TY - CHAP A1 - Brzoska, Patrick A1 - Voigtländer, Sven A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Potenziale und Limitationen der Reha-Statistik-Datenbasis für die rehabilitationswissenschaftliche Migrationsforschung T2 - Gesundheit, Migration und Einkommensgleichheit Y1 - 2010 SN - 978-3-00-033860-1 SP - 121 EP - 130 PB - DRV Schriftenband CY - Berlin ER - TY - GEN A1 - Spallek, Jacob A1 - Zeeb, Hajo A1 - Razum, Oliver T1 - What do we have to know from migrants‘ past exposure to understand their health status? A life course approach T2 - Emerging Themes in Epidemiology Y1 - 2011 U6 - https://doi.org/10.1186/1742-7622-8-6 SN - 1742-7622 VL - 8 SP - 6 ER - TY - GEN A1 - Reeske, Anna A1 - Spallek, Jacob T1 - Sozioökonomische Aspekte der Primärprävention von Adipositas bei Kindern und Jugendlichen - Ansatzpunkte vor dem Hintergrund eines lebenslaufbasierten Ansatzes der Adipositasentstehung T2 - Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz Y1 - 2011 U6 - https://doi.org/10.1007/s00103-010-1221-x SN - 1436-9990 SN - 1437-1588 VL - 54 IS - 3 SP - 272 EP - 280 ER - TY - GEN A1 - Spallek, Jacob A1 - Zeeb, Hajo A1 - Razum, Oliver T1 - Prevention among Immigrants: The example of Germany T2 - BMC Public Health Y1 - 2010 U6 - https://doi.org/10.1186/1471-2458-10-92 SN - 1471-2458 VL - 10 ER - TY - GEN A1 - Zeeb, Hajo A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Epidemiologische Perspektiven der Migrationsforschung am Beispiel von Krebserkrankungen T2 - Psychotherapie, Psychosomatik, Medizinische Psychologie Y1 - 2008 U6 - https://doi.org/10.1055/s-2008-1067347 SN - 1439-1058 SN - 0937-2032 VL - 58 IS - 3 SP - 130 EP - 135 ER - TY - GEN A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Gesundheit von Migranten: Defizite im Bereich der Prävention T2 - Medzinische Klinik Y1 - 2007 U6 - https://doi.org/10.1007/s00063-007-1058-8 SN - 2193-6218 SN - 2193-6226 VL - 102 IS - 6 SP - 451 EP - 456 ER - TY - GEN A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Migration und Geschlecht T2 - Public Heatlth Forum Y1 - 2015 U6 - https://doi.org/10.1515/pubhef-2015-0027 SN - 1876-4851 SN - 0944-5587 VL - 23 IS - 2 SP - 73 EP - 75 ER - TY - GEN A1 - Reiss, Katharina A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Die Entwicklung des Rauchverhaltens im Kontext der Migration nach Deutschland T2 - Public Health Forum Y1 - 2015 U6 - https://doi.org/10.1515/pubhef-2015-0031 SN - 1876-4851 SN - 0944-5587 VL - 23 IS - 2 SP - 85 EP - 87 ER - TY - GEN A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Migration und Gesundheit T2 - Public Health Forum Y1 - 2015 U6 - https://doi.org/10.1515/pubhef-2015-0021 SN - 1876-4851 SN - 0944-5587 VL - 23 IS - 2 SP - 54 EP - 57 ER - TY - GEN A1 - Ernst, Sinja Alexandra A1 - Reeske, Anna A1 - Spallek, Jacob A1 - Petersen, Knud A1 - Brand, Tilman A1 - Zeeb, Hajo T1 - Care-related factors associated with antepartal diagnosis of intrauterine growth restriction: a case-control study T2 - BMC Pregnancy and Childbirth Y1 - 2014 U6 - https://doi.org/10.1186/s12884-014-0371-5 SN - 1471-2393 VL - 14 SP - 371 ER - TY - GEN A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Addressing health-related interventions to immigrants: migrant-specific or diversity-sensitive? T2 - International Journal Public Health Y1 - 2014 U6 - https://doi.org/10.1007/s00038-014-0584-4 SN - 1661-8556 SN - 1661-8564 VL - 59 IS - 6 SP - 893 EP - 895 ER - TY - RPRT A1 - Brzoska, Patrick A1 - Voigtländer, Sven A1 - Reutin, Barbara A1 - Yilmaz-Aslan, Yüce A1 - Barz, Irina A1 - Starikow, Klara A1 - Reiss, Katharina A1 - Dröge, Angela A1 - Hinz, Julia A1 - Exner, Anne A1 - Striedelmeyer, Lena A1 - Krupa, Elzbieta A1 - Spallek, Jacob A1 - Berg-Beckhoff, Gabriele A1 - Schott, Thomas A1 - Razum, Oliver T1 - Rehabilitative Versorgung und gesundheitsbedingte Frühberentung von Personen mit Migrationshintergrund in Deutschland Y1 - 2010 PB - Bundesministerium für Arbeit und Soziales CY - Bonn ER - TY - GEN A1 - Ernst, Sinja Alexandra A1 - Brand, Tilman A1 - Reeske, Anna A1 - Spallek, Jacob A1 - Petersen, Knud A1 - Zeeb, Hajo T1 - Care-Related and Maternal Risk Factors Associated with the Antenatal Nondetection of Intrauterine Growth Restriction: A Case-Control Study from Bremen,Germany T2 - BioMed Research International Y1 - 2017 U6 - https://doi.org/10.1155/2017/1746146 SN - 2314-6141 SN - 2314-6133 SP - 1746146 ER - TY - GEN A1 - Spallek, Jacob A1 - Grosser, Angelique A1 - Höller-Holtrichter, Chantal A1 - Doyle, Ina-Merle A1 - Breckenkamp, Jürgen A1 - Razum, Oliver T1 - Early childhood health in Bielefeld, Germany (BaBi study) : study protocol of a social-epidemiological birth cohort T2 - British Medical Journal Open Y1 - 2017 U6 - https://doi.org/10.1136/bmjopen-2017-018398 SN - 2044-6055 VL - 7 IS - 8 ER - TY - CHAP A1 - Razum, Oliver A1 - Butler, Jeffrey A1 - Spallek, Jacob ED - Gesemann, Frank ED - Roth, Roland T1 - Gesundheitliche Chancen und Risiken von MigrantInnen: Handlungsmöglichkeiten einer kommunalen Gesundheitspolitik T2 - Handbuch Lokale Integrationspolitik Y1 - 2018 SN - 978-3-658-13409-9 U6 - https://doi.org/10.1007/978-3-658-13409-9_25 SP - 565 EP - 584 PB - Springer Fachmedien CY - Wiesbaden ER - TY - JOUR A1 - Reeske, Anna A1 - Spallek, Jacob T1 - Deeper Analysis Desirable JF - Deutsches Ärzteblatt N2 - The Prevalence of Gestational Diabetes A Population-Based Analysis of a Nationwide Screening Program by Dr. phil. Hanne Melchior, Diana Kurch-Bek, Dr. med. Monika Mund in issue 24/2017 Y1 - 2017 U6 - https://doi.org/10.3238/arztebl.2017.0689c VL - 114 IS - 41 SP - 689 EP - 690 ER - TY - GEN A1 - Weckmann, Gesine A1 - Chenot, Jean-François A1 - Stracke, Sylvia A1 - Haase, Annekathrin A1 - Spallek, Jacob A1 - Angelow, Aniela T1 - Auswirkung von Überweisungskriterien zum Nephrologen bei chronischer Niereninsuffizienz – Analyse einer Populationsbasierten Stichprobe T2 - Das Gesundheitswesen Y1 - 2017 U6 - https://doi.org/10.1055/s-0037-1605664 SN - 1439-4421 SN - 0941-3790 VL - 79 IS - 08/09 SP - 656 EP - 804 ER - TY - GEN A1 - Grosser, Angelique A1 - Höller-Holtrichter, Chantal A1 - Breckenkamp, Jürgen A1 - Hoffmann, Renata A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Impact of migration background on the uptake of antenatal care: the BaBi birth cohort study, Germany T2 - Das Gesundheitswesen Y1 - 2017 U6 - https://doi.org/10.1055/s-0037-1605903 SN - 1439-4421 SN - 0941-3790 VL - 79 IS - 08/09 SP - 656 EP - 804 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Reder, Maren A1 - Razum, Oliver A1 - Kolip, Petra A1 - Spallek, Jacob T1 - Informed choice in mammography screening program: a survey among first-time invitees in Germany T2 - European Journal of Public Health Y1 - 2017 U6 - https://doi.org/10.1093/eurpub/ckx187.213 SN - 1464-360X SN - 1101-1262 VL - 27 IS - Suppl. 3 SP - S. 83 ER - TY - GEN A1 - Grosser, Angelique A1 - Höller-Holtrichter, Chantal A1 - Miani, Celine A1 - Hoffmann, Renata A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Caesarean birth frequency among women with and without migration background in Germany: the BaBi birth cohort study, Germany T2 - European Journal of Public Health Y1 - 2017 U6 - https://doi.org/10.1093/eurpub/ckx187.466 SN - 1464-360X SN - 1101-1262 VL - 27 IS - Suppl. 