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 - 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 - medRxiv 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 - SARS-CoV-2 KW - migrants KW - displaced populations KW - rapid systematic review Y1 - 2020 UR - https://www.medrxiv.org/content/10.1101/2020.12.14.20248152v1.full.pdf+html U6 - https://doi.org/10.1101/2020.12.14.20248152 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 - CHAP A1 - Spallek, Jacob A1 - Razum, Oliver ED - Spallek, Jacob ED - Zeeb, Hajo T1 - Epidemiologische Erklärungsmodelle für den Zusammenhang zwischen Migration und Gesundheit T2 - Handbuch Migration und Gesundheit : Grundlagen, Perspektiven und Strategien N2 - Migration beeinflusst die Gesundheit. Ob sich Migration gesundheitlich positiv oder negativ auswirkt, hängt von einer Vielzahl von Faktoren ab, die in verschiedenen Erklärungsmodellen in einen Zusammenhang gebracht werden. Wichtig bei der Beschreibung des Zusammenhangs sind eine zeitliche Komponente und die Einbeziehung der individuellen Lebensläufe der Migrant*innen mit ihren Lebensabschnitten vor, während und nach der Migration. KW - Epidemiologische Erklärungsmodelle KW - Migration KW - Gesundheit Y1 - 2021 SN - 978-3-456-85995-8 U6 - https://doi.org/10.1024/85995-000 SP - 81 EP - 90 PB - Hogrefe AG CY - Bern ET - 1 ER - TY - CHAP A1 - Scholaske, Laura A1 - Spallek, Jacob A1 - Entringer, Sonja ED - Spallek, Jacob ED - Zeeb, Hajo T1 - Intergenerationale Übertragung von Migrationserfahrungen und fetale Programmierung von Krankheit und Gesundheit T2 - Handbuch Migration und Gesundheit : Grundlagen, Perspektiven und Strategien N2 - Gesundheitsdisparitäten manifestieren sich in der Nachkommengeneration von Migrant*innen teilweise schon in frühen Lebensjahren. Viele dieser Gesundheits-disparitäten werden durch sozioökonomische Benachteiligung und Akkulturation vermittelt. Anhand des Konzeptes der fetalen Pro-grammierung kann erklärt werden, dass das mütterliche Stresserleben – vermittelt über endokrine und immunologische Prozesse – die spätere Gesundheit und Krank-heitsvulnerabilität der Nachkommen bereits in der Schwangerschaft beeinflusst. Es gibt aus der internationalen Forschung zahlreiche Belege dafür, dass endokrine und immunologische Prozesse den Zusam-menhang zwischen mütterlichen migrationsbezogenen Stressoren und Schwangerschafts-, Geburts- und späteren Gesundheitsoutcomes des Kindes vermitteln. Bei Migrant*innen in Deutschland sind diese Zusammenhänge weitestgehend unterforscht. KW - Intergenerationale Übertragung KW - Migrationserfahrungen Y1 - 2021 SN - 978-3-456-85995-8 SP - 351 EP - 368 PB - Hogrefe AG CY - Bern ET - 1 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 - 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 - 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 - 2021 SN - 978-3-662-62426-5 SN - 978-3-662-62425-8 U6 - https://doi.org/10.1007/978-3-662-62426-5_28 SN - 2662-6942 SN - 2662-6950 SP - 199 EP - 211 PB - Springer CY - Berlin, Heidelberg 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 - CHAP A1 - Hoffmann, Stephanie A1 - Tallarek, Marie A1 - Spallek, Jacob ED - Goldfriedrich, Martin ED - Hurrelmann, Klaus T1 - Gesundheitswissenschaftliche Grundlagen für den Gesundheitsunterricht. Gesundheit und Vielfalt in Schule, Ausbildung und Studium T2 - Gesundheitsdidaktik N2 - Dieses Kapitel stellt theoretische und empirische Grundlagen der Gesundheit, ihrer Determinanten und der gesundheitlichen Ungleichheit als Gegenstand eines systematischen Gesundheitsunterrichts vor (Goldfriedrich/Hurrelmann in diesem Band, Kern-Wert 2 des Gesundheitsunterrichtes). Das Wissen um die Komplexität menschlicher Vielfalt und deren Einfluss auf die gesundheitliche Situation bildet die Grundlage für das Verständnis zentraler Gesundheitsdimensionen (u. a. Müller/Porges in diesem Band) sowie die didaktische Schwerpunktsetzung in verschiedenen Institutionen im Entwicklungsverlauf, wie dem Gymnasium (Schwegmann in diesem Band), der Berufsschule (Trumpa/Dorn in diesem Band) oder in Hochschulen (Sprenger in diesem Band). In diesem Kontext erläutert das Kapitel die Problematik ungleich verteilter Gesundheitschancen und stellt die Bandbreite relevanter Einflussfaktoren am Beispiel der sozialen Lage, des Migrationshintergrunds und des Geschlechts bei Kindern und Jugendlichen vor. Es zeigt auf, wie dieses Wissen im Bildungskontext curricular implementiert werden kann, um bereits im Kindes- und Jugendalter einen Beitrag zur gesundheitlichen Chancengleichheit leisten zu können. KW - Gesundheitswissenschaft KW - Gesundheitsunterricht KW - Gesundheit KW - Vielfalt KW - Schule KW - Ausbildung KW - Studium Y1 - 2021 UR - https://www.beltz.de/fileadmin/beltz/leseproben/978-3-7799-6371-4.pdf SN - 978-3-7799-6371-4 SP - 134 EP - 155 PB - Beltz Juventa CY - Weinheim, Basel ET - 1 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 - 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 - Hoffmann, Stephanie A1 - Sander, Lydia A1 - Blume, Miriam A1 - Schneider, Sven A1 - Herke, Max A1 - Matos Fialho, Paula Mayara A1 - Pischke, Claudia R. A1 - Schüttig, Wiebke A1 - Lampert, Thomas A1 - Spallek, Jacob T1 - Do families have moderating or mediating effects on early