@misc{LoefflerHoffmannFischeretal., author = {L{\"o}ffler, Antje and Hoffmann, Stephanie and Fischer, Stefanie and Spallek, Jacob}, title = {Ambulante Haus- und Facharztversorgung im l{\"a}ndlichen Raum in Deutschland - Wie stellt sich die Versorgungssituation aus Sicht {\"a}lterer Einwohner im Landkreis Oberspreewald-Lausitz dar?}, series = {Das Gesundheitswesen}, volume = {83 (2021)}, journal = {Das Gesundheitswesen}, number = {1}, issn = {0941-3790}, doi = {10.1055/a-1010-6277}, pages = {47 -- 52}, abstract = {Ziel der Studie: Die medizinische Versorgung der Bundesrepublik Deutschland ist von Verteilungsproblemen gepr{\"a}gt. Vor allem in l{\"a}ndlichen Regionen droht Unterversorgung. In dieser Studie wurde untersucht, wie {\"a}ltere Bewohner des Landkreises Oberspreewald-Lausitz (OSL) des Bundeslandes Brandenburg ihre derzeitige medizinische Versorgungssituation einsch{\"a}tzen und welche W{\"u}nsche und Bedenken sie hinsichtlich deren zuk{\"u}nftigen Entwicklung im Jahr 2030 haben. Methodik: In der vorliegenden Querschnitterhebung wurden 3006 Einwohner im Alter von 50-56 Jahren und von 65-71 Jahren des Landkreises OSL befragt. Ein Fragebogen mit geschlossenem und offenem Antwortformat wurde zur Erfassung der Zielstellung eingesetzt. Ergebnisse: In der vorliegenden Untersuchung {\"a}ußerten sich die Einwohner des Landkreises OSL aktuell zufrieden oder sehr zufrieden mit der haus{\"a}rztlichen (93,1\%) und der fach{\"a}rztlichen Versorgung (83,3\%). Innerhalb des Landkreises zeigen sich in einigen Regionen Defizite. Im Gebiet Lauchhammer/Schwarzheide {\"a}ußerten sich insbesondere zur fach{\"a}rztlichen Versorgung 27,1\% der Befragten unzufrieden oder sehr unzufrieden. Alternative und erg{\"a}nzende Versorgungsangebote wie die Community Nurse sind akzeptierte, jedoch derzeit unterrepr{\"a}sentierte Maßnahmen zur Sicherstellung der zuk{\"u}nftigen medizinischen Versorgung. Schlussfolgerung: Derzeit zeigen sich Bewohner des l{\"a}ndlichen, metropolenfernen Landkreises OSL zufrieden mit der ambulanten medizinischen Versorgung, jedoch stellen sich in einigen Regionen Defizite, insbesondere bei der zuk{\"u}nftigen Facharztversorgung dar. Alternative Versorgungsangebote wie Telemedizin sind seitens der Bewohner gew{\"u}nschte Maßnahmen zur Erg{\"a}nzung und Sicherstellung der zuk{\"u}nftigen medizinischen Versorgung im l{\"a}ndlichen Raum.}, language = {de} } @misc{MianiLudwigBreckenkampetal., author = {Miani, Celine and Ludwig, A. and Breckenkamp, J{\"u}rgen and Sauzet, Odile and Doyle, Ina-Merle and H{\"o}ller-Holtrichter, Chantal and Spallek, Jacob and Razum, Oliver}, title = {Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study}, series = {BMC pregnancy and childbirth}, volume = {20}, journal = {BMC pregnancy and childbirth}, issn = {1471-2393}, doi = {10.1186/s12884-020-2725-5}, pages = {7}, abstract = {BACKGROUND: Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. METHODS: In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. RESULTS: Of the 881 participants, 21\% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01-3.81; and aOR: 2.36, CI: 1.27-4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups. CONCLUSIONS: Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care.}, language = {en} } @misc{SchillingSchneiderMauletal., author = {Schilling, Laura and Schneider, Sven and Maul, Holger and Spallek, Jacob}, title = {STudy on E-Cigarettes and Pregnancy (STEP)-Study Protocolof a Mixed Methods Study on Risk Perception of E-Cigarette UseDuring Pregnancy and Sample Description}, series = {Geburtshilfe und Frauenheilkunde}, volume = {80}, journal = {Geburtshilfe und Frauenheilkunde}, number = {01}, issn = {1438-8804}, doi = {10.1055/a-1061-7288}, pages = {66 -- 75}, abstract = {Introduction: During pregnancy, the motherʼs healthy life-style is crucial for the health of the fetus. Potential risk factorsfor maternal and child health should therefore be identifiedand reduced as early as possible. The consumption of e-ciga-rettes represents one of these potential risk factors. Exploringrisk perceptions about e-cigarette use during pregnancy canprovide early indications of possible user motives. Therefore,our mixed methodsSTudy onE-cigarettes andPregnancy(STEP) aimed to comprehensively analyze risk perceptionsabout e-cigarette use during pregnancy based on anInte-gratedHealthBeliefModel (IHBM). This paper describes thestudy design, methods, sample population and limitations ofSTEP. Methods: Our sequential mixed methods study combinedqualitative and quantitative approaches. In the qualitativesection of the study which preceded the quantitative part ofthe study, we aimed to characterize risk perceptions aboute‑cigarette use during pregnancy. We used a netnographic re-search approach which analyzed discussion threads in onlineforums dealing with e-cigarette use during pregnancy. Theanalysis was based on an IHBM. Identified themes were incor-porated in the questionnaire which was developed for the quantitative part of the study. The quantitative section aimedto quantify, among other things, perceived threats, barriersand benefits and to explore differences in risk perception ac-cording to sociodemographic characteristics and tobacco ande-cigarette usage. Results: In the qualitative section, 1552 posts in 25 online dis-cussion threads dealing, inter alia, with e-cigarette use duringpregnancy were identified. The quantitative part looked atthe responses in the questionnaires handed in by 575 preg-nant women who attended a hospital in Hamburg (Germany)from April 2018 to January 2019 (response rate: 27.5\%). Conclusion: Data collection was successful for both the qual-itative and quantitative parts of the study. When interpretingthe results of STEP, different limitations should be taken intoaccount. The results of STEP provide starting points for thedevelopment of tailored preventive measures for pregnantwomen.