TY - GEN A1 - Löffler, Antje A1 - Hoffmann, Stephanie A1 - Fischer, Stefanie A1 - Spallek, Jacob T1 - Ambulante Haus- und Facharztversorgung im ländlichen Raum in Deutschland – Wie stellt sich die Versorgungssituation aus Sicht älterer Einwohner im Landkreis Oberspreewald-Lausitz dar? T2 - Das Gesundheitswesen N2 - Ziel der Studie: Die medizinische Versorgung der Bundesrepublik Deutschland ist von Verteilungsproblemen geprägt. Vor allem in ländlichen Regionen droht Unterversorgung. In dieser Studie wurde untersucht, wie ältere Bewohner des Landkreises Oberspreewald-Lausitz (OSL) des Bundeslandes Brandenburg ihre derzeitige medizinische Versorgungssituation einschätzen und welche Wünsche und Bedenken sie hinsichtlich deren zukünftigen Entwicklung im Jahr 2030 haben. Methodik: In der vorliegenden Querschnitterhebung wurden 3006 Einwohner im Alter von 50–56 Jahren und von 65–71 Jahren des Landkreises OSL befragt. Ein Fragebogen mit geschlossenem und offenem Antwortformat wurde zur Erfassung der Zielstellung eingesetzt. Ergebnisse: In der vorliegenden Untersuchung äußerten sich die Einwohner des Landkreises OSL aktuell zufrieden oder sehr zufrieden mit der hausärztlichen (93,1%) und der fachärztlichen Versorgung (83,3%). Innerhalb des Landkreises zeigen sich in einigen Regionen Defizite. Im Gebiet Lauchhammer/Schwarzheide äußerten sich insbesondere zur fachärztlichen Versorgung 27,1% der Befragten unzufrieden oder sehr unzufrieden. Alternative und ergänzende Versorgungsangebote wie die Community Nurse sind akzeptierte, jedoch derzeit unterrepräsentierte Maßnahmen zur Sicherstellung der zukünftigen medizinischen Versorgung. Schlussfolgerung: Derzeit zeigen sich Bewohner des ländlichen, metropolenfernen Landkreises OSL zufrieden mit der ambulanten medizinischen Versorgung, jedoch stellen sich in einigen Regionen Defizite, insbesondere bei der zukünftigen Facharztversorgung dar. Alternative Versorgungsangebote wie Telemedizin sind seitens der Bewohner gewünschte Maßnahmen zur Ergänzung und Sicherstellung der zukünftigen medizinischen Versorgung im ländlichen Raum. KW - Versorgung KW - Hausarzt KW - Facharzt KW - ländlicher Raum Y1 - 2019 U6 - https://doi.org/10.1055/a-1010-6277 SN - 0941-3790 VL - 83 (2021) IS - 1 SP - 47 EP - 52 ER - TY - GEN A1 - Miani, Celine A1 - Ludwig, A. A1 - Breckenkamp, Jürgen A1 - Sauzet, Odile A1 - Doyle, Ina-Merle A1 - Höller-Holtrichter, Chantal A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study T2 - BMC pregnancy and childbirth N2 - BACKGROUND: Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. METHODS: In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. RESULTS: Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01-3.81; and aOR: 2.36, CI: 1.27-4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups. CONCLUSIONS: Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care. KW - Acculturation KW - Birth cohort KW - Caesarean section KW - Education KW - Emergency KW - Germany KW - Income KW - Migration KW - Obstetric care KW - Socioeconomic determinants Y1 - 2020 U6 - https://doi.org/10.1186/s12884-020-2725-5 SN - 1471-2393 VL - 20 ER - TY - GEN A1 - Schilling, Laura A1 - Schneider, Sven A1 - Maul, Holger A1 - Spallek, Jacob T1 - STudy on E-Cigarettes and Pregnancy (STEP)–Study Protocolof a Mixed Methods Study on Risk Perception of E-Cigarette UseDuring Pregnancy and Sample Description T2 - Geburtshilfe und Frauenheilkunde N2 - Introduction: During pregnancy, the motherʼs healthy life-style is crucial for the health of the fetus. Potential risk factorsfor maternal and child health should therefore be identifiedand reduced as early as possible. The consumption of e-ciga-rettes represents one of these potential risk factors. Exploringrisk perceptions about e-cigarette use during pregnancy canprovide early indications of possible user motives. Therefore,our mixed methodsSTudy onE-cigarettes andPregnancy(STEP) aimed to comprehensively analyze risk perceptionsabout e-cigarette use during pregnancy based on anInte-gratedHealthBeliefModel (IHBM). This paper describes thestudy design, methods, sample population and limitations ofSTEP. Methods: Our sequential mixed methods study combinedqualitative and quantitative approaches. In the qualitativesection of the study which preceded the quantitative part ofthe study, we aimed to characterize risk