@misc{TallarekSpallek, author = {Tallarek, Marie and Spallek, Jacob}, title = {Factors promoting or limiting self-determined childbirth: midwives' perspectives in Germany}, series = {European Journal of Public Health}, volume = {32}, journal = {European Journal of Public Health}, number = {Supplement_3}, issn = {1101-1262}, doi = {10.1093/eurpub/ckac131.423}, pages = {1}, abstract = {Background Claims for self-determined childbirth (SDC) have gained increasing scientific, political and societal attention. However, research on SDC is limited. This study analyzes and compares midwives' experiences and perspectives on factors that promote or limit SDC in hospitals, birthing centers and during home births in Germany. We argue that these insights are essential in order to foster self-determination and to avoid its violation. Methods A qualitative case study was conducted based on semi-structured face-to-face interviews with midwives working in hospitals, birthing centers, and offering home births in Germany. In total, nine interviews were conducted in 2021 and have been audiotaped, transcribed, anonymized and analyzed by use of Thematic Analysis. Results The results indicate eight inter-related categories, each of which imply promoting and limiting factors: 1) Structural/ legal conditions; 2) Perception of birth (e. g. as natural or medical process; required competence and control); 3) Trust and atmosphere; 4) Getting acquainted/relationship building; 5) Birthing person's socioeconomic position; 6) Birthing person's preparation/ education; 7) Birthing person's capability of decision making and expression; and 8) Behavior of accompanying persons. Moreover, we identified midwives' strategies to extend possibilities of choice. Several factors clearly differ depending on the birth setting. Conclusions The opportunities for SDC seem to differ according to the setting (e.g. institutional routines), inter-personal relations (e.g. getting acquainted, trust), and individual factors (e.g. socioeconomic position, capabilities). Hence, political, institutional and individual strategies may support SDC in consideration of the above factors. Measures may, among others, include the improvement of information processes, the reduction of economic barriers, relationship building before and during birth as well as respective structural adjustments.}, language = {en} } @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{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{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{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} } @misc{HoffmannTschornMichalskietal., author = {Hoffmann, Stephanie and Tschorn, Mira and Michalski, Niels and Hoebel, Jens and F{\"o}rstner, Bernd R. and Rapp, Michael A. and Spallek, Jacob}, title = {Do regional characteristics predict developmental delay? Analyses of German school entry examination}, series = {European Journal of Public Health}, volume = {32}, journal = {European Journal of Public Health}, number = {Supplement_3}, issn = {1101-1262}, doi = {10.1093/eurpub/ckac129.342}, pages = {2}, abstract = {Background Children's health and development are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living region. However, research on the impact of the living region on children's development beyond family SEP is scarce. This study evaluated whether rurality and regional socioeconomic deprivation (DEP) are associated with children's development independently of family SEP. Methods The study used population-based data of 5-6.5 years old children (n = 22,801) from mandatory school entry examinations (SEE) in the German federal state of Brandenburg, which were examined in 2018/2019. The SEE data have been linked with data on i. rurality that was defined by an inverted population density and ii. regional DEP that were provided by the German Index of Socioeconomic Deprivation. By binary multilevel models, the predictive values of rurality and regional DEP for global developmental delay (GDD) were evaluated, while adjusting for family SEP. Results Children with high family SEP showed reduced odds for GDD compared to medium family SEP (female: OR = 4.26, CI95=3.14-5.79, male: OR = 3.46, CI95=2.83-4.22) and low family SEP (female: OR = 16.58, CI95=11.90-23.09, male: OR = 12.79, CI95=10.13-16.16). Regional DEP additionally predicted GDD, with higher odds for children from more deprived regions (female: OR = 1.35, CI95=1.13-1.62, male: OR = 1.20, CI95=1.05-1.39). Rurality did not predict GDD beyond family SEP and regional DEP. Conclusions In addition to family SEP, the regional DEP has an effect on children's developmental delay. Hence, Public Health should take into account regional socioeconomic conditions as determinant of health over the life course in addition to family SEP.