@misc{HoffmannSchulzeLoeffleretal., author = {Hoffmann, Stephanie and Schulze, Susanne and L{\"o}ffler, Antje and Becker, Juliane and Hufert, Frank and Gremmels, Heinz-Detlef and Holmberg, Christine and Rapp, Michael A. and Entringer, Sonja and Spallek, Jacob}, title = {Depressive Symptome bei Besch{\"a}ftigten im Gesundheitswesen w{\"a}hrend der COVID-19-Pandemie: Ergebnisse einer Kohortenstudie in einem Krankenhaus der Regelversorgung in Deutschland}, series = {Gesundheitswesen}, volume = {85}, journal = {Gesundheitswesen}, number = {809}, doi = {10.1055/s-0043-1770597}, abstract = {Einleitung Bisher liegen in Deutschland wenig empirische Ergebnisse zu den Auswirkungen der COVID-19 Pandemie auf die seelische Gesundheit von Besch{\"a}ftigten im Gesundheitswesen vor. In dieser Studie wird die zeitliche Entwicklung depressiver Symptome und der Zusammenhang mit a) der Stresswahrnehmung, b) der eigenen COVID-19-Infektion und c) der arbeitsplatzbezogenen COVID-19-Exposition untersucht. Methoden Die Kohortenstudie mit 91 Besch{\"a}ftigten (90\% wbl, x̅=45 Jr) eines Krankenhauses schloss (1) medizinisches, pflegerisches und therapeutisches sowie (2) administratives Personal im Zeitraum von Juli 2020 bis Dezember 2020 ein. Gemischte Modelle analysierten zeitliche Depressionswerte ('Allg. Depressionsskala') mit wahrgenommenem Stress ('Perceived Stress Scale'). Eine eigene COVID-19-Infektion (Laborbefund) wurde als Moderator getestet. Die zeitliche Entwicklung von Symptommodalit{\"a}ten (u.a. somatisch) wurde nach beruflicher Exposition analysiert. Ergebnisse Die Depressionswerte stiegen insgesamt w{\"a}hrend des Studienzeitraums an (b=.03, .02-.05). Stressempfinden war mit depressiven Symptomen assoziiert (b=.12, .10-.14). Eine eigene Infektion war mit einem h{\"o}heren Anstieg assoziiert (b=.06, .01-.10). Somatische Depressionssymptome nahmen nur bei beruflichem Kontakt mit COVID-19 zu (b=.25, .13-.38). Schlussfolgerung Die Zunahme somatischer depressiver Symptome bei Besch{\"a}ftigten mit beruflichem Kontakt zu COVID-19 zeigt einen Bedarf an Forschung {\"u}ber und Ressourcen f{\"u}r Gesundheitsschutz und -f{\"o}rderung. Das Bewusstsein f{\"u}r Schutzmaßnahmen sollte gest{\"a}rkt werden.}, language = {de} } @incollection{TetzlaffPurohitSpalleketal., author = {Tetzlaff, Laura and Purohit, Anne-Maria and Spallek, Jacob and Holmberg, Christine and Schrader, Thomas}, title = {Evaluating Interoperability in German Critical Incident Reporting Systems}, series = {German Medical Data Sciences 2023 - Science. Close to People, Proceedings of the 68th Annual Meeting of the German Association of Medical Informatics, Biometry, and Epidemiology e.V. (gmds) 2023 in Heilbronn, Germany}, booktitle = {German Medical Data Sciences 2023 - Science. Close to People, Proceedings of the 68th Annual Meeting of the German Association of Medical Informatics, Biometry, and Epidemiology e.V. (gmds) 2023 in Heilbronn, Germany}, publisher = {IOS Press}, address = {Amsterdam [u.a.]}, isbn = {978-1-64368-429-1}, doi = {10.3233/SHTI230722}, pages = {249 -- 257}, abstract = {Introduction: In industrialised countries, one in ten patients suffers harm during hospitalization. Critical Incident Reporting Systems (CIRS) aim to minimize this by learning from errors and identifying potential risks. However, a lack of interoperability among the 16 CIRS in Germany hampers their effectiveness. Methods: This study investigates reports' syntactic and semantic interoperability across seven different reporting systems. Syntactic interoperability was examined using WHO's Minimal Information Models (MIM), while semantic interoperability was evaluated with SNOMED concepts. Results: The findings reveal a low structural overlap, with only two terms correctly represented in the SNOMED CT terminology. In addition, most systems showed no syntactic interoperability. Conclusion: Improving interoperability is essential for increasing the effectiveness and usability of CIRS. The study suggests a unified data model such as MIM or using Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) resources and expanding SNOMED CT with patient safety-relevant terms for semantic interoperability. Given the current lack of both syntactic and semantic interoperability in CIRS, developing a patient safety ontology is recommended for efficient critical incident analysis too.}, language = {en} } @misc{RattayBlumeWachtleretal., author = {Rattay, Petra and Blume, Miriam and Wachtler, Benjamin and Wollgast, Lina and Spallek, Jacob and Hoffmann, Stephanie and Sander, Lydia and Herr, Raphael and Herke, Max and Reuter, Marvin and Novelli, Anna and H{\"o}vener, Claudia}, title = {Socioeconomic position and self-rated health among female and male adolescents: The role of familial determinants in explaining health inequalities. Results of the German KiGGS study}, series = {PloS one}, volume = {17}, journal = {PloS one}, number = {4}, issn = {1932-6203}, doi = {10.1371/journal.pone.0266463}, abstract = {Objective Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining the association between the family's socioeconomic position and adolescents' self-rated health. The current study aimed to explore whether the association between socioeconomic position and self-rated health was mediated by familial determinants. Methods Using data from wave 2 of the"German Health Interview and Examination Survey for Children and Adolescents" (KiGGS) (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of income, education, occupational status, socioeconomic position index and adolescents' subjective social status on self-rated health into direct effects and indirect effects through familial determinants (family cohesion, parental well-being, parental stress, parenting styles, parental obesity, smoking and sporting activity). Results A significant total effect of all socioeconomic position indicators on self-rated health was found, except for income in male adolescents. In female adolescents, more than 70\% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations between income, parental education, the socioeconomic position index and subjective social status were also mediated by familial determinants (family cohesion, parental smoking, obesity and living in a single-mother family). However, a significant direct effect of subjective social status remained. Conclusion The analysis revealed how a family's position of socioeconomic disadvantage can lead to poorer health in adolescents through different family practices. The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions (macro-level), community-based strategies (meso-level) and programs to improve parenting and family functioning (micro-level).