TY - GEN A1 - Wandschneider, Lisa A1 - Sauzet, Odile A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Kleinräumige Merkmale und ihr Einfluss auf ein niedriges Geburtsgewicht – eine theoriegeleitete Analyse T2 - 14. Jahrestagung der DGEpi, 11-13. September, Ulm N2 - Hintergrund: Der Wohnort kann eine Dimension sozialer Ungleichheiten darstellen, und es gibt Hinweise dafür, dass sich dieser bereits auf die perinatale Entwicklung auswirken könnte. Die zugrunde liegenden Wirkmechanismen sind nach wie vor unbekannt; theorie-basierte und hypothesengeleitete Analysen fehlen. Um diesen Herausforderungen zu begegnen, untersucht diese Studie, inwieweit kleinräumige Merkmale zu einem niedrigen Geburtsgewicht beitragen, unabhängig von individuellen Merkmalen. Auf der Grundlage eines konzeptionellen Modells1 wurden kleinräumige Merkmale ausgewählt, erhoben und deren Auswirkungen auf niedriges Geburtsgewicht analysiert. Methoden: Die Individualdaten stammen aus der Geburtskohortenstudie „Gesundheit von Babys und Kindern in Bielefeld“. Die Stichprobe besteht aus 958 Frauen und ihren Säuglingen, verteilt auf 80 statistische Bezirke in Bielefeld. Kleinräumige Daten wurden anhand von lokalen Lärmkarten, dem Emissionskataster, Google Street View und dem Melderegister erhoben. Zur Quantifizierung des Einflusses kleinräumiger Merkmale wurde eine lineare Mehrebenenanalyse mit einer Zwei-Ebenen-Struktur (Individuen, die in statistische Bezirke eingebettet sind) durchgeführt. Ergebnisse: Insgesamt sind die Auswirkungen der ausgewählten kleinräumigen Merkmale gering bis nicht existent, es zeigen sich keine signifikanten Effekten für niedriges Geburtsgewicht. Tendenziell weisen Neugeborene aus ästhetisch weniger ansprechenden und subjektiv unsicher wahrgenommenen Stadtteilen einen höheren Anteil an niedrigem Geburtsgewicht auf. Schlussfolgerungen: Die Analyse liefert keine eindeutigen Hinweise auf negative Auswirkungen kleinräumiger Faktoren auf ein niedriges Geburtsgewicht. Auf methodischer Seite bestätigt die Studie, dass ein angemessener Stichprobenumfang, eine zuverlässige Expositionsabschätzung und die Operationalisierung des kleinräumigen Kontextes mit Blick auf die verfügbaren Daten die zentralen Herausforderungen des Forschungsfeldes darstellen. KW - Geburtsgewicht Y1 - 2019 UR - https://www.eventclass.org/contxt_dgepi2019/online-program/session?s=AG13%7C1 SP - 113 EP - 113 ER - TY - GEN A1 - Schilling, Laura A1 - Spallek, Jacob A1 - Maul, Holger A1 - Schneider, Sven T1 - E-Zigaretten und Tabakzigaretten in der Schwangerschaft – eine Analyse von aktiver und passiver Exposition und Einstellung unter Schwangeren in Deutschland T2 - 14. Jahrestagung der DGEpi, 11.-13. Septmeber 2019, Ulm N2 - Hintergrund: In Deutschland greift ein Zehntel der Schwangeren zur Tabakzigarette. Gleichzeitig verbreiten sich E-Zigaretten insbesondere unter jungen Erwachsenen in Deutschland zunehmend. Das Ziel dieser Studie war es, die aktive und passive Exposition durch E-Zigaretten- und Tabakzigaretten sowie die Einstellung zur E-Zigarette unter Schwangeren in Deutschland zu erforschen. Methoden: Im Rahmen der STEP (STudy on E-cigarettes and Pregnancy) beantworteten 575 Schwangere an einer Geburtsklinik in Hamburg von April 2018 bis Januar 2019 Fragen zur E-Zigaretten- und Tabakzigarettenexposition sowie ihren Einstellungen zur E-Zigarette. Ergebnisse: Insgesamt nutzten 1,2% der Befragten ausschließlich E-Zigaretten, 6,7% E- und Tabakzigaretten und 20,3% ausschließlich Tabakzigaretten vor der Schwangerschaft. In der Schwangerschaft nutzten 0,5% E-Zigaretten und 9,1% Tabakzigaretten. 86,9% aller Schwangeren waren der Ansicht, dass E-Zigaretten nicht als Alternative zu Tabakzigaretten genutzt werden sollten. Befragte, die die Tabakzigarette während der Schwangerschaft nutzten, vertraten seltener diese Einstellung als Nichtnutzer (78,0% vs. 88,0%; p=0,045). Der aktuelle Konsum der E-Zigarette (bzw. Tabakzigarette) durch den Partner erfolgte bei 5,5% (bzw. 24,4%) der Befragten. 