}, language = {en} } @techreport{GoldfriedrichHoffmannMuelleretal., author = {Goldfriedrich, Martin and Hoffmann, Stephanie and M{\"u}ller, Yvonne and Schmidt, Andrea C. and Spallek, Jacob and Stroß, Annette M. and Tallarek, Marie}, title = {Konzeptpapier f{\"u}r einen Modellstudiengang „Gesundheitsp{\"a}dagogik und Gesundheitsdidaktik"}, editor = {Goldfriedrich, Martin and Hurrelmann, Klaus}, publisher = {Universit{\"a}t}, address = {Erfurt}, doi = {10.22032/dbt.52342}, url = {http://nbn-resolving.de/urn:nbn:de:gbv:547-202200367}, pages = {23}, abstract = {Angesichts der immer st{\"a}rker werdenden Diskussion um die Bedeutung von Gesundheit f{\"u}r den schulischen und außerschulischen Bildungs- und Lernprozess und der Risiken wachsender gesundheitlicher Ungleichheit bei Kindern und Jugendlichen (Hurrelmann/Richter 2013, Lampert et al. 2019) ist die Etablierung eines Studienganges „Gesundheitsp{\"a}dagogik und Gesundheitsdidaktik" l{\"a}ngst {\"u}berf{\"a}llig und von besonderer Bedeutung f{\"u}r gesundheitliche Chancengleichheit (Goldfriedrich \& Hurrelmann, 2021a; 2021b). Dieses Konzeptpapier stellt einen Modellstudiengang vor, bei dem insbesondere die Vermittlungsebenen - also die gesundheitsdidaktischen Gegenstandsbereiche - im Vordergrund stehen. Die Ausarbeitungen des Entwurfs basieren auf der Grundlage politischer Bestrebungen, der bisherigen Forschung zur Gesundheitsp{\"a}dagogik und Gesundheitsdidaktik, den Erkenntnissen der Erziehungs- und Gesundheitswissenschaften sowie wissenschaftlichen und interprofessionellen Beitr{\"a}gen des Netzwerks Gesundheitsdidaktik (bestehend aus 33 Expert*innen aus 24 Fachbereichen).}, language = {de} } @misc{ScholaskeAdamSpalleketal., author = {Scholaske, Laura and Adam, Emma K. and Spallek, Jacob and Entringer, Sonja}, title = {Maternal BMI and inflammation during pregnancy: a bi- or unidirectional association?}, series = {Brain, Behavior, and Immunity}, volume = {106}, journal = {Brain, Behavior, and Immunity}, publisher = {Elsevier}, doi = {10.1016/j.bbi.2022.07.049}, pages = {12}, abstract = {Methods: 140 pregnant women participated in a multi-site prospective cohort study in, Germany with two study visits during pregnancy (T1: 24.44 ± 2.34, T2: 32.92 ± 1.72 weeks of gestation). Maternal BMI was derived from body length and current weight and was residualized for gestational week at assessment. Pro-inflammatory markers CRP and IL-6 were analyzed from venous blood samples and combined into a repeatedly measured composite inflammation score. Results: In a path model, T1-BMI significantly predicted T2-inflammation (b=0.53, SE=0.02, p <.001), and T1-inflammation predicted T2-BMI (b=0.46, SE=0.42, p <.001), suggesting a bidirectional relationship between BMI and inflammation. However, further adjustment for pre-pregnancy BMI diminished the association between T1-inflammation and T2-BMI (b=0.004, SE=0.22, p =.922), whereas the relationship between T1-BMI and T2-inflammation remained significant (b=0.20, SE=0.01, p =.004). Thus, adjusting for pre-pregnancy BMI underlined a unidirectional relationship. Conclusions: Based on these results, reducing overweight may be a relevant target for interventions to reduce inflammation and the risk of subsequent adverse outcomes.}, language = {en} } @misc{DeindlDiehlSpalleketal., author = {Deindl, Christian and Diehl, Katharina and Spallek, Jacob and Richter, Matthias and Sch{\"u}ttig, Wiebke and Rattay, Petra and Dragano, Nico and Pischke, Claudia R.}, title = {Self-rated health of university students in Germany-The importance of material, psychosocial, and behavioral factors and the parental socio-economic status}, series = {Frontiers in Public Health}, volume = {11}, journal = {Frontiers in Public Health}, issn = {2296-2565}, doi = {10.3389/fpubh.2023.1075142}, abstract = {Health inequalities start early in life. The time of young adulthood, between late teens and early twenties, is especially interesting in this regard. This time of emerging adulthood, the transition from being a child to becoming an adult, is characterised by the detachment from parents and establishing of an own independent life. From a health inequality