@misc{SpallekTempesRicksgersetal., author = {Spallek, Jacob and Tempes, Jana and Ricksgers, Hannah and Marquardt, Louisa and Pr{\"u}fer-Kr{\"a}mer, Luise and Kr{\"a}mer, Alexander}, title = {Gesundheitliche Situation und Versorgung unbegleiteter minderj{\"a}hriger Fl{\"u}chtlinge - eine N{\"a}herung anhand qualitativer und quantitativer Forschung in der Stadt Bielefeld}, series = {Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz}, volume = {59}, journal = {Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz}, number = {5}, issn = {1436-9990}, doi = {10.1007/s00103-016-2339-2}, pages = {636 -- 641}, abstract = {Unbegleitete minderj{\"a}hrige Fl{\"u}chtlinge (UMF) sind Kinder oder Jugendliche unter 18 Jahren, die sich ohne Begleitung eines f{\"u}r sie zust{\"a}ndigen Vormundes auf die Flucht begeben. Internationale Studien zeigen, dass minderj{\"a}hrige unbegleitete Fl{\"u}chtlinge eine besondere Risikogruppe darstellen. Empirische Ergebnisse {\"u}ber die gesundheitliche Situation von unbegleiteten minderj{\"a}hrigen Fl{\"u}chtlingen in Deutschland in der aktuellen Situation sind kaum vorhanden. Ziel dieses Beitrags ist die Beschreibung der gesundheitlichen Situation und Versorgung von unbegleiteten minderj{\"a}hrigen Fl{\"u}chtlingen in Bielefeld. Daf{\"u}r werden zwei qualitative und eine quantitative Studie aus Bielefeld genutzt. Die Ergebnisse zeigen, dass die gesundheitliche Versorgung von unbegleiteten minderj{\"a}hrigen Fl{\"u}chtlingen Besonderheiten unterliegt und weisen vor allem auf zwei spezifische (medizinische) Bedarfe hin: die psychische/psychiatrische Versorgung und die Versorgung von Infektionskrankheiten. Weitere Herausforderungen in der gesundheitlichen Versorgung ergeben sich aus der spezifischen Situation der unbegleiteten minderj{\"a}hrigen Fl{\"u}chtlinge und schließen die rechtlichen Rahmenbedingungen sowie sprachliche und kulturelle Kompetenzen auf Seiten der Versorger und auf Seiten der unbegleiteten minderj{\"a}hrigen Fl{\"u}chtlinge ein.}, language = {de} } @misc{SchillingSpallekMauletal., author = {Schilling, Laura and Spallek, Jacob and Maul, Holger and Tallarek, Marie and Schneider, Sven}, title = {Active and Passive Exposure to Tobacco and e-Cigarettes During Pregnancy}, series = {Maternal and Child Health Journal}, volume = {25}, journal = {Maternal and Child Health Journal}, number = {4}, issn = {1092-7875}, doi = {10.1007/s10995-020-03037-8}, pages = {656 -- 665}, abstract = {Objectives Active and passive exposure to tobacco cigarettes during pregnancy is associated with multiple negative health outcomes for the fetus. In addition, exposure to e-cigarettes has been progressively discussed as a new threat to fetal health. Until now, there has been a lack of studies examining active and passive exposure to tobacco and e-cigarettes among pregnant women. The objective of our current STudy on E-cigarettes and Pregnancy (STEP) was to advance and complement the current knowledge regarding active and passive exposure to tobacco and e-cigarettes before pregnancy and during early and late pregnancy. Methods One element of the STEP study was a quantitative cross-sectional design: A sample of 540 pregnant women recruited at an obstetrician clinic in Hamburg from April 2018 to January 2019 were surveyed once via a standardized questionnaire and provided complete information regarding their consumption of tobacco and e-cigarettes. We performed a descriptive analysis of tobacco and e-cigarette use before pregnancy and during early and late pregnancy, as well as bivariate analysis of these variables with sociodemographic determinants. Passive exposure was assessed by asking the participating pregnant women about the consumption of tobacco and e-cigarettes by their partners, in general, and in their homes. Results Before pregnancy, 20.0\% of the participants used tobacco cigarettes exclusively, 1.3\% used e-cigarettes exclusively, and 6.5\% were dual users. Educational level was significantly associated with tobacco cigarette use (p < 0.001) and dual use (p = 0.047) before pregnancy. During early (late) pregnancy, 8.7\% (2.8\%) used tobacco cigarettes and 0.4\% (0.0\%) used e-cigarettes exclusively. Twenty-point nine percent of women's partners consumed tobacco cigarettes exclusively, 2.7\% consumed e-cigarettes exclusively, and 2.7\% consumed both. A total of 8.5\% (16.7\%) of the partners who consumed tobacco cigarettes exclusively (e-cigarettes exclusively) did so in the women's homes. Conclusions for Practice Among pregnant women, the use of tobacco cigarettes remains prominent before and during pregnancy, while e-cigarette use predominately occurs before pregnancy. Our study shows that pregnant women are frequently exposed to their partners' tobacco and e-cigarette use within their homes. Strategies to reduce such exposure should be further intensified. Significance In the last decade, e-cigarettes have become popular, and e-cigarette use has been increasing, even among pregnant women. However, there is a lack of knowledge concerning the exposure to e-cigarettes before pregnancy and during early and late pregnancy, as well as studies comparing e-cigarettes and tobacco cigarettes. The current study found that active exposure to e-cigarettes before pregnancy is high, while exposure during pregnancy is marginal. In contrast, exposure to tobacco cigarettes before and in early pregnancy is high but decreases during late pregnancy. In addition, the results of our study show that pregnant women are passively exposed to tobacco and e-cigarettes at home. Pregnant women should be advised against exposing themselves, actively or passively, to tobacco and e-cigarette smoke.