health inequalities? A scoping review T2 - European Journal of Public Health N2 - Background During early childhood, families have a crucial impact on children's health behaviour, health, and development (bhd). However, a family's socioeconomic position (SEP) determines both the parental behaviour, living conditions, and child health. To understand how family characteristics may influence the development of health inequalities, this scoping review synthesised research on their mediating and moderating effects. Methods The review followed the guidelines of the PRISMA Extension for Scoping Reviews. The search included German and English peer-reviewed articles published between January 1st, 2000 and December 19th, 2019. The search in PubMed, PsycINFO, and Scopus used both free text terms in the title/abstract and index terms within linked keyword blocks: (1) family characteristics, (2) inequalities, (3) income, education, occupation, (4) bhd, (5) newborn, infant, toddler, preschooler. Two researchers independently examined eligibility for inclusion in two rounds (title/abstract; full-text). Results Of 7,089 articles identified, ten sources were included that studied family characteristics and health inequalities among 0-6 years olds. Parental rules, stress, and screentime, and TV in bedroom showed mediating effects on inequalities in behaviour problems or children's screentime. Families' negativity, single parenthood, and the number of children in the household moderated differences in impairment, health, behaviour problems, development or breastfeeding initiation. Conclusions The effect of family characteristics on early health inequalities has been sparsely investigated. The evidence supported models of family stress and investment. Further research is needed to comprehensively understand this association. Key messages Family characteristics contribute to health inequalities. Taking families’ stress and investment into account could improve targeted prevention efforts aimed at reducing health inequalities. KW - Family KW - health inequalities KW - moderation KW - mediation KW - scoping review KW - early childhood Y1 - 2021 U6 - https://doi.org/10.1093/eurpub/ckab165.506 VL - 31 IS - Supplement_3 PB - Oxford University Press ER - TY - CHAP A1 - Tallarek, Marie A1 - Spallek, Jacob ED - Sieberer, Marcel ED - Jung, Petra ED - Führmann, Fabienne T1 - Gesundheitliche Situation von Migranten in Deutschland T2 - Migration & Gesundheit : Das Wichtigste für Ärztinnen und Ärzte aller Fachrichtungen N2 - Kernaussagen - Menschen mit Migrationshintergrund sind nicht per se kränker oder gesünder als die Bevölkerung ohne Migrationshintergrund. Expositionen vor, während und nach der Migration können aber unterschiedliche Gesundheitsressourcen und Krankheitsrisiken mit sich bringen. - Über das Merkmal „Migrationshintergrund“ hinaus variiert eine Vielzahl an Krankheitsrisiken abhängig vom sozioökonomischen Status (SES), dem Alter, Geschlecht und der Aufenthaltsdauer im Zielland. - Bei 11 bis 17-jährigen Kindern und Jugendlichen mit und ohne Migrationshintergrund bestehen kaum Unterschiede in der Selbsteinschätzung der körperlichen Gesundheit. - Erwachsene mit Migrationshintergrund aus spezifischen Herkunftsländern weisen statistisch ein geringeres Risiko für bösartige Neubildungen wie Brust-, Haut- oder Lungenkrebs sowie für Herz-Kreislauf-Erkrankungen auf. Erhöhte Risiken bestehen für Arbeitsunfälle, psychsiche Erkrankungen sowie in einzelnen Sub-Gruppen für Infektionskrankheiten wie Tuberkulose, Hepatitis und HIV. - Ausländische Säuglinge, Kinder und Jugendliche in Deutschland weisen eine höhere Mortalitätsrate auf als deutsche Gleichaltrige. Zugewanderte Menschen im Alter von 20 bis 60 Jahren haben eine geringere, im Alter von 65 bis 69 Jahren eine höhere Mortalitätsrate als die nicht-migrierte Bevölkerung. - Die Sterblichkeit ausländischer Personen gleicht sich mit zunehmender Aufenthaltsdauer in Deutschland an das Mortalitätsmuster der einheimischen Bevölkerung an. KW - Migration KW - Migrationshintergrund KW - Gesundheit Y1 - 2021 SN - 9783437235108 PB - Urban & Fischer Verlag/Elsevier GmbH CY - München, Jena ET - 1 ER - TY - CHAP A1 - Spallek, Jacob A1 - Schumann, Maria A1 - Reeske-Behrens, Anna ED - Haring, Robin T1 - Migration und Gesundheit – Gestaltungsmöglichkeiten von Gesundheitsversorgung und Public Health in diversen Gesellschaften T2 - Gesundheitswissenschaften N2 - Der Zusammenhang zwischen Migration und Gesundheit ist vielschichtig. In aktuellen Erklärungsmodellen werden verschiedene Determinanten und Dimensionen angeführt, die über den Lebenslauf von Migranten zu gesundheitlichen Vor- und Nachteilen führen können. Gesundheitsversorgung und Public Health in einem Einwanderungsland wie Deutschland müssen diese gesundheitlichen Unterschiede beachten und – neben den bei besonderen Risikokonstellationen notwendigen gezielten Maßnahmen für Migranten – sich insgesamt so ausrichten, dass sie der Diversität der Bevölkerung gerecht werden. Besondere Chancen bieten dabei Ansätze, die im Rahmen von integrierten kommunalen Strategien zur Gesundheitsförderung die Bedarfe der Menschen in ihren Lebenswelten aufgreifen. KW - Migration KW - Gesundheit KW - Gesundheitsversorgung KW - Public