@misc{ScholaskeLindnerMatthesKurtetal., author = {Scholaske, Laura and Lindner-Matthes, Denise and Kurt, Medlin and Duman, Elif Aysimi and Sahbaz, C. and Spallek, Jacob and Entringer, Sonja}, title = {Intergenerational transmission of health disparities among Turkish-origin residents in Germany: role of maternal stress and stress biology during pregnancy. A study protocol}, series = {European Journal of Public Health}, volume = {28}, journal = {European Journal of Public Health}, number = {Suppl. 1}, issn = {1464-360X}, doi = {10.1093/eurpub/cky048.044}, pages = {S. 126}, abstract = {Background:Turkish-origin immigrants constitute one of the biggest migration groups in Germany where they exhibit higher levels of social disadvantage when compared to the majority population. Research has elucidated the underlying mechanisms by which social disadvantage is biologically embedded to impact health over the lifespan. However, relatively little is known about how its effects are transmitted across generations. Aims of the study: To elucidate the effects of maternal migration status and socioeconomic status on stress-related maternal-placental-foetal (MPF) biological processes across gestation and on subsequent infant birth and health outcomes. Methods: We are conducting a longitudinal cohort study of N = 450 child-mother dyads with serial measures across gestation and birth through the first year of life. Our proposed study population will include approximately equal numbers of Turkish-origin women in Germany, German women in Germany, Turkish women living in Turkey and their offspring. Study visits are conducted from the second trimester of pregnancy to the end of the first year of life to assess maternal socio-economic and migration-related information, psychological well-being, nutrition, medical risk variables, and MPF stress biology markers from maternal blood and saliva samples. Infant anthropometric measures, developmental outcomes and stress markers in saliva are assessed throughout the first year of life. Analyses: We will test specific hypotheses regarding the association between migration background, socioeconomic status and MPF stress biology. We will furthermore quantify the association of maternal migration background- and social disadvantage-related MPF stress biology measures on pregnancy and child health outcomes. Discussion: This is the first study on foetal programming of health disparities with a focus on Turkish-origin women in Germany. The significance and impact of this study derives from the importance of achieving a better understanding of underlying mechanisms that alter disease vulnerability in minority and disadvantaged populations.}, language = {en} } @misc{ScholaskeBroseSpalleketal., author = {Scholaske, Laura and Brose, Annette and Spallek, Jacob and Entringer, Sonja}, title = {The role of discrimination for the risk of preterm birth among Turkish immigrant women}, series = {European Journal of Public Health}, volume = {28}, journal = {European Journal of Public Health}, number = {4}, issn = {1464-360X}, doi = {10.1093/eurpub/cky213.566}, pages = {192 -- 192}, abstract = {Background: Preterm birth (PTB) is one of the most severe risk factors for early child death and developmental impairment. Epidemiological research suggests that immigrants from lower to higher income countries exhibit a health decline over time that is transmitted to the offspring generation in which health disparities become prevalent already at a very early age in terms of adverse birth outcomes. Perceived discrimination (PD) is discussed in the context of health disparities related to migration. The relationship between PD and health outcomes is still understudied among Turkish immigrants in Germany. We examined whether PD contributes to PTB risk in Turkish immigrant women. Methods: We used data from the German Socio-Economic Panel (SOEP). The newborn questionnaire ("Mother-Child: Age 0-1", 2003 - 2016, v33) provided information on birth outcomes and we included information on maternal socioeconomic situation, migration background and PD due to origin (for Turkish immigrant women only) that were collected in the survey before birth. The final sample comprised N = 2,525 (8.60\% Turkish immigrant women). A dummy variable indicating occurrence of PTB (0 = non PTB, i.e. ≥ 37 wks