}, language = {en} } @misc{WachtlerHoffmannBlumeetal., author = {Wachtler, Benjamin and Hoffmann, Stephanie and Blume, Miriam and Rattay, Petra and Herr, Raphael and Deindl, Christian and Sundmacher, Leonie and Richter, Matthias and Spallek, Jacob and Lampert, Thomas}, title = {The impact of the family on health inequalities in children - A systematic scoping review}, series = {European Journal of Public Health}, volume = {30}, journal = {European Journal of Public Health}, number = {Supplement_5}, publisher = {Univ. Press}, address = {Oxford}, issn = {1101-1262}, doi = {10.1093/eurpub/ckaa166.898}, pages = {1}, abstract = {Background Health inequalities in school-aged children and adolescents were repeatedly reported across Europe but less is known about the contextual and compositional factors of families that might influence and reproduce those health inequalities. In this systematic scoping review we aim to provide a comprehensive overview of the available international literature on the mediating and moderating influence of the family on health inequalities in children and adolescents in Europe and North America. Methods This review follows the PRISMA guidelines for scoping reviews. After defining the research question a search strategy was developed in cooperation with a scientific librarian and the study protocol was registered. A search of three databases (Pubmed, Scopus, PsycINFO) was conducted to identify relevant literature in English or German published between the year 2000 and 2019. A qualitative data charting process was used to extract the relevant data. Results In total 11.838 records were identified through the multi database search (Pubmed n = 6370, PsycINFO n = 3505, Scopus n = 1963). After elimination of duplicates and records from excluded countries, 8862 abstracts were screened by two researchers independently. Different cluster of evidence of family influences on health inequalities were identified: Parental behaviors and children's obesity, parents' smoking and drinking habits and adolescents' risk behaviors, parenting style and children's common mental disorders, parental resources and children's quality of life. Conclusions There are different aspects of family's contextual and compositional characteristics on health inequalities identifiable in the international literature. These characteristics might be new targets for family-focused health promotion strategies. Key messages: -A systematic scoping review found different family aspects that influence health inequalities in children and adolescents. - The identified family traits are promising targets for family-focused health promotion strategies to reduce health inequalities.}, language = {en} } @misc{HoffmannSanderBlumeetal., author = {Hoffmann, Stephanie and Sander, Lydia and Blume, Miriam and Schneider, Sven and Herke, Max and Matos Fialho, Paula M. and Pischke, Claudia R. and Sch{\"u}ttig, Wiebke and Lampert, Thomas and Spallek, Jacob}, title = {Do families have moderating or mediating effects on early health inequalities? A scoping review}, series = {European Journal of Public Health}, volume = {31}, journal = {European Journal of Public Health}, number = {Supplement_3}, publisher = {Oxford University Press}, doi = {10.1093/eurpub/ckab165.506}, abstract = {Background During early childhood, families have a crucial impact on children's health behaviour, health, and development (bhd). However, a family's socioeconomic position (SEP) determines both the parental behaviour, living conditions, and child health. To understand how family characteristics may influence the development of health inequalities, this scoping review synthesised research on their mediating and moderating effects. Methods The review followed the guidelines of the PRISMA Extension for Scoping Reviews. The search included German and English peer-reviewed articles published between January 1st, 2000 and December 19th, 2019. The search in PubMed, PsycINFO, and Scopus used both free text terms in the title/abstract and index terms within linked keyword blocks: (1) family characteristics, (2) inequalities, (3) income, education, occupation, (4) bhd, (5) newborn, infant, toddler, preschooler. Two researchers independently examined eligibility for inclusion in two rounds (title/abstract; full-text). Results Of 7,089 articles identified, ten sources were included that studied family characteristics and health inequalities among 0-6 years olds. Parental rules, stress, and screentime, and TV in bedroom showed mediating effects on inequalities in behaviour problems or children's screentime. Families' negativity, single parenthood, and the number of children in the household moderated differences in impairment, health, behaviour problems, development or breastfeeding initiation. Conclusions The effect of family characteristics on early health inequalities has been sparsely investigated. The evidence supported models of family stress and investment. Further research is needed to comprehensively understand this association. Key messages Family characteristics contribute to health inequalities. Taking families' stress and investment into account could improve targeted prevention efforts aimed at reducing health inequalities.