TY - GEN A1 - Herke, Max A1 - Reuter, Marvin A1 - Mayer, A. A1 - Spallek, Jacob A1 - Rattay, Petra A1 - Moor, Irene A1 - Richter, Matthias T1 - Wie wirkt sich die sozioökonomische Komposition der Schule auf Ungleichheiten im subjektiven Wohlbefinden von Schülerinnen und Schülern in Deutschland aus? T2 - Gesundheitswesen N2 - Einleitung Zielsetzung des Beitrags ist es, zu untersuchen, inwiefern die sozioökonomische Komposition von Schulen mit dem Wohlbefinden von Schülerinnen und Schülern in Deutschland assoziiert ist. Konkret wurden die Assoziationen der Bildung, des Einkommens und des beruflichen Status der Eltern auf Individualebene und aggregiert auf Schulebene sowie die Interaktionen zwischen diesen Ebenen auf das subjektive Wohlbefinden von Schülern der Sekundarstufe I untersucht. Methoden Es wurden Daten der Startkohorte „Klasse 5“ des Nationalen Bildungspanels (NEPS) herangezogen. Die Kohorte startete 2010 mit einer repräsentativen Stichprobe von Fünftklässlern in Deutschland, welche jährlich nachverfolgt wurden. Es wurden Erhebungswellen von der fünften bis zur neunten Klasse zusammengefasst. Damit konnten 14.265 Beobachtungen mit vollständigen Angaben von 3.977 Schülerinnen und Schülern in 218 Schulen in den Analysen berücksichtigt werden. Mit Mixed-Models wurde getestet, ob die sozioökonomische Position auf individueller und/oder schulischer Ebene und die ebenenübergreifende Interaktion dieser Indikatoren mit dem Wohlbefinden (adaptierter Personal Well-Being – School Children-Index) der Jugendlichen assoziiert ist. Es wurde für Alter, Geschlecht, Migrationshintergrund, Familienform, Schultyp und Notendurchschnitt kontrolliert. Ergebnisse Auf individueller Ebene war das elterliche Einkommen mit höherem Wohlbefinden verbunden. Der berufliche Status der Eltern zeigte keine signifikanten Assoziationen. Auf Schulebene fanden wir einen geringen, positiven Zusammenhang zwischen dem durchschnittlichen elterlichen Einkommen und dem individuellen Wohlbefinden, aber auch einen mäßig negativen Einfluss eines hohen Anteils hoch gebildeter Eltern auf das Wohlbefinden. In Sensitivitätsanalysen blieben diese Zusammenhänge auch bei separater Betrachtung dieser Indikatoren bestehen. Die Zusammenhänge auf Individualebene wurden nicht durch die sozioökonomische Komposition von Schulen moderiert, es konnten keine signifikanten ebenenübergreifende Interaktionen festgestellt werden. Schlussfolgerung Es wurde ein Zusammenhang der sozioökonomischen Zusammensetzung der Schule mit dem subjektiven Wohlbefinden der Jugendlichen gefunden. Internationale Befunde einer Moderation der Zusammenhänge auf individueller Ebene durch sozioökonomische Charakteristika auf Schulebene konnten jedoch nicht repliziert werden. Die Zusammenhänge zwischen individueller SEP und Wohlbefinden variieren somit nicht in Abhängigkeit von der SEP auf Schulebene. Es zeigen sich vielmehr in Teilen additive Effekte für die individuelle und schulische SEP. KW - sozioökonomische Komposition KW - Schule KW - subjektives Wohlbefinden KW - Ungleichheit Y1 - 2022 UR - https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0042-1753867 U6 - https://doi.org/10.1055/s-0042-1753867 VL - 84 IS - 08/09 SP - 826 PB - Georg Thieme Verlag ER - TY - GEN A1 - Rattay, Petra A1 - Blume, Miriam A1 - Spallek, Jacob A1 - Hoffmann, Stephanie A1 - Sander, Lydia A1 - Herr, Raphael A1 - Herke, Max A1 - Reuter, Marvin A1 - Novelli, Anna A1 - Hövener, Claudia T1 - Socioeconomic position and self-rated health among adolescents: the mediating role of the family T2 - European Journal of Public Health N2 - Background Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining adolescents’ health inequalities. The study aimed to explore whether the association between socioeconomic position and self-rated health (SRH) was mediated by familial determinants. Methods Using data from wave 2 of the KiGGS study (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of parents’ education, occupation, income, socioeconomic position index, and adolescents’ subjective social status on SRH into direct effects and indirect effects through familial determinants (family cohesion, parenting styles, parental well-being, stress, obesity, smoking and sporting activity). Results A significant total effect of all socioeconomic position indicators on SRH was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations of parental education, the socioeconomic position index and subjective social status with SRH were also mediated by familial determinants (family cohesion, parental smoking and obesity). However, a significant direct effect of subjective social status remained. Conclusions The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions, community-based strategies, as well as programs to improve parenting and family functioning. KW - Socioeconomic position KW - self-rated health KW - adolescents KW - family Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.580/6765541?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.580 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - GEN A1 - Rattay, Petra A1 - Blume, Miriam A1 - Wachtler, Benjamin A1 - Wollgast, Lina A1 - Spallek, Jacob A1 - Hoffmann, Stephanie A1 - Sander, Lydia A1 - Herr, Raphael A1 - Herke, Max A1 - Reuter, Marvin A1 - Novelli, Anna A1 - Hövener, Claudia T1 - 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 T2 - PloS one N2 - 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). KW - Socioeconomic position KW - self-rated health KW - adolescents KW - familial determinants KW - health inequalities Y1 - 2022 UR - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0266463 U6 - https://doi.org/10.1371/journal.pone.0266463 SN - 1932-6203 VL - 17 IS - 4 ER - TY - GEN A1 - Wachtler, Benjamin A1 - Hoffmann, Stephanie A1 - Blume, Miriam A1 - Rattay, Petra A1 - Herr, Raphael A1 - Deindl, Christian A1 - Sundmacher, Leonie A1 - Richter, Matthias A1 - Spallek, Jacob A1 - Lampert, Thomas T1 - The impact of the family on health inequalities in children – A systematic scoping review T2 - European Journal of Public Health N2 - 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. KW - Health inequalities KW - family KW - scoping review KW - children KW - adolescents Y1 - 2020 U6 - https://doi.org/10.1093/eurpub/ckaa166.898 SN - 1101-1262 SN - 1464-360X VL - 30 IS - Supplement_5 PB - Univ. Press CY - Oxford ER - TY - RPRT A1 - Wachtler, Benjamin A1 - Hoffmann, Stephanie A1 - Rattay, Petra A1 - Sander, Lydia T1 - Systematic review of qualitative and quantitative studies on the mediating and moderating role of family characteristics on health inequalities in school-aged children and adolescents in countries with developed economies N2 - PROSPERO International prospective register of systematic reviews: registered study protocol. Review question: Which family characteristics mediate or moderate the association between the family’s socioeconomic position and health in school-aged children and adolescents in countries with developed economies? KW - Systematic review KW - family characteristics KW - health inequalities KW - children KW - adolescents KW - developed economies Y1 - 2020 UR - https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020165614 PB - National Institute for Health Research - PROSPERO ER - TY - GEN A1 - Blume, Miriam A1 - Rattay, Petra A1 - Hoffmann, Stephanie A1 - Spallek, Jacob A1 - Sander, Lydia A1 - Herr, Raphael A1 - Moor, Irene A1 - Pischke, Claudia R. A1 - Iashchenko, Iryna A1 - Hövener, Claudia T1 - Zusammenhang zwischen der sozioökonomischen Position der Familie und Adipositas bei Jugendlichen in Deutschland – welche Rolle hat die Familie? T2 - Gesundheitswesen N2 - Einleitung Die gesundheitlichen Folgen von Adipositas für junge Menschen können schwerwiegend sein. Bei der Entwicklung verschiedener Gesundheitsoutcomes wie Adipositas spielt für junge Menschen die Familie als auch ihre sozioökonomische Position (SEP) eine große Rolle. In dieser Analyse wird untersucht, welche familiäre Determinanten den Zusammenhang zwischen SEP der Familie und Adipositas bei Jugendlichen erklären. Methoden Die vorliegende Analyse wurde mit Daten der "Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland" (KiGGS) (Basiserhebung, Welle 1 und 