of gestation, 1 = PTB, i.e. < 37 weeks of gestation) was used as the outcome variable in logistic regression models. Results: Logistic regression models on the whole sample indicated a higher risk of PTB among Turkish compared to German native women (OR: 2.75) that remained after adjusting for socioeconomic status. Within the subsample of Turkish women, prenatal PD was related to a higher risk for PTB (OR: 4.91). Conclusions: Unlike in other studies we found evidence for a higher prevalence of PTB among Turkish immigrant women in the SOEP data. PD may explain the prevalence of PTB among Turkish immigrant women in Germany. There is a need for further research examining the impact of discrimination on the intergenerational transmission of health disparities among Turkish immigrants in Germany.}, language = {en} } @misc{ScholaskeBroseSpalleketal., author = {Scholaske, Laura and Brose, Annette and Spallek, Jacob and Entringer, Sonja}, title = {Perceived discrimination and risk of preterm birth among Turkish immigrant women in Germany}, series = {Social Science \& Medicine}, volume = {236}, journal = {Social Science \& Medicine}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2019.112427}, pages = {7}, abstract = {Background: Health disparities, including adverse birth outcomes, exist between Turkish immigrants and the autochthonous population in Germany. The state of research on the risk of preterm birth (PTB, defined as <37 weeks of gestation), the leading cause of infant mortality and morbidity, among Turkish immigrant women is mixed. Perceived discrimination is discussed in the context of health disparities related to migration. We examined whether PTB risk is also increased in Turkish immigrant women in Germany and whether perceived discrimination due to origin contributes to this risk. Methods: We selected a sample from the German Socio-Economic Panel (SOEP) study of German autochthonous and Turkish immigrant women who recently gave birth (between 2002 and 2016) (N = 2,525, incl. n = 217 Turkish immigrant women of which n = 111 completed an item on perceived discrimination). The included variables of central interest were immigrant status, perceived discrimination, gestational age, and socioeconomic situation. Results: Logistic regression models indicated that PTB risk was significantly higher for Turkish immigrant women than autochthonous women (OR: 2.75, 95\% CI [1.79-4.16]), even when adjusting for socioeconomic status. Within the subsample of Turkish immigrant women, perceived discrimination was related to a significantly higher PTB risk (OR: 4.91, 95\% CI [1.76-15.06]). Conclusions: Our study provides evidence for a higher PTB risk in Turkish immigrant women compared to autochthonous women in Germany. Perceived discrimination may contribute to this higher risk. The findings represent an important first step towards developing targeted interventions to improve pregnancy and birth outcomes in minority groups.}, language = {en} } @misc{ScholaskeRodriguezSarietal., author = {Scholaske, Laura and Rodriguez, Norma and Sari, Nida Emel and Spallek, Jacob and Ziegler, Matthias and Entringer, Sonja}, title = {The German Version of the Multidimensional Acculturative Stress Inventory (MASI) for Turkish-Origin Immigrants. Measurement Invariance of Filter Questions and Validation}, series = {European Journal of Psychological Assessment}, volume = {36}, journal = {European Journal of Psychological Assessment}, number = {5}, issn = {2151-2426}, doi = {10.1027/1015-5759/a000567}, pages = {889 -- 900}, abstract = {The Multidimensional Acculturative Stress Inventory (MASI) is an established measure of acculturative stress for people of Mexican origin living in the USA that has been associated with mental health outcomes in this population. We translated the MASI into German and adapted it for use with Turkish-origin immigrants in Germany. The MASI includes filter questions asking if a potentially stressful event had actually occurred before reporting the stress appraisal of these situations. Measurement invariance testing has become a standard practice to evaluate questionnaire translations, however, measurement invariance of filter questions has been scarcely studied. In Study 1, we evaluated measurement invariance of the filter questions between a German-based Turkish sample (N = 233) and the Mexican-origin sample from the original study (N = 174) and could show partial strong factorial invariance for three of the four factors. In Study 2, a validation study, relations between the German MASI scores and measures of acculturation and stress indicated discriminant validity. This study contributes to research on measurement invariance of filter questions, thereby providing a measure of acculturative stress that can be used in future research to understand the etiology of health disparities in Turkish-origin immigrants in Germany.