perceptions aboute‑cigarette use during pregnancy. We used a netnographic re-search approach which analyzed discussion threads in onlineforums dealing with e-cigarette use during pregnancy. Theanalysis was based on an IHBM. Identified themes were incor-porated in the questionnaire which was developed for the quantitative part of the study. The quantitative section aimedto quantify, among other things, perceived threats, barriersand benefits and to explore differences in risk perception ac-cording to sociodemographic characteristics and tobacco ande-cigarette usage. Results: In the qualitative section, 1552 posts in 25 online dis-cussion threads dealing, inter alia, with e-cigarette use duringpregnancy were identified. The quantitative part looked atthe responses in the questionnaires handed in by 575 preg-nant women who attended a hospital in Hamburg (Germany)from April 2018 to January 2019 (response rate: 27.5%). Conclusion: Data collection was successful for both the qual-itative and quantitative parts of the study. When interpretingthe results of STEP, different limitations should be taken intoaccount. The results of STEP provide starting points for thedevelopment of tailored preventive measures for pregnantwomen. KW - e‑cigarette KW - pregnancy KW - risk perception KW - mixed methods study KW - Health Belief Model Y1 - 2020 UR - https://www.thieme-connect.de/products/ejournals/pdf/10.1055/a-1061-7288.pdf U6 - https://doi.org/10.1055/a-1061-7288 SN - 1438-8804 SN - 0016-5751 VL - 80 IS - 01 SP - 66 EP - 75 ER - TY - CHAP A1 - Tallarek, Marie A1 - Mlinarić, Martin A1 - Spallek, Jacob ED - Tiemann, Michael ED - Mohokum, Melvin T1 - Migration – Bedeutung und Implikationen für die Prävention und Gesundheitsförderung T2 - Prävention und Gesundheitsförderung. Springer Reference Pflege – Therapie – Gesundheit N2 - Die Bevölkerungsgruppe der Menschen mit Migrationshintergrund umfasst fast ein Viertel der Gesamtbevölkerung in Deutschland und ist höchst heterogen. Pauschalisierende Aussagen zum Gesundheitsstatus dieser Gruppe sind daher nicht möglich. Menschen mit Migrationshintergrund sind nicht grundsätzlich gesünder oder kränker als die Mehrheitsbevölkerung. Allerdings können sie sich aufgrund von Expositionen vor, während und nach der Migration in ihren Gesundheitschancen und -risiken von der Mehrheitsbevölkerung unterscheiden. Prävention und Gesundheitsförderung sollten daraus resultierende spezifische Bedarfe ebenso berücksichtigen wie die Diversität der Bevölkerung insgesamt. Erfolgversprechend ist eine Kombination aus diversitätssensiblen, für die Gesamtbevölkerung zugänglichen Angeboten und migrationsspezifischen Ansätzen in besonders risikoreichen Situationen. Kommunale, settingorientierte sowie soziokulturell angepasste Angebote verbessern die Erreichbarkeit der Zielgruppen maßgeblich. KW - Migration KW - Prävention KW - Gesundheitsförderung Y1 - 2019 UR - https://link.springer.com/referenceworkentry/10.1007%2F978-3-662-55793-8_28-1 SN - 978-3-662-55793-8 U6 - https://doi.org/10.1007/978-3-662-55793-8_28-1 SN - 2662-6942 SN - 2662-6950 SP - 1 EP - 13 PB - Springer CY - Berlin, Heidelberg ET - 1 ER - TY - GEN A1 - Miani, Céline A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Health of the offspring of immigrants: the BaBi birth cohort study T2 - Public Health Forum N2 - Children with a migration background are more at risk of health-related problems than those without a migration background. The German health system still does not adequately meet the challenges of on increasingly heterogeneous population, not least due to a lack of adequate epidemiological data and models. The BaBi study contributes to gaining new insights in the development of health inequalities due to cultural diversity in Germany, with a focus on pregnancy and early childhood. KW - cohort study KW - early childhood KW - migration KW - quantitative analysis KW - social epidemiology Y1 - 2019 UR - https://www.degruyter.com/view/j/pubhef.2019.27.issue-4/pubhef-2019-0062/pubhef-2019-0062.xml U6 - https://doi.org/10.1515/pubhef-2019-0062 SN - 1876-4851 SN - 0944-5587 VL - 27 IS - 4 SP - 298 EP - 300 ER - TY - GEN A1 - Grosser, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi cohort study, Germany T2 - European Journal of Public Health N2 - Background: Breastfeeding is considered beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, a goal reached by only 34% of mothers in 2012. The WHO’s recommendation of exclusively breastfeeding for six months was met by 19% only. Hardly modifiable factors such as socio-economic status and migration background have been associated with duration of breastfeeding but little is known about the impact of psychosocial factors such as personality traits and social support. We hypothesise that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding. Methods: We analyse baseline and follow-up data of the Bielefeld BaBi birth cohort (2013-16). They include detailed migration and socio-economic backgrounds, as well as three measures of psychological characteristics: the optimism scale, the Big Five inventory and the locus of control scales. We perform bivariate and multivariate analyses in order to identify psychosocial determinants of fully breastfeeding for four and six months. Results: Out of 780 BaBi study participants, 548 fully breastfed for four months (70.3%), of which 279 continued until at least six months (35.8%). Logistic regression analyses show that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed and the attendance of antenatal class during this or previous pregnancies. Personality characteristics, social status and migration background show however no significant association with breastfeeding duration. Conclusions: Our study results support the promotion of individuals’ breastfeeding intention and attendance to antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in maternal and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration. KW - breastfeeding KW - cohort study KW - psychosocial Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz187.122 SN - 1464-360X SN - 1101-1262 VL - 29 IS - 4 ER - TY - GEN A1 - Sauzet, Odile A1 - Zolitschka, Kim Alexandra A1 - Spallek, Jacob A1 - Breckenkamp, Jürgen A1 - Razum, Oliver T1 - An ego-centred approach for the evaluation of health inequalities in urban areas T2 - European Journal of Public Health N2 - Background: Neighbourhood possesses attributes, structural, physical and social, for which pathways to health inequalities could be hypothesized. Hence, neighbourhood is a complex mixture of factors which cannot be simply defined by a delineation on a map, making common definitions of neighbourhood (e.g. administrative borders) problematic. We present a new concept for the evaluation of contextual health inequalities in an urban setting. Methods: An ego-centred approach to neighbourhood effects on health allows to establish to what degree the health outcomes of a person are on average correlated to the health outcomes of his/her neighbours. This approach does not necessitate the definition of what a neighbourhood is, or of its boundaries. Using data from the BaBi birth cohort following up 958 mother-child pairs in Bielefeld/Germany we illustrate how the method provides information about the spatial structure of a possible association between unmeasured neighbourhood factors and birthweight. Spatially correlated birthweight indicates a neighbourhood effect on maternal health. Results: A parametric model of the correlation structure gives two indicators: a distance after which health outcomes are no longer correlated (practical range), and the strength of correlation (RSV). We modelled birthweight directly and residuals after controlling for (spatially correlated) covariates. After adjusting for the mother’s demographics and neighbourhood characteristics, birthweights remained spatially correlated with RSV of 11% and a practical range of 128 m. Conclusions: Modelling the spatial correlation of a health outcome provides a measure of the degree of health correlation, thus offering new evidence on the production of health inequalities while incorporating current modelling approaches. Moreover, it measures heterogeneity in a city. This could be used as an indicator for policy makers or town planners to identify areas in need of socioeconomic investment. KW - health inequalities KW - urban KW - birth weight KW - child KW - demography KW - ego KW - Germany KW - socioeconomic factors KW - health disparity KW - towns KW - maternal health Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz186.243 SN - 1101-1262 SN - 1464-360X VL - 29 IS - 4 ER - TY - GEN A1 - Schröder, Sara Lena