TY - GEN A1 - Spallek, Lena A1 - Yilmaz-Aslan, Yüce A1 - Klein-Ellinghaus, Funda A1 - Gök, Yeşim A1 - Zeeb, Hajo A1 - Kolip, Petra A1 - Spallek, Jacob T1 - Deficits in psycho-oncological care among Turkish immigrant women with breast cancer in Germany – an interview study T2 - International Journal of Psychotherapy Practice and Research Y1 - 2017 UR - http://openaccesspub.org/ijpr/article/590 U6 - https://doi.org/10.14302/issn.2574-612X.ijpr-17-1746 SN - 2574-612X VL - 1 IS - 2 SP - 1 EP - 10 ER - TY - GEN A1 - Spallek, Jacob A1 - Tempes, Jana A1 - Ricksgers, Hannah A1 - Marquardt, Louisa A1 - Prüfer-Krämer, Luise A1 - Krämer, Alexander T1 - Gesundheitliche Situation und Versorgung unbegleiteter minderjähriger Flüchtlinge – eine Näherung anhand qualitativer und quantitativer Forschung in der Stadt Bielefeld T2 - Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz N2 - Unbegleitete minderjährige Flüchtlinge (UMF) sind Kinder oder Jugendliche unter 18 Jahren, die sich ohne Begleitung eines für sie zuständigen Vormundes auf die Flucht begeben. Internationale Studien zeigen, dass minderjährige unbegleitete Flüchtlinge eine besondere Risikogruppe darstellen. Empirische Ergebnisse über die gesundheitliche Situation von unbegleiteten minderjährigen Flüchtlingen in Deutschland in der aktuellen Situation sind kaum vorhanden. Ziel dieses Beitrags ist die Beschreibung der gesundheitlichen Situation und Versorgung von unbegleiteten minderjährigen Flüchtlingen in Bielefeld. Dafür werden zwei qualitative und eine quantitative Studie aus Bielefeld genutzt. Die Ergebnisse zeigen, dass die gesundheitliche Versorgung von unbegleiteten minderjährigen Flüchtlingen Besonderheiten unterliegt und weisen vor allem auf zwei spezifische (medizinische) Bedarfe hin: die psychische/psychiatrische Versorgung und die Versorgung von Infektionskrankheiten. Weitere Herausforderungen in der gesundheitlichen Versorgung ergeben sich aus der spezifischen Situation der unbegleiteten minderjährigen Flüchtlinge und schließen die rechtlichen Rahmenbedingungen sowie sprachliche und kulturelle Kompetenzen auf Seiten der Versorger und auf Seiten der unbegleiteten minderjährigen Flüchtlinge ein. N2 - Unaccompanied minor refugees are children or adolescents below the age of 18 years who are not accompanied by their parents. International studies show that unaccompanied minor refugees represent a special risk group. Currently, empirical study results about the health status of unaccompanied minor refugees barely exist for Germany. Therefore, the goal of this article is an assessment of the health status and health care of unaccompanied minor refugees in Bielefeld, Germany. For this purpose, two qualitative studies and one quantitative study from Bielefeld are used. Results demonstrate that the health care of unaccompanied minor refugees underlies certain peculiarities that indicate major medical needs: Firstly, the need for psychological/psychiatric care and secondly the need for health care regarding infectious diseases. Further challenges in the health care needs of this population group result from its specific situation, and comprise legal conditions, as well as language and cultural competencies on behalf of the health care providers and the unaccompanied minor refugees themselves. KW - Unbegleitete minderjährige Flüchtlinge KW - Gesundheitliche Versorgung KW - Gesundheitssituation KW - Medizinische Bedarfe KW - Infektionskrankheiten Y1 - 2016 U6 - https://doi.org/10.1007/s00103-016-2339-2 SN - 1436-9990 VL - 59 IS - 5 SP - 636 EP - 641 ER - TY - GEN A1 - Grosser, Angelique A1 - Razum, Oliver A1 - Vrijkotte, Tanja G. M. A1 - Hinz, Ina-Merle A1 - Spallek, Jacob T1 - Inclusion of migrants and ethnic minorities in European birth cohort studies - a scoping review T2 - The European Journal of Public Health N2 - Background: Migrant and ethnic minority groups constitute substantial parts of European populations. They frequently experience health disadvantages relative to the respective majority populations. Birth cohort studies can help to disentangle social and biological factors producing these health inequalities over the life course. We investigated whether birth cohorts in European countries (i) assess migration history and ethnicity in the study design; and (ii) use this information in data analyses. Methods: A scoping review was performed in which European birth cohort studies were identified using dedicated web-based registries, MEDLINE and EMBASE. Two reviewers systematically assessed all identified birth cohorts and selected those fulfilling defined inclusion criteria (e.g. enrolment after 1980). Publications and websites were screened for information on the inclusion of migrants and ethnic minorities. To obtain more detailed information, researchers of enrolled birth cohorts were contacted individually. Results: Eighty-eight birth cohorts were identified in 20 European countries, with more than 486 250 children enrolled in total. Sixty-two studies (70.5%) reported collecting data about migration history or ethnic background. Twenty-three studies (26%) used information on migration history or ethnicity for data analyses or plan to do so in future. Conclusion: The majority of European birth cohorts assessed participants’ migration history or ethnic background; however, this information was seldom used for comparative analyses in trying to disentangle reasons for health inequalities. Also, heterogeneous indicators were used. Better use of data already available, as well as harmonization of data collection on migration history and ethnicity, could yield interesting insights into the production of health inequalities. KW - migrants KW - ethnic minorities KW - birth cohort KW - review Y1 - 2016 UR - http://eurpub.oxfordjournals.org/content/early/2016/06/03/eurpub.ckw068 U6 - https://doi.org/10.1093/eurpub/ckw068 SN - 1464-360X VL - 26 IS - 6 SP - 984 EP - 991 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Reder, Maren A1 - Razum, Oliver A1 - Kolip, Petra A1 - Spallek, Jacob T1 - Informed Choice in the German Mammography Screening Program by Education and Migrant Status: Survey among First-Time Invitees T2 - PLOS ONE N2 - Breast cancer is the most prevalent cancer among women and mammography screening programs are seen as a key strategy to reduce breast cancer mortality. In Germany, women are invited to the population-based mammography screening program between ages 50 to 69. It is still discussed whether the benefits of mammography screening outweigh its harms. Therefore, the concept of informed choice comprising knowledge, attitude and intention has gained importance. The objective of this observational study was to assess the proportion of informed choices among women invited to the German mammography screening program for the first time. A representative sample of 17,349 women aged 50 years from a sub-region of North Rhine Westphalia was invited to participate in a postal survey. Turkish immigrant women were oversampled. The effects of education level and migration status on informed choice and its components were assessed. 5,847 (33.7%) women responded to the postal questionnaire of which 4,113 were used for analyses. 31.5% of the women had sufficient knowledge. The proportion of sufficient knowledge was lower among immigrants and among women with low education levels. The proportion of women making informed choices was low (27.1%), with similar associations with education level and migration status. Women of low (OR 2.75; 95% CI 2.18–3.46) and medium education level (OR 1.49; 95% CI 1.27–1.75) were more likely to make an uninformed choice than women of high education level. Turkish immigrant women had the greatest odds for making an uninformed choice (OR 5.30, 95% CI 1.92–14.66) compared to non-immigrant women. Other immigrant women only had slightly greater odds for making an uninformed choice than non-immigrant women. As immigrant populations and women with low education level have been shown to have poor knowledge, they need special attention in measures to increase knowledge and thus informed choices. KW - German Mammography Screening Program Y1 - 2015 UR - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631499/ U6 - https://doi.org/10.1371/journal.pone.0142316 SN - 1932-6203 VL - 10 IS - 11 SP - 1 EP - 11 ER - TY - GEN A1 - Moor, Irene A1 - Spallek, Jacob A1 - Richter, Matthias T1 - Explaining socioeconomic inequalities in self-rated health - A systematic review of the relative contribution of material, psychological and behavioural factors T2 - Journal of Epidemiology & Community Health Y1 - 2017 U6 - https://doi.org/10.1136/jech-2016-207589 SN - 1470-2738 VL - 71 IS - 6 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Yilmaz-Aslan, Yüce A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Determinants of mammography screening participation among Turkish immigrant women in Germany – a qualitative study reflecting key informants’ and women’s perspectives. T2 - European Journal of Cancer Care Y1 - 2016 U6 - https://doi.org/10.1111/ecc.12334 SN - 1365-2354 VL - 25 IS - 1 SP - 38 EP - 48 ER - TY - GEN A1 - Spallek, Jacob A1 - Reeske, Anna A1 - Norredam, Marie A1 - Smith Nielsen, Signe A1 - Lehnardt, Jessica A1 - Razum, Oliver T1 - Suicide among immigrants in Europe — a systematic literature review T2 - The European Journal of Public Health Y1 - 2015 U6 - https://doi.org/10.1093/eurpub/cku121 SN - 1464-360X VL - 25 IS - 1 SP - 63 EP - 71 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Stahl, Lisa A1 - Yilmaz-Aslan, Yüce A1 - Sauzet, Odile A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Participation in breast cancer screening among women of Turkish origin in Germany - a register-based study T2 - BMC Women's Health Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:0070-pub-26613854 SN - 1472-6874 VL - 14 ER - TY - GEN A1 - Moor, Irene A1 - Lampert, Thomas A1 - Rathmann, Katharina A1 - Kuntz, Benjamin A1 - Kolip, Petra A1 - Spallek, Jacob A1 - Richter, Matthias T1 - Explaining educational inequalities in adolescent life satisfaction: Do health behaviour and gender matter T2 - International Journal of Public Health Y1 - 2014 SN - 1661-8564 VL - 59 IS - 2 SP - 309 EP - 317 ER - TY - GEN A1 - Makarova, Nataliya A1 - Reiss, Katharina A1 - Zeeb, Hajo A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Verbesserte Möglichkeiten zur Identifikation von Menschen mit Migrationshintergrund für die Mortalitätsforschung am Beispiel Bremens T2 - Gesundheitswesen Y1 - 2013 U6 - https://doi.org/10.1055/s-0032-1321767 SN - 1439-4421 SN - 0941-3790 VL - 75 IS - 6 SP - 360 EP - 365 ER - TY - GEN A1 - Reiss, Katharina A1 - Makarova, Nataliya A1 - Spallek, Jacob A1 - Zeeb, Hajo A1 - Razum, Oliver T1 - Identifizierung und Rekrutierung von Menschen mit Migrationshintergrund für epidemiologische Studien in Deutschland T2 - Gesundheitswesen Y1 - 2013 U6 - https://doi.org/10.1055/s-0032-1321768 SN - 1439-4421 SN - 0941-3790 VL - 75 IS - 6 SP - e49 EP - e58 ER - TY - GEN A1 - Reeske, Anna A1 - Spallek, Jacob A1 - Bammann, Karin A1 - Eiben, Gabriele A1 - De Henauw, Stefaan A1 - Kourides, Yiannis A1 - Nagy, Peter A1 - Ahrens, Wolfgang T1 - Migrant Background and Weight Gain in Early Infancy: Results from the German Study Sample of the IDEFICS Study T2 - PLoS One Y1 - 2013 U6 - https://doi.org/10.1371/journal.pone.0060648 SN - 1932-6203 VL - 8 IS - 4 ER - TY - GEN A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Kraywinkel, Klaus A1 - Krieg, V. A1 - Schwabe, Wolfgang A1 - Greiner, Wolfgang A1 - Damm, Oliver A1 - Hense, H. W. A1 - Razum, Oliver T1 - Abgleich von Verwaltungsdaten des Medizinischen Dienstes der Krankenversicherung mit Krebsregisterdaten T2 - Gesundheitswesen Y1 - 2012 U6 - https://doi.org/10.1055/s-0031-1286274 SN - 1439-4421 SN - 0941-3790 VL - 74 IS - 7 SP - e52 EP - e60 ER - TY - GEN A1 - Spallek, Jacob A1 - Arnold, Melina A1 - Razum, Oliver A1 - Juel, Knud A1 - Rey, Gregoire A1 - Deboosere, Patrick A1 - Mackenbach, Johan Pieter A1 - Kunst, Anton Eduard T1 - Cancer mortality patterns among Turkish immigrants in four European countries and in Turkey