Health Y1 - 2021 SN - 978-3-662-54179-1 U6 - https://doi.org/10.1007/978-3-662-54179-1_49-2 SN - 2662-6942 PB - Springer CY - Berlin, Heidelberg ET - 2. Auflage 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 - Jaehn, Philipp A1 - Sasko, Benjamin A1 - Holmberg, Christine A1 - Hoffmann, Stephanie A1 - Spallek, Jacob A1 - Kelesidis, Theodoros A1 - Rapp, Michael A. A1 - Westhoff, Timm H. A1 - Ritter, Oliver A1 - Pagonas, Nikolaos T1 - Levels of high-density lipoprotein lipid peroxidation according to spatial socioeconomic deprivation and rurality among patients with coronary artery disease T2 - European Journal of Preventive Cardiology N2 - Atherosclerotic coronary artery disease (CAD) is the leading cause of mortality worldwide.1 In this context, the burden of CAD shows considerable regional heterogeneity at the national level. For example, age-standardized mortality rates varied between 106 and 178 deaths per 100 000 at the level of German federal states in 2019.2 The regional heterogeneity of cardiovascular mortality suggests that the residential environment should be considered as an important determinant for successful secondary prevention. Environmental features that were frequently drawn upon to explain regional inequalities of cardiovascular outcomes are spatial socioeconomic deprivation (SSD) and rurality.3 Rurality may impact cardiovascular health due to impaired access to healthcare services. Socioeconomically deprived neighbourhoods, on the other hand, exhibit restricted opportunities to eat healthy, exercise regularly, utilize health care, and avoid environmental hazards such as air pollution. KW - spatial socioeconomic deprivation KW - rurality KW - coronary artery disease KW - lipoprotein lipid peroxidation Y1 - 2022 UR - https://pubmed.ncbi.nlm.nih.gov/35574936/ U6 - https://doi.org/10.1093/eurjpc/zwac068 SN - 2047-4873 VL - 29 IS - 15 SP - e343 EP - e346 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 - CHAP A1 - Tallarek, Marie A1 - Spallek, Jacob ED - Sieberer, Marcel ED - Jung, Petra ED - Führmann, Fabienne T1 - Die gesundheitliche Situation von eingewanderten Menschen in Deutschland T2 - Migration & Gesundheit N2 - Kernaussagen: - Menschen mit Migrationshintergrund sind nicht per se kränker oder gesünder als die Bevölkerung ohne Migrationshintergrund. Expositionen vor, während und nach der Migration können aber unterschiedliche Gesundheitsressourcen und Krankheitsrisiken mit sich bringen. - Über das Merkmal „Migrationshintergrund“ hinaus variiert eine Vielzahl an Krankheitsrisiken abhängig vom sozioökonomischen Status (SES), dem Alter, Geschlecht und der Aufenthaltsdauer im Zielland. - Bei 11 bis 17-jährigen Kindern und Jugendlichen mit und ohne Migrationshintergrund bestehen kaum Unterschiede in der Selbsteinschätzung der körperlichen Gesundheit. - Erwachsene mit Migrationshintergrund aus spezifischen Herkunftsländern weisen statistisch ein geringeres Risiko für bösartige Neubildungen wie Brust-, Haut- oder Lungenkrebs sowie für Herz-Kreislauf-Erkrankungen auf. Erhöhte Risiken bestehen für Arbeitsunfälle, psychsiche Erkrankungen sowie in einzelnen Sub-Gruppen für Infektionskrankheiten wie Tuberkulose, Hepatitis und HIV. - Ausländische Säuglinge, Kinder und Jugendliche in Deutschland weisen eine höhere Mortalitätsrate auf als deutsche Gleichaltrige. Zugewanderte Menschen im Alter von 20 bis 60 Jahren haben eine geringere, im Alter von 65 bis 69 Jahren eine höhere Mortalitätsrate als die nicht-migrierte Bevölkerung. - Die Sterblichkeit ausländischer Personen gleicht sich mit zunehmender Aufenthaltsdauer in Deutschland an das Mortalitätsmuster der einheimischen Bevölkerung an. KW - Gesundheit KW - Migration KW - eingewanderte Menschen Y1 - 2022 U6 - https://doi.org/10.1016/B978-3-437-23510-8.00007-0 SP - 31 EP - 36 PB - Urban & Fischer CY - München ET - 1 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 - Tallarek, Marie A1 - Spallek, Jacob T1 - Die Selbstbestimmung Gebärender: Förderliche und begrenzende Faktoren aus der Perspektive von Hebammen in Krankenhäusern, Geburtshäusern und bei Hausgeburten T2 - 21. Deutscher Kongress für Versorgungsforschung : 05.10.-07.10.2022, Potsdam N2 - Hintergrund und Stand (inter)nationaler Forschung: Die Forderung nach einer selbstbestimmten Geburt ist in Deutschland und weltweit in den fachlichen und öffentlichen Fokus gerückt. Allerdings liegen bisher wenige Forschungsergebnisse zur Selbstbestimmung Gebärender und ihrer förderlichen und begrenzenden Bedingungen vor. Diese Erkenntnisse sind jedoch essentiell, um Selbstbestimmung gezielt unterstützen und ihre Verletzung vermeiden zu können. Fragestellung und Zielsetzung: Die Studie untersucht und vergleicht die Erfahrungen und Perspektiven von Hebammen in Bezug auf förderliche und begrenzende Faktoren einer selbstbestimmten Geburt in Krankenhäusern, Geburtshäusern und bei Hausgeburten in Deutschland. Methode: Es wurde eine qualitative Fallstudie auf der Basis von zehn problemzentrierten Einzelinterviews mit Hebammen durchgeführt. Eingeschlossen wurden Hebammen mit laufender oder abgeschlossener Ausbildung, deren letzte begleitete Geburt nicht länger als sechs Monate zurücklag. Die Sampling-Strategie erlaubte die Berücksichtigung unterschiedlicher