}, language = {en} } @incollection{TallarekMlinarićSpallek, author = {Tallarek, Marie and Mlinarić, Martin and Spallek, Jacob}, title = {Migration - Bedeutung und Implikationen f{\"u}r die Pr{\"a}vention und Gesundheitsf{\"o}rderung}, series = {Pr{\"a}vention und Gesundheitsf{\"o}rderung. Springer Reference Pflege - Therapie - Gesundheit}, booktitle = {Pr{\"a}vention und Gesundheitsf{\"o}rderung. Springer Reference Pflege - Therapie - Gesundheit}, editor = {Tiemann, Michael and Mohokum, Melvin}, edition = {1}, publisher = {Springer}, address = {Berlin, Heidelberg}, isbn = {978-3-662-55793-8}, issn = {2662-6942}, doi = {10.1007/978-3-662-55793-8_28-1}, pages = {1 -- 13}, abstract = {Die Bev{\"o}lkerungsgruppe der Menschen mit Migrationshintergrund umfasst fast ein Viertel der Gesamtbev{\"o}lkerung in Deutschland und ist h{\"o}chst heterogen. Pauschalisierende Aussagen zum Gesundheitsstatus dieser Gruppe sind daher nicht m{\"o}glich. Menschen mit Migrationshintergrund sind nicht grunds{\"a}tzlich ges{\"u}nder oder kr{\"a}nker als die Mehrheitsbev{\"o}lkerung. Allerdings k{\"o}nnen sie sich aufgrund von Expositionen vor, w{\"a}hrend und nach der Migration in ihren Gesundheitschancen und -risiken von der Mehrheitsbev{\"o}lkerung unterscheiden. Pr{\"a}vention und Gesundheitsf{\"o}rderung sollten daraus resultierende spezifische Bedarfe ebenso ber{\"u}cksichtigen wie die Diversit{\"a}t der Bev{\"o}lkerung insgesamt. Erfolgversprechend ist eine Kombination aus diversit{\"a}tssensiblen, f{\"u}r die Gesamtbev{\"o}lkerung zug{\"a}nglichen Angeboten und migrationsspezifischen Ans{\"a}tzen in besonders risikoreichen Situationen. Kommunale, settingorientierte sowie soziokulturell angepasste Angebote verbessern die Erreichbarkeit der Zielgruppen maßgeblich.}, language = {de} } @misc{MianiRazumSpallek, author = {Miani, C{\´e}line and Razum, Oliver and Spallek, Jacob}, title = {Health of the offspring of immigrants: the BaBi birth cohort study}, series = {Public Health Forum}, volume = {27}, journal = {Public Health Forum}, number = {4}, issn = {1876-4851}, doi = {10.1515/pubhef-2019-0062}, pages = {298 -- 300}, abstract = {Children with a migration background are more at risk of health-related problems than those without a migration background. The German health system still does not adequately meet the challenges of on increasingly heterogeneous population, not least due to a lack of adequate epidemiological data and models. The BaBi study contributes to gaining new insights in the development of health inequalities due to cultural diversity in Germany, with a focus on pregnancy and early childhood.}, language = {en} } @misc{GrosserDoyleLoeffleretal., author = {Grosser, Angelique and Doyle, Ina-Merle and L{\"o}ffler, Antje and Breckenkamp, J{\"u}rgen and Spallek, Jacob and Razum, Oliver and Miani, Celine}, title = {The impact of psychosocial factors on breastfeeding duration in the BaBi cohort study, Germany}, series = {European Journal of Public Health}, volume = {29}, journal = {European Journal of Public Health}, number = {4}, issn = {1464-360X}, doi = {10.1093/eurpub/ckz187.122}, pages = {2}, abstract = {Background: Breastfeeding is considered beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, a goal reached by only 34\% of mothers in 2012. The WHO's recommendation of exclusively breastfeeding for six months was met by 19\% only. Hardly modifiable factors such as socio-economic status and migration background have been associated with duration of breastfeeding but little is known about the impact of psychosocial factors such as personality traits and social support. We hypothesise that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding. Methods: We analyse baseline and follow-up data of the Bielefeld BaBi birth cohort (2013-16). They include detailed migration and socio-economic backgrounds, as well as three measures of psychological characteristics: the optimism scale, the Big Five inventory and the locus of control scales. We perform bivariate and multivariate analyses in order to identify psychosocial determinants of fully breastfeeding for four and six months. Results: Out of 780 BaBi study participants, 548 fully breastfed for four months (70.3\%), of which 279 continued until at least six months (35.8\%). Logistic regression analyses show that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed and the attendance of antenatal class during this or previous pregnancies. Personality characteristics, social status and migration background show however no significant association with breastfeeding duration. Conclusions: Our study results support the promotion of individuals' breastfeeding intention and attendance to antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in maternal and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration.}, language = {en} } @misc{SauzetZolitschkaSpalleketal., author = {Sauzet, Odile and Zolitschka, Kim Alexandra and Spallek, Jacob and Breckenkamp, J{\"u}rgen and Razum, Oliver}, title = {An ego-centred approach for the evaluation of health inequalities in urban areas}, series = {European Journal of Public Health}, volume = {29}, journal = {European Journal of Public Health}, number = {4}, issn = {1101-1262}, doi = {10.1093/eurpub/ckz186.243}, pages = {1}, abstract = {Background: Neighbourhood possesses attributes, structural, physical and social, for which pathways to health inequalities could be hypothesized. Hence, neighbourhood is a complex mixture of factors which cannot be simply defined by a delineation on a map, making common definitions of neighbourhood (e.g. administrative borders) problematic. We present a new concept for the evaluation of contextual health inequalities in an urban setting. Methods: An ego-centred approach to neighbourhood effects on health allows to establish to what degree the health outcomes of a person are on average correlated to the health outcomes of his/her neighbours. This approach does not necessitate the definition of what a neighbourhood is, or of its boundaries. Using data from the BaBi birth cohort following up 958 mother-child pairs in Bielefeld/Germany we illustrate how the method provides information about the spatial structure of a possible association between unmeasured neighbourhood factors and birthweight. Spatially correlated birthweight indicates a neighbourhood effect on maternal health. Results: A parametric model of the correlation structure gives two indicators: a distance after which health outcomes are no longer correlated (practical range), and the strength of correlation (RSV). We modelled birthweight directly and residuals after controlling for (spatially correlated) covariates. After adjusting for the mother's demographics and neighbourhood characteristics, birthweights remained spatially correlated with RSV of 11\% and a practical range of 128 m. Conclusions: Modelling the spatial correlation of a health outcome provides a measure of the degree of health correlation, thus offering new evidence on the production of health inequalities while incorporating current modelling approaches. Moreover, it measures heterogeneity in a city. This could be used as an indicator for policy makers or town planners to identify areas in need of socioeconomic investment.}, language = {en} } @misc{SchroederHoebelRoicketal., author = {Schr{\"o}der, Sara Lena and Hoebel, Jens and Roick, Julia and Markert, Jenny and Spallek, Jacob and Knesebeck, Olaf von dem and Richter, Matthias}, title = {Inequalities in the utilisation of primary and specialist physicians in Europe - a systematic review}, series = {European Journal of Public Health}, volume = {29}, journal = {European Journal of Public Health}, number = {4}, issn = {1101-1262}, doi = {10.1093/eurpub/ckz186.377}, abstract = {Background: The evidence on inequalities in health clearly shows that people with lower socioeconomic status (SES) have poorer health and higher mortality. Nevertheless, generalized evidence for inequalities in healthcare is lacking. So far, the international literature was only summarised with regard to inequalities in the utilisation of disease-specific treatment. Therefore, our aim was to synthetize the literature on socioeconomic inequalities in the utilisation of primary and specialist physicians in the general population. Methods: This systematic review searched Medline und Web of Science from 2004 to 2018. Articles that reported quantitative data on the association of SES with utilisation of primary or specialist physicians in Europe were included. Title and abstract screening were performed by two independent researchers and 50 full texts are currently sifted whether they fulfil the inclusion criteria. Results: The studies analysed utilisation of physicians in terms of probability or frequency. The initial check of the studies indicates that socioeconomic inequalities in the utilisation of physicians differ between primary and specialist care. Specialist physicians were found to be visited with a higher probability and more often by the least disadvantaged in most studies. Inequalities in the utilisation of primary physicians revealed to be more diverse with a weak pattern of equally distributed probability of GP visits and more frequent utilisation by the disadvantaged. Conclusions: The preliminary results indicate that pro-rich utilisation seems to be more pronounced in visiting specialists compared to primary health care. Aiming to reduce inequalities in healthcare, public health actions might primarily focus on reaching a needs-based consultation of specialist physicians.}, 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} }