perspective, the question about the importance of the socio-economic background of parents is important. University students are an especially interesting group. Many students come from a privileged background and the question of health inequality among university students has not yet been properly studied. Based on the National Educational Panel Study (NEPS), we analysed health inequalities among 9,000 students in Germany ({\O} 20 years in the first year of their studies) over a period of eight years. We found that university students in Germany report a good and very good health. Yet, we still found substantial health inequalities. Students whose parents had a higher occupational status also reported less health problems. We were also able to tie health inequality on health behaviour, psychosocial resources, and material conditions.}, language = {en} } @techreport{DeSantisMuellmannPanetal., author = {De Santis, Karina Karolina and M{\"u}llmann, Saskia and Pan, Chen-Chia and Spallek, Jacob and Hoffmann, Stephanie and Haug, Ulrike and Zeeb, Hajo}, title = {Digitalisierung und Gesundheit: Ergebnisse einer zweiten bundesweiten Befragung in Deutschland}, pages = {21}, abstract = {Diese Studie untersuchte Einstellungen zu und Nutzung von digitalen Technologien im Gesundheitskontext anhand einer zweiten bundesweiten Befragung von Internetnutzenden in Deutschland. Unser Ziel war es zu ermitteln, ob und wie sich Einstellungen zu und Nutzung von digitalen Technologien im Gesundheitskontext zwei Jahre nach der ersten Befragung ver{\"a}ndert haben.}, language = {de} } @misc{ReuterDiehlRichteretal., author = {Reuter, Marvin and Diehl, Katharina and Richter, Matthias and Sundmacher, Leonie and H{\"o}vener, Claudia and Spallek, Jacob and Dragano, Nico}, title = {A longitudinal analysis of health inequalities from adolescence to young adulthood and their underlying causes}, series = {Advances in Lifecourse Research}, volume = {Vol. 59}, journal = {Advances in Lifecourse Research}, issn = {1879-6974}, doi = {10.1016/j.alcr.2024.100593}, abstract = {Research suggests that children of low-educated parents face greater health burdens during the passage from adolescence to young adulthood, as they are more likely to become low-educated themselves, establish behavioural and psychosocial disadvantages, or being exposed to unhealthy working conditions. However, studies examining the development and drivers of health inequalities during this particular life stage are limited in number and have produced varied results. This study investigates trajectories of self-rated health and overweight from 14 to 25 years of age, stratified by parental education, and explores the role of potential mediators (educational achievement, health behaviours, psychosocial factors, working conditions). We rely on prospective cohort data from the National Educational Panel Study (NEPS), a representative sample of 14,981 German ninth graders interviewed yearly from 2011 to 2021 (n = 90,096 person-years). First, we estimated random-effects growth curves for self-rated health and overweight over participants' age and calculated the average marginal effect of high versus low parental education. Second, a series of simulation-based mediation analyses were performed to test how much of health inequalities were explained by children's educational attainment (years of school education, years in university), health behaviours (smoking, alcohol, physical inactivity), psychosocial factors (number of grade repetitions, years in unemployment, chronic stress, self-esteem) and working conditions (physical and psychosocial job demands). We accounted for potential confounding by controlling for age, sex, migration background, residential area, household composition, and interview mode. Results show that higher parental education was related to higher self-rated health and lower probabilities of being overweight. Interaction between parental education and age indicated that, after some equalisation in late adolescence, health inequalities increased in young adulthood. Furthermore, educational attainment, health behaviours, psychosocial factors, and early-career working conditions played a significant role in mediating health inequalities. Of the variables examined, the level of school education and years spent in university were particular strong mediating factors. School education accounted for around one-third of the inequalities in self-rated health and one-fifth of the differences in overweight among individuals. Results support the idea that the transition to adulthood is a sensitive period in life and that early socio-economic adversity increases the likelihood to accumulate health disadvantages in multiple dimensions. In Germany, a country with comparatively low educational mobility, intergenerational continuities in class location seem to play a key role in the explanation of health inequalities in youth.