@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{RattayBlumeSpalleketal., author = {Rattay, Petra and Blume, Miriam and Spallek, Jacob and Hoffmann, Stephanie and Sander, Lydia and Herr, Raphael and Herke, Max and Reuter, Marvin and Novelli, Anna and H{\"o}vener, Claudia}, title = {Socioeconomic position and self-rated health among adolescents: the mediating role of the family}, series = {European Journal of Public Health}, volume = {32}, journal = {European Journal of Public Health}, number = {Supplement_3}, issn = {1101-1262}, doi = {10.1093/eurpub/ckac129.580}, pages = {1}, abstract = {Background Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining adolescents' health inequalities. The study aimed to explore whether the association between socioeconomic position and self-rated health (SRH) was mediated by familial determinants. Methods Using data from wave 2 of the KiGGS study (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of parents' education, occupation, income, socioeconomic position index, and adolescents' subjective social status on SRH into direct effects and indirect effects through familial determinants (family cohesion, parenting styles, parental well-being, stress, obesity, smoking and sporting activity). Results A significant total effect of all socioeconomic position indicators on SRH was found, except for income in male adolescents. In female adolescents, more than 70\% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations of parental education, the socioeconomic position index and subjective social status with SRH were also mediated by familial determinants (family cohesion, parental smoking and obesity). However, a significant direct effect of subjective social status remained. Conclusions The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions, community-based strategies, as well as programs to improve parenting and family functioning.}, language = {en} } @misc{MayerHerrKleinetal., author = {Mayer, Alena and Herr, Raphael M. and Klein, Thomas and Wiedemann, Eva and Diehl, Katharina and Hoffmann, Stephanie and Blume, Miriam and Jepsen, Dennis and Sundmacher, Leonie and Andreas, Marike and Schneider, Sven}, title = {Socio-economic inequalities in body mass index among preschool children: do sports programs in early childhood education and care centers make a difference?}, series = {Frontiers in Public Health}, volume = {Vol. 11}, journal = {Frontiers in Public Health}, issn = {2296-2565}, doi = {10.3389/fpubh.2023.1079871}, abstract = {Background: Overweight in childhood is considered to be one of the most serious public health challenges. Many studies have investigated individual-level determinants of children's body mass index (BMI), yet studies exploring determinants at the meso-level are sparse. The aim of our study was to examine how a sports focus at early childhood education and care (ECEC) centers moderates the effect of parental socio-economic position (SEP) on children's BMI. Methods: We used data from the German National Educational Panel Study and included 1,891 children (955 boys and 936 girls) from 224 ECEC centers in our analysis. Linear multilevel regressions were used to estimate the main effects of family SEP and the ECEC center sports focus, as well as their interaction, on children's BMI. All analyses were stratified by sex and adjusted for age, migration background, number of siblings, and employment status of parents. Results: Our analysis confirmed the wellknown health inequalities in childhood overweight with a social gradient toward a higher BMI for children from lower SEP families. An interactive effect between family SEP and ECEC center sports focus was found. Boys with low family SEP not attending a sports-focused ECEC center had the highest BMI among all boys. In contrast, boys with low family SEP attending a sports-focused ECEC center had the lowest BMI. For girls, no association regarding ECEC center focus or interactive effects emerged. Girls with a high SEP had the lowest BMI, independent of the ECEC center focus. Conclusion: We provided evidence for the gender-specific relevance of sports-focused ECEC centers for the prevention of overweight. Especially boys from low SEP families benefited from a sports focus, whereas for girls the family's SEP was more relevant. As a consequence, gender differences in determinants for BMI at different levels and their interaction should be considered in further research and preventive measures. Our research indicates that ECEC centers may decrease health inequalities by providing opportunities for physical activity.}, language = {en} } @misc{RattayBlumeWachtleretal., author = {Rattay, Petra and Blume, Miriam and Wachtler, Benjamin and Wollgast, Lina and Spallek, Jacob and Hoffmann, Stephanie and Sander, Lydia and Herr, Raphael and Herke, Max and Reuter, Marvin and Novelli, Anna and H{\"o}vener, Claudia}, title = {Socioeconomic position and self-rated health among female and male adolescents: The role of familial determinants in explaining health inequalities. Results of the German KiGGS study}, series = {PloS one}, volume = {17}, journal = {PloS one}, number = {4}, issn = {1932-6203}, doi = {10.1371/journal.pone.0266463}, abstract = {Objective Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining the association between the family's socioeconomic position and adolescents' self-rated health. The current study aimed to explore whether the association between socioeconomic position and self-rated health was mediated by familial determinants. Methods Using data from wave 2 of the"German Health Interview and Examination Survey for Children and