T2 - European Journal of Epidemiology Y1 - 2012 U6 - https://doi.org/10.1007/s10654-012-9746-y SN - 1573-7284 SN - 0393-2990 VL - 27 IS - 12 SP - 915 EP - 921 ER - TY - GEN A1 - Spallek, Jacob A1 - Reeske, Anna A1 - Grosser, Angelique A1 - Schwabe, Wolfgang A1 - Rieger, Michael A1 - Krahn, U. A1 - Razum, Oliver T1 - Pflegebedürftigkeit bei türkischstämmigen und nicht-türkischstämmigen Säuglingen. Eine Analyse der Pflegegutachten des MDK-Westfalen-Lippe von 2004 bis 2008 T2 - Gesundheitswesen Y1 - 2012 U6 - https://doi.org/10.1055/s-0031-1286276 SN - 1439-4421 SN - 0941-3790 VL - 74 IS - 8-9 SP - 485 EP - 487 ER - TY - GEN A1 - Höpker, T. A1 - Lampert, Thomas A1 - Spallek, Jacob T1 - Identifizierung und Charakterisierung von Gesundheitsverhaltenstypen bei 11- bis 17-jährigen Jungen und Mädchen. Eine Clusteranalyse auf Basis der Daten des Kinder- und Jugendgesundheitssurveys (KiGGS) T2 - Gesundheitswesen Y1 - 2014 U6 - https://doi.org/10.1055/s-0034-1372619 SN - 1439-4421 SN - 0941-3790 VL - 76 IS - 7 SP - 453 EP - 461 ER - TY - GEN A1 - Spallek, Jacob A1 - Lehnhardt, Jessica A1 - Reeske, Anna A1 - Razum, Oliver A1 - David, Matthias T1 - Perinatal outcomes of immigrant women of Turkish, Middle Eastern and North African origin in Berlin, Germany: a comparison of two time periods T2 - Archives of Gynecology and Obstetrics Y1 - 2014 U6 - https://doi.org/10.1007/s00404-013-2986-6 SN - 1432-0711 SN - 0932-0067 VL - 289 IS - 3 SP - 505 EP - 512 ER - TY - GEN A1 - Reiss, Katharina A1 - Sauzet, Odile A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver T1 - How do immigrants adapt their smoking behaviour? A comparative analysis among Turkish immigrants in Germany and the Netherlands T2 - BMC Public Health Y1 - 2014 U6 - https://doi.org/10.1186/1471-2458-14-844 SN - 1471-2458 VL - 14 ER - TY - GEN A1 - Moor, Irene A1 - Rathmann, Katharina A1 - Stronks, Karien A1 - Levin, Kate A1 - Spallek, Jacob A1 - Richter, Matthias T1 - Psychosocial and behavioural factors in the explanation of socioeconomic inequalities in adolescent health. A multilevel analysis in 28 European and North American countries T2 - Journal of epidemiology and community health Y1 - 2014 U6 - https://doi.org/10.1136/jech-2014-203933 SN - 1470-2738 VL - 68 IS - 10 SP - 912 EP - 921 ER - TY - GEN A1 - Reeske, Anna A1 - Zeeb, Hajo A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Differences in the Incidence of Gestational Diabetes between Women of Turkish and German Origin: An Analysis of Health Insurance Data From a Statutory Health Insurance in Berlin, Germany (AOK), 2005–2007 T2 - Geburtshilfe und Frauenheilkunde Y1 - 2012 U6 - https://doi.org/10.1055/s-0031-1280428 SN - 0016-5751 VL - 72 IS - 4 SP - 305 EP - 310 ER - TY - GEN A1 - Reeske, Anna A1 - Kutschmann, Marcus A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Stillbirth differences according to regions of origin: an analysis of the German perinatal database, 2004-2007 T2 - BMC Pregnancy and Childbirth Y1 - 2011 U6 - https://doi.org/10.1186/1471-2393-11-63 SN - 1471-2393 VL - 11 SP - 63 ER - TY - GEN A1 - Doyle, Ina-Merle A1 - Borrmann, Brigitte A1 - Grosser, Angelique A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Determinants of dietary patterns and diet quality during pregnancy: a systematic review with narrative synthesis T2 - Public Health Nutrition Y1 - 2016 U6 - https://doi.org/10.1017/S1368980016002937 SN - 1475-2727 N1 - First online SP - 1 EP - 20 ER - TY - GEN A1 - Spallek, Jacob A1 - Berens, Eva-Maria A1 - Kolip, Petra T1 - Früherkennung – Herausforderung der „Informierten Entscheidung“ im Kontext des Mammografie-Screening-Programms T2 - Geburtshilfe und Frauenheilkunde Y1 - 2016 U6 - https://doi.org/10.1055/s-0042-112118 SN - 1438-8804 VL - 76 IS - 11 SP - 1117 EP - 1120 ER - TY - GEN A1 - Reiss, Katharina A1 - Spallek, Jacob A1 - Razum, Oliver T1 - 'Imported risk' or 'health transition'? Smoking prevalence among ethnic German immigrants from the Former Soviet Union by duration of stay in Germany - analysis of microcensus data T2 - International Journal for Equity in Health Y1 - 2010 U6 - https://doi.org/10.1186/1475-9276-9-15 SN - 1475-9276 VL - 9 SP - 15 ER - TY - GEN A1 - Brzoska, Patrick A1 - Voigtländer, Sven A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Utilization and effectiveness of medical rehabilitation in foreign nationals residing in Germany T2 - European Journal Epidemiology Y1 - 2010 U6 - https://doi.org/10.1007/s10654-010-9468-y SN - 1573-7284 SN - 0393-2990 VL - 25 IS - 9 SP - 651 EP - 660 ER - TY - GEN A1 - Spallek, Jacob A1 - Arnold, Melina A1 - Hentschel, Stefan A1 - Razum, Oliver T1 - Cancer incidence rate ratios of Turkish immigrants in Hamburg, Germany. A registry based study T2 - Cancer Epidemiology Y1 - 2009 U6 - https://doi.org/10.1016/j.canep.2009.10.006 SN - 1877-7821 VL - 33 IS - 6 SP - 413 EP - 418 ER - TY - GEN A1 - Reeske, Anna A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Changes in smoking prevalence among first- and second-generation Turkish migrants in Germany - an analysis of the 2005 Microcensus T2 - International Journal for Equity in Health Y1 - 2009 U6 - https://doi.org/10.1186/1475-9276-8-26 SN - 1475-9276 VL - 8 SP - 26 ER - TY - GEN A1 - Spix, Claudia A1 - Spallek, Jacob A1 - Kaatsch, Peter A1 - Razum, Oliver A1 - Zeeb, Hajo T1 - Cancer survival among children of Turkish descent in Germany 1980-2005: a registry-based analysis T2 - BMC Cancer Y1 - 2008 U6 - https://doi.org/10.1186/1471-2407-8-355 SN - 1471-2407 VL - 8 SP - 355 ER - TY - GEN A1 - Spallek, Jacob A1 - Spix, Claudia A1 - Zeeb, Hajo A1 - Kaatsch, Peter A1 - Razum, Oliver T1 - Cancer patterns among children of Turkish descent in Germany: a study at the German Childhood Cancer Registry T2 - BMC Public Health Y1 - 2008 U6 - https://doi.org/10.1186/1471-2458-8-152 SN - 1471-2458 VL - 8 SP - 152 ER - TY - GEN A1 - Berg, Gabriele A1 - Spallek, Jacob A1 - Schüz, Joachim A1 - Schlehofer, Brigitte A1 - Böhler, Eva A1 - Schlaefer, Klaus A1 - Hettinger, Iris A1 - Kunna-Grass, Katharina A1 - Wahrendorf, Jürgen A1 - Blettner, Maria T1 - Occupational exposure of radiofrequency radiation and risk of brain tumors T2 - American Journal of Epidemiology Y1 - 2006 U6 - https://doi.org/10.1093/aje/kwj247 SN - 1476-6256 SN - 0002-9262 VL - 164 IS - 6 SP - 538 EP - 548 ER - TY - GEN A1 - Spallek, Jacob A1 - Kaatsch, Peter A1 - Spix, Claudia A1 - Ulusoy, Nazan A1 - Zeeb, Hajo A1 - Razum, Oliver T1 - Namensbasierte Identifizierung von Fällen mit türkischer Herkunft im Kinderkrebsregister Mainz T2 - Gesundheitswesen Y1 - 2006 U6 - https://doi.org/10.1055/s-2006-927166 SN - 1439-4421 SN - 0941-3790 VL - 68 IS - 10 SP - 643 EP - 649 ER - TY - GEN A1 - Lampert, Thomas A1 - Richter, Matthias A1 - Schreiber, Sven A1 - Spallek, Jacob A1 - Dragano, Nico T1 - Soziale Ungleichheit und Gesundheit. Stand und Perspektiven der sozialepidemiologischen Forschung in Deutschland T2 - Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Y1 - 2016 U6 - https://doi.org/10.1007/s00103-015-2275-6 SN - 1436-9990 SN - 1437-1588 VL - 59 IS - 2 SP - 153 EP - 165 ER - TY - GEN A1 - Razum, Oliver A1 - Karrasch, Laura A1 - Spallek, Jacob T1 - Migration : Eine vernachlässigte Dimension gesundheitlicher Ungleichheit? T2 - Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Y1 - 2016 U6 - https://doi.org/10.1007/s00103-015-2286-3 SN - 1436-9990 SN - 1437-1588 VL - 59 IS - 2 SP - 259 EP - 265 ER - TY - GEN A1 - Brzoska, Patrick A1 - Voigtländer, Sven A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Die Nutzung von Routinedaten in der rehabilitationswissenschaftlichen Versorgungsforschung bei Menschen mit Migrationshintergrund: Möglichkeiten und Grenzen T2 - Gesundheitswesen Y1 - 2012 U6 - https://doi.org/10.1055/s-0031-1280759 SN - 1439-442 SN - 0941-3790 VL - 74 IS - 6 SP - 371 EP - 378 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Reeder, Maren A1 - Kolip, Petra A1 - Spallek, Jacob T1 - A cross-sectional study on informed choice in the mammography screening programme in Germany (InEMa): a study protocol T2 - BMJ Open Y1 - 2014 U6 - https://doi.org/10.1136/bmjopen-2014-006145 SN - 2044-6055 VL - 4 IS - 9 SP - 006145 ER - TY - GEN A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Gesundheitschancen. Frühzeitige Weichenstellung. [BaBi-Studie] T2 - Deutsches Ärzteblatt Y1 - 2012 VL - 109 IS - 46 ER - TY - GEN A1 - Jahn, Ingeborg A1 - Bolte, Gabriele A1 - Spallek, Jacob T1 - Epidemiologische Fachgesellschaften für „Geschlechtersensible Planung und Durchführung der geplanten Nationalen Kohortenstudie“ Ein wichtiger Schritt für geschlechtersensible Gesundheitsforschung in Deutschland T2 - Gesundheitswesen Y1 - 2010 U6 - https://doi.org/10.1055/s-0030-1261917 VL - 72 IS - 7 SP - 383 EP - 386 ER - TY - GEN A1 - Spallek, Jacob A1 - Zeeb, Hajo T1 - Gesundheit von Migranten. Erkenntnisse am Beispiel der Zuwanderer in Deutschland T2 - Ärzteblatt Rheinland-Pfalz Y1 - 2009 SN - 0001-9488 VL - 62 IS - 7 SP - 20 ER - TY - GEN A1 - Spallek, Jacob A1 - Kuntz, Benjamin A1 - Schott, Thomas T1 - Sozialepidemiologie T2 - Public Health Forum Y1 - 2012 U6 - https://doi.org/10.1016/j.phf.2012.06.015 SN - 1876-4851 SN - 0944-5587 VL - 20 IS - 3 SP - 4 EP - 8 ER - TY - GEN A1 - Spallek, Jacob A1 - Zeeb, Hajo A1 - Razum, Oliver T1 - What do we have to know from migrants‘ past exposure to understand their health status? A life course approach T2 - Emerging Themes in Epidemiology Y1 - 2011 U6 - https://doi.org/10.1186/1742-7622-8-6 SN - 1742-7622 VL - 8 SP - 6 ER - TY - GEN A1 - Reeske, Anna A1 - Spallek, Jacob T1 - Sozioökonomische Aspekte der Primärprävention von Adipositas bei Kindern und Jugendlichen - Ansatzpunkte vor dem Hintergrund eines lebenslaufbasierten Ansatzes der Adipositasentstehung T2 - Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz Y1 - 2011 U6 - https://doi.org/10.1007/s00103-010-1221-x SN - 1436-9990 SN - 1437-1588 VL - 54 IS - 3 SP - 272 EP - 280 ER - TY - GEN A1 - Spallek, Jacob A1 - Zeeb, Hajo A1 - Razum, Oliver T1 - Prevention among Immigrants: The example of Germany T2 - BMC Public Health Y1 - 2010 U6 - https://doi.org/10.1186/1471-2458-10-92 SN - 1471-2458 VL - 10 ER - TY - GEN A1 - Zeeb, Hajo A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Epidemiologische Perspektiven der Migrationsforschung am Beispiel von Krebserkrankungen T2 - Psychotherapie, Psychosomatik, Medizinische Psychologie Y1 - 2008 U6 - https://doi.org/10.1055/s-2008-1067347 SN - 1439-1058 SN - 0937-2032 VL - 58 IS - 3 SP - 130 EP - 135 ER - TY - GEN A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Gesundheit von Migranten: Defizite im Bereich der Prävention T2 - Medzinische Klinik Y1 - 2007 U6 - https://doi.org/10.1007/s00063-007-1058-8 SN - 2193-6218 SN - 2193-6226 VL - 102 IS - 6 SP - 451 EP - 456 ER - TY - GEN A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Migration und Geschlecht T2 - Public Heatlth Forum Y1 - 2015 U6 - https://doi.org/10.1515/pubhef-2015-0027 SN - 1876-4851 SN - 0944-5587 VL - 23 IS - 2 SP - 73 EP - 75 ER - TY - GEN A1 - Reiss, Katharina A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Die Entwicklung des Rauchverhaltens im Kontext der Migration nach Deutschland T2 - Public Health Forum Y1 - 2015 U6 - https://doi.org/10.1515/pubhef-2015-0031 SN - 1876-4851 SN - 0944-5587 VL - 23 IS - 2 SP - 85 EP - 87 ER - TY - GEN A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Migration und Gesundheit T2 - Public Health Forum Y1 - 2015 U6 - https://doi.org/10.1515/pubhef-2015-0021 SN - 1876-4851 SN - 0944-5587 VL - 23 IS - 2 SP - 54 EP - 57 ER - TY - GEN A1 - Ernst, Sinja Alexandra A1 - Reeske, Anna A1 - Spallek, Jacob A1 - Petersen, Knud A1 - Brand, Tilman A1 - Zeeb, Hajo T1 - Care-related factors associated with antepartal diagnosis of intrauterine growth restriction: a case-control study T2 - BMC Pregnancy and Childbirth Y1 - 2014 U6 - https://doi.org/10.1186/s12884-014-0371-5 SN - 1471-2393 VL - 14 SP - 371 ER - TY - GEN A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Addressing health-related interventions to immigrants: migrant-specific or diversity-sensitive? T2 - International Journal Public