A1 - Hoebel, Jens A1 - Roick, Julia A1 - Markert, Jenny A1 - Spallek, Jacob A1 - Knesebeck, Olaf von dem A1 - Richter, Matthias T1 - Inequalities in the utilisation of primary and specialist physicians in Europe - a systematic review T2 - European Journal of Public Health N2 - Background: The evidence on inequalities in health clearly shows that people with lower socioeconomic status (SES) have poorer health and higher mortality. Nevertheless, generalized evidence for inequalities in healthcare is lacking. So far, the international literature was only summarised with regard to inequalities in the utilisation of disease-specific treatment. Therefore, our aim was to synthetize the literature on socioeconomic inequalities in the utilisation of primary and specialist physicians in the general population. Methods: This systematic review searched Medline und Web of Science from 2004 to 2018. Articles that reported quantitative data on the association of SES with utilisation of primary or specialist physicians in Europe were included. Title and abstract screening were performed by two independent researchers and 50 full texts are currently sifted whether they fulfil the inclusion criteria. Results: The studies analysed utilisation of physicians in terms of probability or frequency. The initial check of the studies indicates that socioeconomic inequalities in the utilisation of physicians differ between primary and specialist care. Specialist physicians were found to be visited with a higher probability and more often by the least disadvantaged in most studies. Inequalities in the utilisation of primary physicians revealed to be more diverse with a weak pattern of equally distributed probability of GP visits and more frequent utilisation by the disadvantaged. Conclusions: The preliminary results indicate that pro-rich utilisation seems to be more pronounced in visiting specialists compared to primary health care. Aiming to reduce inequalities in healthcare, public health actions might primarily focus on reaching a needs-based consultation of specialist physicians. KW - Inequalities KW - Review KW - Primary health care KW - specialist health care KW - utilization Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz186.377 SN - 1101-1262 SN - 1464-360X VL - 29 IS - 4 ER - TY - GEN A1 - Scholaske, Laura A1 - Rodriguez, Norma A1 - Sari, Nida Emel A1 - Spallek, Jacob A1 - Ziegler, Matthias A1 - Entringer, Sonja T1 - The German Version of the Multidimensional Acculturative Stress Inventory (MASI) for Turkish-Origin Immigrants. Measurement Invariance of Filter Questions and Validation T2 - European Journal of Psychological Assessment N2 - The Multidimensional Acculturative Stress Inventory (MASI) is an established measure of acculturative stress for people of Mexican origin living in the USA that has been associated with mental health outcomes in this population. We translated the MASI into German and adapted it for use with Turkish-origin immigrants in Germany. The MASI includes filter questions asking if a potentially stressful event had actually occurred before reporting the stress appraisal of these situations. Measurement invariance testing has become a standard practice to evaluate questionnaire translations, however, measurement invariance of filter questions has been scarcely studied. In Study 1, we evaluated measurement invariance of the filter questions between a German-based Turkish sample (N = 233) and the Mexican-origin sample from the original study (N = 174) and could show partial strong factorial invariance for three of the four factors. In Study 2, a validation study, relations between the German MASI scores and measures of acculturation and stress indicated discriminant validity. This study contributes to research on measurement invariance of filter questions, thereby providing a measure of acculturative stress that can be used in future research to understand the etiology of health disparities in Turkish-origin immigrants in Germany. KW - German Multidimensional Acculturative Stress Inventory KW - Measurement invariance KW - Validation KW - Filter questions KW - Turkish-origin immigrants Y1 - 2020 U6 - https://doi.org/10.1027/1015-5759/a000567 SN - 2151-2426 VL - 36 IS - 5 SP - 889 EP - 900 ER - TY - GEN A1 - Spallek, Jacob A1 - Scholaske, Laura A1 - Kurt, Medlin A1 - Lindner-Matthes, Denise A1 - Entringer, Sonja T1 - Intergenerational transmission of health disparities among Turkish-origin immigrants in Germany: study protocol of a multi-centric cohort study (BaBi-stress and BaBeK study) T2 - BMC pregnancy and childbirth N2 - Background: Immigrants in Germany exhibit higher levels of social disadvantage when compared to the non-immigrated population. Turkish-origin immigrants constitute an important immigrant group in Germany and show disparities in some health domains that are evident from birth onwards. Several studies have shown the mechanisms by which social disadvantage is biologically embedded to affect health over the lifespan. Relatively little, however, is still known about if and how the maternal social situation is transmitted to the next generation. This study therefore aims to analyse the effects of maternal socioeconomic status and migration status on stress-related maternal-placental-fetal (MPF) biological processes during pregnancy on infant birth and health outcomes. Methods: This longitudinal cohort study of N = 144 child-mother dyads is located at two study sites in Germany and includes pregnant women of Turkish origin living in Germany as well as pregnant German women. During pregnancy, MPF stress biology markers from maternal blood and saliva samples, maternal socio-economic and migration-related information, medical risk variables and psychological well-being are assessed. After birth, infant anthropometric measures and developmental outcomes are assessed. The same measures will be assessed in and compared to Turkish pregnant women based on a collaboration with BABIP study in Istanbul. Discussion: This is the first study on intergenerational transmission of health disparities in Germany with a focus on women of Turkish-origin. The study faces similar risks of bias as other birth cohorts do. The study has implemented various measures, e.g. culturally sensitive recruitment strategies, attempt to recruit and follow-up as many pregnant women as possible independent of their social or cultural background. Nevertheless, the response rate among lower-educated families is lower. The possibility to compare results with a cohort from Turkey is a strength of this study. However, starting at different times and with slightly different recruitment strategies and designs may result in cohort effects and may affect comparability of the sub-cohorts. KW - Transmission of health inequalities KW - Stress biology KW - Turkish immigrants KW - Pregnancy KW - Birth Y1 - 2020 U6 - https://doi.org/10.1186/s12884-020-2853-y VL - 20 IS - 1 SP - 158 ER - TY - GEN A1 - Ludwig, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi-Study. Analysis of a birth cohort study in Germany T2 - Midwifery N2 - Breastfeeding is beneficial for both mother and child. A breastfed child can benefit from improved mental developments, protection against infectious diseases and infectious disease mortality, and a decreased risk of overweight and obesity (Whalen and Cramton 2010)(Regional Office for Europe (World Health Organisation) 2019). Furthermore, there is evidence on protection against type 1 and 2 diabetes, allergic rhinitis, asthma or wheezing, atopic dermatitis, childhood leukemia, hypercholesterolemia later in life, sudden infant death syndrome (Whalen and Cramton 2010) and malocclusion (Victora et al. 2016). Breastfeeding women have a lower risk of breast and ovarian cancer, postpartum depression, and type 2 diabetes. They can, furthermore, benefit from prolonged lactational amenorrhea (Victora et al. 2016), improved postpartum sleep (Whalen and Cramton 2010) and postpartum weight loss (Kramer and Kakuma 2012). KW - psychosocial factors KW - breastfeeding duration KW - birth KW - cohort study Y1 - 2020 U6 - https://doi.org/10.1016/j.midw.2020.102688 SN - 1532-3099 SN - 0266-6138 VL - 86 ER - TY - GEN A1 - Wandschneider, Lisa A1 - Sauzet, Odile A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Small-Area Factors and Their Impact on Low Birth Weight—Results of a Birth Cohort Study in Bielefeld, Germany T2 - Frontiers in Public Health N2 - Introduction: The location of residence is a factor possibly contributing to social inequalities and emerging evidence indicates that it already affects perinatal development. The underlying pathways remain unknown; theory-based