}, language = {en} } @incollection{TallarekSpallek, author = {Tallarek, Marie and Spallek, Jacob}, title = {Migration and health. Theoretical foundations, empirical findings, and public health responses using the example of Germany}, series = {Contemporary challenges of social work in Poland and Germany: war migrants as a challenge}, booktitle = {Contemporary challenges of social work in Poland and Germany: war migrants as a challenge}, editor = {Orlowska, Beata and Paetzold, Ulrich}, edition = {1}, publisher = {Akademia im. Jakuba z Paradyża w Gorzowie Wielkopolskim}, address = {Gorz{\´o}w Wielkopolski}, isbn = {978-83-67705-24-0}, pages = {11 -- 31}, abstract = {Migrants and their offspring, referred to as people with a migration background in this article, are an utmost heterogeneous group whose health situation can be better, similar or worse compared to the health of the population without a migration background. A better understanding of the health of people with a migration background requires the consideration of their individual life course as well as several additional explanatory factors. The latter include, for instance, their social position, age, and gender, as well as the policies, health care system, social climate, living situation, and length of stay in the destination country. Particularly promising public health strategies for migrant health include a combination of migration sensitive and migration specific offers, setting approaches, and inclusionary public health approaches that critically reflect on mechanisms of othering, marginalization, and exclusion.}, 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{BammertSchuettigNovellietal., author = {Bammert, Philip and Sch{\"u}ttig, Wiebke and Novelli, Anna and Iashchenko, Iryna and Spallek, Jacob and Blume, Miriam and Diehl, Katharina and Moor, Irene and Dragano, Nico and Sundmacher, Leonie}, title = {The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review}, series = {International Journal for Equity in Health}, volume = {23}, journal = {International Journal for Equity in Health}, number = {1}, issn = {1475-9276}, doi = {10.1186/s12939-024-02122-6}, abstract = {Background: Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. Methods: We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. Results: Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. Conclusions: Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.}, language = {en} } @misc{KnautheFieberGlauschetal., author = {Knauthe, Nadja and Fieber, Vera and Glausch, Melanie and Geissler, Mark Enrik and Dallal, Anna and Doll, Konrad and Meister, Lisa and Tallarek, Marie and Weigmann-Faßbender, Sandra and Giesemann, Nadine and Hofbauer, Christine and Bornh{\"a}user, Martin and Letsch, Anne and Ratjen, Ilka and Spallek, Jacob and St{\"o}lzel, Friederike}, title = {„Aktiv leben mit Krebs": acceptance and effect of a lowthreshold information on health behavior for cancer patients}, series = {Oncology Research and Treatment 2024 : 36. Deutscher Krebskongress. Fortschritt gemeinsam gestalten, 21.-24. Februar 2024, Berlin: ABSTRACTS}, volume = {47}, journal = {Oncology Research and Treatment 2024 : 36. Deutscher Krebskongress. Fortschritt gemeinsam gestalten, 21.-24. Februar 2024, Berlin: ABSTRACTS}, number = {1}, editor = {B{\"u}ttner, Reinhard}, issn = {2296-5262}, doi = {10.1159/000535363}, pages = {216}, abstract = {Background: In Germany, more than 4.65 million people are currently living with a cancer diagnosis. Patients can benefit from a healthy lifestyle both during and after therapy. In order to provide patients with practical and scientifically based information on health behavior, the authors developed "Aktiv leben mit Krebs" (ALMIK) using participatory program planning. Methods: A non-blinded randomized controlled trial with intervention (IG) and wait list control group (WCG) was conducted at NCT/UCC Dresden and UCCSH in Kiel in 2022/2023 with a convenience sample of n=227 patients during and after therapy (65.7 years ± 11.7, 54.2\% male). IG and WCG received a questionnaire at baseline and after 1 month. IG received the ALMIK brochure and a link to the website with videos. Changes in health literacy (HLS-EU Q) and acceptance were assessed. Result: Acceptance of ALMIK in IG was high: 94.1\% of all n=109 patients in the IG reported having used the brochure. 