}, language = {en} } @misc{HerkeMoorWinteretal., author = {Herke, Max and Moor, Irene and Winter, Kristina and Hoffmann, Stephanie and Spallek, Jacob and Hilger-Kolb, Jennifer and Pischke, Claudia R. and Dragano, Nico and Novelli, Anna and Richter, Matthias}, title = {Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: protocol for a scoping review}, series = {BMJ Open}, volume = {10}, journal = {BMJ Open}, number = {12}, issn = {2044-6055}, doi = {10.1136/bmjopen-2020-038999}, pages = {7}, abstract = {Introduction Childhood and adolescence are crucial life stages for health trajectories and the development of health inequalities in later life. The relevance of schools for health and well-being of children and adolescents has long been recognised, and there is some research regarding the association of contextual and compositional characteristics of schools and classes with health, health behaviour and well-being in this population. Little is known about the role of meso-level characteristics in relation to health inequalities. The aim of this scoping review is to retrieve and synthesise evidence about the mediating or moderating role of compositional or contextual characteristics of schools for the association between students' socioeconomic position and health in primary and secondary education. Methods and analysis We will conduct a systematic search of electronic databases in PubMed/Medline, Web of Science and Education Resources Information Center. Studies must meet the following inclusion criteria: (1) The population must be students attending primary or secondary schools in developed economies. (2) The outcomes must include at least one indicator for individual health, health behaviour or well-being. (3) The study must include at least one contextual or compositional characteristic of the school context and one individual determinant of socioeconomic position. (4) The study must also examine the mediating or moderating role of the contextual or compositional characteristic of the school context for the associations between socioeconomic position and health, health behaviour or well-being. (5) The study must be published since 1 January 2000 in English or German language. We will provide a narrative synthesis of findings. Ethics and dissemination We will not collect primary data and only include secondary data derived from previously published studies. Therefore, ethical approval is not required. We intend to publish our findings in an international peer-reviewed journal and to present them at national and international conferences.}, language = {en} } @misc{HoffmannSanderWachtleretal., author = {Hoffmann, Stephanie and Sander, Lydia and Wachtler, Benjamin and Blume, Miriam and Schneider, Sven and Herke, Max and Pischke, Claudia R. and Matos Fialho, Paula M. and Schuettig, Wiebke and Tallarek, Marie and Lampert, Thomas and Spallek, Jacob}, title = {Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high‑income countries - a scoping review}, series = {BMC Public Health}, volume = {22}, journal = {BMC Public Health}, issn = {1471-2458}, doi = {10.1186/s12889-022-12603-4}, pages = {1 -- 14}, abstract = {Background: By explaining the development of health inequalities, eco-social theories highlight the importance of social environments that children are embedded in. The most important environment during early childhood is the family, as it profoundly influences children's health through various characteristics. These include family processes, family structure/size, and living conditions, and are closely linked to the socioeconomic position (SEP) of the family. Although it is known that the SEP contributes to health inequalities in early childhood, the effects of family characteristics on health inequalities remain unclear. The objective of this scoping review is to synthesise existing research on the mediating and moderating effects of family characteristics on socioeconomic health inequalities (HI) during early childhood in high-income countries. Methods: This review followed the methodology of "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews". To identify German and English scientific peer-reviewed literature published from January 1st, 2000, to December 19th, 2019, the following search term blocks were linked with the logical operator "AND": (1) family structure/size, processes, living conditions, (2) inequalities, disparities, diversities, (3) income, education, occupation, (4) health and (5) young children. The search covered the electronic databases PubMed, PsycINFO, and Scopus. Results: The search yielded 7,089 records. After title/abstract and full-text screening, only ten peer-reviewed articles were included in the synthesis, which analysed the effects of family characteristics on HI in early childhood. Family processes (i.e., rules /descriptive norms, stress, parental screen time, parent-child conflicts) are identified to have mediating or moderating effects. While families' living conditions (i.e., TVs in children's bedrooms) are suggested as mediating factors, family structure/size (i.e., single parenthood, number of children in the household) appear to moderate health inequalities. Conclusion: Family characteristics contribute to health inequalities in early childhood. The results provide overall support of models of family stress and family investment. However, knowledge gaps remain regarding the role of family health literacy, regarding a wide range of children's health outcomes (e.g., oral health, inflammation parameters, weight, and height), and the development of health inequalities over the life course starting at birth.}, language = {en} } @misc{BlumeRattayHoffmannetal., author = {Blume, Miriam and Rattay, Petra and Hoffmann, Stephanie and Spallek, Jacob and Sander, Lydia and Herr, Raphael and Moor, Irene and Pischke, Claudia R. and Iashchenko, Iryna and H{\"o}vener, Claudia}, title = {Zusammenhang zwischen der sozio{\"o}konomischen Position der Familie und Adipositas bei Jugendlichen in Deutschland - welche Rolle hat die Familie?