and hypothesis-driven analyses are lacking. To address these challenges, we aim to establish to what extent small-area characteristics contribute to low birth weight (LBW), independently of individual characteristics. First, we select small-area characteristics based on a conceptual model and measure them. Then, we empirically analyse the impact of these characteristics on LBW. Material and methods: Individual data were provided by the birth cohort study “Health of infants and children in Bielefeld/Germany.” The sample consists of 892 eligible women and their infants distributed over 80 statistical districts in Bielefeld. Small-area data were obtained from local noise maps, emission inventory, Google Street View and civil registries. A linear multilevel analysis with a two-level structure (individuals nested within statistical districts) was conducted. Results: The effects of the selected small-area characteristics on LBW are small to non-existent, no significant effects are detected. The differences in proportion of LBW based on marginal effects are small, ranging from zero to 1.1%. Newborns from less aesthetic and subjectively perceived unsafe neighbourhoods tend to have higher proportions of LBW. Discussion: We could not find evidence for negative effects of small-area factors on LBW, but our study confirms that obtaining adequate sample size, reliable measure of exposure and using available data for operationalisation of the small-area context represent the core challenges in this field of research. KW - low birth weight KW - small-area analysis KW - multilevel analysis KW - virtual audit KW - noise pollution KW - fine particulate matter KW - socioeconomic deprivation KW - cohort study Y1 - 2020 U6 - https://doi.org/10.3389/fpubh.2020.00136 SN - 2296-2565 VL - 8 ER - 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 - RPRT A1 - Hoffmann, Stephanie A1 - Wachtler, Benjamin A1 - Sander, Lydia A1 - Blume, Miriam A1 - Hilger-Kolb, Jennifer A1 - Herke, Max A1 - Matos Fialho, Paula Mayara A1 - Pischke, Claudia R. A1 - Novelli, Anna A1 - Lampert, Thomas A1 - Spallek, Jacob T1 - Health inequalities among infants and pre-school children: Protocol for a scoping review examining the moderating and mediating role of contextual and compositional family characteristics N2 - Background: Although early childhood is a life period of overall good health, research shows that families’ socioeconomic position (SEP) is affecting children’s health from pregnancy on, ultimately leading to health inequalities. Little is currently known about the pathways by which family SEP is influencing child health and health-related behaviour, and which role family characteristics play. The scoping review therefore aims to screen the international literature on the mediating and moderating effects of contextual and compositional family characteristics on socioeconomic health risks of pre-school children in developed countries. Methods: Following the PRISMA guidelines for scoping reviews, three online databases (Pubmed, PsycINFO, and Scopus) will be searched for literature in English or German published after year 2000. The two-step data screening approach and the subsequent data extraction will be conducted independently by two researchers in consideration of specific criteria and a previously tested standardized data extraction form. Due to the broad research question at hand, various study designs (e.g. cross-sectional, intervention, cohort studies, and qualitative studies), SEP measures (e.g. education, income) and compositional (e.g. family size, migration) or contextual (e.g. parenting, housing) family characteristics influencing children ́s health will be included. Since diverse definitions and reporting formats of subjective health, health behaviour, well-being, and diseases will be considered, a substantial heterogeneity in outcome measures focusing on the age group of 0-6 years is expected. Thus, a narrative synthesis of the findings will be performed according to the Centre for Reviews and Dissemination framework. Ethics and dissemination: Because no primary data will be collected, ethical clearance will not be required. Dissemination will include peer-reviewed publications and conferences. KW - Health inequalities KW - family institutional characteristics KW - family context KW - pre-school