18,5% (bzw. 9,3%) der Partner mit E-Zigarettenkonsum (bzw. Tabakzigarettenkonsum) konsumierten zuhause. Schlussfolgerungen: Die aktive E-Zigarettenexposition ist – im Gegensatz zur aktiven Tabakzigarettenexposition - in der Schwangerschaft bisher gering. Gleichzeitig kommt eine passive Exposition durch den konsumierenden Partner von Schwangeren häufiger bei der E-Zigarette vor. Die Ergebnisse betonen die Wichtigkeit der weiterführenden Tabakprävention und der Erforschung der Gesundheitsrisiken des Passivdampfes in der Schwangerschaft. KW - E-Zigaretten KW - Tabakzigaretten KW - Schwangerschaft Y1 - 2019 UR - https://www.eventclass.org/contxt_dgepi2019/online-program/session?s=AG13%7C1 SP - 117 EP - 117 ER - TY - GEN A1 - Grosser, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi-Study. Analysis of a birth cohort study in Germany T2 - Gesundheitswesen 2019 N2 - Background: Breastfeeding is beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, which has only been reached by 34% in 2012. The WHO's aim of exclusively breastfeeding for six months was reached by 19% only. Socio-economic status and migration background have been identified to be associated with duration of breastfeeding but little is known about the impact of psychosocial factors e.g. personality traits and social support. We hypothesized that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding. Methods: Baseline and follow up data of the Bielefeld BaBi birth cohort (2013 – 16) were analysed. Bivariate and multivariate analyses were performed in order to identify psychosocial determinants for fully breastfeeding for four and six months. Results: Out of 780 BaBi study participants, 548 fully breastfeed for four months (70.3%) and 279 continued until at least six months (35.8%). Logistic regression analyses shows that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed (OR 7.3 [C.I. 4.54.-11.21) and the attendance of antenatal class (OR 1.4 [C.I. 1.01.-2.06). Personality characteristics, social status und migration background showed no significant association with breastfeeding duration. Conclusion: Our study results suggest to promote individuals' breastfeeding intention and the attendance of antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in mother and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration. KW - Breastfeeding Y1 - 2019 U6 - https://doi.org/10.1055/s-0039-1694422 VL - 81 IS - 08/09 SP - 686 EP - 686 PB - Georg Thieme Verlag CY - Stuttgart ER - TY - GEN A1 - Schilling, Laura A1 - Schneider, Sven A1 - Karlheim, Christoph A1 - Maul, Holger A1 - Tallarek, Marie A1 - Spallek, Jacob T1 - Perceived threats, benefits and barriers of e-cigarette use during pregnancy. A qualitative analysis of risk perception within existing threads in online discussion forums T2 - Midwifery N2 - Objective Previous studies have shown that e-cigarettes are perceived as being less harmful than tobacco cigarettes by pregnant women and might be used to quit smoking during pregnancy. Our aim was to further explore and characterise perceived threats, benefits and barriers of e-cigarette use during pregnancy. Methods Our STudy on E-cigarettes and Pregnancy (STEP) was, among others, based on a netnographic approach of analysing existing threads in German-speaking online discussion forums dealing with perceived threats and benefits of e-cigarette use during pregnancy. For the analysis, we used an inductive-deductive qualitative content analysis. Findings Based on 25 online discussion threads containing 1552 posts, we identified perceived threats, perceived benefits and perceived barriers to e-cigarette use during pregnancy, among others, as main themes. Subthemes identified within the main theme perceived threats were severe nicotine related health risks, potential health risks of additional ingredients, relative risks and lack of knowledge and research studies. As perceived benefits, we identified possibility and facilitation of smoking cessation, harm reduction and financial benefits. Perceived barriers were lack of satisfaction