}, series = {Gesundheitswesen}, volume = {84}, journal = {Gesundheitswesen}, number = {08/09}, doi = {10.1055/s-0042-1753866}, pages = {826}, abstract = {Einleitung Die gesundheitlichen Folgen von Adipositas f{\"u}r junge Menschen k{\"o}nnen schwerwiegend sein. Bei der Entwicklung verschiedener Gesundheitsoutcomes wie Adipositas spielt f{\"u}r junge Menschen die Familie als auch ihre sozio{\"o}konomische Position (SEP) eine große Rolle. In dieser Analyse wird untersucht, welche famili{\"a}re Determinanten den Zusammenhang zwischen SEP der Familie und Adipositas bei Jugendlichen erkl{\"a}ren. Methoden Die vorliegende Analyse wurde mit Daten der "Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland" (KiGGS) (Basiserhebung, Welle 1 und 2) durchgef{\"u}hrt (1301 weibliche und 1232 m{\"a}nnliche 11- bis 17-J{\"a}hrige). Mittels logistischer Regressionsmodelle (KHB-Methode) wurden f{\"u}r den Zusammenhang zwischen der SEP der Familie (Einkommen, berufliche Stellung, Bildung, SES-Index) und Adipositas (Ja/Nein) bei Jugendlichen die mediierenden Effekte von famili{\"a}ren Determinanten (elterliches Rauchen, elterliche sportliche Aktivit{\"a}ten, elterliches {\"U}bergewicht, famili{\"a}rer Stress und famili{\"a}rer Zusammenhalt) analysiert. Ergebnisse Die Pr{\"a}valenz von Adipositas betrug 7,9 \% bei den weiblichen und 8,4 \% bei den m{\"a}nnlichen Jugendlichen. Es zeigen sich signifikante Zusammenh{\"a}nge zwischen Adipositas und SEP zu Ungunsten von jenen mit niedriger sozio{\"o}konomischer Position. Famili{\"a}re Determinanten erkl{\"a}ren teilweise oder vollst{\"a}ndig den Zusammenhang zwischen SEP und Adipositas bei Jugendlichen. Es wurden geschlechtsspezifische Unterschiede im Ausmaß der Mediation der Familie gefunden. Bei Jungen erkl{\"a}ren famili{\"a}re Determinanten vollst{\"a}ndig den Zusammenhang zwischen Adipositas und Einkommen sowie zwischen Adipositas und der beruflichen Stellung der Eltern. Bei m{\"a}nnlichen Jugendlichen l{\"a}sst sich der indirekte Effekt abh{\"a}ngig von der jeweiligen SEP-Variable zu 20,8 - 27,9 \% auf das elterliche Rauchen, zu 14,8 - 26,3 \% auf die elterliche sportliche Aktivit{\"a}t und zu 42,6 - 63,6 \% auf das elterliche {\"U}bergewicht zur{\"u}ckf{\"u}hren. Bei M{\"a}dchen wurde der Zusammenhang zwischen der SEP und Adipositas teilweise durch famili{\"a}re Determinanten erkl{\"a}rt. Bei weiblichen Jugendlichen l{\"a}sst sich der indirekte Effekt abh{\"a}ngig von der jeweiligen SEP-Variable zu 26,0 - 52,2 \% auf das elterliche Rauchen und zu 41,6 - 67,6 \% auf das elterliche {\"U}bergewicht zur{\"u}ckf{\"u}hren. Schlussfolgerung Die Adipositas-Pr{\"a}valenz von Jugendlichen variiert nach dem SEP. Famili{\"a}re Determinanten sind wichtige mediierende Faktoren f{\"u}r gesundheitliche Ungleichheiten bei Adipositas von Jugendlichen. Es zeigt sich, dass sich Unterschiede in der Adipositas nach SEP insbesondere durch das elterliche Gesundheitsverhalten (v.a. elterliches Rauchen, elterliches {\"U}bergewicht und elterliche sportliche Aktivit{\"a}t) erkl{\"a}ren lassen. Die Ber{\"u}cksichtigung und Einbindung der Familie bei der Planung und Umsetzung von Gesundheitsf{\"o}rderungs- und Pr{\"a}ventionsprogrammen f{\"u}r gesundheitliche Chancengleichheit bei Jugendlichen ist essentiell.}, language = {de} } @misc{IashchenkoSchuettigBammertetal., author = {Iashchenko, Iryna and Sch{\"u}ttig, Wiebke and Bammert, Philip and Spallek, Jacob and Rattay, Petra and Schneider, Sven and Moor, Irene and Pischke, Claudia R. and Sundmacher, Leonie}, title = {The role of regional health policy for socioeconomic inequality in health services utilization}, series = {European Journal of Public Health}, volume = {32}, journal = {European Journal of Public Health}, number = {Supplement_3}, issn = {1101-1262}, doi = {10.1093/eurpub/ckac129.584}, pages = {1}, abstract = {Background "J1" is a preventative routine examination in Germany recommended for adolescents at the age of 12-14 years. In contrast to the well-established U1-U9 examinations for younger children, with participation rates above 90\%, the attendance of the J1 examination is approximately only 40\%. The most frequent reason for not attending J1 is the unawareness of this examination. "Ticket to J1" is an intervention including an information leaflet introduced in Bavaria in 2017 to inform adolescents about J1. The aims of the present analysis are to investigate (1) if the regional policy was effective in increasing the attendance in J1, (2) if the effects vary by family socioeconomic status (SES), and (3) which meso-level characteristics of the healthcare system correlate with attendance rates in J1. Methods We used anonymised data of a large statutory health insurance in Germany for the timeframe of 2016-2018. To investigate the effect of the policy, a difference-in-differences design at the individual level was used. Assuming a parallel trend at the level of federal states, the likelihood of attendance in J1 of 13- and 14-year-olds was compared between Bavaria and other federal German states before and after policy introduction. All analyses were additionally stratified by SES. Results The introduction of "Ticket to J1" increased participation in J1 by 1\% after controlling for all confounders. Furthermore, the effect was stronger for children from families with lower SES (an increase of 5\%). Density of pediatricians was positively significantly correlated with participation in J1. Discussion Regional health policy intervention had a significant positive impact on attendance of J1 and appears to have the potential to reduce socioeconomic inequalities in healthcare utilization. Informing adolescents about J1 seems to increase the attendance, in particular for children from families with lower SES.