}, language = {en} } @misc{SpallekScholaskeKurtetal., author = {Spallek, Jacob and Scholaske, Laura and Kurt, Medlin and Lindner-Matthes, Denise and Entringer, Sonja}, title = {Intergenerational transmission of health disparities among Turkish-origin immigrants in Germany: study protocol of a multi-centric cohort study (BaBi-stress and BaBeK study)}, series = {BMC pregnancy and childbirth}, volume = {20}, journal = {BMC pregnancy and childbirth}, number = {1}, doi = {10.1186/s12884-020-2853-y}, pages = {158}, abstract = {Background: Immigrants in Germany exhibit higher levels of social disadvantage when compared to the non-immigrated population. Turkish-origin immigrants constitute an important immigrant group in Germany and show disparities in some health domains that are evident from birth onwards. Several studies have shown the mechanisms by which social disadvantage is biologically embedded to affect health over the lifespan. Relatively little, however, is still known about if and how the maternal social situation is transmitted to the next generation. This study therefore aims to analyse the effects of maternal socioeconomic status and migration status on stress-related maternal-placental-fetal (MPF) biological processes during pregnancy on infant birth and health outcomes. Methods: This longitudinal cohort study of N = 144 child-mother dyads is located at two study sites in Germany and includes pregnant women of Turkish origin living in Germany as well as pregnant German women. During pregnancy, MPF stress biology markers from maternal blood and saliva samples, maternal socio-economic and migration-related information, medical risk variables and psychological well-being are assessed. After birth, infant anthropometric measures and developmental outcomes are assessed. The same measures will be assessed in and compared to Turkish pregnant women based on a collaboration with BABIP study in Istanbul. Discussion: This is the first study on intergenerational transmission of health disparities in Germany with a focus on women of Turkish-origin. The study faces similar risks of bias as other birth cohorts do. The study has implemented various measures, e.g. culturally sensitive recruitment strategies, attempt to recruit and follow-up as many pregnant women as possible independent of their social or cultural background. Nevertheless, the response rate among lower-educated families is lower. The possibility to compare results with a cohort from Turkey is a strength of this study. However, starting at different times and with slightly different recruitment strategies and designs may result in cohort effects and may affect comparability of the sub-cohorts.}, language = {en} } @incollection{ScholaskeSpallekEntringer, author = {Scholaske, Laura and Spallek, Jacob and Entringer, Sonja}, title = {Intergenerationale {\"U}bertragung von Migrationserfahrungen und fetale Programmierung von Krankheit und Gesundheit}, series = {Handbuch Migration und Gesundheit : Grundlagen, Perspektiven und Strategien}, booktitle = {Handbuch Migration und Gesundheit : Grundlagen, Perspektiven und Strategien}, editor = {Spallek, Jacob and Zeeb, Hajo}, edition = {1}, publisher = {Hogrefe AG}, address = {Bern}, isbn = {978-3-456-85995-8}, pages = {351 -- 368}, abstract = {Gesundheitsdisparit{\"a}ten manifestieren sich in der Nachkommengeneration von Migrant*innen teilweise schon in fr{\"u}hen Lebensjahren. Viele dieser Gesundheits-disparit{\"a}ten werden durch sozio{\"o}konomische Benachteiligung und Akkulturation vermittelt. Anhand des Konzeptes der fetalen Pro-grammierung kann erkl{\"a}rt werden, dass das m{\"u}tterliche Stresserleben - vermittelt {\"u}ber endokrine und immunologische Prozesse - die sp{\"a}tere Gesundheit und Krank-heitsvulnerabilit{\"a}t der Nachkommen bereits in der Schwangerschaft beeinflusst. Es gibt aus der internationalen Forschung zahlreiche Belege daf{\"u}r, dass endokrine und immunologische Prozesse den Zusam-menhang zwischen m{\"u}tterlichen migrationsbezogenen Stressoren und Schwangerschafts-, Geburts- und sp{\"a}teren Gesundheitsoutcomes des Kindes vermitteln. Bei Migrant*innen in Deutschland sind diese Zusammenh{\"a}nge weitestgehend unterforscht.