and social stigma. Conclusion Our qualitative results suggest that the perception of the health threats related to e-cigarette use during pregnancy varies according to the nicotine content and the perception of relative risks compared with tobacco cigarettes. In addition to this, risk perception is defined through further health and non-health related barriers and benefits (e.g. suitability of e-cigarettes as a smoking cessation aid, social stigma). KW - Electronic cigarette KW - Pregnancy KW - Risk perception KW - Health beliefs KW - Online forums Y1 - 2019 U6 - https://doi.org/10.1016/j.midw.2019.102533 SN - 0266-6138 VL - 79 ER - TY - GEN A1 - Löffler, Antje A1 - Hoffmann, Stephanie A1 - Fischer, Stefanie A1 - Spallek, Jacob T1 - Ambulante Haus- und Facharztversorgung im ländlichen Raum in Deutschland – Wie stellt sich die Versorgungssituation aus Sicht älterer Einwohner im Landkreis Oberspreewald-Lausitz dar? T2 - Das Gesundheitswesen N2 - Ziel der Studie: Die medizinische Versorgung der Bundesrepublik Deutschland ist von Verteilungsproblemen geprägt. Vor allem in ländlichen Regionen droht Unterversorgung. In dieser Studie wurde untersucht, wie ältere Bewohner des Landkreises Oberspreewald-Lausitz (OSL) des Bundeslandes Brandenburg ihre derzeitige medizinische Versorgungssituation einschätzen und welche Wünsche und Bedenken sie hinsichtlich deren zukünftigen Entwicklung im Jahr 2030 haben. Methodik: In der vorliegenden Querschnitterhebung wurden 3006 Einwohner im Alter von 50–56 Jahren und von 65–71 Jahren des Landkreises OSL befragt. Ein Fragebogen mit geschlossenem und offenem Antwortformat wurde zur Erfassung der Zielstellung eingesetzt. Ergebnisse: In der vorliegenden Untersuchung äußerten sich die Einwohner des Landkreises OSL aktuell zufrieden oder sehr zufrieden mit der hausärztlichen (93,1%) und der fachärztlichen Versorgung (83,3%). Innerhalb des Landkreises zeigen sich in einigen Regionen Defizite. Im Gebiet Lauchhammer/Schwarzheide äußerten sich insbesondere zur fachärztlichen Versorgung 27,1% der Befragten unzufrieden oder sehr unzufrieden. Alternative und ergänzende Versorgungsangebote wie die Community Nurse sind akzeptierte, jedoch derzeit unterrepräsentierte Maßnahmen zur Sicherstellung der zukünftigen medizinischen Versorgung. Schlussfolgerung: Derzeit zeigen sich Bewohner des ländlichen, metropolenfernen Landkreises OSL zufrieden mit der ambulanten medizinischen Versorgung, jedoch stellen sich in einigen Regionen Defizite, insbesondere bei der zukünftigen Facharztversorgung dar. Alternative Versorgungsangebote wie Telemedizin sind seitens der Bewohner gewünschte Maßnahmen zur Ergänzung und Sicherstellung der zukünftigen medizinischen Versorgung im ländlichen Raum. KW - Versorgung KW - Hausarzt KW - Facharzt KW - ländlicher Raum Y1 - 2019 U6 - https://doi.org/10.1055/a-1010-6277 SN - 0941-3790 VL - 83 (2021) IS - 1 SP - 47 EP - 52 ER - TY - GEN A1 - Miani, Celine A1 - Ludwig, A. A1 - Breckenkamp, Jürgen A1 - Sauzet, Odile A1 - Doyle, Ina-Merle A1 - Höller-Holtrichter, Chantal A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study T2 - BMC pregnancy and childbirth N2 - BACKGROUND: Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. METHODS: In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. RESULTS: Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01-3.81; and aOR: 2.36, CI: 1.27-4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups. CONCLUSIONS: Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care. KW - Acculturation KW - Birth cohort KW - Caesarean section KW - Education KW - Emergency KW - Germany KW - Income KW - Migration KW - Obstetric care KW - Socioeconomic determinants Y1 - 2020 U6 - https://doi.org/10.1186/s12884-020-2725-5 SN - 1471-2393 VL - 20 ER - TY - GEN A1 - Schilling, Laura A1 - Schneider, Sven A1 - Maul, Holger A1 - Spallek, Jacob T1 - STudy on E-Cigarettes and Pregnancy (STEP)–Study Protocolof a Mixed Methods Study on Risk Perception of E-Cigarette UseDuring Pregnancy and Sample Description T2 - Geburtshilfe und Frauenheilkunde N2 - Introduction: During pregnancy, the motherʼs healthy life-style is crucial for the health of the fetus. Potential risk factorsfor maternal and child health should therefore be identifiedand reduced as early as possible. The consumption of e-ciga-rettes represents one of these potential risk factors. Exploringrisk perceptions about e-cigarette use during pregnancy canprovide early indications of possible user motives. Therefore,our mixed methodsSTudy onE-cigarettes andPregnancy(STEP) aimed to comprehensively analyze risk perceptionsabout e-cigarette use during pregnancy based on anInte-gratedHealthBeliefModel (IHBM). This paper describes thestudy design, methods, sample population and limitations ofSTEP. Methods: Our sequential mixed methods study combinedqualitative and quantitative approaches. In the qualitativesection of the study which preceded the quantitative part ofthe study, we aimed to characterize risk perceptions aboute‑cigarette use during pregnancy. We used a netnographic re-search approach which analyzed discussion threads in onlineforums dealing with e-cigarette use during pregnancy. Theanalysis was based on an IHBM. Identified themes were incor-porated in the questionnaire which was developed for the quantitative part of the study. The quantitative section aimedto quantify, among other things, perceived threats, barriersand benefits and to explore differences in risk perception ac-cording to sociodemographic characteristics and tobacco ande-cigarette usage. Results: In the qualitative section, 1552 posts in 25 online dis-cussion threads dealing, inter alia, with e-cigarette use duringpregnancy were identified. The quantitative part looked atthe responses in the questionnaires handed in by 575 preg-nant women who attended a hospital in Hamburg (Germany)from April 2018 to January 2019 (response rate: 27.5%). Conclusion: Data collection was successful for both the qual-itative and quantitative parts of the study. When interpretingthe results of STEP, different limitations should be taken intoaccount. The results of STEP provide starting points for thedevelopment of tailored preventive measures for pregnantwomen. KW - e‑cigarette KW - pregnancy KW - risk perception KW - mixed methods study KW - Health Belief Model Y1 - 2020 UR - https://www.thieme-connect.de/products/ejournals/pdf/10.1055/a-1061-7288.pdf U6 - https://doi.org/10.1055/a-1061-7288 SN - 1438-8804 SN - 0016-5751 VL - 80 IS - 01 SP - 66 EP - 75 ER - TY - CHAP A1 - Tallarek, Marie A1 - Mlinarić, Martin A1 - Spallek, Jacob ED - Tiemann, Michael ED - Mohokum, Melvin T1 - Migration – Bedeutung und Implikationen für die Prävention und Gesundheitsförderung T2 - Prävention und Gesundheitsförderung. Springer Reference Pflege – Therapie – Gesundheit N2 - Die Bevölkerungsgruppe der Menschen mit Migrationshintergrund umfasst fast ein Viertel der Gesamtbevölkerung in Deutschland und ist höchst heterogen. Pauschalisierende Aussagen zum Gesundheitsstatus dieser Gruppe sind daher nicht möglich. Menschen mit Migrationshintergrund sind nicht grundsätzlich gesünder oder kränker als die Mehrheitsbevölkerung. Allerdings können sie sich aufgrund von Expositionen vor, während und nach der Migration in ihren Gesundheitschancen und -risiken von der Mehrheitsbevölkerung unterscheiden. Prävention und Gesundheitsförderung sollten daraus resultierende spezifische Bedarfe ebenso berücksichtigen wie die Diversität der Bevölkerung insgesamt. Erfolgversprechend ist eine Kombination aus diversitätssensiblen, für die Gesamtbevölkerung zugänglichen Angeboten und migrationsspezifischen Ansätzen in besonders risikoreichen Situationen. Kommunale, settingorientierte sowie soziokulturell angepasste Angebote verbessern die Erreichbarkeit der Zielgruppen maßgeblich. KW - Migration KW - Prävention KW - Gesundheitsförderung Y1 - 2019 UR - https://link.springer.com/referenceworkentry/10.1007%2F978-3-662-55793-8_28-1 SN - 978-3-662-55793-8 U6 - https://doi.org/10.1007/978-3-662-55793-8_28-1 SN - 2662-6942 