children KW - infants KW - health KW - health behaviour KW - compositional characteristics KW - contextual characteristics KW - socioeconomic position Y1 - 2020 UR - https://osf.io/k2phw/ U6 - https://doi.org/10.17605/OSF.IO/3U4ST PB - Open Science Framework 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 - RPRT A1 - Bozorgmehr, Kayvan A1 - Hintermeier, Maren A1 - Razum, Oliver A1 - Mohsenpour, Amir A1 - Biddle, Louise A1 - Oertelt‐Prigione, Sabine A1 - Spallek, Jacob A1 - Tallarek, Marie A1 - Jahn, Rosa T1 - SARS‐CoV‐2 in Aufnahmeeinrichtungen und Gemeinschaftsunterkünften für Geflüchtete: Epidemiologische und normativ‐rechtliche Aspekte N2 - Ziel des Factsheets ist es, das „Ausbreitungspotential“ (als kumulatives Inzidenzrisiko) von SARSCoV‐ 2 in Aufnahmeeinrichtungen und Gemeinschaftsunterkünften bei Auftreten eines Falls zu ermitteln, Zusammenhänge mit Einrichtungstyp und Strategie des Ausbruchsmanagements zu explorieren und normativ‐rechtliche Aspekte zu diskutieren. Zusammengefasst kann gesagt werden: - Das Risiko, mit dem weitere Bewohner*innen nach einem ersten nachgewiesenen Fall von SARS‐CoV‐2 (mittels PCR) positiv getestet werden ist in Aufnahmeeinrichtungen und Gemeinschaftsunterkünften mit durchschnittlich 17% als hoch einzuschätzen, wobei es eine große Varianz zwischen den Einrichtungen gibt. - Eine Kollektivquarantäne hat bezogen auf das Infektionsrisiko der unter Quarantäne gestellten Bewohner*innen gegenüber anderen Strategien keinen messbaren Vorteil. Ist innerhalb der Quarantäne eine physische Distanzierung nur bedingt möglich, ist von einer Erhöhung des Infektionsrisikos für die nicht‐infizierten Bewohner*innen auszugehen. Studien zur Quarantäne unter den vergleichsweisen günstigen Bedingungen von Kreuzfahrtschiffen bestätigen dies. Es gibt keine Daten darüber, ob die Kollektivquarantäne einen gesundheitlichen Nutzen für die Bevölkerung außerhalb der Einrichtung bedeutet. Da sie allerdings erhebliche normativ‐rechtliche Probleme birgt, ist die Kollektivquarantäne nach aktuellem Kenntnisstand zu vermeiden. - Die Unterbringung von Geflüchteten sollte grundsätzlich coronaschutzkonform erfolgen, d.h. möglichst dezentral bzw. bei zentralen Einrichtungen möglichst in Einzelunterbringung in kleinen Wohneinheiten, damit bei Auftreten eines Falls eine rasche Ausbreitung vermieden wird und eine adäquate Kontaktnachverfolgung möglich ist. - Nationale Empfehlungen zum Umgang mit SARS‐CoV‐2 in Aufnahmeeinrichtungen und Gemeinschaftsunterkünften unter Berücksichtigung der bisher vor Ort entwickelten Präventions‐ und Lösungsansätze sowie epidemiologischer und normativ‐rechtlicher Überlegungen sind dringend notwendig, um die beteiligten Akteur*innen in ihrem Engagement für die Gesundheit der Bewohner*innen zu unterstützen. Dieses Papier richtet sich an: Politikverantwortliche sowie Akteur*innen der Flüchtlingsversorgung und der Wissenschaft. KW - SARS‐CoV‐2 KW - COVID-19 KW - Aufnahmeeinrichtungen KW - Gemeinschaftsunterkünfte KW - Geflüchtete KW - Ausbreitungspotential KW - kumulatives Inzidenzrisiko Y1 - 2020 UR - https://www.public-health-covid19.de/ergebnisse.html U6 - https://doi.org/10.4119/UNIBI/2943665 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 - Wachtler, Benjamin A1 - Hoffmann, Stephanie A1 - Blume, Miriam A1 - Rattay, Petra A1 - Herr, Raphael A1 - Deindl, Christian A1 - Sundmacher, Leonie A1 - Richter, Matthias A1 - Spallek, Jacob A1 - Lampert, Thomas T1 - The impact of the family on health inequalities in children – A systematic scoping review T2 - European Journal of Public Health N2 - Background Health inequalities in school-aged children and adolescents were repeatedly reported across Europe but less is known about the contextual and compositional factors of families that might influence and reproduce those health inequalities. In this systematic scoping review we aim to provide a comprehensive overview of the available international literature on the mediating and moderating influence of the family on health inequalities in children and adolescents in Europe and North America. Methods This review follows the PRISMA guidelines for scoping reviews. After defining the research question a search strategy was developed in cooperation with a scientific librarian and the study protocol was registered. A search of three databases (Pubmed, Scopus, PsycINFO) was