TY - GEN A1 - Herke, Max A1 - Moor, Irene A1 - Winter, Kristina A1 - Hoffmann, Stephanie A1 - Spallek, Jacob A1 - Hilger-Kolb, Jennifer A1 - Pischke, Claudia R. A1 - Dragano, Nico A1 - Novelli, Anna A1 - Richter, Matthias T1 - Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: protocol for a scoping review T2 - BMJ Open N2 - 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. KW - contextual characteristics KW - compositional characteristics KW - schools KW - health inequalities KW - childhood KW - adolescence KW - scoping review Y1 - 2020 UR - https://bmjopen.bmj.com/content/10/12/e038999 U6 - https://doi.org/10.1136/bmjopen-2020-038999 SN - 2044-6055 VL - 10 IS - 12 ER - TY - GEN A1 - Herr, Raphael A1 - Diehl, Katharina A1 - Schneider, Sven A1 - Osenbruegge, Nina A1 - Memmer, Nicole A1 - Sachse, Steffi A1 - Hoffmann, Stephanie A1 - Wachtler, Benjamin A1 - Herke, Max A1 - Pischke, Claudia R. A1 - Novelli, Anna A1 - Hilger-Kolb, Jennifer T1 - Which Meso-Level Characteristics of Early Childhood Education and Care Centers Are Associated with Health, Health Behavior, and Well-Being of Young Children? Findings of a Scoping Review T2 - International Journal of Environmental Research and Public Health N2 - Characteristics of early childhood education and care (ECEC) centers might be relevant for children’s health. This scoping review aims to provide an overview of the association between meso-level characteristics (MLCs) of ECEC centers with children’s health, health behavior, and wellbeing. Five databases were searched for quantitative and qualitative research articles published in English or German since 1 January 2000 on health, health behavior, and wellbeing of children aged 0 to 6 years considering MLCs of ECEC centers. Two authors screened 10,396 potentially eligible manuscripts and identified 117 papers, including 3077 examinations of the association between MLCs and children’s health indicators (Kappas > 0.91). Five categories of MLCs were identified: (1) structural characteristics, (2) equipment/furnishings, (3) location, (4) facilities/environment, (5) culture/activities/policies/practices, and 6) staff. Only very few studies found an association of MLCs with body weight/obesity, and general health and wellbeing. Especially physical activity and mental health were related to MLCs. In general, the location (rural vs. urban, neighborhood status) seemed to be a relevant health aspect. MLCs of ECEC centers appeared relevant for child health indicators to different degrees. Future research should focus on these associations, in detail, to identify concrete ECEC indicators that can support health promotion in early childhood. KW - scoping review KW - early childhood education and care (ECEC) centers KW - kindergarten KW - young children KW - meso-level characteristics KW - health KW - health behavior KW - socioeconomic position KW - health inequalities Y1 - 2021 UR - https://www.mdpi.com/1660-4601/18/9/4973 U6 - https://doi.org/10.3390/ijerph18094973 VL - 18 IS - 9 SP - 4973 ER - TY - GEN A1 - Hoffmann, Stephanie A1 - Sander, Lydia A1 - Blume, Miriam A1 - Schneider, Sven A1 - Herke, Max A1 - Matos Fialho, Paula Mayara A1 - Pischke, Claudia R. A1 - Schüttig, Wiebke A1 - Lampert, Thomas A1 - Spallek, Jacob T1 - Do families have moderating or mediating effects on early health inequalities? A scoping review T2 - European Journal of Public Health N2 - 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. KW - Family KW - health inequalities KW - moderation KW - mediation KW - scoping review KW - early childhood Y1 - 2021 U6 - https://doi.org/10.1093/eurpub/ckab165.506 VL - 31 IS - Supplement_3 PB - Oxford University Press ER - TY - GEN A1 - Herke, Max A1 - Moor, Irene A1 - Winter, Kristina A1 - Hack, Miriam A1 - Hoffmann, Stephanie A1 - Spallek, Jacob A1 - Hilger-Kolb, Jennifer A1 - Herr, Raphael A1 - Pischke, Claudia R. A1 - Dragano, Nico A1 - Novelli, Anna A1 - Richter, Matthias T1 - Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: a scoping review T2 - BMJ Open N2 - 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. KW - community child health KW - health policy KW - public health Y1 - 2022 UR - https://pubmed.ncbi.nlm.nih.gov/35105578/ U6 - https://doi.org/10.1136/bmjopen-2021-052925 SN - 2044-6055 VL - 12 IS - 2 ER - TY - GEN A1 - Hoffmann, Stephanie A1 - Sander, Lydia A1 - Wachtler, Benjamin A1 - Blume, Miriam A1 - Schneider, Sven A1 - Herke, Max A1 - Pischke, Claudia R. A1 - Matos Fialho, Paula Mayara A1 - Schuettig, Wiebke A1 - Tallarek, Marie A1 - Lampert, Thomas A1 - Spallek, Jacob T1 - Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high‑income countries – a scoping review T2 - BMC Public Health N2 - 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. KW - Child KW - family KW - health KW - Health status disparities KW - infant KW - Socioeconomic factors KW - Socioeconomic health inequalities Y1 - 2022 UR - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12603-4 U6 - https://doi.org/10.1186/s12889-022-12603-4 SN - 1471-2458 VL - 22 SP - 1 EP - 14 ER - TY - GEN A1 - Matos Fialho, Paula Mayara A1 - Dragano, Nico A1 - Reuter, Marvin A1 - Deindl, Christian A1 - Schleberger, Sarah A1 - Metzendorf, Maria-Inti A1 - Hoffmann, Stephanie A1 - Diehl, Katharina A1 - Wachtler, Benjamin A1 - Schüttig, Wiebke A1 - Herke, Max A1 - Richter, Matthias A1 - Pischke, Claudia R. T1 - School-to-work and school-to-university transition and health inequalities among young adults: a scoping review T2 - BMJ Open N2 - Objectives The main objective was to systematically map evidence regarding the emergence of health inequalities in individuals aged 16–24 years during school-to-work and school-to-university transition (STWT). Second, we aimed to summarise the evidence on potential effects of contextual and compositional characteristics of specific institutional contexts entered during STWT on health and health behaviours. Design Scoping review. Study selection Relevant literature was systematically searched following the methodological framework proposed by Arksey and O’Malley. Ovid MEDLINE and Web of Science, and websites of the International Labour Organization and National Institute for Occupational Safety and Health were searched, using a predetermined search strategy. Articles in English or German published between 1 January 2000 and 3 February 2020 were considered. Data extraction To collect the main information from the selected studies, a data extraction spreadsheet was created. Data were summarised and grouped into five health outcomes and five institutional contexts (school, vocational training, university, work, unemployment). Results A total of 678 articles were screened for inclusion. To be able to draw a picture of the development of various health outcomes over time, we focused on longitudinal studies. Forty-six prospective studies mapping health-related outcomes during STWT were identified. Higher family socioeconomic position (SEP) was associated with higher levels of health behaviour and lower levels of health-damaging behaviour, but there was also some evidence pointing in the opposite direction. Disadvantaged family SEP negatively impacted on mental health and predicted an adverse weight development. There was limited evidence for the outcomes physical/somatic symptoms and self-rated health. Meso-level characteristics of the institutional contexts identified were not systematically assessed, only individual-level factors resulting from an exposure to these contexts, rendering an analysis of effects of contextual and compositional characteristics on health and health behaviours impossible. Conclusions This scoping review demonstrated a wide range of health inequalities during STWT for various health outcomes. However, knowledge on the role of the core institutional contexts regarding the development of health inequalities is limited. KW - School-to-work transition KW - school-to-university transition KW - health inequalities KW - young adults KW - scoping review Y1 - 2022 UR - https://bmjopen.bmj.com/content/12/7/e058273 U6 - https://doi.org/10.1136/bmjopen-2021-058273 SN - 2044-6055 VL - 12 IS - 7 SP - e058273 ER - TY - GEN A1 - Reuter, Marvin A1 - Herke, Max A1 - Richter, Matthias A1 - Diehl, Katharina A1 - Hoffmann, Stephanie A1 - Pischke, Claudia R. A1 - Dragano, Nico T1 - Young people’s health and well-being during the school-to-work transition: a prospective cohort study comparing post-secondary pathways T2 - BMC Public Health N2 - Background: At the end of secondary education, young people can either start vocational