}, language = {de} } @misc{ScholaskeSpallekEntringer, author = {Scholaske, Laura and Spallek, Jacob and Entringer, Sonja}, title = {Fetale Programmierung von Gesundheitsdisparit{\"a}ten bei Kindern mit Migrationshintergrund}, series = {Public Health Forum}, volume = {29}, journal = {Public Health Forum}, number = {2}, issn = {1876-4851}, doi = {10.1515/pubhef-2021-0015}, pages = {131 -- 134}, abstract = {Kinder von Migrant*innen zeigen bereits in fr{\"u}hen Lebensjahren h{\"a}ufig Gesundheitsdisparit{\"a}ten, die mit m{\"u}tterlicher Gesundheit und migrationsbezogenen Faktoren eng zusammenh{\"a}ngen. Zur Erkl{\"a}rung dieses Ph{\"a}nomens der intergenerationalen Transmission von Gesundheitsdisparit{\"a}ten schlagen wir ein Modell vor, das eine Lebensverlaufsperspektive mit dem Konzept der fetalen Programmierung von Gesundheit und Krankheitsvulnerabilit{\"a}t zusammenbringt.}, language = {de} } @misc{SpallekScholaskeDumanetal., author = {Spallek, Jacob and Scholaske, Laura and Duman, Elif Aysimi and Razum, Oliver and Entringer, Sonja}, title = {Association of maternal migrant background with inflammation during pregnancy - results of a birth cohort study in Germany}, series = {Brain, Behavior, and Immunity}, volume = {Vol. 96}, journal = {Brain, Behavior, and Immunity}, issn = {1090-2139}, doi = {10.1016/j.bbi.2021.06.010}, pages = {271 -- 278}, abstract = {Background Health disparities in children of immigrants are prevalent from birth and are hypothesized to - in part - emerge as a biological consequence of migration's unfavorable social and psychological sequelae. The aim of this study was to examine whether maternal migrant background is associated with inflammation during pregnancy - a key pathway by which maternal states and conditions during pregnancy may influence fetal development and subsequent pregnancy, birth, and child developmental and health outcomes. Material and Methods Data was available from 126 pregnant women who participated in a population based multi-site prospective birth cohort study in Bielefeld and Berlin, Germany. The study included two study visits in mid- and late pregnancy. At each visit, a composite maternal pro-inflammatory score was derived from circulating levels of plasma inflammatory markers (IL-6, CRP). Migrant background was defined by country of origin of participants and their parents' (Turkey or other) and generation status (1st or 2nd generation). We applied hierarchical linear models (HLM) in order to quantify the relationship between different migrant background variables and inflammation during pregnancy after adjustment for potential confounders (including socioeconomic status). Results Migrant background was significantly associated with inflammation during pregnancy. When compared to women without migrant background, levels of inflammation were increased in 1) pregnant women with migrant background in general (B = 0.35, SE = 0.12, p < .01); 2) 1st (B = 0.28, SE = 0.15, p < .10) and 2nd generation (B = 0.40, SE = 0.15, p < .01); 3) women with a Turkish migrant background (B = 0.28, SE = 0.14, p < .10) and women with another migrant background (B = 0.42, SE = 0.15, p <.01); and 4) 2nd generation Turkish origin women (B = 0.38, SE = 0.20, p <.10), 1st generation women with other migrant background (B = 0.44, SE = 0.26, p <.10), and 2nd generation women with other migrant background (B=0.43, SE = 0.17, p <.05). Discussion Our findings support a role for maternal inflammation as a pathway of intergenerational transmission of migration-related health inequalities, suggest that the effect seems to persist in 2nd generation immigrants, and highlight the need for future research and targeted interventions in this context.