Geburtshilfe-Settings und Regionen in Deutschland. Alle Interviews wurden aufgezeichnet, transkribiert, anonymisiert und mittels der Thematischen Analyse ausgewertet. Ein positives Ethik-Votum liegt vor. Ergebnisse: Die Ergebnisse legen acht zusammenhängende Kategorien nahe, die jeweils fördernde und begrenzende Faktoren implizieren: 1. Strukturelle/rechtliche Bedingungen auf Meso-/Makroebene; 2. Wahrnehmung von Geburt (z.B. als medizinischer/natürlicher Vorgang, notwendige Kompetenz und Kontrolle); 3. Vertrauen/Atmosphäre; 4. Kennenlernen/ Beziehungsaufbau mit Gebärenden; 5. Sozioökonomische Position (SEP) der Gebärenden; 6. Information der Gebärenden; 7. Entscheidungs- und Artikulationsfähigkeit der Gebärenden und 8. Verhalten der Begleitpersonen. Zudem wurden Strategien der Hebammen zur Erweiterung des Handlungsspielraums identifiziert. Mehrere Faktoren unterscheiden sich abhängig vom Geburtssetting. Diskussion: Die Möglichkeiten für eine selbstbestimmte Geburt können sich je nach Setting (z.B. institutionelle Routinen), zwischenmenschlichen Beziehungen (z.B. Vertrauen) und individuellen Faktoren (z.B. SEP) unterscheiden. Folglich können politische, institutionelle und individuelle Strategien eine selbstbestimmte Geburt – und damit eine personenzentrierte, situativ angemessene Versorgung – unter Berücksichtigung der oben genannten Faktoren unterstützen. Praktische Implikationen: Die Ergebnisse liefern konkrete Anhaltspunkte für Maßnahmen zur Unterstützung einer selbstbestimmten Geburt in verschiedenen Geburtssettings. Empfohlen werden u. a. die Verbesserung von Informationsprozessen vor und während der Geburt, die Verbesserung des Zugangs zu Versorgungsangeboten, der Abbau finanzieller Hürden in der Inanspruchnahme, die Förderung von Beziehungsaufbau und eine Stärkung der hebammengeleiteten Geburt. Appell für die Praxis (Wissenschaft und/oder Versorgung) in einem Satz: Akteur*innen und Entscheidungsträger*innen der Geburtshilfe können die Selbstbestimmung Gebärender durch gezielte individuelle, institutionelle und politische Maßnahmen fördern. KW - Selbstbestimmte Geburt KW - Hebammen KW - Klinik KW - Geburtshaus KW - Hausgeburt KW - Selbstbestimmung KW - Geburtshilfe KW - Qualitative Fallsstudie KW - Interviewstudie Y1 - 2022 UR - https://www.egms.de/static/de/meetings/dkvf2022/22dkvf321.shtml U6 - https://doi.org/10.3205/22dkvf321 PB - Deutsches Netzwerk Versorgungsforschung e.V. CY - Düsseldorf 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 - Schulze, Susanne A1 - Merz, Sibille A1 - Lincke, Hans-Joachim A1 - Nübling, Matthias A1 - Rapp, Michael A. A1 - Spallek, Jacob A1 - Tallarek, Marie A1 - Thier, Anne Kathrin A1 - Holmberg, Christine T1 - Psychosocial burden in nurses working in nursing homes during the Covid-19 pandemic T2 - 21. Deutscher Kongress für Versorgungsforschung (DKVF) : 05.10.-07.10.2022, Potsdam N2 - Background: Nurses’ work-related strain and psychological burden increased during the Covid-19 pandemic, resulting in high prevalences of mental health problems among nurses worldwide. Nurses in long-term care facilities seem to be particularly prone to overall heightened burden and poor mental health. Research question: We investigated which work-related psychosocial burdens and potential positive aspects nurses working in nursing homes experience during the Covid-19 pandemic. Method: We conducted a mixed-methods study. Eligible for participation were nurses and nursing assistants working in nursing homes within the state of Brandenburg, Germany. Between August and October 2020, we distributed an anonymous survey containing 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, drawn from the German COPSOQ databank and kindly shared by the Freiburg Research Centre for Occupational Science. In June 2021, we also conducted semi-structured interviews with geriatric nurses to reach a deeper understanding of their experiences on work-related changes and burdens during the first phases of the pandemic. Data were analysed using thematic coding (Braun and Clarke). Results: Our survey sample (n=177) differed significantly from the reference group in 14 out of 31 COPSOQ scales. Amongst others, our sample scored significantly worse regarding the scales ‘support at work’, ‘recognition’, ‘quantitative demands’, ‘hiding emotions’, ‘role conflicts’, ‘intention to leave profession’, ‘burnout’ and ‘inability to relax’. The interviews (n=17) revealed five main themes related to nurses’ psychosocial stress: ‘overall working conditions under the hygiene measures’, ‘concern for isolated residents’, ‘management of relatives’, ‘inability to provide terminal care‘, ‘tensions between being infected and infecting others’ and ‘technicisation of care’. ‘Enhanced community cohesion’ and ‘meaning of work’ were identified as positive effects of the pandemic. Discussion: Results indicate that nurses in nursing homes experience enhanced psychosocial and work-related strain. The comparisons with the pre-pandemic reference group suggest that the situation further aggravated during the pandemic. Nurses exhibited high psychosocial burden, e.g., due to strongly impeded possibilities to fulfill the emotional and social dimensions of care and the constant fear of infection