Health Y1 - 2014 U6 - https://doi.org/10.1007/s00038-014-0584-4 SN - 1661-8556 SN - 1661-8564 VL - 59 IS - 6 SP - 893 EP - 895 ER - TY - GEN A1 - Ernst, Sinja Alexandra A1 - Brand, Tilman A1 - Reeske, Anna A1 - Spallek, Jacob A1 - Petersen, Knud A1 - Zeeb, Hajo T1 - Care-Related and Maternal Risk Factors Associated with the Antenatal Nondetection of Intrauterine Growth Restriction: A Case-Control Study from Bremen,Germany T2 - BioMed Research International Y1 - 2017 U6 - https://doi.org/10.1155/2017/1746146 SN - 2314-6141 SN - 2314-6133 SP - 1746146 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Riedel, Jörg A1 - Reder, Maren A1 - Razum, Oliver A1 - Kolip, Petra A1 - Spallek, Jacob T1 - Postalische Befragung von Frauen mit türkischem Migrationshintergrund – Identifizierung, Stichprobenbereinigung und Response im Rahmen der InEMa-Studie T1 - Postal Survey Among Women With Turkish Migration Background in Germany – Identification, Sample Revision and Response in the InEMa Study T2 - Das Gesundheitswesen Y1 - 2017 U6 - https://doi.org/10.1055/s-0035-1564076 SN - 0941-3790 VL - 79 IS - 12 SP - 1000 EP - 1003 ER - TY - GEN A1 - Spallek, Jacob A1 - Schumann, Maria A1 - Zeeb, Hajo T1 - Utilization of prevention and health promotion among migrants T2 - Public Health Forum N2 - The uptake of existing preventive and health promotion offers by migrants in Germany is rather heterogeneous, and major information gaps are noted. Current results provide limited evidence that migrants and their children seem to use prevention and health promotion services less frequently than non-migrants. In order to improve access to preventive and other health services for migrants, a combination of migrant-specific and migrant-sensitive approaches seems to be useful. KW - accessibility KW - health promotion KW - migration KW - prevention KW - utilization Y1 - 2018 SN - 1876-4851 SN - 0944-5587 VL - 26 IS - 2 SP - 116 EP - 120 ER - TY - GEN A1 - Grosser, Angelique A1 - Höller-Holtrichter, Chantal A1 - Doyle, Ina-Merle A1 - Schmitz, Jutta A1 - Hoffmann, Renata A1 - Ergin-Akkoyun, Emine A1 - Mauro, Antonia A1 - Breckenkamp, Jürgen A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Rekrutierungsstrategien für Migrantinnen in einer Geburtskohorte am Beispiel der BaBi-Studie T2 - Das Gesundheitswesen N2 - Die Rekrutierung von Studienteilnehmern aller relevanten Bevölkerungsgruppen stellt eine der Herausforderungen in der (sozial-)epidemiologischen Forschung dar. Es existiert eine Vielzahl von Strategien, die der Rekrutierung von ethnischen Minderheiten und bestimmter Migrantengruppen dienen können. Unklar ist bisher, ob diese Strategien auch bei der Etablierung einer Geburtskohorte geeignet sind. Ziel der vorliegenden Arbeit ist die Darstellung und Evaluation von Rekrutierungsstrategien für Migrantinnen in einer Geburtskohorte am Beispiel der BaBi-Studie. Die Rekrutierung erfolgte von Oktober 2013 bis Oktober 2016. Als Vorbereitung wurden Fokusgruppen mit Schwangeren und Müttern und leitfadengestützte Experteninterviews mit Hebammen und GynäkologInnen durchgeführt, um Studienmaterialien, Befragungsinstrumente und Sprachpräferenzen zu prüfen. In der Vorstudie wurden unterschiedliche Rekrutierungswege getestet. Im Rekrutierungsverlauf fand eine kontinuierliche Evaluation statt, um erfolgreiche Rekrutierungsstrategien für Teilnehmerinnen mit Migrationshintergrund zu ermitteln und anzupassen. Von den eingeschlossenen 980 Teilnehmerinnen hatten 390 einen Migrationshintergrund (40%). Es wurden aktive und passive Rekrutierungsstrategien verfolgt, in denen u. a. türkische Übersetzungen und multikulturelles Personal zum Einsatz kamen. Für die passive Rekrutierung über gynäkologische Praxen und Hebammen mussten die schwangeren Frauen und Wöchnerinnen eine hohe Motivation für die Rekrutierung mitbringen. Die aktive Rekrutierung in den Geburtskliniken (Ansprache durch Study-Nurses) erhöhte den Anteil an Teilnehmerinnen mit Migrationshintergrund von 22 auf 49% aller Teilnehmerinnen. Durch frühzeitige Überprüfungen und Anpassungen der Zugangswege konnte die Teilnahmebereitschaft erhöht werden. Für die Rekrutierung von Frauen mit Migrationshintergrund sind gründliche Vorbereitungen in Form von Befragungen (Fokusgruppen, Leitfadeninterviews) und einer Vorstudie sinnvoll. Von Beginn an sind Verfahren zur frühzeitigen Evaluation der unterschiedlichen Rekrutierungsstrategien und ein erhöhter Personalaufwand (z. B. für (Rück-/ Übersetzungen) einzuplanen). Der Einschluss von Menschen mit Migrationshintergrund in sozialepidemiologischen Studien sollte in Deutschland zur Normalität werden. KW - Rekrutierung KW - Geburtskohorte KW - Migranten KW - Türkei KW - Spätaussiedler Y1 - 2019 U6 - https://doi.org/10.1055/a-0600-2392 SN - 0941-3790 VL - 81 IS - 8/9 SP - 621 EP - 628 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Mohwinkel, Lea-Marie A1 - Eckert, Sandra van A1 - Reder, Maren A1 - Kolip, Petra A1 - Spallek, Jacob T1 - Uptake of Gynecological Cancer Screening and Performance of Breast Self-Examination Among 50-Year-Old Migrant and Non-migrant Women in Germany: Results of a Cross-Sectional Study (InEMa) T2 - Journal of Immigrant and Minority Health N2 - Our aim was to provide data regarding uptake of gynecological early detection measures and performance of breast self-examinations among migrant women in Germany. Cross-sectional self-reported data were collected using paper-and-pencil questionnaires. Descriptive analyses, Chi square-tests, and logistic regression were applied. Results were adjusted for educational level. Of 5387 women, 89.9% were autochthonous, 4.1% German resettlers, 2.8% Turkish, 3.1% other migrants. Participation rates regarding cancer screening differed significantly, with the lowest proportion in Turkish migrants (65.0%), resettlers (67.8%), other migrants (68.2%) and autochthonous population (78.2%). No differences in performance of breast self-examinations were detected. When adjusted for education, results indicated only slight changes in the odds to participate in screening irregularly or not at all. Results support existing evidence by showing lower participation rates in cancer screening among migrant women, but there were no differences regarding breast self-examinations. Migrant women form a potential high-risk group for late-stage diagnosis of cervical or breast cancer. KW - Migrants KW - Non-migrants KW - Cervical and breast cancer KW - Cancer screening KW - Participation KW - Performance KW - Uptake Y1 - 2019 U6 - https://doi.org/10.1007/s10903-018-0785-7 SN - 1557-1920 VL - 21 IS - 3 SP - 674 EP - 677 ER - TY - GEN A1 - Spallek, Jacob A1 - Breckenkamp, Jürgen A1 - Kraywinkel, Klaus A1 - Schwabe, Wolfgang A1 - Krieg, Volker A1 - Greiner, Wolfgang A1 - Damm, Oliver A1 - Razum, Oliver T1 - Need for nursing care support in cancer patients: Registry-linkage study in Germany T2 - South Eastern European Journal of Public Health N2 - Aim: In Germany, very little is known about the need for assistance and nursing care support among cancer patients after hospitalization. The aim of this study was to describe nursing care support for cancer patients and to analyse whether these patients need more care assistance than other persons in need for care. Methods: This was a registry linkage study conducted in 2011. Cases were identified from the population-based cancer registry for the Muenster District in north-western Germany and in factually anonymised form linked by a semi-automatic probabilistic procedure (the standard procedure of the cancer registry) with medical examination records of patients applying for assistance and nursing care support from the regional statutory health insurance. The application records of 4,029 patients with colon, breast and prostate cancer were compared to a reference group of 13,104 non-cancer patients. Results: In only 41.7% of colon, 45.8% of breast and 37.4% of prostate cancer patients was the malignancy the main underlying diagnostic cause for the application of assistance and nursing care. These patients were on average younger (mean age 71.1 vs. 76.8 years) than the non-cancer reference group, required higher levels of support (79.5 vs. 58.1% “considerable” or higher level care need) and their applications were less likely to be rejected (odds ratios [ORs] 0.26, 0.28, and 0.31, respectively). By contrast, the proportion of successful applications and the level of support granted did not differ between multimorbid cancer patients with other main diagnoses as compared to non-cancer applicants. Conclusion: Patients with colon, breast or prostate cancer do not need per se more nursing care than non-cancer patients. Only if cancer is the main underlying diagnosis for nursing care support, higher levels of support are needed. KW - cancer patients KW - nursing care Y1 - 2018 U6 - https://doi.org/10.4119/UNIBI/SEEJPH-2018-204 SN - 2197-5248 IS - 11 SP - 1 EP - 10 ER - TY - GEN A1 - Weckmann, Gesine A1 - Stracke, Sylvia A1 - Haase, Annekathrin A1 - Spallek, Jacob A1 - Ludwig, Fabian A1 - Angelow, Aniela A1 - Emmelkamp, Jetske M. A1 - Mahner, Maria A1 - Chenot, Jean-François T1 - Diagnosis and management of non-dialysis chronic kidney disease in ambulatory care: a systematic review of clinical practice guidelines T2 - BMC Nephrology N2 - Background: Chronic kidney disease (CKD) is age-dependent and has a high prevalence in the general population. Most patients are managed in ambulatory care. This systematic review provides an updated overview of quality and content of international clinical practice guidelines for diagnosis and management of non-dialysis CKD relevant to patients in ambulatory care. Methods: We identified guidelines published from 2012-to March 2018 in guideline portals, databases and by manual search. Methodological quality was assessed with the Appraisal of Guidelines for Research and Evaluation II instrument. Recommendations were extracted and evaluated. Results: Eight hundred fifty-two publications were identified, 9 of which were eligible guidelines. Methodological quality ranged from 34 to 77%, with domains “scope and purpose” and “clarity of presentation” attaining highest and “applicability” lowest scores. Guidelines were similar in recommendations on CKD definition, screening of patients with diabetes and hypertension, blood pressure targets and referral of patients with progressive or stage G4 CKD. Definition of high risk groups and recommended tests in newly diagnosed CKD varied. Conclusions: Guidelines quality ranged from moderate to high. Guidelines generally agreed on management of patients with high risk or advanced CKD, but varied in regarding the range of recommended measurements, the need for referrals to nephrology, monitoring intervals and comprehensiveness. More research is needed on efficient management of patients with low risk of CKD progression to end stage renal disease. KW - Chronic kidney disease KW - Management KW - Clinical practice guideline KW - Systematic review Y1 - 2018 U6 - https://doi.org/10.1186/s12882-018-1048-5 SN - 1471-2369 IS - 19 ER - TY - GEN A1 - Lampert, Thomas A1 - Kuntz, Benjamin A1 - Schneider, Sven A1 - Spallek, Jacob T1 - Soziale Ungleichheit und Gesundheit: die Entwicklung sozialepidemiologischer Forschung in Deutschland T2 - Public Health Forum N2 - Die Sozialepidemiologie befasst sich mit der sozialen Verteilung von Erkrankungsrisiken und Gesundheitschancen und den daraus resultierenden gesundheitlichen Ungleichheiten. Für die letzten 20 Jahre lässt sich ein kontinuierlicher Zuwachs an sozialepidemiologischen Forschungsbefunden in Deutschland konstatieren. Mit den gesundheitlichen Ungleichheiten und den sozialen Determinanten der Gesundheit adressiert die Sozialepidemiologie Kernbereiche von Public Health, deren Bearbeitung auch in Zukunft erheblichen Einfluss auf die wissenschaftlichen, politischen und praxisorientierten Perspektiven des Fachs haben dürfte. KW - gesundheitliche Ungleichheiten KW - Public Health KW - Sozialepidemiologie KW - soziale Ungleichheit Y1 - 2018 U6 - https://doi.org/10.1515/pubhef-2018-0062 SN - 0944-5587 SN - 1876-4851 VL - 26 