SN - 2662-6950 SP - 1 EP - 13 PB - Springer CY - Berlin, Heidelberg ET - 1 ER - TY - GEN A1 - Miani, Céline A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Health of the offspring of immigrants: the BaBi birth cohort study T2 - Public Health Forum N2 - Children with a migration background are more at risk of health-related problems than those without a migration background. The German health system still does not adequately meet the challenges of on increasingly heterogeneous population, not least due to a lack of adequate epidemiological data and models. The BaBi study contributes to gaining new insights in the development of health inequalities due to cultural diversity in Germany, with a focus on pregnancy and early childhood. KW - cohort study KW - early childhood KW - migration KW - quantitative analysis KW - social epidemiology Y1 - 2019 UR - https://www.degruyter.com/view/j/pubhef.2019.27.issue-4/pubhef-2019-0062/pubhef-2019-0062.xml U6 - https://doi.org/10.1515/pubhef-2019-0062 SN - 1876-4851 SN - 0944-5587 VL - 27 IS - 4 SP - 298 EP - 300 ER - TY - GEN A1 - Grosser, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi cohort study, Germany T2 - European Journal of Public Health N2 - Background: Breastfeeding is considered beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, a goal reached by only 34% of mothers in 2012. The WHO’s recommendation of exclusively breastfeeding for six months was met by 19% only. Hardly modifiable factors such as socio-economic status and migration background have been associated with duration of breastfeeding but little is known about the impact of psychosocial factors such as personality traits and social support. We hypothesise that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding. Methods: We analyse baseline and follow-up data of the Bielefeld BaBi birth cohort (2013-16). They include detailed migration and socio-economic backgrounds, as well as three measures of psychological characteristics: the optimism scale, the Big Five inventory and the locus of control scales. We perform bivariate and multivariate analyses in order to identify psychosocial determinants of fully breastfeeding for four and six months. Results: Out of 780 BaBi study participants, 548 fully breastfed for four months (70.3%), of which 279 continued until at least six months (35.8%). Logistic regression analyses show that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed and the attendance of antenatal class during this or previous pregnancies. Personality characteristics, social status and migration background show however no significant association with breastfeeding duration. Conclusions: Our study results support the promotion of individuals’ breastfeeding intention and attendance to antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in maternal and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration. KW - breastfeeding KW - cohort study KW - psychosocial Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz187.122 SN - 1464-360X SN - 1101-1262 VL - 29 IS - 4 ER - TY - GEN A1 - Sauzet, Odile A1 - Zolitschka, Kim Alexandra A1 - Spallek, Jacob A1 - Breckenkamp, Jürgen A1 - Razum, Oliver T1 - An ego-centred approach for the evaluation of health inequalities in urban areas T2 - European Journal of Public Health N2 - Background: Neighbourhood possesses attributes, structural, physical and social, for which pathways to health inequalities could be hypothesized. Hence, neighbourhood is a complex mixture of factors which cannot be simply defined by a delineation on a map, making common definitions of neighbourhood (e.g. administrative borders) problematic. We present a new concept for the evaluation of contextual health inequalities in an urban setting. Methods: An ego-centred approach to neighbourhood effects on health allows to establish to what degree the health outcomes of a person are on average correlated to the health outcomes of his/her neighbours. This approach does not necessitate the definition of what a