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 - De Santis, Karina Karolina A1 - Müllmann, Saskia A1 - Pan, Chen-Chia A1 - Hoffmann, Stephanie A1 - Spallek, Jacob A1 - Haug, Ulrike A1 - Zeeb, Hajo T1 - Digital technology use for physical activity promotion: Results of a nationwide survey in Germany T2 - 37th Annual Conference of the European Health Psychology Society N2 - Background. Digital technologies can contribute to healthy behaviour. We aimed to investigate a digital technology use for physical activity (PA) promotion using a nationwide survey. Methods. Our cross-sectional survey was conducted using a panel sample of 1020 adult internet users living in Germany (age: 18-92 years, 47% female). Computer-assisted telephone interviews were conducted using a self-developed questionnaire in November 2022. Survey data were analysed using relative frequencies and bivariate logistic regression. Findings. Among all participants, 626/1020 reported internet use in health context and 278/626 (44%) reported digital technology use for PA promotion. Most of the 278 users for PA promotion reported that such technologies are easy to use (92%) and use them at least once a week (91%). The reasons for using digital technologies were to measure own PA (74%) or to find exercise ideas (57%). Most participants reported using mobile devices (e.g., smartphones, 77%, or activity trackers, 58%) and rated device feedback as helpful (69%). Among sociodemographic factors (age, gender, education, household income), health status and eHealth literacy, younger age was the only significant predictor (OR=.98, 95% CI: .97-.99) of digital technology use for PA promotion. Discussion. Despite their availability, the prevalence of digital technology use for PA promotion is still low among adult internet users in Germany. Such technologies are likely to support PA behaviour change because users rate them as easy to use, their feedback as helpful and use them frequently. Health interventions are necessary to encourage digital technology use for PA promotion among adults in Germany. Y1 - 2023 U6 - https://doi.org/10.13140/RG.2.2.22062.48967 ER - TY - GEN A1 - Müllmann, Saskia A1 - De Santis, Karina Karolina A1 - Pan, Chen-Chia A1 - Hoffmann, Stephanie A1 - Spallek, Jacob A1 - Haug, Ulrike A1 - Zeeb, Hajo T1 - Attitudes towards digital technology use in health context according to a nationwide survey in Germany T2 - 37th Annual Conference of the European Health Psychology Society N2 - Background Digitalization has led to a proliferation of digital health technologies and online health information. We aimed to assess the attitudes towards digital technology use in health context using a nationwide survey. Methods A cross-sectional nationwide survey of a panel sample of adult internet users living in Germany was conducted in November 2022. Participants completed computer-assisted telephone interviews using a self-developed, 30-item questionnaire. Survey data were analysed using frequencies and univariate multiple regression analysis. Findings Among 1,020 participants (18-92 years, 56±16 years, 47% female), 62% completed up to tertiary education and 42% reported the household income of up to 3500 Euro/month. The minority of participants reported that they trust health websites when recommended by friends and family (39%), that their social network relies on the internet for health information (35%), that they consider the internet as the immediate source of health information (39%) and that they are interested in digital health technologies (40%). Most participants (71%) reported that they prefer to receive health information in person or on paper. The preference for such sources of health information was associated with lower eHealth literacy (β= -.12, p<.001), worse health status (β= -.08, p=.026) and female gender (β= -.08, p=.033). Discussion The trust in the internet as the source of health information and the interest in digital health technologies were low among internet users in Germany. Interventions should strengthen eHealth literacy to empower adults to find, understand and assess reliable health information on the Internet. Y1 - 2023 U6 - https://doi.org/10.13140/RG.2.2.24579.07200 ER - TY - GEN A1 - Scholaske, Laura A1 - Adam, Emma K. A1 - Spallek, Jacob A1 - Entringer, Sonja T1 - Maternal BMI and inflammation during pregnancy: a bi- or unidirectional association? T2 - Brain, Behavior, and Immunity N2 - Methods: 140 pregnant women participated in a multi-site prospective cohort study in, Germany with two study visits during pregnancy (T1: 24.44 ± 2.34, T2: 32.92 ± 1.72 weeks of gestation). Maternal BMI was derived from body length and current weight and was residualized for gestational week at assessment. Pro-inflammatory markers CRP and IL-6 were analyzed from venous blood samples and combined into a repeatedly measured composite inflammation score. Results: In a path model, T1-BMI significantly predicted T2-inflammation (b=0.53, SE=0.02, p <.001), and T1-inflammation predicted T2-BMI (b=0.46, SE=0.42, p <.001), suggesting a bidirectional relationship between BMI and inflammation. However, further adjustment for pre-pregnancy BMI diminished the association between T1-inflammation and T2-BMI (b=0.004, SE=0.22, p =.922), whereas the relationship between T1-BMI and T2-inflammation remained significant (b=0.20, SE=0.01, p =.004). Thus, adjusting for pre-pregnancy BMI underlined a unidirectional relationship. Conclusions: Based on these results, reducing overweight may be a relevant target for interventions to reduce