or transmission. Deteriorated working conditions (e.g., higher workload through staff shortages and additional tasks) further exacerbated these burdens. Few positive aspects of the pandemic may be important sources of resilience. Practical implications: The reduction of nurses’ strain through psychosocial support and the improvement of working conditions is crucial for the protection of nurses’ health. Appeal for practice in one sentence: Political players as well as care facilities should take measures to improve nurses’ situation in order to maintain a healthy workforce and high-quality care. KW - Psychosocial burden KW - Nursing home KW - Covid-19 Y1 - 2022 UR - https://www.egms.de/static/de/meetings/dkvf2022/22dkvf025.shtml U6 - https://doi.org/10.3205/22dkvf025 PB - German Medical Science GMS Publishing House CY - Düsseldorf 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 - Regionale sozioökonomische Deprivation, Ruralität und kindliche Entwicklung: Analyse von Daten der Schuleingangsuntersuchung des Bundeslandes Brandenburgs T2 - 17. JAHRESTAGUNG DER DGEpi ABSTRACT BOOK N2 - Einleitung Die gesundheitliche Entwicklung von Kindern wird neben der sozioökonomischen Position (SEP) der Familie auch von Merkmalen der Lebensumgebung geprägt. Ruralität oder regionale sozioökonomische Deprivation werden als mögliche unabhängige Einflussgrößen postuliert, ohne dass bisher ausreichende empirische Ergebnisse vorliegen. In dieser Studie wurde untersucht, ob regionale sozioökonomische Deprivation und Ruralität unabhängig von familiärer SEP mit der Entwicklung von Kindern assoziiert sind. Methoden Daten des Sozialpädiatrischen Entwicklungsscreenings im Rahmen der Einschulungsuntersuchungen aus dem Jahr 2018/2019 in Brandenburg (n=22.801 Kinder) wurden verknüpft mit Daten zur regionalen Bevölkerungsdichte (Ruralität) sowie mit dem German Index of Socioeconomic Deprivation (regionale Deprivation). Mittels gemischter Modelle wurde der Zusammenhang einer Allgemeinen Entwicklungsverzögerung (AEV) mit Ruralität und mit regionaler Deprivation analysiert (OR=Odds Ratio (95% Konfidenzintervall)), wobei für familiäre SEP (hoch, mittel, niedrig) adjustiert und nach Geschlecht (M=Mädchen, J=Jungen) stratifiziert wurde. Ergebnisse Kinder mit hoher familiärer SEP zeigten geringere Chancen einer AEV als Kinder mit mittlerer familiärer SEP (ORM=4,26(3,14-5,79); ORJ=3,46(2,83-4,22)) und niedriger familiärer SEP (ORM=16,58(11,90-23,09); ORJ=12,79(10,13-16,16)). Größere regionale Deprivation war unabhängig von familiärer SEP und Ruralität mit AEV assoziiert (ORM=1,35(1,13-1,62); ORJ=1,20(1,05-1,39)). Neben familiärer SEP und regionaler Deprivation zeigte Ruralität keine Assoziation mit AEV. Schlussfolgerung Neben der familiären SEP wirkt sich die regionale sozioökonomische Deprivation auf Entwicklungsverzögerungen von Kindern aus. Sozialepidemiologie und Public Health sollten daher neben den individuellen sozioökonomischen Voraussetzungen auch die regionalen sozioökonomischen Bedingungen als Determinante der gesundheitlichen Entwicklung über den Lebenslauf berücksichtigen. Y1 - 2022 UR - https://www.researchgate.net/publication/364213456_Regionale_soziookonomische_Deprivation_Ruralitat_und_kindliche_Entwicklung_Analyse_von_Daten_der_Schuleingangsuntersuchung_des_Bundeslandes_Brandenburgs ER - TY - CHAP A1 - Tallarek, Marie A1 - Zeeb, Hajo A1 - Spallek, Jacob ED - Klosinski, Matthias ED - Castro Núñez, Sandra ED - Oestereich, Cornelia ED - Hegemann, Thomas T1 - Psychiatrisch-psychotherapeutische Versorgung von zugewanderten Menschen in Deutschland. Bedarf, Inanspruchnahme und Verbesserungspotenziale T2 - Handbuch Transkulturelle Psychiatrie N2 - Dieser Beitrag gibt einen Überblick über theoretische Konzepte sowie epidemiologisch-empirische Erkenntnisse zu Häufigkeit und Determinanten psychischer Erkrankungen bei zugewanderten Menschen sowie zur Inanspruchnahme und Versorgungspraxis. Auf der Basis dieser Erkenntnisse werden vielversprechende Ansätze der Versorgungspraxis sowie der weiteren Forschung vorgestellt. KW - Psychiatrisch-psychotherapeutische Versorgung KW - Migration KW - zugewanderte Menschen KW - Gesundheit KW - Gesundheitsversorgung Y1 - 2022 SN - 978-3-8252-5945-7 U6 - https://doi.org/10.36198/9783838559452 SP - 77 EP - 92 PB - Psychiatrie Verlag CY - Köln ET - 1 ER - TY - GEN A1 - Tallarek, Marie A1 - Spallek, Jacob T1 - Factors promoting or limiting self-determined childbirth: midwives’ perspectives in Germany T2 - European Journal of Public Health N2 - Background Claims for self-determined childbirth (SDC) have gained increasing scientific, political and societal attention. However, research on SDC is limited. This study analyzes and compares midwives’ experiences and perspectives on factors that promote or limit SDC in hospitals, birthing centers and during home births in Germany. We argue that these insights are essential in order to foster self-determination and to avoid its violation. Methods A qualitative case study was conducted based on semi-structured face-to-face interviews with midwives working in hospitals, birthing centers, and offering home births in Germany. In total, nine interviews were conducted in 2021 and have been audiotaped, transcribed, anonymized and