40.4\% had visited the website. Videos were used by 36.7\%. Almost all patients rated the brochure as understandable (97.8\%), relevant (90.3\%) and clearly presented (98.9\%). Patients also rated the website as well-structured (95.6\%) and attractively designed (97.6\%), and the videos as understandable (93.0\%) and relevant (79.1\%). Overall, 97.8\% were satisfied with the program and 98.9\% would recommend it to others. Patients of IG did not achieve higher HLS-score in comparison to WCG (p=0.75). Discussion: The brochure was used by many patients and was very well accepted. The website and videos were used less frequently, but overall by more than one-third of patients, who were also satisfied with them. Health literacy was not increased by ALMIK, which may be due to the low intervention strength. Conclusion: The high number of participants who used ALMIK indicates a high need for health behavior information for cancer patients. Patient involvement has proven to be an important component in creating well accepted program materials}, language = {en} } @misc{DeSantisMuellmannPanetal., author = {De Santis, Karina Karolina and Muellmann, Saskia and Pan, Chen-Chia and Hoffmann, Stephanie and Spallek, Jacob and Haug, Ulrike and Zeeb, Hajo}, title = {Digitisation and health: Second nationwide survey of internet users in Germany}, series = {Digital Health}, volume = {Volume 10}, journal = {Digital Health}, doi = {10.1177/20552076241301457}, pages = {16}, abstract = {Objective: Rapid digitisation of health occurred during the COVID-19 pandemic worldwide. In October 2020, we conducted a survey on digital health technology use in Germany. This study aimed to conduct a second survey to investigate in more detail the internet use in health context and digital technology use for health promotion and disease prevention in Germany. Methods: A cross-sectional, nationwide telephone survey was conducted in November 2022. Anonymous data on internet and digital technology use, digital health literacy, and sociodemographic characteristics were analysed using descriptive statistics and binary logistic regressions. Results: The 1020 participants were aged 18-92 years, 53\% were male, 62\% completed primary or secondary education, 71\% resided in large cities, and 45\% reported a country-average net household income. Overall, 61\% reported internet use in health context via 1-4 devices. Among those, more than 50\% used the internet and apps to obtain general health information and less than 50\% used digital technologies for physical activity promotion or cancer prevention. Overall, 34\% were confident in using the internet for health decisions and 71\% preferred to receive health information non-digitally (e.g. on paper). Internet, app, and digital technology use were associated with higher digital health literacy and income, and residence in larger cities. Digital technologies were used for physical activity promotion by younger and for cancer prevention by older participants. Conclusion: The internet and digital technologies were predominantly used to obtain health information, but less often for health promotion and disease prevention in 2022 in Germany. While health app and digital technology use for physical activity promotion increased, the confidence in using online information for health decisions decreased in 2022 relative to 2020. Factors that promote confidence in online health information and digital technology use for health promotion and disease prevention need to be investigated in future studies.}, language = {en} } @incollection{SpallekSchumannBrand, author = {Spallek, Jacob and Schumann, Maria and Brand, Tilman}, title = {Pr{\"a}vention und Gesundheitsf{\"o}rderung bei Migrantinnen und Migranten}, series = {Referenzwerk Pr{\"a}vention und Gesundheitsf{\"o}rderung}, booktitle = {Referenzwerk Pr{\"a}vention und Gesundheitsf{\"o}rderung}, editor = {Hurrelmann, Klaus and Richter, Matthias and Stock, Stephanie}, edition = {6., {\"u}berarb. u. erw. Aufl.