Adolescents" (KiGGS) (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of income, education, occupational status, socioeconomic position index and adolescents' subjective social status on self-rated health into direct effects and indirect effects through familial determinants (family cohesion, parental well-being, parental stress, parenting styles, parental obesity, smoking and sporting activity). Results A significant total effect of all socioeconomic position indicators on self-rated health was found, except for income in male adolescents. In female adolescents, more than 70\% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations between income, parental education, the socioeconomic position index and subjective social status were also mediated by familial determinants (family cohesion, parental smoking, obesity and living in a single-mother family). However, a significant direct effect of subjective social status remained. Conclusion The analysis revealed how a family's position of socioeconomic disadvantage can lead to poorer health in adolescents through different family practices. The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions (macro-level), community-based strategies (meso-level) and programs to improve parenting and family functioning (micro-level).}, language = {en} } @misc{WachtlerHoffmannBlumeetal., author = {Wachtler, Benjamin and Hoffmann, Stephanie and Blume, Miriam and Rattay, Petra and Herr, Raphael and Deindl, Christian and Sundmacher, Leonie and Richter, Matthias and Spallek, Jacob and Lampert, Thomas}, title = {The impact of the family on health inequalities in children - A systematic scoping review}, series = {European Journal of Public Health}, volume = {30}, journal = {European Journal of Public Health}, number = {Supplement_5}, publisher = {Univ. Press}, address = {Oxford}, issn = {1101-1262}, doi = {10.1093/eurpub/ckaa166.898}, pages = {1}, abstract = {Background Health inequalities in school-aged children and adolescents were repeatedly reported across Europe but less is known about the contextual and compositional factors of families that might influence and reproduce those health inequalities. In this systematic scoping review we aim to provide a comprehensive overview of the available international literature on the mediating and moderating influence of the family on health inequalities in children and adolescents in Europe and North America. Methods This review follows the PRISMA guidelines for scoping reviews. After defining the research question a search strategy was developed in cooperation with a scientific librarian and the study protocol was registered. A search of three databases (Pubmed, Scopus, PsycINFO) was conducted to identify relevant literature in English or German published between the year 2000 and 2019. A qualitative data charting process was used to extract the relevant data. Results In total 11.838 records were identified through the multi database search (Pubmed n = 6370, PsycINFO n = 3505, Scopus n = 1963). After elimination of duplicates and records from excluded countries, 8862 abstracts were screened by two researchers independently. Different cluster of evidence of family influences on health inequalities were identified: Parental behaviors and children's obesity, parents' smoking and drinking habits and adolescents' risk behaviors, parenting style and children's common mental disorders, parental resources and children's quality of life. Conclusions There are different aspects of family's contextual and compositional characteristics on health inequalities identifiable in the international literature. These characteristics might be new targets for family-focused health promotion strategies. Key messages: -A systematic scoping review found different family aspects that influence health inequalities in children and adolescents. - The identified family traits are promising targets for family-focused health promotion strategies to reduce health inequalities.}, language = {en} } @misc{HoffmannSanderBlumeetal., author = {Hoffmann, Stephanie and Sander, Lydia and Blume, Miriam and Schneider, Sven and Herke, Max and Matos Fialho, Paula M. and Pischke, Claudia R. and Sch{\"u}ttig, Wiebke and Lampert, Thomas and Spallek, Jacob}, title = {Do families have moderating or mediating effects on early health inequalities? A scoping review}, series = {European Journal of Public Health}, volume = {31}, journal = {European Journal of Public Health}, number = {Supplement_3}, publisher = {Oxford University Press}, doi = {10.1093/eurpub/ckab165.506}, abstract = {Background During early childhood, families have a crucial impact on children's health behaviour, health, and development (bhd). However, a family's socioeconomic position (SEP) determines both the parental behaviour, living conditions, and child health. To understand how family characteristics may influence the development of health inequalities, this scoping review synthesised research on their mediating and moderating effects. Methods The review followed the guidelines of the PRISMA Extension for Scoping Reviews. The search included German and English peer-reviewed articles published between January 1st, 2000 and December 19th, 2019. The search in PubMed, PsycINFO, and Scopus used both free text terms in the title/abstract and index terms within linked keyword blocks: (1) family characteristics, (2) inequalities, (3) income, education, occupation, (4) bhd, (5) newborn, infant, toddler, preschooler. Two researchers independently examined eligibility for inclusion in two rounds (title/abstract; full-text). Results Of 7,089 articles identified, ten sources were included that