}, language = {en} } @misc{ReuterPischkeRigoetal., author = {Reuter, Marvin and Pischke, Claudia R. and Rigo, Mariann and Diehl, Katharina and Spallek, Jacob and Richter, Matthias and H{\"o}vener, Claudia and Dragano, Nico}, title = {Health inequalities among young workers: the mediating role of working conditions and company characteristics}, series = {International Archives of Occupational and Environmental Health}, volume = {96}, journal = {International Archives of Occupational and Environmental Health}, number = {10}, issn = {1432-1246}, doi = {10.1007/s00420-023-02010-6}, pages = {1313 -- 1324}, abstract = {Objective Few studies have investigated health inequalities among young workers. The objectives of this study are to assess the extent of health inequalities in a sample of job starters and to explore the contribution of job demands and organisational factors. Methods We analyze data from the BIBB/BAuA Youth Employment Survey 2012. The cross-sectional survey includes a representative sample of 3214 German employees, apprentices, and trainees aged 15-24 years. Individuals were grouped by their years of schooling into low (< 12 years) and high levels of education (≥ 12 years). Regression analysis estimated the link between education and four health outcomes: self-rated health, number of health events, musculoskeletal symptoms, and mental health problems over the last 12 months. Counterfactual mediation analysis tested for indirect effects of education via working conditions (i.e., physical and psychosocial job demands) and company characteristics (i.e., company size, health prevention measures, financial situation, downsizing). All analyses were adjusted for age, sex, nationality, region, working hours, job tenure, employment relationship, and economic sector. Results Highly educated workers reported better self-rated health (b = 0.24, 95\% CI 0.18-0.31) and lower numbers of health events (Rate Ratio (RR) = 0.74, 95\% CI 0.67-0.82), musculoskeletal symptoms (RR = 0.73, 95\% CI 0.66-0.80) and mental health problems (RR = 0.84, 95\% CI 0.76-0.93). Total job demands explained between 21.6\% and 87.2\% of the educational differences (depending on health outcome). Unfavourable company characteristics were associated with worse health, but showed no or only small mediation effects. Conclusions Health inequalities are already present at the early working career due to socio-economically stratified working hazards. To enhance prevention measures that aim at reducing inequalities in workplace health, we propose shifting attention towards earlier stages of life.}, language = {en} } @misc{BammertSchuettigIashchenkoetal., author = {Bammert, Philip and Sch{\"u}ttig, Wiebke and Iashchenko, Iryna and Spallek, Jacob and Rattay, Petra and Schneider, Sven and Richter, Matthias and Pischke, Claudia R. and Dragano, Nico and Sundmacher, Leonie}, title = {The role of sociodemographic, psychosocial, and behavioral factors in the use of preventive healthcare services in children and adolescents: results of the KiGGS Wave 2 study}, series = {BMC Pediatrics}, volume = {24}, journal = {BMC Pediatrics}, issn = {1471-2431}, doi = {10.1186/s12887-024-04650-0}, abstract = {Background: In Germany, various preventive services are offered to children and adolescents. These include regular standardized examinations (so called U/J examinations) and several vaccinations. Although strongly recommended, most of them are not mandatory. Our aim is to identify factors associated with the use of U/J examinations and vaccination against diphtheria, hepatitis B, Hib, pertussis, polio, and tetanus. While previous research has focused on sociodemographic factors, we also include socioeconomic, behavioral, and psychosocial factors. Methods: We analyzed cross-sectional data from 15,023 participants (aged 0-17 years) of the nationwide representative KiGGS Wave 2 Survey. Participation in U/J examinations was assessed using a questionnaire, filled out by participants and/or their parents. Information on vaccination status was drawn from the participants' vaccination booklets. To identify relevant determinants for the use of preventive examinations and vaccinations, unadjusted and adjusted logistic regression models were employed with up to 16 different independent variables. Results: Various independent variables showed an association with the use of preventive services. Higher socioeconomic status, absence of migration background, and lower household size were associated with significantly higher utilization of U examinations. Parents' marital status, area of residence, behavioral and psychosocial factors yielded insignificant results for most U/J examinations. Higher vaccination rates were found for children with no migration background, with residence in eastern Germany, lower household size, and with married parents. Conclusion: This study attempted to depict the influence of sociodemographic, psychosocial, and behavioral factors on the use of several preventive services. Our results indicate that predominantly sociodemographic variables influence the use of preventive services. Further efforts should be made to investigate the interplay of different determinants of healthcare use in children and adolescents.}, language = {en} } @misc{HoffmannRattayBlumeetal., author = {Hoffmann, Stephanie and Rattay, Petra and Blume, Miriam and H{\"o}vener, Claudia and Schneider, Sven and Moor, Irene and Pischke, Claudia R. and Sch{\"u}ttig, Wiebke and De Bock, Freia and Spallek, Jacob}, title = {Do family characteristics explain a social gradient in overweight in early childhood?}, series = {European Journal of Public Health}, volume = {32}, journal = {European Journal of Public Health}, number = {Supplement_3}, issn = {1101-1262}, doi = {10.1093/eurpub/ckac129.581}, pages = {1}, abstract = {Background Children's overweight is associated with many factors, including their living situation, in particular their family's socioeconomic position (SEP) and family characteristics. Research on the extent to which family characteristics account for a social gradient in overweight in early life is scarce. This study evaluated whether family characteristics explain SEP differences in the risk of overweight in early childhood. Methods The study used baseline data of 3-6 year-old children (n = 1,116) from the intervention 'Ene mene fit' conducted at kindergartens in Baden-W{\"u}rttemberg, Germany. Data included overweight (body mass index > 90 percentile) and parents' reports on their education and family characteristics associated with overweight (child consumes: sweets in front of TV, soft drinks; family joined time: outdoor, breakfast, sports; cooking; child sets table; role model). Model-based single mediation analyses decomposed the total effect of highest parental education on overweight into direct (unmediated) and indirect (mediated) effects (OR, 95\% CI). Results Girls and boys with low parental education had higher odds for overweight than children with high/medium education. Among boys, low education influenced the risk of overweight via indirect effects of i. 