IS - 3 SP - 212 EP - 215 ER - TY - GEN A1 - Hoffmann, Stephanie A1 - Spallek, Jacob T1 - Migration, Gesundheit und soziale Lage T2 - Public Health Forum N2 - Das Zusammenspiel zwischen Migration, Gesundheit und sozialer Lage ist durch verschiedene Wirkmechanismen gekennzeichnet. Die soziale Lage beeinflusst gesundheitliche Chancen und Risiken sowie die Migration selbst und trägt dazu bei, ob migrationsbedingte Einflüsse auf die Gesundheit verstärkt oder abgeschwächt werden. Migration ist bedeutend für die Erklärung gesundheitlicher Ungleichheit, obgleich Verzerrungen und Messartefakte bei Interpretationen berücksichtigt werden müssen. KW - Gesundheitliche Ungleichheit KW - Migration KW - Sozialstatus Y1 - 2018 U6 - https://doi.org/10.1515/pubhef-2018-0107 SN - 1876-4851 SN - 0944-5587 VL - 26 IS - 4 SP - 345 EP - 348 ER - TY - GEN A1 - Reder, Maren A1 - Berens, Eva-Maria A1 - Spallek, Jacob A1 - Kolip, Petra T1 - Development of the Informed Choice in Mammography Screening Questionnaire (IMQ): factor structure, reliability, and validity T2 - BMC Psychology N2 - Background: Informed choice is of ethical and practical importance in mammography screening. To assess the level to which decisions regarding such screening are informed is thus imperative, but no specific instrument has been available to measure informed choice in the German mammography screening programme. The aims of this study were to develop the Informed Choice in Mammography Screening Questionnaire (IMQ) and to find first evidence for the factor structure, reliability and validity of its different components. Methods: The IMQ was sent to 17.349 women aged 50 in Westphalia-Lippe, Germany. The instrument has been developed after consideration of (1) the results of qualitative interviews on decision making in the mammography screening programme, (2) relevant literature on other informed choice instruments and (3) a qualitative study on influencing factors. The IMQ comprises 3 scales (attitude, norms, and barriers), 1 index (knowledge) and singular items covering intention to participate and sociodemographic variables. To assess the psychometric properties of the components of the IMQ, confirmatory factor and item response theory analyses were conducted. Additionally, reliability, validity and item statistics were assessed. Results: 5.847 questionnaires were returned (response rate 33.7%). For attitude, the confirmatory factor analysis supported a one-factor structure. For norms, the model fit was not acceptable. Reliability levels were good with a Cronbach‘s α of.793 for attitude (4 items) and.795 for norms (5 items). For barriers, 9 items were deleted because of low discrimination indices; 6 items remained. The hypothesised assumption-subscale and the importance-subscale were confirmed, but these subscales showed poor reliabilities with Cronbach‘s α=.525 (4 items) and.583 (2 items). For the knowledge index, item response theory analysis showed that 6 out of 7 items were suitable. Hypotheses concerning the correlations between the different components were confirmed, which supported their convergent and divergent validity. Conclusion: The results of this study demonstrated that the IMQ is a multidimensional instrument. Further development of the barriers and norms scales is necessary. The IMQ can be utilised to assess the level of informed choices as well as influencing factors. KW - Mammography screening KW - Informed choice KW - Confirmatory factor analysis KW - Reliability KW - Validity Y1 - 2019 U6 - https://doi.org/10.1186/s40359-019-0291-2 SN - 2050-7283 VL - 7 IS - 1 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Kaucher, Simone A1 - Eckert, Sandra van A1 - Reder, Maren A1 - Kolip, Petra A1 - Spallek, Jacob T1 - Knowledge about mammography screening in Germany by education and migrant status – results of a cross-sectional study (InEMa) T2 - Applied Cancer Research N2 - Background: The population-based mammography screening program (MSP) is aimed to reduce breast cancer mortality, to detect breast cancer at an early stage, and to allow for less invasive treatment. However, it also has some potential harms, such as overdiagnosis and overtreatment. Therefore, it is necessary that women receive sufficient and balanced information to enable informed decision-making. We examined knowledge about benefits and harms of the MSP in Germany among first-time invitees of different socio-demographic backgrounds. Methods: This observational study assessed knowledge about benefits and harms of the MSP among women who were invited to the MSP for the first time by six multiple choice items, using a postal survey. We investigated (i) single items of knowledge, (ii) the distribution of sufficient knowledge stratified by education, migration status and invitation, and (iii) possible determinants of sufficient knowledge by analyzing Odds Ratios (ORs) using bivariate and multivariate logistic regression. Results: In total, 5397 women included in the analyses. 46.1% of the study population had sufficient knowledge about benefits and harms of the MSP. However, women with low educational level and migration background had higher proportions of insufficient knowledge and used most frequently the option “don’t know”. Women had the most difficulties answering the numeric question and the question about the target group correctly. Results from the logistic regression showed that the odds of having sufficient knowledge were higher among well-educated women (OR 3.84, 95%CI 3.24–4.55), among women who already received the MSP invitation (OR 1.38, 95%CI 1.20–1.59) and lowest among Turkish women (OR 0.14, 95%CI 0.07–0.25). Conclusions: Women with low education and migration background need adapted information regarding benefits and harms of the MSP and are important target groups for further developing the information material about mammography screening to reduce disparities in knowledge and enable informed decision-making. KW - Mammography screening program, Knowledge, Education, Migrants, Benefits, Harms Y1 - 2019 U6 - https://doi.org/10.1186/s41241-019-0076-1 SN - 1980-5578 VL - 39 IS - 6 ER - TY - GEN A1 - Scholaske, Laura A1 - Brose, Annette A1 - Spallek, Jacob A1 - Entringer, Sonja T1 - Perceived discrimination and risk of preterm birth among Turkish immigrant women in Germany T2 - Social Science & Medicine N2 - Background: Health disparities, including adverse birth outcomes, exist between Turkish immigrants and the autochthonous population in Germany. The state of research on the risk of preterm birth (PTB, defined as <37 weeks of gestation), the leading cause of infant mortality and morbidity, among Turkish immigrant women is mixed. Perceived discrimination is discussed in the context of health disparities related to migration. We examined whether PTB risk is also increased in Turkish immigrant women in Germany and whether perceived discrimination due to origin contributes to this risk. Methods: We selected a sample from the German Socio-Economic Panel (SOEP) study of German autochthonous and Turkish immigrant women who recently gave birth (between 2002 and 2016) (N = 2,525, incl. n = 217 Turkish immigrant women of which n = 111 completed an item on perceived discrimination). The included variables of central interest were immigrant status, perceived discrimination, gestational age, and socioeconomic situation. Results: Logistic regression models indicated that PTB risk was significantly higher for Turkish immigrant women than autochthonous women (OR: 2.75, 95% CI [1.79–4.16]), even when adjusting for socioeconomic status. Within the subsample of Turkish immigrant women, perceived discrimination was related to a significantly higher PTB risk (OR: 4.91, 95% CI [1.76–15.06]). Conclusions: Our study provides evidence for a higher PTB risk in Turkish immigrant women compared to autochthonous women in Germany. Perceived discrimination may contribute to this higher risk. The findings represent an important first step towards developing targeted interventions to improve pregnancy and birth outcomes in minority groups. KW - Perceived discrimination KW - Preterm birth KW - Turkish immigrants KW - Health disparities Y1 - 2019 U6 - https://doi.org/10.1016/j.socscimed.2019.112427 SN - 0277-9536 SN - 1873-5347 SN - 0037-7856 VL - 236 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 - 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 - 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 - 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 - TY - GEN A1 - Kaucher, Simone A1 - Khil, Laura A1 - Kajüter, Hiltraud A1 - Becher, Heiko A1 - Reder, Maren A1 - Kolip, Petra A1 - Spallek, Jacob A1 - Winkler, Volker A1 - Berens, Eva-Maria T1 - Breast cancer incidence and mammography screening among resettlers in Germany T2 - BMC public health N2 - Background – European studies showed that women with a migration background are less likely to participate in mammography screenings than autochthonous women. However, the participation in the German mammography screening programme (MSP) among ethnic German migrants from countries of the former Soviet Union (called resettlers) is unclear so far. The aim of this study was to identify possible differences regarding MSP participation between resettlers from the FSU and the general German population. Methods – Data from two independent, complementary studies from North Rhine-Westphalia, Germany (a retrospective cohort study 1994–2013; a cross-sectional study 2013/14) were used for comparisons between resettlers and the general population: Odds Ratios (ORs) for MSP participation utilizing the cross-sectional data and time trends of breast cancer incidence rates as well as Chi-Square tests for breast cancer stages utilizing the cohort data. Results – Resettlers showed higher Odds to participate in the MSP than the general population (OR 2.42, 95% CI 1.08–5.42). Among resettlers, a large increase in incidence rates was observed during the MSP implementation (2005–2009), resulting in stable and comparable incidence rates after the implementation. Furthermore, pre-MSP implementation, the proportion of advanced breast cancer stages was higher among resettlers than in the German population, post-MSP implementation the proportion was comparable. Conclusions – MSP participating seems surprisingly high among resettlers. An explanation for the increased willingness to participate might be the structured invitation procedure of the MSP. However, the exact reasons remain unclear and future research is needed to confirm this hypothesis and rule out the possibility of selection bias in the cross-sectional study. KW - Resettlers KW - Migrants KW - Breast cancer KW - Stage at diagnosis KW - Mammography screening programme KW - Participation Y1 - 2020 U6 - https://doi.org/10.1186/s12889-020-08534-7 VL - 20 IS - 1 ER - TY - GEN A1 - Ludwig, Angelique A1 - Miani, Céline A1 - Breckenkamp, Jürgen A1 - Sauzet, Odile A1 - Borde, Theda A1 - Doyle, Ina-Merle A1 - Brenne, Silke A1 - Höller-Holtrichter, Chantal A1 - David, Matthias A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies T2 - Maternal and Child Health Journal N2 - Objective: Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular. Methods: Baseline data of the Bielefeld BaBi birth cohort (2013–2016) and the Berlin perinatal study (2011–2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status.ResultsIn Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake. Conclusions for Practice: Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups. KW - Non-medical antenatal care KW - Migration background KW - Education KW - Socioeconomic status KW - Pregnancy Y1 - 2020 U6 - https://doi.org/10.1007/s10995-020-02937-z SN - 1573-6628 SN - 1092-7875 VL - 24 IS - 7 SP - 943 EP - 952 ER - TY - GEN A1 - Ulrich, Hanna-Sophie A1 - Kohler, Emma A1 - Fach, Eva-Maria A1 - Spallek, Jacob A1 - Richter, Matthias A1 - Mlinarić, Martin T1 - Healthcare needs among unaccompanied minor refugees: a study protocol of a qualitative study explaining access and utilisation across place and gender T2 - BMJ Open N2 - Introduction: Several studies have