}, publisher = {Hogrefe}, address = {Bern}, isbn = {978-3-456-86350-4}, doi = {10.1024/86350-000}, pages = {479 -- 494}, language = {de} } @misc{SpallekHoffmannStableretal., author = {Spallek, Jacob and Hoffmann, Stephanie and Stabler, Martin and Hecht, Henriette and Bangert, Benjamin and Martens, Lea and Irrgang, Christopher and Ladewig, Katharina and Zeeb, Hajo}, title = {Digital Public Health in l{\"a}ndlichen Regionen Deutschlands mit relativer sozio{\"o}konomischer Deprivation: das Beispiel des Lausitzer Zentrums f{\"u}r Digital Public Health}, series = {German Medical Sciences}, journal = {German Medical Sciences}, doi = {10.3205/24gmds630}, url = {http://nbn-resolving.de/urn:nbn:de:0183-24gmds6307}, abstract = {Einleitung: Digitale Gesundheitstechnologien - wie online Plattformen und tragbare Ger{\"a}te - bieten vermehrt M{\"o}glichkeiten zur Verbesserung von Pr{\"a}vention, Gesundheitsf{\"o}rderung und Gesundheitsversorgung. Europ{\"a}ische Studien haben aber auch gezeigt, dass sie nicht f{\"u}r alle Bev{\"o}lkerungsgruppen und Gebiete gleichermaßen zug{\"a}nglich, nutzbar und wirksam sind, um die Gesundheit zu verbessern. Vor allem Menschen, die in l{\"a}ndlichen Gebieten leben, Sprachbarrieren haben oder sozio{\"o}konomisch benachteiligt sind, profitieren seltener vom digitalen Wandel [1]. Um das Potenzial digitaler Gesundheitstechnologien f{\"u}r die Gesundheit der Bev{\"o}lkerung auszusch{\"o}pfen, sollten sie passgenau auf die relevanten Bev{\"o}lkerungsgruppen zugeschnitten sein und die regionalen Lebensbedingungen ber{\"u}cksichtigen. Ziel des Lausitzer Zentrums f{\"u}r Digital Public Health (LauZeDiPH) ist es, den digitalen Wandel unter dem Aspekt der gesundheitlichen Chancengerechtigkeit zu erforschen und zu unterst{\"u}tzen. Methoden: Die Forschung des LauZeDiPH [2] basiert mit Fokus auf die Bev{\"o}lkerung in der Lausitz sowohl auf Prim{\"a}r- und Sekund{\"a}rdaten aus bev{\"o}lkerungsbasierten Erhebungen als auch auf gezielt und partizipativ erhobenen Daten von spezifischen Gruppen, wie z.B. Patienten mit chronisch obstruktiver Lungenerkrankung (COPD) oder Menschen mit geringer digitaler Kompetenz. Relevante Zielgr{\"o}ßen sind dabei u.a. der allgemeine Gesundheitszustand der lokalen Bev{\"o}lkerung, der Zugang zur und die Inanspruchnahme von Gesundheitsversorgung, der Zugang zu digitalen Gesundheitstechnologien, die digitale Gesundheitskompetenz und die Versorgungspr{\"a}ferenzen der Bev{\"o}lkerung in der Region. Ergebnisse: Die bisherigen Analysen in der Gesamtschau betonen die Bedeutung sozialer und regionaler Gesundheitsdeterminanten von der fr{\"u}hen Kindheit an in Brandenburg insgesamt sowie in der Lausitz, z.B. bei Besch{\"a}ftigten der Gesundheitsversorgung [3], [4], und damit die spezifischen Anforderungen f{\"u}r (Digital) Public Health in der Region. Neue Technologien werden oftmals in urbanen Settings f{\"u}r urbane Settings entwickelt und evaluiert. Maßgeschneiderte, regional eingebettete Maßnahmen sind daher essentiell, um bedarfsgerecht auch bisher nicht gut erreichte Bev{\"o}lkerungsgruppen und die Bev{\"o}lkerung in weniger erschlossenen Regionen zu erreichen. Die Ergebnisse zeigen die Notwendigkeit der partizipativen Entwicklung und Evaluation von neuen Instrumenten f{\"u}r Public Health und die Gesundheitsversorgung, insbesondere mit der Unterst{\"u}tzung von Menschen mit eingeschr{\"a}nktem digitalem Zugang, niedrigem Bildungshintergrund, wenigen digitalen F{\"a}higkeiten oder mangelndem Vertrauen in die Forschung und digitale Technologien. Schlussfolgerung: Die Anwendung partizipativer regionaler Ans{\"a}tze kann einen gerechteren digitalen Wandel im Gesundheitsbereich erleichtern. Die Einbeziehung marginalisierter und schwer erreichbarer Gruppen in digitale Public Health Interventionen kann neue M{\"o}glichkeiten f{\"u}r Pr{\"a}vention, Gesundheitsversorgung und Forschung er{\"o}ffnen und ist aus Sicht der gesundheitlichen Chancengerechtigkeit essentiell [5]. K{\"u}nftige digitale Ans{\"a}tze sollten so gestaltet werden, dass sie den spezifischen Bed{\"u}rfnissen benachteiligter Gruppen und Regionen gerecht werden. Literatur 1. WHO. Neue Studie belegt: Digitale Gesundheit ist nicht f{\"u}r alle gleich zug{\"a}nglich. 2022 [zuletzt aufgerufen: 23.04.2024]. Verf{\"u}gbar unter: https://www.who.int/europe/de/news/item/21-12-2022-digital-health-not-accessible-by-everyone-equally-new-study-finds 2. Lausitzer Zentrum f{\"u}r Digital Public Health. Forschung. [zuletzt aufgerufen: 23.04.2024]. Verf{\"u}gbar unter: https://www.b-tu.de/digital-public-health/forschung 3. Hoffmann S, Tschorn M, Spallek J. Social inequalities in early childhood language development during the COVID-19 pandemic: a descriptive study with data from three consecutive school entry surveys in Germany. Int J Equity Health. 