'sweets consumption in front of TV' (OR = 1.31, 1.05-1.59) and ii. 'no joined sports' (OR = 1.14, 1.00-1.44). The direct effect of low education only remained significant when 'no joined sports' was considered (OR = 2.19, 1.11-5.19). Among girls, family characteristics measured here did not explain SEP differences in overweight. Conclusions The family characteristics 'sweets consumption in front of TV' and 'no joined sports' contribute to inequalities in overweight among boys, but not among girls. Therefore, more gender-sensitive research is needed to identify family risk and protective characteristics that explain health inequalities among both boys and girls.}, language = {en} } @misc{NovelliSchuettigSpalleketal., author = {Novelli, Anna and Sch{\"u}ttig, Wiebke and Spallek, Jacob and Wachtler, Benjamin and Diehl, Katharina and Moor, Irene and Richter, Matthias and Dragano, Nico and Sundmacher, Leonie}, title = {Correlation of mesolevel characteristics of the healthcare system and socioeconomic inequality in healthcare use: a scoping review protocol}, series = {BMJ Open}, volume = {11}, journal = {BMJ Open}, number = {2}, issn = {2044-6055}, doi = {10.1136/bmjopen-2020-044301}, pages = {7}, abstract = {Introduction Although the impact of macrolevel characteristics of health systems on socioeconomic inequity in health has been studied extensively, the impact of access characteristics on a smaller scale of health systems has received less attention. These mesolevel characteristics can influence access to healthcare and might have the potential to moderate or aggravate socioeconomic inequity in healthcare use. This scoping review aims to map the existing evidence of the association of socioeconomic inequity in healthcare use and mesolevel access characteristics of the health system. Methods and analysis In conducting the scoping review, we follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Extension for Scoping Reviews. The search will be carried out in four scientific databases: MEDLINE (via PubMed), Web of Science, Scopus and PsycINFO. Main eligibility criteria are inclusion in the analysis of a measure of socioeconomic position, a measure of individual healthcare use and a mesolevel determinant of access to healthcare services. The selection process consists of two consecutive screening stages (first: title/abstract; second: full text). At both stages, two reviewers independently assess the eligibility of studies. In case of disagreement, a third reviewer will be involved. Cohen's kappa will be calculated to report inter-rater agreement between reviewers. Results are synthesised narratively, as a high heterogeneity of studies is expected. Ethics and dissemination No primary data are collected for the presented scoping review. Therefore, ethical approval is not necessary. The scoping review will be published in an international peer-reviewed journal, and findings will be presented on national and international conferences.}, language = {en} } @misc{BlumeRattayHoffmannetal., author = {Blume, Miriam and Rattay, Petra and Hoffmann, Stephanie and Spallek, Jacob and Sander, Lydia and Herr, Raphael and Richter, Matthias and Moor, Irene and Dragano, Nico and Pischke, Claudia R. and Iashchenko, Iryna and H{\"o}vener, Claudia and Wachtler, Benjamin}, title = {Health Inequalities in Children and Adolescents: A Scoping Review of the Mediating and Moderating Effects of Family Characteristics}, series = {International Journal of Environmental Research and Public Health}, volume = {18}, journal = {International Journal of Environmental Research and Public Health}, number = {15}, issn = {1660-4601}, doi = {10.3390/ijerph18157739}, pages = {33}, abstract = {This scoping review systematically mapped evidence of the mediating and moderating effects of family characteristics on health inequalities in school-aged children and adolescents (6-18 years) in countries with developed economies in Europe and North America. We conducted a systematic scoping review following the PRISMA extension for Scoping Reviews recommendations. We searched the PubMed, PsycINFO and Scopus databases. Two reviewers independently screened titles, abstracts and full texts. Evidence was synthesized narratively. Of the 12,403 records initially identified, 50 articles were included in the synthesis. The included studies were conducted in the United States (n = 27), Europe (n = 18), Canada (n = 3), or in multiple countries combined (n = 2). We found that mental health was the most frequently assessed health outcome. The included studies reported that different family characteristics mediated or moderated health inequalities. Parental mental health, parenting practices, and parent-child-relationships were most frequently examined, and were found to be important mediating or moderating factors. In addition, family conflict and distress were relevant family characteristics. Future research should integrate additional health outcomes besides mental health, and attempt to integrate the complexity of families. The family characteristics identified in this review represent potential starting points for reducing health inequalities in childhood and adolescence.