3 SP - S. 183 ER - TY - GEN A1 - Grosser, Angelique A1 - Höller-Holtrichter, Chantal A1 - Miani, Celine A1 - Hoffmann, Renata A1 - Breckenkamp, Jürgen A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Impact of migration background on the uptake of antenatal care: the BaBi birth cohort study, Germany T2 - European Journal of Public Health Y1 - 2017 U6 - https://doi.org/10.1093/eurpub/ckx187.467 SN - 1464-360X SN - 1101-1262 VL - 27 IS - Suppl. 3 SP - S. 183 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Riedel, Jörg A1 - Reder, Maren A1 - Razum, Oliver A1 - Kolip, Petra A1 - Spallek, Jacob T1 - Postalische Befragung von Frauen mit türkischem Migrationshintergrund – Identifizierung, Stichprobenbereinigung und Response im Rahmen der InEMa-Studie T1 - Postal Survey Among Women With Turkish Migration Background in Germany – Identification, Sample Revision and Response in the InEMa Study T2 - Das Gesundheitswesen Y1 - 2017 U6 - https://doi.org/10.1055/s-0035-1564076 SN - 0941-3790 VL - 79 IS - 12 SP - 1000 EP - 1003 ER - TY - GEN A1 - Spallek, Jacob A1 - Schumann, Maria A1 - Zeeb, Hajo T1 - Utilization of prevention and health promotion among migrants T2 - Public Health Forum N2 - The uptake of existing preventive and health promotion offers by migrants in Germany is rather heterogeneous, and major information gaps are noted. Current results provide limited evidence that migrants and their children seem to use prevention and health promotion services less frequently than non-migrants. In order to improve access to preventive and other health services for migrants, a combination of migrant-specific and migrant-sensitive approaches seems to be useful. KW - accessibility KW - health promotion KW - migration KW - prevention KW - utilization Y1 - 2018 SN - 1876-4851 SN - 0944-5587 VL - 26 IS - 2 SP - 116 EP - 120 ER - TY - GEN A1 - Grosser, Angelique A1 - Höller-Holtrichter, Chantal A1 - Doyle, Ina-Merle A1 - Schmitz, Jutta A1 - Hoffmann, Renata A1 - Ergin-Akkoyun, Emine A1 - Mauro, Antonia A1 - Breckenkamp, Jürgen A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Rekrutierungsstrategien für Migrantinnen in einer Geburtskohorte am Beispiel der BaBi-Studie T2 - Das Gesundheitswesen N2 - Die Rekrutierung von Studienteilnehmern aller relevanten Bevölkerungsgruppen stellt eine der Herausforderungen in der (sozial-)epidemiologischen Forschung dar. Es existiert eine Vielzahl von Strategien, die der Rekrutierung von ethnischen Minderheiten und bestimmter Migrantengruppen dienen können. Unklar ist bisher, ob diese Strategien auch bei der Etablierung einer Geburtskohorte geeignet sind. Ziel der vorliegenden Arbeit ist die Darstellung und Evaluation von Rekrutierungsstrategien für Migrantinnen in einer Geburtskohorte am Beispiel der BaBi-Studie. Die Rekrutierung erfolgte von Oktober 2013 bis Oktober 2016. Als Vorbereitung wurden Fokusgruppen mit Schwangeren und Müttern und leitfadengestützte Experteninterviews mit Hebammen und GynäkologInnen durchgeführt, um Studienmaterialien, Befragungsinstrumente und Sprachpräferenzen zu prüfen. In der Vorstudie wurden unterschiedliche Rekrutierungswege getestet. Im Rekrutierungsverlauf fand eine kontinuierliche Evaluation statt, um erfolgreiche Rekrutierungsstrategien für Teilnehmerinnen mit Migrationshintergrund zu ermitteln und anzupassen. Von den eingeschlossenen 980 Teilnehmerinnen hatten 390 einen Migrationshintergrund (40%). Es wurden aktive und passive Rekrutierungsstrategien verfolgt, in denen u. a. türkische Übersetzungen und multikulturelles Personal zum Einsatz