neighbourhood is, or of its boundaries. Using data from the BaBi birth cohort following up 958 mother-child pairs in Bielefeld/Germany we illustrate how the method provides information about the spatial structure of a possible association between unmeasured neighbourhood factors and birthweight. Spatially correlated birthweight indicates a neighbourhood effect on maternal health. Results: A parametric model of the correlation structure gives two indicators: a distance after which health outcomes are no longer correlated (practical range), and the strength of correlation (RSV). We modelled birthweight directly and residuals after controlling for (spatially correlated) covariates. After adjusting for the mother’s demographics and neighbourhood characteristics, birthweights remained spatially correlated with RSV of 11% and a practical range of 128 m. Conclusions: Modelling the spatial correlation of a health outcome provides a measure of the degree of health correlation, thus offering new evidence on the production of health inequalities while incorporating current modelling approaches. Moreover, it measures heterogeneity in a city. This could be used as an indicator for policy makers or town planners to identify areas in need of socioeconomic investment. KW - health inequalities KW - urban KW - birth weight KW - child KW - demography KW - ego KW - Germany KW - socioeconomic factors KW - health disparity KW - towns KW - maternal health Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz186.243 SN - 1101-1262 SN - 1464-360X VL - 29 IS - 4 ER - TY - GEN A1 - Schröder, Sara Lena A1 - Hoebel, Jens A1 - Roick, Julia A1 - Markert, Jenny A1 - Spallek, Jacob A1 - Knesebeck, Olaf von dem A1 - Richter, Matthias T1 - Inequalities in the utilisation of primary and specialist physicians in Europe - a systematic review T2 - European Journal of Public Health N2 - Background: The evidence on inequalities in health clearly shows that people with lower socioeconomic status (SES) have poorer health and higher mortality. Nevertheless, generalized evidence for inequalities in healthcare is lacking. So far, the international literature was only summarised with regard to inequalities in the utilisation of disease-specific treatment. Therefore, our aim was to synthetize the literature on socioeconomic inequalities in the utilisation of primary and specialist physicians in the general population. Methods: This systematic review searched Medline und Web of Science from 2004 to 2018. Articles that reported quantitative data on the association of SES with utilisation of primary or specialist physicians in Europe were included. Title and abstract screening were performed by two independent researchers and 50 full texts are currently sifted whether they fulfil the inclusion criteria. Results: The studies analysed utilisation of physicians in terms of probability or frequency. The initial check of the studies indicates that socioeconomic inequalities in the utilisation of physicians differ between primary and specialist care. Specialist physicians were found to be visited with a higher probability and more often by the least disadvantaged in most studies. Inequalities in the utilisation of primary physicians revealed to be more diverse with a weak pattern of equally distributed probability of GP visits and more frequent utilisation by the disadvantaged. Conclusions: The preliminary results indicate that pro-rich utilisation seems to be more pronounced in visiting specialists compared to primary health care. Aiming to reduce inequalities in healthcare, public health actions might primarily focus on reaching a needs-based consultation of specialist physicians. KW - Inequalities KW - Review KW - Primary health care KW - specialist health care KW - utilization Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz186.377 SN - 1101-1262 SN - 1464-360X VL - 29 IS - 4 ER - TY - GEN A1 - Scholaske, Laura A1 - Rodriguez, Norma A1 - Sari, Nida Emel A1 - Spallek, Jacob A1 - Ziegler, Matthias A1 - Entringer, Sonja