identified that unaccompanied minor refugees (UMRs) are allegedly ‘vulnerable’ and belong to a high-risk group in terms of psychological distress and post-traumatic stress disorder due to their preflight, periflight and postflight experiences. Psychosocial care (PSC) is of high importance for UMRs, but little is known about barriers to access and utilisation of PSC across place and gender. The aims of this gender-sensitive qualitative study will be to build on the existing body of literature and to provide qualitative evidence on the contexts and mechanisms of PSC for male and female UMRs in Germany by comparing two German regions. Methods and analysis: Following the study preparing realist review, a qualitative study will be undertaken in Berlin and Central German cities. Approximately 24 experts from the field of PSC and 12 lay UMRs will participate in face-to-face, semistructured interviews. Data will be transcribed and analysed based on the grounded theory research paradigm. Ethics and dissemination: Only participants who have been informed in both German and their native tongue and who have signed a declaration of consent will be included in the study. The study will comply rigorously with German data protection standards. Approval from the Ethical Review Committee at Martin Luther University Halle-Wittenberg, Germany has been obtained and granted. The results of the study will be presented at several conferences and will be published in high-quality, peer-reviewed international journals. The results will display a differentiated picture of the PSC of UMRs in Germany. Such knowledge is a precondition for a ‘science of change’ that translates explanations into practical recommendations on how to improve healthcare policies. KW - Healthcare KW - unaccompanied minor refugees KW - access KW - utilisation KW - gender Y1 - 2020 UR - https://bmjopen.bmj.com/content/10/9/e038882 U6 - https://doi.org/10.1136/bmjopen-2020-038882 SN - 2044-6055 VL - 10 IS - 9 ER - TY - GEN A1 - Schilling, Laura A1 - Spallek, Jacob A1 - Maul, Holger A1 - Tallarek, Marie A1 - Schneider, Sven T1 - Active and Passive Exposure to Tobacco and e-Cigarettes During Pregnancy T2 - Maternal and Child Health Journal N2 - Objectives Active and passive exposure to tobacco cigarettes during pregnancy is associated with multiple negative health outcomes for the fetus. In addition, exposure to e-cigarettes has been progressively discussed as a new threat to fetal health. Until now, there has been a lack of studies examining active and passive exposure to tobacco and e-cigarettes among pregnant women. The objective of our current STudy on E-cigarettes and Pregnancy (STEP) was to advance and complement the current knowledge regarding active and passive exposure to tobacco and e-cigarettes before pregnancy and during early and late pregnancy. Methods One element of the STEP study was a quantitative cross-sectional design: A sample of 540 pregnant women recruited at an obstetrician clinic in Hamburg from April 2018 to January 2019 were surveyed once via a standardized questionnaire and provided complete information regarding their consumption of tobacco and e-cigarettes. We performed a descriptive analysis of tobacco and e-cigarette use before pregnancy and during early and late pregnancy, as well as bivariate analysis of these variables with sociodemographic determinants. Passive exposure was assessed by asking the participating pregnant women about the consumption of tobacco and e-cigarettes by their partners, in general, and in their homes. Results Before pregnancy, 20.0% of the participants used tobacco cigarettes exclusively, 1.3% used e-cigarettes exclusively, and 6.5% were dual users. Educational level was significantly associated with tobacco cigarette use (p < 0.001) and dual use (p = 0.047) before pregnancy. During early (late) pregnancy, 8.7% (2.8%) used tobacco cigarettes and 0.4% (0.0%) used e-cigarettes exclusively. Twenty-point nine percent of women’s partners consumed tobacco cigarettes exclusively, 2.7% consumed e-cigarettes exclusively, and 2.7% consumed both. A total of 8.5% (16.7%) of the partners who consumed tobacco cigarettes exclusively (e-cigarettes exclusively) did so in the women’s homes. Conclusions for Practice Among pregnant women, the use of tobacco cigarettes remains prominent before and during pregnancy, while e-cigarette use predominately occurs before pregnancy. Our study shows that pregnant women are frequently exposed to their partners’ tobacco and e-cigarette use within their homes. Strategies to reduce such exposure should be further intensified. Significance In the last decade, e-cigarettes have become popular, and e-cigarette use has been increasing, even among pregnant women. However, there is a lack of knowledge concerning the exposure to e-cigarettes before pregnancy and during early and late pregnancy, as well as studies comparing e-cigarettes and tobacco cigarettes. The current study found that active exposure to e-cigarettes before pregnancy is high, while exposure during pregnancy is marginal. In contrast, exposure to tobacco cigarettes before and in early pregnancy is high but decreases during late pregnancy. In addition, the results of our study show that pregnant women are passively exposed to tobacco and e-cigarettes at home. Pregnant women should be advised against exposing themselves, actively or passively, to tobacco and e-cigarette smoke. KW - E-cigarette KW - Tobacco cigarette KW - Nicotine KW - Passive exposure KW - Pregnancy Y1 - 2020 U6 - https://doi.org/10.1007/s10995-020-03037-8 SN - 1092-7875 SN - 1573-6628 VL - 25 IS - 4 SP - 656 EP - 665 ER - TY - GEN A1 - Tallarek, Marie A1 - Bozorgmehr, Kayvan A1 - Spallek, Jacob T1 - Towards inclusionary and diversity-sensitive public health: the consequences of exclusionary othering in public health using the example of COVID-19 management in German reception centres and asylum camps T2 - BMJ Global Health N2 - The German government’s response to the COVID-19 pandemic has been predominantly considered wellfounded. Still, the practice of mass quarantine in reception centres and asylum camps has been criticised for its discrimination of refugees and asylum seekers. Building on the concept of othering, this article argues that processes of othering are structurally anchored in German asylum regulations and they have further pervaded public health measures against COVID-19. The practice of mass quarantine made the negative consequences of exclusionary othering for public health particularly noticeable. In the light of recent data indicating this measure to be epidemiologically, legally and ethically insufficient, we apply the concept of othering to public health and discuss (1) exclusionary, (2) inclusionary and (3) diversity-sensitive approaches to public health. We finally conclude that a shift of perspective from exclusion to inclusion, from subordination to empowerment and from silencing to participation is urgently required. KW - inclusionary public health KW - exclusionary public health KW - diversity-sensitive public health KW - othering KW - COVID-19 KW - refugees KW - asylum seekers KW - mass quarantine Y1 - 2020 UR - https://gh.bmj.com/content/bmjgh/5/12/e003789.full.pdf U6 - https://doi.org/10.1136/bmjgh-2020-003789 SN - 2059-7908 VL - 5 IS - 12 ER - 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 - Miani, Céline A1 - Batram-Zantvoort, Stephanie A1 - Wandschneider, Lisa A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Potential of Standard Perinatal Data for Measuring Violation of Birth Integrity T2 - Frontiers in global women's health N2 - Background: Measuring the phenomenon of violation of birth integrity (vBI) (e.g., obstetric violence) relies in part on the availability and content of maternity care providers' data. The population coverage and linkage possibilities that these data provide make for a yet untapped potential. Although vBI is a complex phenomenon best measured with dedicated instruments, we argue that maternity care providers' data could contribute to enhance our knowledge of the manifestations and frequency of vBI, and allow for analyses across different sub-groups of the population. Looking into the German standardized perinatal data, we investigate which variables are relevant to vBI-related research, and how complete their reporting is. Methods: First, we analyse state-of-the-art frameworks and recommendations, and, for each vBI-related domain, we search for and list corresponding variables in the perinatal data which could contribute to a better understanding of vBI issues. Second, we use an example and analyse the content of perinatal data obtained between 2013 and 2016 in the context of the BaBi birth cohort study set in Bielefeld, Germany. We use descriptive statistics to assess the completeness of the data. Results: The vBI-related variables can be classified in three main categories: discrimination based on specific patient socio-demographic attributes (e.g., height and weight to calculate BMI before pregnancy, foreign origin), indication for medical interventions (i.e., medicalization-related variables: indication for cesarean sections and induction), and supportive care, in particular the mobilization dimension (e.g., continuous fetal heartbeat monitoring). The data analyses included 876 births, of which 601 were vaginal birth. We found poor reporting on demographic variables in terms of completeness. Medicalization and mobilization variables are better documented, although limited in scope. Conclusions: Putting more emphasis on the completeness of standardized data could increase their potential for vBI-related research. Perinatal data alone are insufficient to assess vBI, but a broader, theory-informed discussion of indicators to be included in standardized datasets would contribute to capturing the different aspects of integrity violation in a more systematic way and expand the evidence-base on different types of vBI. KW - childbirth KW - respectful maternity care KW - mistreatment KW - perinatal data KW - Germany KW - birth integrity KW - obstetric violence Y1 - 2021 U6 - https://doi.org/10.3389/fgwh.2020.581244 SN - 2673-5059 IS - 1 ER - TY - GEN A1 - Schilling, Laura A1 - Spallek, Jacob A1 - Maul, Holger A1 - Schneider, Sven T1 - Study on E-Cigarettes and Pregnancy (STEP) – Results of a Mixed Methods Study on Risk Perceptionof E-Cigarette Use During Pregnancy T2 - Geburtshilfe und Frauenheilkunde N2 - Introduction E-cigarette use during pregnancy is a risk factor for maternal and fetal health. Early studies on animals showed that in utero exposure to e-cigarettes can have negative health outcomes for the fetus. There has been only limited research into the risk perceptions of e-cigarette use during pregnancy. This study was conducted to comprehensively characterize the constructs of risk perceptions with regard to e-cigarette use during pregnancy using an Integrated Health Belief Model (IHBM). Methods Our STudy on E-cigarettes and Pregnancy (STEP)used a mixed methods approach, with the study divided intoan initial qualitative part and a quantitative part. A netno-graphic approach was used for the first part, which consistedof the analysis of 1552 posts from 25 German-language on-line discussion threads on e-cigarette use during pregnancy. Using these qualitative results, a quantitative questionnaire was developed to explore risk perception constructs about e‑cigarette use during pregnancy. This questionnaire was subsequently administered to pregnant women (n = 575) in onehospital in Hamburg, Germany. Descriptive and bivariate analysis was used to examine differences in risk perception ac-cording to participantsʼ tobacco and e-cigarette user status before and during pregnancy. While the study design, methods and sample have been extensively described in our recently published study protocol in the January 2020 issue of Geburtshilfe und Frauenheilkunde, this paper is devoted to apresentation of the results of our mixed methods study. Results Themes related to perceived threats identified in the qualitative study part were