analyzed by use of Thematic Analysis. Results The results indicate eight inter-related categories, each of which imply promoting and limiting factors: 1) Structural/ legal conditions; 2) Perception of birth (e. g. as natural or medical process; required competence and control); 3) Trust and atmosphere; 4) Getting acquainted/relationship building; 5) Birthing person’s socioeconomic position; 6) Birthing person’s preparation/ education; 7) Birthing person’s capability of decision making and expression; and 8) Behavior of accompanying persons. Moreover, we identified midwives’ strategies to extend possibilities of choice. Several factors clearly differ depending on the birth setting. Conclusions The opportunities for SDC seem to differ according to the setting (e.g. institutional routines), inter-personal relations (e.g. getting acquainted, trust), and individual factors (e.g. socioeconomic position, capabilities). Hence, political, institutional and individual strategies may support SDC in consideration of the above factors. Measures may, among others, include the improvement of information processes, the reduction of economic barriers, relationship building before and during birth as well as respective structural adjustments. KW - self-determined childbirth KW - interview study KW - obstetric care KW - hospitals KW - birthing centers KW - home birth Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac131.423/6765637?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac131.423 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - GEN A1 - Iashchenko, Iryna A1 - Schüttig, Wiebke A1 - Bammert, Philip A1 - Spallek, Jacob A1 - Rattay, Petra A1 - Schneider, Sven A1 - Moor, Irene A1 - Pischke, Claudia R. A1 - Sundmacher, Leonie T1 - The role of regional health policy for socioeconomic inequality in health services utilization T2 - European Journal of Public Health N2 - Background “J1” is a preventative routine examination in Germany recommended for adolescents at the age of 12-14 years. In contrast to the well-established U1-U9 examinations for younger children, with participation rates above 90%, the attendance of the J1 examination is approximately only 40%. The most frequent reason for not attending J1 is the unawareness of this examination. “Ticket to J1” is an intervention including an information leaflet introduced in Bavaria in 2017 to inform adolescents about J1. The aims of the present analysis are to investigate (1) if the regional policy was effective in increasing the attendance in J1, (2) if the effects vary by family socioeconomic status (SES), and (3) which meso-level characteristics of the healthcare system correlate with attendance rates in J1. Methods We used anonymised data of a large statutory health insurance in Germany for the timeframe of 2016-2018. To investigate the effect of the policy, a difference-in-differences design at the individual level was used. Assuming a parallel trend at the level of federal states, the likelihood of attendance in J1 of 13- and 14-year-olds was compared between Bavaria and other federal German states before and after policy introduction. All analyses were additionally stratified by SES. Results The introduction of “Ticket to J1” increased participation in J1 by 1% after controlling for all confounders. Furthermore, the effect was stronger for children from families with lower SES (an increase of 5%). Density of pediatricians was positively significantly correlated with participation in J1. Discussion Regional health policy intervention had a significant positive impact on attendance of J1 and appears to have the potential to reduce socioeconomic inequalities in healthcare utilization. Informing adolescents about J1 seems to increase the attendance, in particular for children from families with lower SES. KW - regional health policy KW - socioeconomic inequality KW - health services KW - utilization Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.584/6765537?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.584 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - GEN A1 - Rattay, Petra A1 - Blume, Miriam A1 - Spallek, Jacob A1 - Hoffmann, Stephanie A1 - Sander, Lydia A1 - Herr, Raphael A1 - Herke, Max A1 - Reuter, Marvin A1 - Novelli, Anna A1 - Hövener, Claudia T1 - Socioeconomic position and self-rated health among adolescents: the mediating role of the family T2 - European Journal of Public Health N2 - Background Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining adolescents’ health inequalities. The study aimed to explore whether the association between socioeconomic position and self-rated health (SRH) was mediated by familial determinants. Methods Using data from wave 2 of the KiGGS study (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of parents’ education, occupation, income, socioeconomic position index, and adolescents’ subjective social status on SRH into direct effects and indirect effects through familial determinants (family cohesion, parenting styles, parental well-being, stress, obesity, smoking and sporting activity). Results A significant total effect of all socioeconomic position indicators on SRH was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations of parental education, the socioeconomic position index and subjective social status with SRH were also mediated by familial determinants (family cohesion, parental smoking and obesity). However, a significant direct effect of subjective social status remained. Conclusions The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions, community-based strategies, as well as programs to improve parenting and family functioning. KW - Socioeconomic position KW - self-rated health KW - adolescents KW - family Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.580/6765541?