kamen. Für die passive Rekrutierung über gynäkologische Praxen und Hebammen mussten die schwangeren Frauen und Wöchnerinnen eine hohe Motivation für die Rekrutierung mitbringen. Die aktive Rekrutierung in den Geburtskliniken (Ansprache durch Study-Nurses) erhöhte den Anteil an Teilnehmerinnen mit Migrationshintergrund von 22 auf 49% aller Teilnehmerinnen. Durch frühzeitige Überprüfungen und Anpassungen der Zugangswege konnte die Teilnahmebereitschaft erhöht werden. Für die Rekrutierung von Frauen mit Migrationshintergrund sind gründliche Vorbereitungen in Form von Befragungen (Fokusgruppen, Leitfadeninterviews) und einer Vorstudie sinnvoll. Von Beginn an sind Verfahren zur frühzeitigen Evaluation der unterschiedlichen Rekrutierungsstrategien und ein erhöhter Personalaufwand (z. B. für (Rück-/ Übersetzungen) einzuplanen). Der Einschluss von Menschen mit Migrationshintergrund in sozialepidemiologischen Studien sollte in Deutschland zur Normalität werden. KW - Rekrutierung KW - Geburtskohorte KW - Migranten KW - Türkei KW - Spätaussiedler Y1 - 2019 U6 - https://doi.org/10.1055/a-0600-2392 SN - 0941-3790 VL - 81 IS - 8/9 SP - 621 EP - 628 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Reder, Maren A1 - Razum, Oliver A1 - Kolip, Petra A1 - Spallek, Jacob T1 - Informed choice in mammography screening program among migrant and non-migrant women: a survey among first-time invitees in Germany, 2013-2015 T2 - European Journal of Public Health N2 - Background: In Germany, women aged 50 to 69 are invited biennially to the population-based mammography screening programme (MSP). There is still a broad discussion whether the benefits of the programme outweigh its harms. Hence, the concept of informed choice is of particular importance for MSP. The aim of this survey was to assess the proportion of informed choices among migrant and non-migrant women invited to the German MSP for the first time. Methods: A random sample of 17,349 women aged 50 from a sub-region of North Rhine Westphalia was invited to participate in a postal cross-sectional survey conducted in German and Turkish. Turkish and other migrants were identified by country of birth and German resettlers additionally by self-reported resettler-status. Turkish migrant women were oversampled, due to expected lower response-rates. The effect of migration status on informed choice and on its three components (knowledge, attitude and intention) were assessed by chi-square tests and logistic regression modelling. Results:5,847 (33.7%) women responded to the postal questionnaire. 4,113 complete cases were included in the analyses. The proportion of women making informed choices was low (27.1%). Turkish migrant women had the highest odds for making an uninformed choice (OR 5.30, 95%CI 1.92-14.66) independent of educational level. Other migrant groups only had slightly higher odds for making an uninformed choice (German resettlers: OR 1.50, 95%CI 1.00-2.25; other migrants: OR 1.57, 95%CI 0.96-2.57) compared to non-migrant women. Fewer Turkish and other immigrant women intended to participate in the MSP. Immigrant women had a more positive attitude and a lower proportion of sufficient knowledge compared to non-migrant women. Conclusions: The overall proportion of informed choice in the German MSP is low and knowledge is poor. Measures are needed to improve information materials, strengthen health literacy and create a user-friendly environment facilitating informed choices especially for migrant women. KW - mammography Y1 - 2018 U6 - https://doi.org/10.1093/eurpub/cky047.107 SN - 1464-360X SN - 1101-1262 N1 - 1st World Congress on Migration, Ethnicity, Race and Health VL - 28 IS - Suppl. 