nicotine-related health risks and po-tential health risks of additional ingredients. Perceived benefits were possibility and facilitation of smoking cessationand a pre-sumed potential to reduce harm. The subsequent quantitative part showed that nearly all participants (99.3%) perceivede‑cigarettes which contained nicotine as constituting a threat to the health of the unborn child. The most commonly perceived barrier was health-related (96.6%), while the most commonly perceived benefit was a reduction in the amount of tobacco cigarettes consumed (31.8%). We found that partic-ularly perceived benefits varied depending on the partici-pantʼs tobacco and e-cigarette user status. Conclusion When considering future prevention strategies, the potential health risks and disputed effectiveness of e-cigarettes as a tool for smoking cessation need to be taken intoaccount and critically discussed. KW - electronic cigarette KW - pregnancy KW - risk perception KW - Health Belief Model KW - online forums KW - mixed methods Y1 - 2021 UR - https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-1308-2376.pdf U6 - https://doi.org/10.1055/a-1308-2376 SN - 0016‑5751 VL - 81 IS - 02 SP - 214 EP - 223 ER - TY - GEN A1 - Novelli, Anna A1 - Schüttig, Wiebke A1 - Spallek, Jacob A1 - Wachtler, Benjamin A1 - Diehl, Katharina A1 - Moor, Irene A1 - Richter, Matthias A1 - Dragano, Nico A1 - Sundmacher, Leonie T1 - Correlation of mesolevel characteristics of the healthcare system and socioeconomic inequality in healthcare use: a scoping review protocol T2 - BMJ Open N2 - 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. KW - mesolevel characteristics KW - healthcare KW - inequality KW - scoping review Y1 - 2021 UR - https://bmjopen.bmj.com/content/11/2/e044301.info U6 - https://doi.org/10.1136/bmjopen-2020-044301 SN - 2044-6055 VL - 11 IS - 2 ER - TY - GEN A1 - Lueckmann, Sara Lena A1 - Hoebel, Jens A1 - Roick, Julia A1 - Markert, Jenny A1 - Spallek, Jacob A1 - Knesebeck, Olaf von dem A1 - Richter, Matthias T1 - Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review T2 - International journal for equity in health N2 - Background Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries. Methods We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria. Results Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES. Conclusion This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare. KW - Socioeconomic inequalities KW - primary-care KW - specialist physician KW - systematic review Y1 - 2021 U6 - https://doi.org/10.1186/s12939-020-01375-1 SN - 1475-9276 VL - 20 ER - TY - GEN A1 - Tallarek, Marie A1 - Spallek, Jacob T1 - Inclusionary und diversitätssensibles Public Health in der Pandemie T2 - Public Health Forum N2 - Othering beschreibt die Markierung von Menschen als „anders“ oder „nicht zugehörig“. Ausgehend von den Konzepten des exclusionary und inclusionary Othering diskutiert dieser Beitrag drei Ansätze zu i) exclusionary Public Health, ii) inclusionary Public Health und iii) diversitätssensiblem Public Health. Die Implikationen der Ansätze werden am Beispiel des Umgangs mit der COVID-19 Pandemie bei schutzsuchenden Menschen in Aufnahmeeinrichtungen und Sammelunterkünften in Deutschland aufgezeigt. KW - Othering KW - exclusionary public health KW - inclusionary public health KW - diversitätssensibles Public Health KW - Pandemie KW - Covid-19 Y1 - 2021 UR - https://www.degruyter.com/document/doi/10.1515/pubhef-2020-0112/html U6 - https://doi.org/10.1515/pubhef-2020-0112 SN - 1876-4851 SN - 0944-5587 VL - 29 IS - 1 SP - 22 EP - 26 ER - TY - GEN A1 - Ulrich, Hanna-Sophie A1 - Kohler, Emma A1 - Spallek, Jacob A1 - Richter, Matthias A1 - Clauß, Daniel A1 - Mlinarić, Martin T1 - Explaining psychosocial care among unaccompanied minor refugees: a realist review T2 - European child & adolescent psychiatry N2 - Research on the psychosocial care (PSC) of unaccompanied minor refugees (UMRs) has mainly taken a socioepidemiological approach and has focused on the perspectives of experts in the field. In contrast, the knowledge concerning the differing context factors and the underlying mechanisms of current PSC which could inform policy recommendations is scant. The study aims at unravelling the contexts, mechanisms and outcomes of PSC for UMRs. For a realist review (RR), scientific evidence and gray literature were synthesised consistent with the RAMESES publication standards for realist synthesis. Based on an iterative keyword search in electronic databases (e.g., PubMed) and screening, 34 works from 2005 to 2019 were included in a realist synthesis. Theory-informed context-mechanism-outcome configurations (CMOs) were extracted, to explain underlying processes and mechanisms. Characterised by their interrelatedness, the dominant CMOs included the UMRs' intersections of transitions (e.g., adolescence and migration), their needs for culture-, and gender-sensitive PSC, and the undersupply of PSC. These contexts and outcomes are mediated by pre-, peri- and post-migratory stressors as well as care structures and are moreover influenced by overarching discourses and concepts. They comprise adverse and beneficial mechanisms in the PSC of UMRs. The existing literature grasps the PSC of UMRs by different disciplines and approaches but does not offer a comprehensive overview on micro-macro intersections and included discourses. The inclusion of lay perspectives and an intersectional approach could inform health service research. The reflection of UMR-related categorical constructs of resilience and vulnerability, discourses of othering, as well as restrictive health policies may guide policy recommendations. KW - Migration KW - Psychosocial care KW - Realist review KW - Unaccompanied minor refugees KW - mental health Y1 - 2021 U6 - https://doi.org/10.1007/s00787-021-01762-1 SN - 1435-165X VL - 31(2022) IS - 12 SP - 1857 EP - 1870 ER - TY - GEN A1 - Scholaske, Laura A1 - Spallek, Jacob A1 - Entringer, Sonja T1 - Fetale Programmierung von Gesundheitsdisparitäten bei Kindern mit Migrationshintergrund T2 - Public Health Forum N2 - Kinder von Migrant*innen zeigen bereits in frühen Lebensjahren häufig Gesundheitsdisparitäten, die mit mütterlicher Gesundheit und migrationsbezogenen Faktoren eng zusammenhängen. Zur Erklärung dieses Phänomens der intergenerationalen Transmission von Gesundheitsdisparitäten schlagen wir ein Modell vor, das eine Lebensverlaufsperspektive mit dem Konzept der fetalen Programmierung von Gesundheit und Krankheitsvulnerabilität zusammenbringt. KW - Fetale Programmierung KW - Gesundheitliche Ungleichheiten KW - Intergenerationale Übertragung KW - Migrant*innen Y1 - 2021 UR - https://www.degruyter.com/document/doi/10.1515/pubhef-2021-0015/html U6 - https://doi.org/10.1515/pubhef-2021-0015 SN - 1876-4851 VL - 29 IS - 2 SP - 131 EP - 134 ER - TY - GEN A1 - Spallek, Jacob A1 - Scholaske, Laura A1 - Duman, Elif Aysimi A1 - Razum, Oliver A1 - Entringer, Sonja T1 - Association of maternal migrant background with inflammation during pregnancy – results of a birth cohort study in Germany T2 - Brain, Behavior, and Immunity N2 - Background Health disparities in children of immigrants are prevalent from birth and are hypothesized to – in part – emerge as a biological consequence of migration’s unfavorable social and psychological sequelae. The aim of this study was to examine whether maternal migrant background is associated with inflammation during pregnancy - a key pathway by which maternal states and conditions during pregnancy may influence fetal development and subsequent pregnancy, birth, and child developmental and health outcomes. Material and Methods Data was available from 126 pregnant women who participated in a population based multi-site prospective birth cohort study in Bielefeld and Berlin, Germany. The study included two study visits in mid- and late pregnancy. At each visit, a composite maternal pro-inflammatory score was derived from circulating levels of plasma inflammatory markers (IL-6, CRP). Migrant background was defined by country of origin of participants and their parents’ (Turkey or other) and generation status (1st or 2nd generation). We applied hierarchical linear models (HLM) in order to quantify the relationship between different migrant background variables and inflammation during pregnancy after adjustment for potential confounders (including socioeconomic status). Results Migrant background was significantly associated with inflammation during pregnancy. When compared to women without migrant background, levels of inflammation were increased in 1) pregnant women with migrant background in general (B = 0.35, SE = 0.12, p < .01); 2) 1st (B = 0.28, SE = 0.15, p < .10) and 2nd generation (B = 0.40, SE = 0.15, p < .01); 3) women with a Turkish migrant background (B = 0.28, SE = 0.14, p < .10) and women with another migrant background (B = 0.42, SE = 0.15, p <.01); and 4) 2nd generation Turkish origin women (B = 0.38, SE = 0.20, p <.10), 1st generation women with other migrant background (B = 0.44, SE = 0.26, p <.10), and 2nd generation women with other migrant background (B=0.43, SE = 0.17, p <.05). Discussion Our findings support a role for maternal inflammation as a pathway of intergenerational transmission of migration-related health inequalities, suggest that the effect seems to persist in 2nd generation immigrants, and highlight the need for future research and targeted interventions in this context. KW - Transmission of Health Inequalities KW - Stress biology KW - Immigrants KW - Inflammation Y1 - 2021 U6 - https://doi.org/10.1016/j.bbi.2021.06.010 SN - 1090-2139 VL - Vol. 96 SP - 271 EP - 278 ER - TY - GEN A1 - Hintermeier, Maren A1 - Gencer, Hande A1 - Kajikhina, Katja A1 - Rohleder, Sven A1 - Santos-Hövener, Claudia A1 - Tallarek, Marie A1 - Spallek, Jacob A1 - Bozorgmehr, Kayvan T1 - SARS-CoV-2 among migrants and forcibly displaced populations: a rapid systematic review T2 - Journal of Migration and Health N2 - The economic and health consequences of the COVID-19 pandemic pose a particular threat to vulnerable groups, such as migrants, particularly forcibly displaced populations. The aim of this review is (i) to synthesise the evidence on risk of infection and transmission among migrants, refugees, asylum seekers and internally displaced populations, and (ii) the effect of lockdown measures on these populations. We searched MEDLINE and WOS, preprint servers, and pertinent websites between 1st December 2019 and 26th June 2020. The included studies showed a high heterogeneity in study design, population, outcome and quality. The incidence risk of SARS-CoV-2 varied from 0•12% to 2•08% in non-outbreak settings and from 5•64% to 21•15% in outbreak settings. Migrants showed a lower hospitalisation rate compared to non-migrants. Negative impacts on mental health due to lockdown measures were found across respective studies. However, findings show a tenuous and heterogeneous data situation, showing the need for more robust and comparative study designs. KW - migrants KW - forcibly displaced KW - SARS-CoV-2 KW - COVID-19 KW - refugees KW - asylum seekers Y1 - 2021 UR - https://www.sciencedirect.com/science/article/pii/S2666623521000234 U6 - https://doi.org/10.1016/j.jmh.2021.100056 SN - 2666-6235 VL - 4 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 - TY - GEN A1 - Breckenkamp, Jürgen A1 - Razum, Oliver A1 - Spallek, Jacob A1 - Berger, Klaus A1 - Chaix, Basile A1 - Sauzet, Odile T1 - A method to define the relevant ego-centred spatial scale for the assessment of neighbourhood effects: the example of cardiovascular risk factors T2 - BMC Public Health N2 - Introduction: The neighbourhood in which one lives affects health through complex pathways not yet fully understood. A way to move forward in assessing these pathways direction is to explore the spatial structure of health phenomena to generate hypotheses and examine whether the neighbourhood characteristics are able to explain this spatial structure. We compare the spatial structure of two cardiovascular disease risk factors in three European urban areas, thus assessing if