}, language = {en} } @misc{EntringerScholaskeKurtetal., author = {Entringer, Sonja and Scholaske, Laura and Kurt, Medlin and Duman, Elif Aysimi and Adam, Emma K. and Razum, Oliver and Spallek, Jacob}, title = {Diurnal cortisol variation during pregnancy in Turkish origin and non-migrant women in a German birth cohort study}, series = {Journal of Psychosomatic Research}, volume = {162}, journal = {Journal of Psychosomatic Research}, issn = {0022-3999}, doi = {10.1016/j.jpsychores.2022.111020}, pages = {1 -- 10}, abstract = {Background Immigrants from Turkey experience health disadvantages relative to non-immigrant populations in Germany that are manifest from the earliest stages of the lifespan onwards and are perpetuated across generations. Chronic stress and perturbations of stress-responsive physiological systems, including the hypothalamus-pituitary-adrenal (HPA)-axis, are believed to in part mediate this relationship. Cortisol plays an important role in the association between maternal stress during pregnancy and many pregnancy-, birth- and offspring-related outcomes. We therefore examined whether maternal migrant background is associated with diurnal cortisol variation during pregnancy. Methods 109 pregnant women (incl. n = 32 Turkish origin women) that participated in a multi-site prospective cohort study in Germany collected saliva samples across the day on two consecutive days around 24 and 32 weeks gestation. Hierarchical linear models were applied to quantify associations between migrant background and diurnal cortisol variation across pregnancy. Results Women of Turkish origin exhibited a significantly lower cortisol awakening response (CAR) and a flatter diurnal cortisol slope (DCS) compared to non-migrant women after adjusting for household income. These relationships between migrant status and diurnal cortisol variation were mainly driven by 2nd generation migrants. Discussion A potential HPA axis dysregulation of Turkish-origin pregnant women may contribute to the intergenerational transmission of health disadvantages in this group.}, language = {en} } @misc{ScholaskeEntringerRazumetal., author = {Scholaske, Laura and Entringer, Sonja and Razum, Oliver and Spallek, Jacob}, title = {Elevated stress during pregnancy in women of Turkish origin: Results from a prospective cohort study}, series = {European Journal of Public Health}, volume = {32}, journal = {European Journal of Public Health}, number = {Supplement_3}, issn = {1101-1262}, doi = {10.1093/eurpub/ckac129.608}, pages = {2}, abstract = {Background Ethnic health disparities exist in the context of pregnancy and childbirth, suggesting that women of Turkish origin (i.e., they or their parents born in Turkey) in Germany have higher risks for some adverse maternal health and child developmental outcomes. Stress is believed to be a relevant pathway by which migration may be associated with these risks. In this study, we tested associations of Turkish origin with stress biology and psychological stress experiences during pregnancy. Methods 140 pregnant women (33 of Turkish/26 of other origin) participated in a prospective cohort study that was carried out in Bielefeld and Berlin (Spallek et al., 2020). Inflammatory markers CRP and IL-6 from venous blood samples and diurnal cortisol profiles from salivary cortisol samples were derived and participants completed the Perceived Stress Scale (PSS) and Center for Epidemiologic Studies Depression Scale (CESD) at two study visits during pregnancy (T1: 20-25 weeks of gestation, T2: 30-35 weeks of gestation). Multilevel models were conducted to account for the nested data structure due to repeated measurements. Results Compared to non-migrant women, women of Turkish origin had significantly higher inflammatory levels (b = 0.28, SE = 0.14, p=.052) (Spallek et al., 2021), a blunted cortisol awakening response (b=-0.21, CI=-0.38-0.03, p<.05), a flatter diurnal cortisol slope (b = 0.02, CI = 0.00-0.04, p<.05), and higher PSS (b = 0.46, SE = 0.13, p< .001) and CESD scores (b = 0.29, SE = 0.08, p<.001) during pregnancy after adjusting for socioeconomic factors. Conclusions The results of our study suggest higher stress at the biological and psychological level in pregnant women of Turkish origin. Stress is a risk factor for pregnancy complications and poor birth and child developmental outcomes. To reduce such unequally distributed risks, interventions for stress reduction are needed that are tailored to women of Turkish origin.}, language = {en} }