studied family characteristics and health inequalities among 0-6 years olds. Parental rules, stress, and screentime, and TV in bedroom showed mediating effects on inequalities in behaviour problems or children's screentime. Families' negativity, single parenthood, and the number of children in the household moderated differences in impairment, health, behaviour problems, development or breastfeeding initiation. Conclusions The effect of family characteristics on early health inequalities has been sparsely investigated. The evidence supported models of family stress and investment. Further research is needed to comprehensively understand this association. Key messages Family characteristics contribute to health inequalities. Taking families' stress and investment into account could improve targeted prevention efforts aimed at reducing health inequalities.}, language = {en} } @misc{HoffmannSanderWachtleretal., author = {Hoffmann, Stephanie and Sander, Lydia and Wachtler, Benjamin and Blume, Miriam and Schneider, Sven and Herke, Max and Pischke, Claudia R. and Matos Fialho, Paula M. and Schuettig, Wiebke and Tallarek, Marie and Lampert, Thomas and Spallek, Jacob}, title = {Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high‑income countries - a scoping review}, series = {BMC Public Health}, volume = {22}, journal = {BMC Public Health}, issn = {1471-2458}, doi = {10.1186/s12889-022-12603-4}, pages = {1 -- 14}, abstract = {Background: By explaining the development of health inequalities, eco-social theories highlight the importance of social environments that children are embedded in. The most important environment during early childhood is the family, as it profoundly influences children's health through various characteristics. These include family processes, family structure/size, and living conditions, and are closely linked to the socioeconomic position (SEP) of the family. Although it is known that the SEP contributes to health inequalities in early childhood, the effects of family characteristics on health inequalities remain unclear. The objective of this scoping review is to synthesise existing research on the mediating and moderating effects of family characteristics on socioeconomic health inequalities (HI) during early childhood in high-income countries. Methods: This review followed the methodology of "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews". To identify German and English scientific peer-reviewed literature published from January 1st, 2000, to December 19th, 2019, the following search term blocks were linked with the logical operator "AND": (1) family structure/size, processes, living conditions, (2) inequalities, disparities, diversities, (3) income, education, occupation, (4) health and (5) young children. The search covered the electronic databases PubMed, PsycINFO, and Scopus. Results: The search yielded 7,089 records. After title/abstract and full-text screening, only ten peer-reviewed articles were included in the synthesis, which analysed the effects of family characteristics on HI in early childhood. Family processes (i.e., rules /descriptive norms, stress, parental screen time, parent-child conflicts) are identified to have mediating or moderating effects. While families' living conditions (i.e., TVs in children's bedrooms) are suggested as mediating factors, family structure/size (i.e., single parenthood, number of children in the household) appear to moderate health inequalities. Conclusion: Family characteristics contribute to health inequalities in early childhood. The results provide overall support of models of family stress and family investment. However, knowledge gaps remain regarding the role of family health literacy, regarding a wide range of children's health outcomes (e.g., oral health, inflammation parameters, weight, and height), and the development of health inequalities over the life course starting at birth.}, 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{HoffmannRattayBlumeetal., author = {Hoffmann, Stephanie and Rattay, Petra and Blume, Miriam and H{\"o}vener, Claudia and Schneider, Sven and Moor, Irene and Pischke, Claudia R. and Sch{\"u}ttig, Wiebke and De Bock, Freia and Spallek, Jacob}, title = {Do family characteristics explain a social gradient in overweight in early childhood?}, series = {European Journal of Public Health}, volume = {32}, journal = {European Journal of Public Health}, number = {Supplement_3}, issn = {1101-1262}, doi = {10.1093/eurpub/ckac129.581}, pages = {1}, abstract = {Background Children's overweight is associated with many factors, including their living situation, in particular their family's socioeconomic position (SEP) and family characteristics. Research on the extent to which family characteristics account for a social gradient in overweight in early life is scarce. This study evaluated whether family characteristics explain SEP differences in the risk of overweight in early childhood. Methods The study used baseline data of 3-6 year-old children (n = 1,116) from the intervention 'Ene mene fit' conducted at kindergartens in Baden-W{\"u}rttemberg, Germany. Data included overweight (body mass index > 90 percentile) and parents' reports on their education and family characteristics associated with overweight (child consumes: sweets in front of TV, soft drinks; family joined time: outdoor, breakfast, sports; cooking; child sets table; role model). Model-based single mediation analyses decomposed the total effect of highest parental education on overweight into direct (unmediated) and indirect (mediated) effects (OR, 95\% CI). Results Girls and boys with low parental education had higher odds for overweight than children with high/medium education. Among boys, low education influenced the risk of overweight via indirect effects of i. 