T1 - The German Version of the Multidimensional Acculturative Stress Inventory (MASI) for Turkish-Origin Immigrants. Measurement Invariance of Filter Questions and Validation T2 - European Journal of Psychological Assessment N2 - The Multidimensional Acculturative Stress Inventory (MASI) is an established measure of acculturative stress for people of Mexican origin living in the USA that has been associated with mental health outcomes in this population. We translated the MASI into German and adapted it for use with Turkish-origin immigrants in Germany. The MASI includes filter questions asking if a potentially stressful event had actually occurred before reporting the stress appraisal of these situations. Measurement invariance testing has become a standard practice to evaluate questionnaire translations, however, measurement invariance of filter questions has been scarcely studied. In Study 1, we evaluated measurement invariance of the filter questions between a German-based Turkish sample (N = 233) and the Mexican-origin sample from the original study (N = 174) and could show partial strong factorial invariance for three of the four factors. In Study 2, a validation study, relations between the German MASI scores and measures of acculturation and stress indicated discriminant validity. This study contributes to research on measurement invariance of filter questions, thereby providing a measure of acculturative stress that can be used in future research to understand the etiology of health disparities in Turkish-origin immigrants in Germany. KW - German Multidimensional Acculturative Stress Inventory KW - Measurement invariance KW - Validation KW - Filter questions KW - Turkish-origin immigrants Y1 - 2020 U6 - https://doi.org/10.1027/1015-5759/a000567 SN - 2151-2426 VL - 36 IS - 5 SP - 889 EP - 900 ER - TY - GEN A1 - Spallek, Jacob A1 - Scholaske, Laura A1 - Kurt, Medlin A1 - Lindner-Matthes, Denise A1 - Entringer, Sonja T1 - Intergenerational transmission of health disparities among Turkish-origin immigrants in Germany: study protocol of a multi-centric cohort study (BaBi-stress and BaBeK study) T2 - BMC pregnancy and childbirth N2 - Background: Immigrants in Germany exhibit higher levels of social disadvantage when compared to the non-immigrated population. Turkish-origin immigrants constitute an important immigrant group in Germany and show disparities in some health domains that are evident from birth onwards. Several studies have shown the mechanisms by which social disadvantage is biologically embedded to affect health over the lifespan. Relatively little, however, is still known about if and how the maternal social situation is transmitted to the next generation. This study therefore aims to analyse the effects of maternal socioeconomic status and migration status on stress-related maternal-placental-fetal (MPF) biological processes during pregnancy on infant birth and health outcomes. Methods: This longitudinal cohort study of N = 144 child-mother dyads is located at two study sites in Germany and includes pregnant women of Turkish origin living in Germany as well as pregnant German women. During pregnancy, MPF stress biology markers from maternal blood and saliva samples, maternal socio-economic and migration-related information, medical risk variables and psychological well-being are assessed. After birth, infant anthropometric measures and developmental outcomes are assessed. The same measures will be assessed in and compared to Turkish pregnant women based on a collaboration with BABIP study in Istanbul. Discussion: This is the first study on intergenerational transmission of health disparities in Germany with a focus on women of Turkish-origin. The study faces similar risks of bias as other birth cohorts do. The study has implemented various measures, e.g. culturally sensitive recruitment strategies, attempt to recruit and follow-up as many pregnant women as possible independent of their social or cultural background. Nevertheless, the response rate