}, language = {en} } @misc{UlrichKohlerFachetal., author = {Ulrich, Hanna-Sophie and Kohler, Emma and Fach, Eva-Maria and Spallek, Jacob and Richter, Matthias and Mlinarić, Martin}, title = {Healthcare needs among unaccompanied minor refugees: a study protocol of a qualitative study explaining access and utilisation across place and gender}, series = {BMJ Open}, volume = {10}, journal = {BMJ Open}, number = {9}, issn = {2044-6055}, doi = {10.1136/bmjopen-2020-038882}, pages = {8}, abstract = {Introduction: Several studies have identified that unaccompanied minor refugees (UMRs) are allegedly 'vulnerable' and belong to a high-risk group in terms of psychological distress and post-traumatic stress disorder due to their preflight, periflight and postflight experiences. Psychosocial care (PSC) is of high importance for UMRs, but little is known about barriers to access and utilisation of PSC across place and gender. The aims of this gender-sensitive qualitative study will be to build on the existing body of literature and to provide qualitative evidence on the contexts and mechanisms of PSC for male and female UMRs in Germany by comparing two German regions. Methods and analysis: Following the study preparing realist review, a qualitative study will be undertaken in Berlin and Central German cities. Approximately 24 experts from the field of PSC and 12 lay UMRs will participate in face-to-face, semistructured interviews. Data will be transcribed and analysed based on the grounded theory research paradigm. Ethics and dissemination: Only participants who have been informed in both German and their native tongue and who have signed a declaration of consent will be included in the study. The study will comply rigorously with German data protection standards. Approval from the Ethical Review Committee at Martin Luther University Halle-Wittenberg, Germany has been obtained and granted. The results of the study will be presented at several conferences and will be published in high-quality, peer-reviewed international journals. The results will display a differentiated picture of the PSC of UMRs in Germany. Such knowledge is a precondition for a 'science of change' that translates explanations into practical recommendations on how to improve healthcare policies.}, language = {en} } @misc{LudwigMianiBreckenkampetal., author = {Ludwig, Angelique and Miani, C{\´e}line and Breckenkamp, J{\"u}rgen and Sauzet, Odile and Borde, Theda and Doyle, Ina-Merle and Brenne, Silke and H{\"o}ller-Holtrichter, Chantal and David, Matthias and Spallek, Jacob and Razum, Oliver}, title = {Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies}, series = {Maternal and Child Health Journal}, volume = {24}, journal = {Maternal and Child Health Journal}, number = {7}, issn = {1573-6628}, doi = {10.1007/s10995-020-02937-z}, pages = {943 -- 952}, abstract = {Objective: Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular. Methods: Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011-2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status.ResultsIn Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake. Conclusions for Practice: Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups.}, language = {en} } @misc{WandschneiderSauzetBreckenkampetal., author = {Wandschneider, Lisa and Sauzet, Odile and Breckenkamp, J{\"u}rgen and Spallek, Jacob and Razum, Oliver}, title = {Small-Area Factors and Their Impact on Low Birth Weight—Results of a Birth Cohort Study in Bielefeld, Germany}, series = {Frontiers in Public Health}, volume = {8}, journal = {Frontiers in Public Health}, issn = {2296-2565}, doi = {10.3389/fpubh.2020.00136}, pages = {10}, abstract = {Introduction: The location of residence is a factor possibly contributing to social inequalities and emerging evidence indicates that it already affects perinatal development. The underlying pathways remain unknown; theory-based and hypothesis-driven analyses are lacking. To address these challenges, we aim to establish to what extent small-area characteristics contribute to low birth weight (LBW), independently of individual characteristics. First, we select small-area characteristics based on a conceptual model and measure them. Then, we empirically analyse the impact of these characteristics on LBW. Material and methods: Individual data were provided by the birth cohort study "Health of infants and children in Bielefeld/Germany." The sample consists of 892 eligible women and their infants distributed over 80 statistical districts in Bielefeld. Small-area data were obtained from local noise maps, emission inventory, Google Street View and civil registries. A linear multilevel analysis with a two-level structure (individuals nested within statistical districts) was conducted. Results: The effects of the selected small-area characteristics on LBW are small to non-existent, no significant effects are detected. The differences in proportion of LBW based on marginal effects are small, ranging from zero to 1.1\%. Newborns from less aesthetic and subjectively perceived unsafe neighbourhoods tend to have higher proportions of LBW. Discussion: We could not find evidence for negative effects of small-area factors on LBW, but our study confirms that obtaining adequate sample size, reliable measure of exposure and using available data for operationalisation of the small-area context represent the core challenges in this field of research.