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.580 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - GEN A1 - Hoffmann, Stephanie A1 - Rattay, Petra A1 - Blume, Miriam A1 - Hövener, Claudia A1 - Schneider, Sven A1 - Moor, Irene A1 - Pischke, Claudia R. A1 - Schüttig, Wiebke A1 - De Bock, Freia A1 - Spallek, Jacob T1 - Do family characteristics explain a social gradient in overweight in early childhood? T2 - European Journal of Public Health N2 - Background Children's overweight is associated with many factors, including their living situation, in particular their family's socioeconomic position (SEP) and family characteristics. Research on the extent to which family characteristics account for a social gradient in overweight in early life is scarce. This study evaluated whether family characteristics explain SEP differences in the risk of overweight in early childhood. Methods The study used baseline data of 3-6 year-old children (n = 1,116) from the intervention ‘Ene mene fit’ conducted at kindergartens in Baden-Württemberg, Germany. Data included overweight (body mass index > 90 percentile) and parents’ reports on their education and family characteristics associated with overweight (child consumes: sweets in front of TV, soft drinks; family joined time: outdoor, breakfast, sports; cooking; child sets table; role model). Model-based single mediation analyses decomposed the total effect of highest parental education on overweight into direct (unmediated) and indirect (mediated) effects (OR, 95% CI). Results Girls and boys with low parental education had higher odds for overweight than children with high/medium education. Among boys, low education influenced the risk of overweight via indirect effects of i. ‘sweets consumption in front of TV’ (OR = 1.31, 1.05-1.59) and ii. ‘no joined sports’ (OR = 1.14, 1.00-1.44). The direct effect of low education only remained significant when ‘no joined sports’ was considered (OR = 2.19, 1.11-5.19). Among girls, family characteristics measured here did not explain SEP differences in overweight. Conclusions The family characteristics ‘sweets consumption in front of TV’ and ‘no joined sports’ contribute to inequalities in overweight among boys, but not among girls. Therefore, more gender-sensitive research is needed to identify family risk and protective characteristics that explain health inequalities among both boys and girls. KW - family characteristics KW - social gradient KW - obesity KW - early childhood Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.581/6765540?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.581 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - GEN A1 - Scholaske, Laura A1 - Entringer, Sonja A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Elevated stress during pregnancy in women of Turkish origin: Results from a prospective cohort study T2 - European Journal of Public Health N2 - Background Ethnic health disparities exist in the context of pregnancy and childbirth, suggesting that women of Turkish origin (i.e., they or their parents born in Turkey) in Germany have higher risks for some adverse maternal health and child developmental outcomes. Stress is believed to be a relevant pathway by which migration may be associated with these risks. In this study, we tested associations of Turkish origin with stress biology and psychological stress experiences during pregnancy. Methods 140 pregnant women (33 of Turkish/26 of other origin) participated in a prospective cohort study that was carried out in Bielefeld and Berlin (Spallek et al., 2020). Inflammatory markers CRP and IL-6 from venous blood samples and diurnal cortisol profiles from salivary cortisol samples were derived and participants completed the Perceived Stress Scale (PSS) and Center for Epidemiologic Studies Depression Scale (CESD) at two study visits during pregnancy (T1: 20-25 weeks of gestation, T2: 30-35 weeks of gestation). Multilevel models were conducted to account for the nested data structure due to repeated measurements. Results Compared to non-migrant women, women of Turkish origin had significantly higher inflammatory levels (b = 0.28, SE = 0.14, p=.052) (Spallek et al., 2021), a blunted cortisol awakening response (b=-0.21, CI=-0.38–0.03, p<.05), a flatter diurnal cortisol slope (b = 0.02, CI = 0.00-0.04, p<.05), and higher PSS (b = 0.46, SE = 0.13, p< .001) and CESD scores (b = 0.29, SE = 0.08, p<.001) during pregnancy after adjusting for socioeconomic factors. Conclusions The results of our study suggest higher stress at the biological and psychological level in pregnant women of Turkish origin. Stress is a risk factor for pregnancy complications and poor birth and child developmental outcomes. To reduce such unequally distributed risks, interventions for stress reduction are needed that are tailored to women of Turkish origin. KW - stress KW - pregnancy KW - Turkish origin KW - prospective cohort study Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.608/6765682?