a non-measured neighbourhood effect or spatial processes is present by either modelling the correlation structure at individual level or by estimating the intra-class correlation within administrative units. Methods: Data from three independent studies (RECORD, DHS and BaBi), covering each a European urban area, are used. The characteristics of the spatial correlation structure of cardiovascular risk factors (BMI and systolic blood pressure) adjusted for age, sex, educational attainment and income are estimated by fitting an exponential model to the semi-variogram based on the geo-coordinates of places of residence. For comparison purposes, a random effect model is also fitted to estimate the intra-class correlation within administrative units. We then discuss the benefits of modelling the correlation structure to evaluate the presence of unmeasured spatial effects on health. Results: BMI and blood pressure are consistently found to be spatially structured across the studies, the spatial correlation structures being stronger for BMI. Eight to 22% of the variability in BMI were spatially structured with radii ranging from 100 to 240 m (range). Only a small part of the correlation of residuals was explained by adjusting for the correlation within administrative units (from 0 to 4 percentage points). Discussion: The individual spatial correlation approach provides much stronger evidence of spatial effects than the multilevel approach even for small administrative units. Spatial correlation structure offers new possibilities to assess the relevant spatial scale for health. Stronger correlation structure seen for BMI may be due to neighbourhood socioeconomic conditions and processes like social norms at work in the immediate neighbourhood. KW - Cardiovascular risk factors KW - Geographic distribution KW - Spatial scale Y1 - 2021 U6 - https://doi.org/10.1186/s12889-021-11356-w SN - 1471-2458 VL - 21 ER - TY - GEN A1 - Hoffmann, Stephanie A1 - Schiebel, Juliane A1 - Hufert, Frank A1 - Gremmels, Heinz-Detlef A1 - Spallek, Jacob T1 - COVID-19 among Healthcare Workers: A Prospective Serological-Epidemiological Cohort Study in a Standard Care Hospital in Rural Germany T2 - International Journal of Environmental Research and Public Health N2 - Healthcare workers (HCW) play a vital role in the SARS-CoV-2 pandemic control. The aim of this study was to assess the prevalence of SARS-CoV-2 antibodies and the risk of COVID-19 infections in a cohort of HCW from four different risk groups (from intensive care unit to administration) of a hospital of a primary care level in rural Germany. The outcomes were monthly measures of antibody seroprevalence over a period of 6 months. Overall, a seroprevalence of 13.41% was determined, with significantly higher prevalence rates among HCW working in areas with more frequent contact to confirmed or suspected cases (30.30%, p = 0.003). The group specific differences in the risk of infection from COVID-19 were detected, as HCW groups with frequent exposure seemed to have an increased risk (RR = 3.18, p = 0.02; CI95 1.09–9.24). The findings contribute to the epidemiological understanding of the virus spread in an unvaccinated population group, which is highly relevant for the pandemic management. KW - SARS-CoV-2 KW - immunity KW - antibody KW - healthcare KW - staff KW - COVID-19 KW - seroprevalence KW - pandemic Y1 - 2021 UR - https://www.mdpi.com/1660-4601/18/20/10999 U6 - https://doi.org/10.3390/ijerph182010999 SN - 1660-4601 VL - 18 IS - 20 ER - TY - GEN A1 - Scholz, Lisa A1 - Schimböck, Florian A1 - Spallek, Jacob T1 - Community Child Health Nursing: Ein Konzept für Deutschland? T1 - Community Child Health Nursing: Conceptual ideas for Germany T2 - Public Health Forum N2 - Soziale Ungleichheit führt bereits im Kindesalter zu gesundheitlicher Benachteiligung. Gesundheitsfördernde Angebote in Deutschland sind noch unzureichend miteinander verknüpft und erreichen sozialbenachteiligte Familien nur bedingt. International ist Community Child Health Nursing (CCHN) verbreitet und bietet einen möglichen Ansatz, um die gesundheitliche Chancengleichheit von Kindern zu stärken. Dieser Beitrag diskutiert das Berufsbild der CCH-Nurses und konzeptionelle Aspekte für die Implementierung in Deutschland. KW - Community Child Health Nursing KW - Gesundheitliche Ungleichheit KW - Kinder Y1 - 2021 UR - https://www.degruyter.com/document/doi/10.1515/pubhef-2021-0063/html U6 - https://doi.org/10.1515/pubhef-2021-0063 VL - 29 IS - 3 SP - 209 EP - 212 ER - TY - GEN A1 - Miani, Céline A1 - Ludwig, Angelique A1 - Doyle, Ina-Merle A1 - Breckenkamp, Jürgen A1 - Höller-Holtrichter, Chantal A1 - Spallek, Jacob A1 - Razum, Oliver T1 - The role of education and migration background in explaining differences in folic acid supplementation intake in pregnancy: Results from a German birth cohort study T2 - Public Health Nutrition N2 - Objective: Official German recommendations advise women to start taking folic acid supplementation (FAS) before conception and continue during the first pregnancy trimester to lower the risk of birth defects. Women from lower socioeconomic background and ethnic minorities tend to be less likely to take FAS in other European countries. As little is known about the determinants of FAS in Germany, we aimed to investigate the association between FAS and formal education and migration background, adjusting for demographic factors. Design: We used data (2013-2016) on nutrition and socioeconomic and migration background from the baseline questionnaire of the BaBi cohort study. We performed multivariate regressions and mediation analyses. Setting: Bielefeld, Germany. Participants: 947 women (pregnant or who had given birth in the past two months). Results: 16.7% of the participants (158/947) didn't use FAS. Migration-related variables (e.g. language, length of stay) were not associated with FAS in the adjusted models. FAS was lower in women with lower level of formal education and in unplanned pregnancies. Reasons given by women for not taking FAS were unplanned pregnancy and lack of knowledge of FAS. Conclusions: Health practitioners may be inclined to see migrant women as an inherently at-risk group for failed intake of FAS. However, it is primarily women who did not plan their pregnancy, and women of lower formal education level, who are at risk. Different public health strategies to counter low supplementation rates should be supported, those addressing the social determinants of health (i.e. education) and those more focussed on family planning. KW - Folic acid supplementation KW - Germany KW - birth cohort KW - education KW - migration KW - pregnancy Y1 - 2021 UR - https://pubmed.ncbi.nlm.nih.gov/34420537/ U6 - https://doi.org/10.1017/S1368980021003621 SN - 1475-2727 SP - 1 EP - 24 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 - Hoffmann, Stephanie A1 - Tschorn, Mira A1 - Michalski, Niels A1 - Hoebel, Jens A1 - Förstner, Bernd R. A1 - Rapp, Michael A. A1 - Spallek, Jacob T1 - Association of regional socioeconomic deprivation and rurality with global developmental delay in early childhood: Data from mandatory school entry examinations in Germany T2 - Health & Place N2 - Background From birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family’s socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration. Method We used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children’s school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high). Results Family SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation. Conclusion Family SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course. KW - Health inequalities KW - Spatial analysis KW - Regional deprivation KW - Rurality KW - Developmental delay KW - Children Y1 - 2022 UR - https://www.sciencedirect.com/science/article/pii/S1353829222000557 U6 - https://doi.org/10.1016/j.healthplace.2022.102794 SN - 1353-8292 VL - 75 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 - Tschorn, Mira A1 - Schulze, Susanne A1 - Förstner, Bernd R. A1 - Holmberg, Christine A1 - Spallek, Jacob A1 - Heinz, Andreas A1 - Rapp, Michael A. T1 - Predictors and prevalence of hazardous alcohol use in middle-late to late adulthood in Europe T2 - Aging & Mental Health N2 - Objectives: Even low to moderate levels of alcohol consumption can have detrimental health consequences, especially in older adults (OA). Although many studies report an increase in the proportion of drinkers among OA, there are regional variations. Therefore, we examined alcohol consumption and the prevalence of hazardous alcohol use (HAU) among men and women aged 50+ years in four European regions and investigated predictors of HAU. Methods: We analyzed data of N = 35,042 participants of the European SHARE study. We investigated differences in alcohol consumption (units last week) according to gender, age and EU-region using ANOVAs. Furthermore, logistic regression models were used to examine the effect of income, education, marital status, history of a low-quality parent–child relationship and smoking on HAU, also stratified for gender and EU-region. HAU was operationalized as binge drinking or risky drinking (<12.5 units of 10 ml alcohol/week). Results: Overall, past week alcohol consumption was 5.0 units (±7.8), prevalence of HAU was 25.4% within our sample of European adults aged 50+ years. Male gender, younger age and living in Western Europe were linked to both higher alcohol consumption and higher risks of HAU. Income, education, smoking, a low-quality parent–child relationship, living in Northern and especially Eastern Europe were positively associated with HAU. Stratified analyses revealed differences by region and gender. Conclusions: HAU was highly prevalent within this European sample of OA. Alcohol consumption and determinants of HAU differed between EU-regions, hinting to a necessity of risk-stratified population-level strategies to prevent HAU and subsequent alcohol use disorders. KW - Hazardous alcohol use KW - older adults KW - middle-aged adults KW - Europe KW - drug and alcohol abuse KW - cross-national/international studies KW - environmental factors/housing/rural-urban factors KW - epidemiology KW - mental health Y1 - 2022 UR - https://www.tandfonline.com/doi/epub/10.1080/13607863.2022.2076208?needAccess=true U6 - https://doi.org/10.1080/13607863.2022.2076208 SN - 1364-6915 VL - 27 (2023) IS - 5 SP - 1001 EP - 1010 ER - TY - GEN A1 - Kiel, Simone A1 - Weckmann, Gesine A1 - Chenot, Jean-François A1 - Stracke, Sylvia A1 - Spallek, Jacob A1 - Angelow, Aniela T1 - Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample T2 - BMC Nephrology N2 - Background: Clinical practice guidelines recommend specialist referral according to different criteria. The aim was to assess recommended and observed referral rate and health care expenditure according to recommendations from: • Kidney Disease Improving Global Outcomes (KDIGO,2012) • National Institute for Health and Care Excellence (NICE,2014) • German Society of Nephrology/German Society of Internal Medicine (DGfN/DGIM,2015) • German College of General Practitioners and Family Physicians (DEGAM,2019) • Kidney failure risk equation (NICE,2021) Methods: Data of the population-based cohort Study of Health in Pomerania were matched with claims data. Proportion of subjects meeting referral criteria and corresponding health care expenditures were calculated and projected to the population of Mecklenburg-Vorpommern. Results: Data from 1927 subjects were analysed. Overall proportion of subjects meeting referral criteria ranged from 4.9% (DEGAM) to 8.3% (DGfN/DGIM). The majority of patients eligible for referral were ≥ 60 years. In subjects older than 60 years, differences were even more pronounced, and rates ranged from 9.7% (DEGAM) to 16.5% (DGfN/DGIM). Estimated population level costs varied between €1,432,440 (DEGAM) and €2,386,186 (DGfN/DGIM). From 190 patients with eGFR < 60 ml/min, 15 had a risk of end stage renal disease > 5% within the next 5 years. Conclusions: Applying different referral criteria results in different referral rates and