2) durchgeführt (1301 weibliche und 1232 männliche 11- bis 17-Jährige). Mittels logistischer Regressionsmodelle (KHB-Methode) wurden für den Zusammenhang zwischen der SEP der Familie (Einkommen, berufliche Stellung, Bildung, SES-Index) und Adipositas (Ja/Nein) bei Jugendlichen die mediierenden Effekte von familiären Determinanten (elterliches Rauchen, elterliche sportliche Aktivitäten, elterliches Übergewicht, familiärer Stress und familiärer Zusammenhalt) analysiert. Ergebnisse Die Prävalenz von Adipositas betrug 7,9 % bei den weiblichen und 8,4 % bei den männlichen Jugendlichen. Es zeigen sich signifikante Zusammenhänge zwischen Adipositas und SEP zu Ungunsten von jenen mit niedriger sozioökonomischer Position. Familiäre Determinanten erklären teilweise oder vollständig den Zusammenhang zwischen SEP und Adipositas bei Jugendlichen. Es wurden geschlechtsspezifische Unterschiede im Ausmaß der Mediation der Familie gefunden. Bei Jungen erklären familiäre Determinanten vollständig den Zusammenhang zwischen Adipositas und Einkommen sowie zwischen Adipositas und der beruflichen Stellung der Eltern. Bei männlichen Jugendlichen lässt sich der indirekte Effekt abhängig von der jeweiligen SEP-Variable zu 20,8 – 27,9 % auf das elterliche Rauchen, zu 14,8 – 26,3 % auf die elterliche sportliche Aktivität und zu 42,6 – 63,6 % auf das elterliche Übergewicht zurückführen. Bei Mädchen wurde der Zusammenhang zwischen der SEP und Adipositas teilweise durch familiäre Determinanten erklärt. Bei weiblichen Jugendlichen lässt sich der indirekte Effekt abhängig von der jeweiligen SEP-Variable zu 26,0 – 52,2 % auf das elterliche Rauchen und zu 41,6 – 67,6 % auf das elterliche Übergewicht zurückführen. Schlussfolgerung Die Adipositas-Prävalenz von Jugendlichen variiert nach dem SEP. Familiäre Determinanten sind wichtige mediierende Faktoren für 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 Übergewicht und elterliche sportliche Aktivität) erklären lassen. Die Berücksichtigung und Einbindung der Familie bei der Planung und Umsetzung von Gesundheitsförderungs- und Präventionsprogrammen für gesundheitliche Chancengleichheit bei Jugendlichen ist essentiell. KW - sozioökonomische Position KW - Familie KW - Adipositas KW - Jugendliche Y1 - 2022 UR - https://www.thieme-connect.de/products/ejournals/html/10.1055/s-0042-1753866 U6 - https://doi.org/10.1055/s-0042-1753866 VL - 84 IS - 08/09 SP - 826 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 - 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 - TY - GEN A1 - Hoffmann, Stephanie A1 - Rattay, Petra A1 - Blume, Miriam A1 - Hövener, Claudia A1 - Schneider, Sven A1 - Moor, Irene A1 - Pischke, Claudia R. A1 - Schüttig, Wiebke A1 - De Bock, Freia A1 - Spallek, Jacob T1 - Do family characteristics explain a social gradient in overweight in early childhood? T2 - European Journal of Public Health N2 - 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-Württemberg, 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. KW - family characteristics KW - social gradient KW - obesity KW - early childhood Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.581/6765540?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.581 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - GEN A1 - Blume, Miriam A1 - Rattay, Petra A1 - Hoffmann, Stephanie A1 - Spallek, Jacob A1 - Sander, Lydia A1 - Herr, Raphael A1 - Richter, Matthias A1 - Moor, Irene A1 - Dragano, Nico A1 - Pischke, Claudia R. A1 - Iashchenko, Iryna A1 - Hövener, Claudia A1 - Wachtler, Benjamin T1 - Health Inequalities in Children and Adolescents: A Scoping Review of the Mediating and Moderating Effects of Family Characteristics T2 - International Journal of Environmental Research and Public Health N2 - 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. KW - health inequalities KW - socioeconomic position KW - health KW - health behavior KW - moderation KW - mediation KW - school-age parenting KW - parent-child relationship KW - family conflict Y1 - 2021 UR - https://www.mdpi.com/1660-4601/18/15/7739 U6 - https://doi.org/10.3390/ijerph18157739 SN - 1660-4601 VL - 18 IS - 15 ER -