training, enter university, directly transition to employment or become unemployed. Research assumes that post-secondary pathways have immediate and/or long-term impacts on health and well-being, but empirical investigations on this are scarce and restricted to few countries. Therefore, this study traced the development of health and well-being throughout the highly institutionalised school-to-work transition (STWT) in Germany. Methods: We used longitudinal data of the National Educational Panel Study (NEPS), a representative sample of 11,098 school-leavers (50.5% girls) repeatedly interviewed between 2011 and 2020. We estimated the effect of post-secondary transitions on self-rated health and subjective well-being by applying fixed-effects (FE) regression, elimi-nating bias resulting from time-constant confounding and self-selection into different pathways. A multiple-sample strategy was used to account for the increasing diversity of STWTs patterns. Models were controlled for age, as well as household and residential changes to minimise temporal heterogeneity. Results: Findings indicate that leaving school was good for health and well-being. Compared with participants who did not find a training position after school, direct transitions to vocational training or university were linked to higher absolute levels of health and well-being, but also to a lower relative decline over time. Furthermore, upward transi-tions (e.g. to programs leading to better education or from unemployment to employment) were associated with improvements in health and well-being, while downward transitions were followed by deteriorations. Conclusion: Findings suggest that school-leave is a sensitive period and that post-secondary pathways provide young people with different abilities to maintain health and well-being. Youth health interventions might benefit when setting a stronger focus on unsuccessful school-leavers. KW - School-to-work transition KW - Institutional context KW - Vocational training KW - Apprenticeship KW - University KW - Prevocational preparation KW - Self-rated health KW - Subjective well-being KW - National Educational Panel Study KW - NEPS Y1 - 2022 U6 - https://doi.org/10.1186/s12889-022-14227-0 SN - 1471-2458 VL - 22 SP - 1 EP - 13 ER - TY - GEN A1 - Iashchenko, Iryna A1 - Schüttig, Wiebke A1 - Bammert, Philip A1 - Spallek, Jacob A1 - Rattay, Petra A1 - Schneider, Sven A1 - Moor, Irene A1 - Pischke, Claudia R. A1 - Sundmacher, Leonie T1 - The role of regional health policy for socioeconomic inequality in health services utilization T2 - European Journal of Public Health N2 - 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. KW - regional health policy KW - socioeconomic inequality KW - health services KW - utilization Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.584/6765537?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.584 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - GEN A1 - Deindl, Christian A1 - Diehl, Katharina A1 - Spallek, Jacob A1 - Richter, Matthias A1 - Schüttig, Wiebke A1 - Rattay, Petra A1 - Dragano, Nico A1 - Pischke, Claudia R. T1 - Self-rated health of university students in Germany-The importance of material, psychosocial, and behavioral factors and the parental socio-economic status T2 - Frontiers in Public Health N2 - 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 (Ø 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. KW - Students KW - Health KW - University KW - Inequality KW - National Educational Panel Study Y1 - 2023 UR - https://www.frontiersin.org/articles/10.3389/fpubh.2023.1075142/full U6 - https://doi.org/10.3389/fpubh.2023.1075142 SN - 2296-2565 VL - 11 ER - TY - GEN A1 - Bammert, Philip A1 - Schüttig, Wiebke A1 - Iashchenko, Iryna A1 - Spallek, Jacob A1 - Rattay, Petra A1 - Schneider, Sven A1 - Richter, Matthias A1 - Pischke, Claudia R. A1 - Dragano, Nico A1 - Sundmacher, Leonie T1 - 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 T2 - BMC Pediatrics N2 - 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. KW - Healthcare use KW - Inequity KW - Pediatrics KW - Prevention KW - Vaccination Y1 - 2024 UR - https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04650-0 U6 - https://doi.org/10.1186/s12887-024-04650-0 SN - 1471-2431 VL - 24 ER -