costs. Referral rates exceed actually observed consultation rates. Criteria need to be evaluated in terms of available workforce, resources and regarding over- and underutilization of nephrology services. KW - chronic kidney disease KW - disease management KW - healthcare KW - Referral criteria KW - population-based cohort Study Y1 - 2022 UR - https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-022-02845-0#citeas U6 - https://doi.org/10.1186/s12882-022-02845-0 SN - 1471-2369 VL - 23 SP - 1 EP - 11 ER - TY - GEN A1 - Schulze, Susanne A1 - Merz, Sibille A1 - Thier, Anne A1 - Tallarek, Marie A1 - König, Franziska A1 - Uhlenbrock, Greta A1 - Nübling, Matthias A1 - Lincke, Hans-Joachim A1 - Rapp, Michael A. A1 - Spallek, Jacob A1 - Holmberg, Christine T1 - Psychosocial burden in nurses working in nursing homes during the Covid-19 pandemic: a cross-sectional study with quantitative and qualitative data T2 - BMC health services research N2 - Background: The Covid-19 pandemic led to increased work-related strain and psychosocial burden in nurses worldwide, resulting in high prevalences of mental health problems. Nurses in long-term care facilities seem to be especially affected by the pandemic. Nevertheless, there are few findings indicating possible positive changes for health care workers. Therefore, we investigated which psychosocial burdens and potential positive aspects nurses working in long-term care facilities experience during the Covid-19 pandemic. Methods: We conducted a mixed-methods study among nurses and nursing assistants working in nursing homes in Germany. The survey contained the third German version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Using Welch's t-tests, we compared the COPSOQ results of our sample against a pre-pandemic reference group of geriatric nurses from Germany. Additionally, we conducted semi-structured interviews with geriatric nurses with a special focus on psychosocial stress, to reach a deeper understanding of their experiences on work-related changes and burdens during the pandemic. Data were analysed using thematic coding (Braun and Clarke). Results: Our survey sample (n = 177) differed significantly from the pre-pandemic reference group in 14 out of 31 COPSOQ scales. Almost all of these differences indicated negative changes. Our sample scored significantly worse regarding the scales 'quantitative demands', 'hiding emotions', 'work-privacy conflicts', 'role conflicts', 'quality of leadership', 'support at work', 'recognition', 'physical demands', 'intention to leave profession', 'burnout', 'presenteeism' and 'inability to relax'. The interviews (n = 15) revealed six main themes related to nurses' psychosocial stress: 'overall working conditions', 'concern for residents', 'management of relatives', 'inability to provide terminal care', 'tensions between being infected and infecting others' and 'technicisation of care'. 'Enhanced community cohesion' (interviews), 'meaning of work' and 'quantity of social relations' (COPSOQ III) were identified as positive effects of the pandemic. Conclusions: Results clearly illustrate an aggravation of geriatric nurses' situation and psychosocial burden and only few positive changes due to the Covid-19 pandemic. Pre-existing hardships seem to have further deteriorated and new stressors added to nurses' strain. The perceived erosion of care, due to an overemphasis of the technical in relation to the social and emotional dimensions of care, seems to be especially burdensome to geriatric nurses. KW - COPSOQ KW - Covid-19 KW - Mixed-methods study KW - Nurses KW - Nursing home KW - Psychosocial burden Y1 - 2022 UR - https://pubmed.ncbi.nlm.nih.gov/35883124/ U6 - https://doi.org/10.1186/s12913-022-08333-3 SN - 1472-6963 VL - 22 SP - 1 EP - 13 ER - TY - GEN A1 - Wandschneider, Lisa A1 - Batram-Zantvoort, Stephanie A1 - Alaze, Anita A1 - Niehues, Vera A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Céline T1 - Self-reported mental well-being of mothers with young children during the first wave of the COVID-19 pandemic in Germany: A mixed-methods study T2 - Women’s Health N2 - Objectives: Mothers of young children have been identified as a particularly vulnerable group during the COVID-19 pandemic. We aimed to explore how occupational, psychosocial and partnership-related factors were associated with their self-reported mental well-being during the first COVID-19 wave. Methods: Five hundred fifty participants of the BaBi cohort study (est. 2013, Bielefeld, North-Rhine Westphalia, Germany) were invited to complete an online survey and to take part in email interviews (April–May 2020). With survey data, we assessed self-reported mental well-being through validated instruments (eight-item Patient Health Questionnaire; short version of the Symptom Checklist) and ran linear regression models for occupational, psychosocial and partnership-related factors. We performed content analysis on the interviews’ data to further understand the determinants of the women’s mental well-being. Results: One hundred twenty-four women participated in the survey; of which 17 also participated in the interviews. A perceived lack of support in childcare was associated with higher levels of depressive symptoms, while having a higher internal locus of control was associated with lower levels. Psychological distress was higher in those reporting lack of emotional or childcare support. Interviews confirmed the interplay of potential stressors and highlighted the difficulties to reconcile different expectations of motherhood. Discussion: Occupational, psychosocial and partner-related factors can act (to varying degree) both as resources and stressors to the self-reported mental well-being of mothers of young children. These impacts took different forms and created opportunities or challenges, depending on specific life circumstances, such as work or family situations, relationships and own psychosocial resources. Although not representative, our study contributes to building the COVID-19 evidence base, delineating the mental health toll of the pandemic on mothers of young children and the factors that contribute to it. KW - COVID-19 KW - mental health KW - mixed-methods analysis KW - motherhood KW - ccupational status KW - psychosocial determinants KW - well-being Y1 - 2022 UR - https://journals.sagepub.com/doi/10.1177/17455057221114274 U6 - https://doi.org/10.1177/17455057221114274 SN - 1617-8041 VL - 18 SP - 1 EP - 17 ER - TY - GEN A1 - Entringer, Sonja A1 - Scholaske, Laura A1 - Kurt, Medlin A1 - Duman, Elif Aysimi A1 - Adam, Emma K. A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Diurnal cortisol variation during pregnancy in Turkish origin and non-migrant women in a German birth cohort study T2 - Journal of Psychosomatic Research N2 - Background Immigrants from Turkey experience health disadvantages relative to non-immigrant populations in Germany that are manifest from the earliest stages of the lifespan onwards and are perpetuated across generations. Chronic stress and perturbations of stress-responsive physiological systems, including the hypothalamus-pituitary-adrenal (HPA)-axis, are believed to in part mediate this relationship. Cortisol plays an important role in the association between maternal stress during pregnancy and many pregnancy-, birth- and offspring-related outcomes. We therefore examined whether maternal migrant background is associated with diurnal cortisol variation during pregnancy. Methods 109 pregnant women (incl. n = 32 Turkish origin women) that participated in a multi-site prospective cohort study in Germany collected saliva samples across the day on two consecutive days around 24 and 32 weeks gestation. Hierarchical linear models were applied to quantify associations between migrant background and diurnal cortisol variation across pregnancy. Results Women of Turkish origin exhibited a significantly lower cortisol awakening response (CAR) and a flatter diurnal cortisol slope (DCS) compared to non-migrant women after adjusting for household income. These relationships between migrant status and diurnal cortisol variation were mainly driven by 2nd generation migrants. Discussion A potential HPA axis dysregulation of Turkish-origin pregnant women may contribute to the intergenerational transmission of health disadvantages in this group. KW - cortisol variation KW - pregnancy KW - Turkish origin KW - birth cohort study KW - Germany Y1 - 2022 UR - https://www.sciencedirect.com/science/article/abs/pii/S0022399922003051 U6 - https://doi.org/10.1016/j.jpsychores.2022.111020 SN - 0022-3999 VL - 162 SP - 1 EP - 10 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 - Reuter, Marvin A1 - Diehl, Katharina A1 - Richter, Matthias A1 - Sundmacher, Leonie A1 - Hövener, Claudia A1 - Spallek, Jacob A1 - Dragano, Nico T1 - A longitudinal analysis of health inequalities from adolescence to young adulthood and their underlying causes T2 - Advances in Lifecourse Research N2 - Research suggests that children of low-educated parents face greater health burdens during the passage from adolescence to young adulthood, as they are more likely to become low-educated themselves, establish behavioural and psychosocial disadvantages, or being exposed to unhealthy working conditions. However, studies examining the development and drivers of health inequalities during this particular life stage are limited in number and have produced varied results. This study investigates trajectories of self-rated health and overweight from 14 to 25 years of age, stratified by parental education, and explores the role of potential mediators (educational achievement, health behaviours, psychosocial factors, working conditions). We rely on prospective cohort data from the National Educational Panel Study (NEPS), a representative sample of 14,981 German ninth graders interviewed yearly from 2011 to 2021 (n = 90,096 person-years). First, we estimated random-effects growth curves for self-rated health and overweight over participants’ age and calculated the average marginal effect of high versus low parental education. Second, a series of simulation-based mediation analyses were performed to test how much of health inequalities were explained by children’s educational attainment (years of school education, years in university), health behaviours (smoking, alcohol, physical inactivity), psychosocial factors (number of grade repetitions, years in unemployment, chronic stress, self-esteem) and working conditions (physical and psychosocial job demands). We accounted for potential confounding by controlling for age, sex, migration background, residential area, household composition, and interview mode. Results show that higher parental education was related to higher self-rated health and lower probabilities of being overweight. Interaction between parental education and age indicated that, after some equalisation in late adolescence, health inequalities increased in young adulthood. Furthermore, educational attainment, health behaviours, psychosocial factors, and early-career working conditions played a significant role in mediating health inequalities. Of the variables examined, the level of school education and years spent in university were particular strong mediating factors. School education accounted for around one-third of the inequalities in self-rated health and one-fifth of the differences in overweight among individuals. Results support the idea that the transition to adulthood is a sensitive period in life and that early socio-economic adversity increases the likelihood to accumulate health disadvantages in multiple dimensions. In Germany, a country with comparatively low educational mobility, intergenerational continuities in class location seem to play a key role in the explanation of health inequalities in youth. KW - Health Inequalities KW - Adolescence KW - School to work transition KW - Socio-economic position Y1 - 2024 UR - https://www.sciencedirect.com/science/article/pii/S1569490924000042?via%3Dihub U6 - https://doi.org/10.1016/j.alcr.2024.100593 SN - 1879-6974 VL - Vol. 59 ER -