@misc{HerkeReuterMayeretal., author = {Herke, Max and Reuter, Marvin and Mayer, A. and Spallek, Jacob and Rattay, Petra and Moor, Irene and Richter, Matthias}, title = {Wie wirkt sich die sozio{\"o}konomische Komposition der Schule auf Ungleichheiten im subjektiven Wohlbefinden von Sch{\"u}lerinnen und Sch{\"u}lern in Deutschland aus?}, series = {Gesundheitswesen}, volume = {84}, journal = {Gesundheitswesen}, number = {08/09}, publisher = {Georg Thieme Verlag}, doi = {10.1055/s-0042-1753867}, pages = {826}, abstract = {Einleitung Zielsetzung des Beitrags ist es, zu untersuchen, inwiefern die sozio{\"o}konomische Komposition von Schulen mit dem Wohlbefinden von Sch{\"u}lerinnen und Sch{\"u}lern in Deutschland assoziiert ist. Konkret wurden die Assoziationen der Bildung, des Einkommens und des beruflichen Status der Eltern auf Individualebene und aggregiert auf Schulebene sowie die Interaktionen zwischen diesen Ebenen auf das subjektive Wohlbefinden von Sch{\"u}lern der Sekundarstufe I untersucht. Methoden Es wurden Daten der Startkohorte „Klasse 5" des Nationalen Bildungspanels (NEPS) herangezogen. Die Kohorte startete 2010 mit einer repr{\"a}sentativen Stichprobe von F{\"u}nftkl{\"a}sslern in Deutschland, welche j{\"a}hrlich nachverfolgt wurden. Es wurden Erhebungswellen von der f{\"u}nften bis zur neunten Klasse zusammengefasst. Damit konnten 14.265 Beobachtungen mit vollst{\"a}ndigen Angaben von 3.977 Sch{\"u}lerinnen und Sch{\"u}lern in 218 Schulen in den Analysen ber{\"u}cksichtigt werden. Mit Mixed-Models wurde getestet, ob die sozio{\"o}konomische Position auf individueller und/oder schulischer Ebene und die ebenen{\"u}bergreifende Interaktion dieser Indikatoren mit dem Wohlbefinden (adaptierter Personal Well-Being - School Children-Index) der Jugendlichen assoziiert ist. Es wurde f{\"u}r Alter, Geschlecht, Migrationshintergrund, Familienform, Schultyp und Notendurchschnitt kontrolliert. Ergebnisse Auf individueller Ebene war das elterliche Einkommen mit h{\"o}herem Wohlbefinden verbunden. Der berufliche Status der Eltern zeigte keine signifikanten Assoziationen. Auf Schulebene fanden wir einen geringen, positiven Zusammenhang zwischen dem durchschnittlichen elterlichen Einkommen und dem individuellen Wohlbefinden, aber auch einen m{\"a}ßig negativen Einfluss eines hohen Anteils hoch gebildeter Eltern auf das Wohlbefinden. In Sensitivit{\"a}tsanalysen blieben diese Zusammenh{\"a}nge auch bei separater Betrachtung dieser Indikatoren bestehen. Die Zusammenh{\"a}nge auf Individualebene wurden nicht durch die sozio{\"o}konomische Komposition von Schulen moderiert, es konnten keine signifikanten ebenen{\"u}bergreifende Interaktionen festgestellt werden. Schlussfolgerung Es wurde ein Zusammenhang der sozio{\"o}konomischen Zusammensetzung der Schule mit dem subjektiven Wohlbefinden der Jugendlichen gefunden. Internationale Befunde einer Moderation der Zusammenh{\"a}nge auf individueller Ebene durch sozio{\"o}konomische Charakteristika auf Schulebene konnten jedoch nicht repliziert werden. Die Zusammenh{\"a}nge zwischen individueller SEP und Wohlbefinden variieren somit nicht in Abh{\"a}ngigkeit von der SEP auf Schulebene. Es zeigen sich vielmehr in Teilen additive Effekte f{\"u}r die individuelle und schulische SEP.}, language = {de} } @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{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} } @techreport{WachtlerHoffmannRattayetal., author = {Wachtler, Benjamin and Hoffmann, Stephanie and Rattay, Petra and Sander, Lydia}, title = {Systematic review of qualitative and quantitative studies on the mediating and moderating role of family characteristics on health inequalities in school-aged children and adolescents in countries with developed economies}, publisher = {National Institute for Health Research - PROSPERO}, pages = {4}, abstract = {PROSPERO International prospective register of systematic reviews: registered study protocol. Review question: Which family characteristics mediate or moderate the association between the family's socioeconomic position and health in school-aged children and adolescents in countries with developed economies?}, 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{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} }