}, language = {en} } @misc{HerkeMoorWinteretal., author = {Herke, Max and Moor, Irene and Winter, Kristina and Hack, Miriam and Hoffmann, Stephanie and Spallek, Jacob and Hilger-Kolb, Jennifer and Herr, Raphael and Pischke, Claudia R. and Dragano, Nico and Novelli, Anna and Richter, Matthias}, title = {Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: a scoping review}, series = {BMJ Open}, volume = {12}, journal = {BMJ Open}, number = {2}, issn = {2044-6055}, doi = {10.1136/bmjopen-2021-052925}, pages = {16}, abstract = {Objectives: To synthesise the evidence on the role of compositional or contextual characteristics of schools in the association between students' socioeconomic position and their health in primary and secondary education in developed economies. Design: Scoping review. We included studies examining the role of at least one school or class characteristic on students' health inequalities and was published since 1 January 2000, in English or German. We searched PubMed/Medline, Web of Science and Education Resources Information Center. We provided a narrative synthesis and an overview of findings. School characteristics were grouped into five broad categories: school composition, school climate, school policies and organisation, food environment and facilities. Results: Of 8520 records identified, 26 studies were included. Twelve studies found a moderating and 3 a mediating effect. The strongest evidence came from studies examining the moderating effect of school composition, that is, the negative impact of a low individual socioeconomic position on mental health and well-being was aggravated by a low average socioeconomic position of schools. Evidence concerning the role of school climate, school stratification (eg, performance base tracking) and sponsorship, food environment and sport facilities and equipment was generally weak or very weak and mostly based on singular findings. Overall, favourable meso-level characteristics mitigated the negative impact of low individual socioeconomic position on health outcomes. Conclusions: School characteristics affect health inequalities in children and adolescents to some degree, but future research is necessary to strengthen the existing evidence and address under-represented aspects in school characteristics and health outcomes.}, language = {en} } @misc{MatosFialhoDraganoReuteretal., author = {Matos Fialho, Paula M. and Dragano, Nico and Reuter, Matthias and Metzendorf, Maria-Inti and Richter, Bernd and Richter, Matthias and Spallek, Jacob and Diehl, Katharina and Lampert, Thomas and Pischke, Claudia R.}, title = {Health inequalities during school-to-work transitions among young adults: Mapping the evidence}, series = {European Journal of Public Health}, volume = {30}, journal = {European Journal of Public Health}, number = {Supplement_5}, doi = {10.1093/eurpub/ckaa166.278}, pages = {1}, abstract = {Background School-to-work transition is a sensitive period that can have a substantial impact on health over the life course. Previous studies suggest pronounced health inequalities during this period but little is known about the determinants at the individual, meso- and macro-levels. We aim to further elucidate possible health inequalities during school-to-work transitions with a focus on multilevel determinants, e.g. evidence on potential effects of contextual and compositional factors of specific institutions involved. Methods We are currently conducting a scoping review (funded by the German Research Foundation) to map the evidence on the above mentioned topic among young adults (aged 16-24 years), following the methodological framework proposed by Arksey and {\´O}Malley and PRISMA. The literature search was performed in Ovid MEDLINE, Web of Science, ILO and NIOSH, using sensitive search strategy developed by text-analysis. Only articles published between January 2000 - February 2020 and written in English or German are considered. The selection process is conducted following a two-step approach:1) screening of titles and abstracts 2) screening of full-texts by two independent reviewers. Any discrepancies in the selection process are resolved by a third researcher. Preliminary Results Following the five stages of the methodological framework, the scoping review is currently in stage 3 (study selection-screening phase). We found 25,069 potentially relevant articles in our primary search. 15,508 articles remained after the duplicates were removed. Up to now, 8,825 papers were screened of which 7,629 were excluded and 1,176 included which qualified for full-text reading. Complete results of the scoping review will be presented at the conference. Conclusions This scoping review will improve our knowledge about the emergence and development of health inequalities during school-to-work transitions by examining health of individuals in different institutional contexts. Key messages - Improving our knowledge of health inequalities during school-to-work transitions. - the role of determinants at the individual, meso- and macro-levels during this stage will also be examined.}, language = {en} } @techreport{HoffmannWachtlerSanderetal., author = {Hoffmann, Stephanie and Wachtler, Benjamin and Sander, Lydia and Blume, Miriam and Hilger-Kolb, Jennifer and Herke, Max and Matos Fialho, Paula M. and Pischke, Claudia R. and Novelli, Anna and Lampert, Thomas and Spallek, Jacob}, title = {Health inequalities among infants and pre-school children: Protocol for a scoping review examining the moderating and mediating role of contextual and compositional family characteristics}, publisher = {Open Science Framework}, doi = {10.17605/OSF.IO/3U4ST}, abstract = {Background: Although early childhood is a life period of overall good health, research shows that families' socioeconomic position (SEP) is affecting children's health from pregnancy on, ultimately leading to health inequalities. Little is currently known about the pathways by which family SEP is influencing child health and health-related behaviour, and which role family characteristics play. The scoping review therefore aims to screen the international literature on the mediating and moderating effects of contextual and compositional family characteristics on socioeconomic health risks of pre-school children in developed countries. Methods: Following the PRISMA guidelines for scoping reviews, three online databases (Pubmed, PsycINFO, and Scopus) will be searched for literature in English or German published after year 2000. The two-step data screening approach and the subsequent data extraction will be conducted independently by two researchers in consideration of specific criteria and a previously tested standardized data extraction form. Due to the broad research question at hand, various study designs (e.g. cross-sectional, intervention, cohort studies, and qualitative studies), SEP measures (e.g. education, income) and compositional (e.g. family size, migration) or contextual (e.g. parenting, housing) family characteristics influencing children's health will be included. Since diverse definitions and reporting formats of subjective health, health behaviour, well-being, and diseases will be considered, a substantial heterogeneity in outcome measures focusing on the age group of 0-6 years is expected. Thus, a narrative synthesis of the findings will be performed according to the Centre for Reviews and Dissemination framework. Ethics and dissemination: Because no primary data will be collected, ethical clearance will not be required. Dissemination will include peer-reviewed publications and conferences.