conducted to identify relevant literature in English or German published between the year 2000 and 2019. A qualitative data charting process was used to extract the relevant data. Results In total 11.838 records were identified through the multi database search (Pubmed n = 6370, PsycINFO n = 3505, Scopus n = 1963). After elimination of duplicates and records from excluded countries, 8862 abstracts were screened by two researchers independently. Different cluster of evidence of family influences on health inequalities were identified: Parental behaviors and children's obesity, parents' smoking and drinking habits and adolescents' risk behaviors, parenting style and children's common mental disorders, parental resources and children's quality of life. Conclusions There are different aspects of family's contextual and compositional characteristics on health inequalities identifiable in the international literature. These characteristics might be new targets for family-focused health promotion strategies. Key messages: -A systematic scoping review found different family aspects that influence health inequalities in children and adolescents. - The identified family traits are promising targets for family-focused health promotion strategies to reduce health inequalities. KW - Health inequalities KW - family KW - scoping review KW - children KW - adolescents Y1 - 2020 U6 - https://doi.org/10.1093/eurpub/ckaa166.898 SN - 1101-1262 SN - 1464-360X VL - 30 IS - Supplement_5 PB - Univ. Press CY - Oxford ER - TY - GEN A1 - Matos Fialho, Paula Mayara A1 - Dragano, Nico A1 - Reuter, Matthias A1 - Metzendorf, Maria-Inti A1 - Richter, Bernd A1 - Richter, Matthias A1 - Spallek, Jacob A1 - Diehl, Katharina A1 - Lampert, Thomas A1 - Pischke, Claudia R. T1 - Health inequalities during school-to-work transitions among young adults: Mapping the evidence T2 - European Journal of Public Health N2 - Background School-to-work transition is a sensitive period that can have a substantial impact on health over the life course. Previous studies suggest pronounced health inequalities during this period but little is known about the determinants at the individual, meso- and macro-levels. We aim to further elucidate possible health inequalities during school-to-work transitions with a focus on multilevel determinants, e.g. evidence on potential effects of contextual and compositional factors of specific institutions involved. Methods We are currently conducting a scoping review (funded by the German Research Foundation) to map the evidence on the above mentioned topic among young adults (aged 16-24 years), following the methodological framework proposed by Arksey and ÓMalley and PRISMA. The literature search was performed in Ovid MEDLINE, Web of Science, ILO and NIOSH, using sensitive search strategy developed by text-analysis. Only articles published between January 2000 - February 2020 and written in English or German are considered. The selection process is conducted following a two-step approach:1) screening of titles and abstracts 2) screening of full-texts by two independent reviewers. Any discrepancies in the selection process are resolved by a third researcher. Preliminary Results Following the five stages of the methodological framework, the scoping review is currently in stage 3 (study selection-screening phase). We found 25,069 potentially relevant articles in our primary search. 15,508 articles remained after the duplicates were removed. Up to now, 8,825 papers were screened of which 7,629 were excluded and 1,176 included which qualified for full-text reading. Complete results of the scoping review will be presented at the conference. Conclusions This scoping review will improve our knowledge about the emergence and development of health inequalities during school-to-work transitions by examining health of individuals in different institutional contexts. Key messages - Improving our knowledge of health inequalities during school-to-work transitions. - the role of determinants at the individual, meso- and macro-levels during this stage will also be examined. KW - Health inequalities KW - school-to-work transition KW - young adults KW - life course Y1 - 2020 U6 - https://doi.org/10.1093/eurpub/ckaa166.278 VL - 30 IS - Supplement_5 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 -