among lower-educated families is lower. The possibility to compare results with a cohort from Turkey is a strength of this study. However, starting at different times and with slightly different recruitment strategies and designs may result in cohort effects and may affect comparability of the sub-cohorts. KW - Transmission of health inequalities KW - Stress biology KW - Turkish immigrants KW - Pregnancy KW - Birth Y1 - 2020 U6 - https://doi.org/10.1186/s12884-020-2853-y VL - 20 IS - 1 SP - 158 ER - TY - GEN A1 - Ludwig, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi-Study. Analysis of a birth cohort study in Germany T2 - Midwifery N2 - Breastfeeding is beneficial for both mother and child. A breastfed child can benefit from improved mental developments, protection against infectious diseases and infectious disease mortality, and a decreased risk of overweight and obesity (Whalen and Cramton 2010)(Regional Office for Europe (World Health Organisation) 2019). Furthermore, there is evidence on protection against type 1 and 2 diabetes, allergic rhinitis, asthma or wheezing, atopic dermatitis, childhood leukemia, hypercholesterolemia later in life, sudden infant death syndrome (Whalen and Cramton 2010) and malocclusion (Victora et al. 2016). Breastfeeding women have a lower risk of breast and ovarian cancer, postpartum depression, and type 2 diabetes. They can, furthermore, benefit from prolonged lactational amenorrhea (Victora et al. 2016), improved postpartum sleep (Whalen and Cramton 2010) and postpartum weight loss (Kramer and Kakuma 2012). KW - psychosocial factors KW - breastfeeding duration KW - birth KW - cohort study Y1 - 2020 U6 - https://doi.org/10.1016/j.midw.2020.102688 SN - 1532-3099 SN - 0266-6138 VL - 86 ER - TY - GEN A1 - Wandschneider, Lisa A1 - Sauzet, Odile A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Small-Area Factors and Their Impact on Low Birth Weight—Results of a Birth Cohort Study in Bielefeld, Germany T2 - Frontiers in Public Health N2 - Introduction: The location of residence is a factor possibly contributing to social inequalities and emerging evidence indicates that it already affects perinatal development. The underlying pathways remain unknown; theory-based and hypothesis-driven analyses are lacking. To address these challenges, we aim to establish to what extent small-area characteristics contribute to low birth weight (LBW), independently of individual characteristics. First, we select small-area characteristics based on a conceptual model and measure them. Then, we empirically analyse the impact of these characteristics on LBW. Material and methods: Individual data were provided by the birth cohort study “Health of infants and children in Bielefeld/Germany.” The sample consists of 892 eligible women and their infants distributed over 80 statistical districts in Bielefeld. Small-area data were obtained from local noise maps, emission inventory, Google Street View and civil registries. A linear multilevel analysis with a two-level structure (individuals nested within statistical districts) was conducted. Results: The effects of the selected small-area characteristics on LBW are small to non-existent, no significant effects are detected. The differences in proportion of LBW based on marginal effects are small, ranging from zero to 1.1%. Newborns from less aesthetic and subjectively perceived unsafe neighbourhoods tend to have higher proportions of LBW. Discussion: We could not find evidence for negative effects of small-area factors on LBW, but our study confirms that obtaining adequate sample size, reliable measure of exposure and using available data for operationalisation of the small-area context represent the core challenges in this field of research. KW - low birth weight KW - small-area analysis KW - multilevel analysis KW - virtual audit KW - noise pollution KW - fine particulate matter KW - socioeconomic deprivation KW - cohort study Y1 - 2020 U6 - https://doi.org/10.3389/fpubh.2020.00136 SN - 2296-2565 VL - 8 ER -