bammert, Philip and Spallek, Jacob and Rattay, Petra and Schneider, Sven and Moor, Irene and Pischke, Claudia R. and Sundmacher, Leonie}, title = {Die Rolle der regionalen Gesundheitspolitik f{\"u}r die sozio{\"o}konomische Ungleichheit in der Inanspruchnahme der Gesundheitsleistungen}, series = {Gesundheitswesen}, volume = {84}, journal = {Gesundheitswesen}, number = {08/09}, publisher = {Georg Thieme Verlag}, doi = {10.1055/s-0042-1753865}, pages = {825}, abstract = {Einleitung Die J1 ist eine Vorsorgeuntersuchung, die f{\"u}r Kinder zwischen 12 und 14 Jahren empfohlen ist. Im Gegensatz zu den etablierten U1- bis U9-Untersuchungen f{\"u}r j{\"u}ngere Kinder mit Teilnahmeraten {\"u}ber 90\% liegt die Teilnahme bei der J1 bei etwa 40\%. Ein Grund f{\"u}r die mangelnde Teilnahme an der J1 ist die geringe Bekanntheit bei Eltern und Kindern. Mehrere Bundesl{\"a}nder haben Einladungswesen eingef{\"u}hrt, um Jugendliche zur Teilnahme an der J1 zu motivieren. Die Einladung „Dein Ticket zur J1" wurde Mitte 2017 in Bayern eingef{\"u}hrt. Das „Ticket" ist ein Informationsflyer {\"u}ber die J1 in einer jugendgerechten Gestaltung. Die vorliegende Analyse untersuchte, ob die regionale Informationskampagne zu einer Steigerung der Teilnahme an der J1 gef{\"u}hrt hat, ob die Effekte mit dem sozio{\"o}konomischen Status der Familie (SES) variieren und welche Meso-Ebene-Merkmale des Gesundheitssystems mit der J1-Teilnahme korrelieren. Methoden Um die Wirkung der Intervention zu untersuchen, wurden bundesweite anonymisierte Routinedaten der Techniker Krankenkasse aus den Jahren 2016-2018 sowie ein Difference-in-Differences-Design auf individueller Ebene verwendet. Unter der Annahme eines parallelen Trends auf Bundesl{\"a}nderebene wurde die J1-Teilnahme von 13- und 14-J{\"a}hrigen in Bayern mit anderen Bundesl{\"a}ndern vor und nach der Intervention verglichen. Zus{\"a}tzlich wurde die Analyse f{\"u}r die verschiedenen SES-Gruppen durchgef{\"u}hrt. Wir untersuchten auch, ob Faktoren auf Mesoebene des Gesundheitssystems mit der Teilnahme an der J1 korrelierten. Ergebnisse Die Einf{\"u}hrung von „Dein Ticket zur J1" erh{\"o}hte die Teilnahme an der J1 um 1 \%. Obwohl eine h{\"o}here Bildung und berufliche Stellung der Eltern positiv mit der J1-Teilnahme korrelierten, war der Effekt der Intervention bei Kindern aus Familien mit niedrigerem SES st{\"a}rker (Anstieg um 5 \%). Die Kinderarztdichte auf Kreisebene korrelierte zudem positiv mit der Teilnahme an der J1. Schlussfolgerung Die Intervention hat das Potenzial, die sozio{\"o}konomische Ungleichheit bei der Inanspruchnahme von Gesundheitsleistungen zu verringern, da die Effekte f{\"u}r Kinder aus Familien mit niedrigerem SES st{\"a}rker waren. Es bedarf jedoch weiterer Maßnahmen, um Jugendliche {\"u}ber die J1 und die damit verbundenen gesundheitlichen Vorteile zu informieren. Zuk{\"u}nftige Studien sollten untersuchen, von welchen weiteren Faktoren die Wirksamkeit der Intervention abh{\"a}ngt, wie z. B. die Art und Anzahl der Kommunikationskan{\"a}le.}, language = {de} }