'sweets consumption in front of TV' (OR = 1.31, 1.05-1.59) and ii. 'no joined sports' (OR = 1.14, 1.00-1.44). The direct effect of low education only remained significant when 'no joined sports' was considered (OR = 2.19, 1.11-5.19). Among girls, family characteristics measured here did not explain SEP differences in overweight. Conclusions The family characteristics 'sweets consumption in front of TV' and 'no joined sports' contribute to inequalities in overweight among boys, but not among girls. Therefore, more gender-sensitive research is needed to identify family risk and protective characteristics that explain health inequalities among both boys and girls.}, 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} } @techreport{HoffmannWachtlerSanderetal., author = {Hoffmann, Stephanie and Wachtler, Benjamin and Sander, Lydia and Blume, Miriam and Hilger-Kolb, Jennifer and Herke, Max and Matos Fialho, Paula M. and Pischke, Claudia R. and Novelli, Anna and Lampert, Thomas and Spallek, Jacob}, title = {Health inequalities among infants and pre-school children: Protocol for a scoping review examining the moderating and mediating role of contextual and compositional family characteristics}, publisher = {Open Science Framework}, doi = {10.17605/OSF.IO/3U4ST}, abstract = {Background: Although early childhood is a life period of overall good health, research shows that families' socioeconomic position (SEP) is affecting children's health from pregnancy on, ultimately leading to health inequalities. Little is currently known about the pathways by which family SEP is influencing child health and health-related behaviour, and which role family characteristics play. The scoping review therefore aims to screen the international literature on the mediating and moderating effects of contextual and compositional family characteristics on socioeconomic health risks of pre-school children in developed countries. Methods: Following the PRISMA guidelines for scoping reviews, three online databases (Pubmed, PsycINFO, and Scopus) will be searched for literature in English or German published after year 2000. The two-step data screening approach and the subsequent data extraction will be conducted independently by two researchers in consideration of specific criteria and a previously tested standardized data extraction form. Due to the broad research question at hand, various study designs (e.g. cross-sectional, intervention, cohort studies, and qualitative studies), SEP measures (e.g. education, income) and compositional (e.g. family size, migration) or contextual (e.g. parenting, housing) family characteristics influencing children's health will be included. Since diverse definitions and reporting formats of subjective health, health behaviour, well-being, and diseases will be considered, a substantial heterogeneity in outcome measures focusing on the age group of 0-6 years is expected. Thus, a narrative synthesis of the findings will be performed according to the Centre for Reviews and Dissemination framework. Ethics and dissemination: Because no primary data will be collected, ethical clearance will not be required. Dissemination will include peer-reviewed publications and conferences.}, language = {en} } @misc{HoffmannSanderRattayetal., author = {Hoffmann, Stephanie and Sander, Lydia and Rattay, Petra and Blume, Miriam and H{\"o}vener, Claudia and Schneider, Sven and Richter, Matthias and Pischke, Claudia R. and Sch{\"u}ttig, Wiebke and De Bock, Freia and Spallek, Jacob}, title = {Do family characteristics contribute to a socioeconomic gradient in overweight in early childhood? - Single mediation analyses of data from German preschool children}, series = {Preventive Medicine Reports}, volume = {33}, journal = {Preventive Medicine Reports}, issn = {2211-3355}, doi = {10.1016/j.pmedr.2023.102178}, abstract = {Children's overweight is strongly associated with family socioeconomic position (SEP) and family characteristics (FC). There is limited research on the extent to which FC account for a socioeconomic gradient in childhood overweight. This study examined whether FC explain SEP differences in the prevalence of overweight. The study used baseline data of preschool-aged children from the German 'PReschool INtervention Study'. The sample (n = 872, 48\% girls) was recruited at kindergartens in Baden-W{\"u}rttemberg, Germany. Data included children's measured weight status and parents' reports on socioeconomic indicators (e.g., school education, vocational education, income) and FC. Variables represent main determinants of overweight (nutrition: sweets consumption in front of TV, soft drink consumption, regular breakfast, child sets table; physical activity: outdoor sports; parental role model). In single mediation analyses indirect effects of SEP on overweight were analysed (OR[95\%CI]). Preschool girls and boys with low parental education had higher odds for overweight than children with high parental education. Among boys, low levels of parental education contributed to the odds of overweight via indirect effects by both factors 'sweets consumption in front of TV' (OR = 1.31[1.05-1.59]) and 'no sports' (OR = 1.14[1.01-1.38]). Among girls, FC measured did not explain SEP differences in overweight. Family nutrition and parental/family physical activity contribute to inequalities in overweight among preschool boys, but not girls. Research is needed to identify FC that explain inequalities in overweight for both.}, language = {en} }