}, language = {en} } @misc{TallarekSpallek, author = {Tallarek, Marie and Spallek, Jacob}, title = {Othering in public health using the example of Covid-19 management in German asylum camps}, series = {European Journal of Public Health}, volume = {31}, journal = {European Journal of Public Health}, number = {Issue Supplement_3}, doi = {10.1093/eurpub/ckab164.795}, pages = {2}, abstract = {Issue/problem In 2020, several German reception centers and asylum camps were imposed mass quarantine after single residents had been infected with SARS-CoV-2. Civil and research networks criticized this measure, as crowded housing conditions limited the implementation of infection protection measures, and mass quarantine further increased the risk of infection. This raised the question why public health (PH) measures in these settings differed from those implemented in the general population, and which implications for future PH approaches can be identified. Problem description Considering the epidemiological evidence and ethical perspectives on the PH strategies described above, we applied the concepts of "Exclusionary Othering" and "Inclusionary Othering" to PH. We further discussed the Covid-19 management in German reception centers and asylum camps. Results We identified three conceptual approaches: 1) exclusionary, 2) inclusionary, and 3) diversity-sensitive approaches to PH. Exclusionary PH is characterized by an exclusion of less powerful groups despite negative health consequences. Inclusive approaches seek to empower less powerful groups in order to understand each other's needs, build cooperations, protect everyone and to prevent the development of "hot spots". Diversity-sensitive PH approaches avoid othering and seek to implement measures for everyone, taking into account diverse needs, conditions, and resources. Lessons We propose a paradigm shift towards inclusionary and diversity-sensitive PH that benefits the entire population, including those forced to flee other countries. This requires a critical reflection of power dynamics and discrimination. The proposed concepts can be transferred to other social groups, regions, and areas of PH. Key messages Public health needs to shift its perspective from exclusion and subordination to inclusion and involvement. Inclusionary and diversity-sensitive PH approaches promote health equity.}, language = {en} } @misc{KaucherKhilKajueteretal., author = {Kaucher, Simone and Khil, Laura and Kaj{\"u}ter, Hiltraud and Becher, Heiko and Reder, Maren and Kolip, Petra and Spallek, Jacob and Winkler, Volker and Berens, Eva-Maria}, title = {Breast cancer incidence and mammography screening among resettlers in Germany}, series = {BMC public health}, volume = {20}, journal = {BMC public health}, number = {1}, doi = {10.1186/s12889-020-08534-7}, pages = {10}, abstract = {Background - European studies showed that women with a migration background are less likely to participate in mammography screenings than autochthonous women. However, the participation in the German mammography screening programme (MSP) among ethnic German migrants from countries of the former Soviet Union (called resettlers) is unclear so far. The aim of this study was to identify possible differences regarding MSP participation between resettlers from the FSU and the general German population. Methods - Data from two independent, complementary studies from North Rhine-Westphalia, Germany (a retrospective cohort study 1994-2013; a cross-sectional study 2013/14) were used for comparisons between resettlers and the general population: Odds Ratios (ORs) for MSP participation utilizing the cross-sectional data and time trends of breast cancer incidence rates as well as Chi-Square tests for breast cancer stages utilizing the cohort data. Results - Resettlers showed higher Odds to participate in the MSP than the general population (OR 2.42, 95\% CI 1.08-5.42). Among resettlers, a large increase in incidence rates was observed during the MSP implementation (2005-2009), resulting in stable and comparable incidence rates after the implementation. Furthermore, pre-MSP implementation, the proportion of advanced breast cancer stages was higher among resettlers than in the German population, post-MSP implementation the proportion was comparable. Conclusions - MSP participating seems surprisingly high among resettlers. An explanation for the increased willingness to participate might be the structured invitation procedure of the MSP. However, the exact reasons remain unclear and future research is needed to confirm this hypothesis and rule out the possibility of selection bias in the cross-sectional study.}, 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{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} }