2024;23(1):2 4. Hoffmann S, Schulze S, L{\"o}ffler A, Becker J, Hufert F, Gremmels HD, et al. Did the prevalence of depressive symptoms change during the COVID-19 pandemic? A multilevel analysis on longitudinal data from healthcare workers. Int J Soc Psychiatry. 2024;70(1):87-98 5. Bammert P, Sch{\"u}ttig W, Novelli A, Iashchenko I, Spallek J, Blume M, et al. The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review. Int J Equity Health. 2024;23:37}, language = {de} } @misc{HechtHoffmannBangertetal., author = {Hecht, Henriette and Hoffmann, Stephanie and Bangert, Benjamin and Irrgang, Christopher and Ladewig, Katharina and Martens, Lea and Stabler, Martin and Spallek, Jacob}, title = {Making digital health services in the real world: ein partizipatives, human-centered-design-framework f{\"u}r eine erreichende Innovationsentwicklung am Beispiel der Lausitz}, series = {Wen erreichen wir mit digitaler Pr{\"a}vention und Gesundheitsf{\"o}rderung? Und wie? : German Medical Science}, journal = {Wen erreichen wir mit digitaler Pr{\"a}vention und Gesundheitsf{\"o}rderung? Und wie? : German Medical Science}, doi = {10.3205/24gmds889}, url = {http://nbn-resolving.de/urn:nbn:de:0183-24gmds8890}, abstract = {F{\"u}r digitale Programme und Angebote der Pr{\"a}vention und Gesundheitsf{\"o}rderung besteht die Herausforderung darin, unterschiedliche Dialoggruppen zu erreichen und sie effektiv zu einzubinden. Barrieren bestehen u. a. aus der digitalen Kluft, da die Zug{\"a}nglichkeit besonders f{\"u}r {\"a}ltere Menschen, Menschen mit niedrigem Einkommen oder aus l{\"a}ndlichen Gebieten eingeschr{\"a}nkt sein kann. Außerdem haben verschiedene Dialoggruppen unterschiedliche kulturelle Hintergr{\"u}nde, sodass digitale Angebote diese Vielfalt ber{\"u}cksichtigen und kultursensibel gestaltet sein sollten, um die Akzeptanz und Teilnahme zu f{\"o}rdern. Wissen {\"u}ber Barrieren der Zug{\"a}nglichkeit sind relevant, um digitale Gesundheitsangebote attraktiv und ansprechend gestalten zu k{\"o}nnen und die langfristige Teilnahme zu f{\"o}rdern. Das Symposium will anhand von Projekten aus Wissenschaft und Praxis thematisieren, wie digitale Angebote sowie die Kontexte und Prozesse ihrer Implementierung gestaltet sein m{\"u}ssen, damit digitale Pr{\"a}vention und Gesundheitsf{\"o}rderung einen großen Kreis von Nutzenden in ihrer Lebenswirklichkeit erreichen k{\"o}nnen. Dazu werden Evaluationsergebnisse von Nutzerinnen und Nutzern einer digitalen Pr{\"a}vention zur Alkoholpr{\"a}vention im Rahmen einer suchtpr{\"a}ventiven Kunstausstellung vorgestellt. Außerdem werden am praktischen Beispiel eines digitalen Elternprogramms verschiedene M{\"o}glichkeiten der Ansprache, Bereitstellung und Begleitung pr{\"a}sentiert. Ein weiterer Beitrag stellt vor, wie im Rahmen des Projekts „Reallabor AI4U" unter Einbeziehung verschiedener Dialoggruppen ein digitales Training zur F{\"o}rderung der psychischen Gesundheit und Resilienz bei Jugendlichen erprobt wurde. Das Training kann im Alltag auf dem Smartphone genutzt werden und bietet auf Person, Moment und Kontext zugeschnittene {\"U}bungen an. Die Weiterentwicklung einer bestehenden spielerischen Intervention zur F{\"o}rderung der navigationalen Gesundheitskompetenz f{\"u}r {\"a}ltere Menschen ist Gegenstand des n{\"a}chsten Vortrags. Abschließend wird ein partizipatives, human-centered-design Konzept auf den Kontext der Lausitz projiziert, um einen Beteiligungsraum zu schaffen, in dem die {\"U}bertragbarkeit von digitalen Gesundheitsinnovationen f{\"u}r die Region gepr{\"u}ft werden kann. Die gemeinsame Darstellung der Beitr{\"a}ge erm{\"o}glicht die Er{\"o}rterung des komplexen Themas der Erreichbarkeit durch digitale Gesundheitsf{\"o}rderung und Pr{\"a}vention aus unterschiedlichen wissenschaftlichen, praxisnahen und prozessbegleitenden Sichtweisen und schafft die Grundlage f{\"u}r eine facettenreiche angewandte Diskussion zusammen mit interessierten Personen aus dem Plenum. {\"U}ber die inhaltliche Diskussion der Beitr{\"a}ge hinaus sollen Synergien und M{\"o}glichkeiten zuk{\"u}nftiger Zusammenarbeit zwischen den Fachbereichen der DGSMP und der DGPH im Themenfeld ausgelotet werden.