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.608 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 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 - Do regional characteristics predict developmental delay? Analyses of German school entry examination T2 - European Journal of Public Health N2 - Background Children's health and development are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living region. However, research on the impact of the living region on children's development beyond family SEP is scarce. This study evaluated whether rurality and regional socioeconomic deprivation (DEP) are associated with children's development independently of family SEP. Methods The study used population-based data of 5-6.5 years old children (n = 22,801) from mandatory school entry examinations (SEE) in the German federal state of Brandenburg, which were examined in 2018/2019. The SEE data have been linked with data on i. rurality that was defined by an inverted population density and ii. regional DEP that were provided by the German Index of Socioeconomic Deprivation. By binary multilevel models, the predictive values of rurality and regional DEP for global developmental delay (GDD) were evaluated, while adjusting for family SEP. Results Children with high family SEP showed reduced odds for GDD compared to medium family SEP (female: OR = 4.26, CI95=3.14-5.79, male: OR = 3.46, CI95=2.83-4.22) and low family SEP (female: OR = 16.58, CI95=11.90-23.09, male: OR = 12.79, CI95=10.13-16.16). Regional DEP additionally predicted GDD, with higher odds for children from more deprived regions (female: OR = 1.35, CI95=1.13-1.62, male: OR = 1.20, CI95=1.05-1.39). Rurality did not predict GDD beyond family SEP and regional DEP. Conclusions In addition to family SEP, the regional DEP has an effect on children's developmental delay. Hence, Public Health should take into account regional socioeconomic conditions as determinant of health over the life course in addition to family SEP. KW - regional characteristics KW - developmental delay KW - school entry examination KW - Germany Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.342/6766047?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.342 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - RPRT A1 - Goldfriedrich, Martin A1 - Hoffmann, Stephanie A1 - Müller, Yvonne A1 - Schmidt, Andrea C. A1 - Spallek, Jacob A1 - Stroß, Annette M. A1 - Tallarek, Marie ED - Goldfriedrich, Martin ED - Hurrelmann, Klaus T1 - Konzeptpapier für einen Modellstudiengang „Gesundheitspädagogik und Gesundheitsdidaktik" N2 - Angesichts der immer stärker werdenden Diskussion um die Bedeutung von Gesundheit für den schulischen und außerschulischen Bildungs- und Lernprozess und der Risiken wachsender gesundheitlicher Ungleichheit bei Kindern und Jugendlichen (Hurrelmann/Richter 2013, Lampert et al. 2019) ist die Etablierung eines Studienganges „Gesundheitspädagogik und Gesundheitsdidaktik“ längst überfällig und von besonderer Bedeutung für gesundheitliche Chancengleichheit (Goldfriedrich & Hurrelmann, 2021a; 2021b). Dieses Konzeptpapier stellt einen Modellstudiengang vor, bei dem insbesondere die Vermittlungsebenen – also die gesundheitsdidaktischen Gegenstandsbereiche – im Vordergrund stehen. Die Ausarbeitungen des Entwurfs basieren auf der Grundlage politischer Bestrebungen, der bisherigen Forschung zur Gesundheitspädagogik und Gesundheitsdidaktik, den Erkenntnissen der Erziehungs- und Gesundheitswissenschaften sowie wissenschaftlichen und interprofessionellen Beiträgen des Netzwerks Gesundheitsdidaktik (bestehend aus 33 Expert*innen aus 24 Fachbereichen). KW - Gesundheitspädagogik KW - Gesundheitsdidaktik KW - Didaktik KW - Erziehungswissenschaften KW - Gesundheitswissenschaften KW - Lehrerbildung KW - Außerschulischer Lernort KW - Curriculum KW - Curriculumforschung Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:gbv:547-202200367 UR - https://www.db-thueringen.de/receive/dbt_mods_00052342 PB - Universität CY - Erfurt 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 - 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 - RPRT A1 - De Santis, Karina Karolina A1 - Müllmann, Saskia A1 - Pan, Chen-Chia A1 - Spallek, Jacob A1 - Hoffmann, Stephanie A1 - Haug, Ulrike A1 - Zeeb, Hajo T1 - Digitalisierung und Gesundheit: Ergebnisse einer zweiten bundesweiten Befragung in Deutschland N2 - Diese Studie untersuchte Einstellungen zu und Nutzung von digitalen Technologien im Gesundheitskontext anhand einer zweiten bundesweiten Befragung von Internetnutzenden in Deutschland. Unser Ziel war es zu ermitteln, ob und wie sich Einstellungen zu und Nutzung von digitalen Technologien im Gesundheitskontext zwei Jahre nach der ersten Befragung verändert haben. Y1 - 2024 UR - https://www.researchgate.net/publication/377635793_Digitalisierung_und_Gesundheit_Ergebnisse_einer_zweiten_bundesweiten_Befragung_in_Deutschland ER -