}, language = {en} } @misc{HoffmannSanderRattayetal., author = {Hoffmann, Stephanie and Sander, Lydia and Rattay, Petra and Blume, Miriam and H{\"o}vener, Claudia and Schneider, Sven and Richter, Matthias and Pischke, Claudia R. and Sch{\"u}ttig, Wiebke and De Bock, Freia and Spallek, Jacob}, title = {Do family characteristics contribute to a socioeconomic gradient in overweight in early childhood? - Single mediation analyses of data from German preschool children}, series = {Preventive Medicine Reports}, volume = {33}, journal = {Preventive Medicine Reports}, issn = {2211-3355}, doi = {10.1016/j.pmedr.2023.102178}, abstract = {Children's overweight is strongly associated with family socioeconomic position (SEP) and family characteristics (FC). There is limited research on the extent to which FC account for a socioeconomic gradient in childhood overweight. This study examined whether FC explain SEP differences in the prevalence of overweight. The study used baseline data of preschool-aged children from the German 'PReschool INtervention Study'. The sample (n = 872, 48\% girls) was recruited at kindergartens in Baden-W{\"u}rttemberg, Germany. Data included children's measured weight status and parents' reports on socioeconomic indicators (e.g., school education, vocational education, income) and FC. Variables represent main determinants of overweight (nutrition: sweets consumption in front of TV, soft drink consumption, regular breakfast, child sets table; physical activity: outdoor sports; parental role model). In single mediation analyses indirect effects of SEP on overweight were analysed (OR[95\%CI]). Preschool girls and boys with low parental education had higher odds for overweight than children with high parental education. Among boys, low levels of parental education contributed to the odds of overweight via indirect effects by both factors 'sweets consumption in front of TV' (OR = 1.31[1.05-1.59]) and 'no sports' (OR = 1.14[1.01-1.38]). Among girls, FC measured did not explain SEP differences in overweight. Family nutrition and parental/family physical activity contribute to inequalities in overweight among preschool boys, but not girls. Research is needed to identify FC that explain inequalities in overweight for both.}, 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} } @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 = {Die Rolle der regionalen Gesundheitspolitik f{\"u}r die sozio{\"o}konomische Ungleichheit in der Inanspruchnahme der Gesundheitsleistungen}, series = {Gesundheitswesen}, volume = {84}, journal = {Gesundheitswesen}, number = {08/09}, publisher = {Georg Thieme Verlag}, doi = {10.1055/s-0042-1753865}, pages = {825}, abstract = {Einleitung Die J1 ist eine Vorsorgeuntersuchung, die f{\"u}r Kinder zwischen 12 und 14 Jahren empfohlen ist. Im Gegensatz zu den etablierten U1- bis U9-Untersuchungen f{\"u}r j{\"u}ngere Kinder mit Teilnahmeraten {\"u}ber 90\% liegt die Teilnahme bei der J1 bei etwa 40\%. Ein Grund f{\"u}r die mangelnde Teilnahme an der J1 ist die geringe Bekanntheit bei Eltern und Kindern. Mehrere Bundesl{\"a}nder haben Einladungswesen eingef{\"u}hrt, um Jugendliche zur Teilnahme an der J1 zu motivieren. Die Einladung „Dein Ticket zur J1" wurde Mitte 2017 in Bayern eingef{\"u}hrt. Das „Ticket" ist ein Informationsflyer {\"u}ber die J1 in einer jugendgerechten Gestaltung. Die vorliegende Analyse untersuchte, ob die regionale Informationskampagne zu einer Steigerung der Teilnahme an der J1 gef{\"u}hrt hat, ob die Effekte mit dem sozio{\"o}konomischen Status der Familie (SES) variieren und welche Meso-Ebene-Merkmale des Gesundheitssystems mit der J1-Teilnahme korrelieren. Methoden Um die Wirkung der Intervention zu untersuchen, wurden bundesweite anonymisierte Routinedaten der Techniker Krankenkasse aus den Jahren 2016-2018 sowie ein Difference-in-Differences-Design auf individueller Ebene verwendet. Unter der Annahme eines parallelen Trends auf Bundesl{\"a}nderebene wurde die J1-Teilnahme von 13- und 14-J{\"a}hrigen in Bayern mit anderen Bundesl{\"a}ndern vor und nach der Intervention verglichen. Zus{\"a}tzlich wurde die Analyse f{\"u}r die verschiedenen SES-Gruppen durchgef{\"u}hrt. Wir untersuchten auch, ob Faktoren auf Mesoebene des Gesundheitssystems mit der Teilnahme an der J1 korrelierten. Ergebnisse Die Einf{\"u}hrung von „Dein Ticket zur J1" erh{\"o}hte die Teilnahme an der J1 um 1 \%. Obwohl eine h{\"o}here Bildung und berufliche Stellung der Eltern positiv mit der J1-Teilnahme korrelierten, war der Effekt der Intervention bei Kindern aus Familien mit niedrigerem SES st{\"a}rker (Anstieg um 5 \%). Die Kinderarztdichte auf Kreisebene korrelierte zudem positiv mit der Teilnahme an der J1. Schlussfolgerung Die Intervention hat das Potenzial, die sozio{\"o}konomische Ungleichheit bei der Inanspruchnahme von Gesundheitsleistungen zu verringern, da die Effekte f{\"u}r Kinder aus Familien mit niedrigerem SES st{\"a}rker waren. Es bedarf jedoch weiterer Maßnahmen, um Jugendliche {\"u}ber die J1 und die damit verbundenen gesundheitlichen Vorteile zu informieren. Zuk{\"u}nftige Studien sollten untersuchen, von welchen weiteren Faktoren die Wirksamkeit der Intervention abh{\"a}ngt, wie z. B. die Art und Anzahl der Kommunikationskan{\"a}le.}, language = {de} }