}, language = {de} } @misc{BangertStablerHoffmannetal., author = {Bangert, Benjamin and Stabler, Martin and Hoffmann, Stephanie and Herath, Tim and Martens, Lea and Hecht, Henriette and Spallek, Jacob and Zeeb, Hajo and Ladewig, Katharina and Irrgang, Christopher}, title = {Assessing accessibility: a comprehensive multimodal study of primary care accessibility across Germany}, series = {German Medical Science}, journal = {German Medical Science}, doi = {10.3205/24gmds812}, url = {http://nbn-resolving.de/urn:nbn:de:0183-24gmds8122}, abstract = {Background: In the context of healthcare, primary care physicians represent the initial point of contact with the healthcare system [1]. In Germany, the use of motorised private transport for day-to-day travel remains the dominant mode of transport [2]. However, a range of factors, including environmental concerns, socio-economic challenges, and health-related issues, may act as deterrents for citizens from utilising these vehicles. This study aims to assess the geographical accessibility of primary care physicians by using alternative transportation modes, such as public transport or walking, to identify regions in Germany with limited accessibility to primary care physicians in order to ensure the equitable distribution of healthcare. Methods: A state-of-the-art routing engine [3] based on the RAPTOR algorithm is employed to calculate travel times from census grid cells to primary care physicians. The routing process incorporates multimodal transportation, including walking, biking, public transport and motorised private transport. Various metrics like the cost to closest facility, Hansen's accessibility measure, and the balanced floating catchment area [4], are utilised to analyse and compare the accessibility and distribution of primary care physicians when using different transportation modes. The data on travel times and frequencies are collected, analysed and visualised using R and Python implementations. Results: A preliminary analysis revealed disparities in how different modes of transport allow individuals to access primary care physicians within a reasonable travel time. It is notable that while public transport has the potential to replace motorised private transport in urban areas, the analysis indicates that it falls short in rural regions and smaller cities. In these key regions the coverage of services and the transport network do not meet the primary care demand as well as they do in urban areas. The preliminary study indicated that regions with higher socio-economic deprivation have less efficient access to primary care physicians by alternative transportation modes. The findings are visualised through heat maps, which highlight key regions where alternatives to motorised private transport do not adequately meet the needs of the population. Conclusion: The study suggests that in Germany, public transport may not yet be sufficient to ensure accessibility to primary care physicians for those without access to motorised private transport, particularly in smaller cities and rural regions. This is probably of particular relevance for the elderly and parents with children likely to have higher primary care needs. Enhanced public transport options could be pivotal in addressing these gaps in equitable healthcare access, especially for rural regions. Although mobile health services suffer from inherent limitations, such as gaps in adaptation for different socio-economic groups [5], they could be employed to address existing scarcities in the transportation networks and ensure that all citizens have the opportunity to access essential healthcare services in an efficient manner. References 1. World Health Organization; UNICEF. Operational framework for primary health care: transforming vision into action. Geneva: World Health Organization, UNICEF; 2020 [cited 2024 Apr 27]. p. 13. Available from: https://www.who.int/publications/i/item/9789240017832 2. European Commission: Directorate-General for Mobility and Transport. EU transport in figures: Statistical pocketbook 2023. Luxembourg: Publications Office of the European Union; 2023. p. 49 3. Higgins C, Palm M, DeJohn A, Xi L, Vaughan J, Farber S, et al. Calculating place-based transit accessibility: Methods, tools and algorithmic dependence. JTLU. 2022; 15(1):95-116. 4. Paez A, Higgins C, Vivona SF. Demand and Level of Service Inflation in Floating Catchment Area (FCA) Methods. PLOS ONE. 2019;14(6):e0218773. 5. Kumar D, Hemmige V, Kallen MA, Giordano TP, Arya M. Mobile Phones May Not Bridge the Digital Divide: A Look at Mobile Phone Literacy in an Underserved Patient Population. Cureus. 2019;11(2):e4104.}, language = {en} }