inflammation and the risk of subsequent adverse outcomes. KW - BMI KW - inflammation KW - pregnancy Y1 - 2022 UR - https://www.sciencedirect.com/science/article/pii/S0889159122002239?via%3Dihub U6 - https://doi.org/10.1016/j.bbi.2022.07.049 VL - 106 SP - 12 PB - Elsevier 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 - 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 - 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 - CHAP A1 - Razum, Oliver A1 - Reeske, Anna A1 - Spallek, Jacob ED - David, Matthias ED - Borde, Theda T1 - Schwangerschaft, Geburt und erstes Lebensjahr in der Migration: gesundheitliche Herausforderungen T2 - Schwangerschaft, Geburt und frühe Kindheit in der Migration N2 - Dieser Artikel beschäftigt sich mit den, durch mangelnde Akkulturation oder geringe Integration bedingte, Risikofaktoren für Gesundheitsprobleme während der Schwangerschaft, in der Perinatalzeit und im ersten Lebensjahr. KW - Migranten KW - Gesundheit KW - Schwangerschaft KW - Gesundheitsversorgung Y1 - 2011 SN - 979-3-940529-91-6 SP - 57 EP - 72 PB - Mabuse-Verlag CY - Frankfurt am Main ER - TY - CHAP A1 - Spallek, Jacob A1 - Zeeb, Hajo ED - Hegemann, Thomas ED - Salman, Ramazan T1 - Bedarf und Inanspruchnahme psychiatrischer Versorgung durch Menschen mit Migrationshintergrund in Deutschland T2 - Handbuch transkulturelle Psychiatrie N2 - Obwohl die Migration ein offensichtlich psychisch stark belastender Vorgang ist, gibt es zu dem Bedarf und der Inanspruchnahme psychiatrischer Versorgung durch Menschen mit Migrationshintergrund in Deutschland wenig erforschtes Wissen. Dieser Artikel zeigt ein Modell auf, wie diese Belastung wirkt, wo Hindernisse und wo noch Bedarf in der Forschung für dieses Thema liegen. KW - Migranten KW - psychiatrisch KW - Gesundheitsversorgung KW - Deutschland Y1 - 2010 SN - 978-3-88414-467-1 SP - 58 EP - 68 PB - Psychiatrie-Verlag CY - Bonn ET - 1. Auflage ER - TY - BOOK A1 - Spallek, Jacob T1 - Migrantengesundheit - Die Sicht der Life-Course-Epidemiologie am Beispiel von Krebs bei türkischen Zuwanderern N2 - Die Gesundheit von Zuwanderern und von der nicht eingewanderten Bevölkerung unterscheidet sich zum Teil erheblich. Mögliche Ursachen dafür können während des ganzen Lebenslaufs der Zuwanderer aufgetreten sein. Dieses Buch beschäftigt sich mit dieser Lebenslaufperspektive anhand der empirischen Ergebnisse von zwei epidemiologischen Untersuchungen zu Krebsrisiken von türkischen Zuwanderern in Deutschland. KW - Migranten KW - Migration KW - Gesundheit KW - Krebs KW - türkische Zuwanderer KW - Deutschland Y1 - 2012 SN - 978-3-7799-1983-4 PB - Beltz Juventa CY - Weinheim und Basel ET - 1. Auflage 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 - 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 - 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 - 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 - 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 - Tallarek, Marie A1 - Spallek, Jacob T1 - Othering in public health using the example of Covid-19 management in German asylum camps T2 - European Journal of Public Health N2 - Issue/problem In 2020, several German reception centers and asylum camps were imposed mass quarantine after single residents had been infected with SARS-CoV-2. Civil and research networks criticized this measure, as crowded housing conditions limited the implementation of infection protection measures, and mass quarantine further increased the risk of infection. This raised the question why public health (PH) measures in these settings differed from those implemented in the general population, and which implications for future PH approaches can be identified. Problem description Considering the epidemiological evidence and ethical perspectives on the PH strategies described above, we applied the concepts of “Exclusionary Othering” and “Inclusionary Othering” to PH. We further discussed the Covid-19 management in German reception centers and asylum camps. Results We identified three conceptual approaches: 1) exclusionary, 2) inclusionary, and 3) diversity-sensitive approaches to PH. Exclusionary PH is characterized by an exclusion of less powerful groups despite negative health consequences. Inclusive approaches seek to empower less powerful groups in order to understand each other's needs, build cooperations, protect everyone and to prevent the development of “hot spots”. Diversity-sensitive PH approaches avoid othering and seek to implement measures for everyone, taking into account diverse needs, conditions, and resources. Lessons We propose a paradigm shift towards inclusionary and diversity-sensitive PH that benefits the entire population, including those forced to flee other countries. This requires a critical reflection of power dynamics and discrimination. The proposed concepts can be transferred to other social groups, regions, and areas of PH. Key messages Public health needs to shift its perspective from exclusion and subordination to inclusion and involvement. Inclusionary and diversity-sensitive PH approaches promote health equity. KW - SARS-CoV-2 KW - Covid-19 KW - Othering KW - Public Health KW - Inclusionary Othering KW - asylum camps KW - mass quarantine KW - reception centers Y1 - 2021 UR - https://academic.oup.com/eurpub/article/31/Supplement_3/ckab164.795/6406172?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckab164.795 VL - 31 IS - Issue Supplement_3 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 - 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 - 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 -