1 SP - S. 55 ER - TY - GEN A1 - Miani, Celine A1 - Breckenkamp, Jürgen A1 - Grosser, Angelique A1 - Höller-Holtrichter, Chantal A1 - Ergin-Akkoyun, Emine A1 - Hoffmann, Renata A1 - Doyle, Ina-Merle A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Socio-economic determinants of breastfeeding uptake and duration intention among women with and without migration background. Results from the BaBi birth cohort study in Bielefeld, Germany T2 - European Journal of Public Health N2 - Background: Disparities in breastfeeding practices have been observed between migrants and majority populations in many countries. We compared breastfeeding practices among women with and without a migration background in Bielefeld, Germany, using data from a birth cohort. Methods: In 2013-16, we conducted 967 standardised interviews with women aged over 18 during pregnancy or shortly after birth, collecting data on breastfeeding uptake and duration intention, as well as on socio-economic and migration background. Bivariate and multivariate analyses were performed, adjusting for clinical factors (e.g. age, parity, birthweight). Results: Breastfeeding uptake was more common among women with a migration background than among non-immigrants (88.9% vs. 83%, p < 0.05). It was particularly high among 2nd and 3rd generation women (92%). Women with a migration background tended to intend to breastfeed longer than non-immigrants (6.2% vs 7.6% between 6 months and one year and 0.67% vs. 2.53% beyond one year). When controlling for clinical and socio-economic characteristics, only a statistically significant correlation between breastfeeding uptake and the opinion of the mother and of the partner with regard to breastfeeding remained, with a negative opinion decreasing the chances of uptake (OR 0.5; CI 0.25-0.79 and OR 0.2; CI 0.12-0.36, respectively). Mothers and partners of women with migration background were more likely to strongly support breastfeeding than those of non-immigrants. Duration intention was positively associated with having a migration background (1.98; CI 1.10-3.55) and negatively associated with income, with higher income decreasing likelihood of breastfeeding beyond 6 months (OR 0.6; CI 0.44-0.94). Conclusions: This study found differences in breastfeeding uptake and duration intention among women with and without a migration background. This calls for public health actions targeting different socio-economic groups if one wants to come closer to the WHO recommended breastfeeding rates. Initiatives that are inclusive of the mother and the partner of the expectant women are also worth considering. KW - breast feeding Y1 - 2018 U6 - https://doi.org/10.1093/eurpub/cky047.093 SN - 1464-360X SN - 1101-1262 N1 - 1st World Congress on Migration, Ethnicity, Race and Health VL - 28 IS - Vol. 1 SP - S. 50 ER - TY - GEN A1 - Scholaske, Laura A1 - Lindner-Matthes, Denise A1 - Kurt, Medlin A1 - Duman, Elif Aysimi A1 - Sahbaz, C. A1 - Spallek, Jacob A1 - Entringer, Sonja T1 - Intergenerational transmission of health disparities among Turkish-origin residents in Germany: role of maternal stress and stress biology during pregnancy. A study protocol T2 - European Journal of Public Health N2 - Background:Turkish-origin immigrants constitute one of the biggest migration groups in Germany where they exhibit higher levels of social disadvantage when compared to the majority population. Research has elucidated the underlying mechanisms by which social disadvantage is biologically embedded to impact health over the lifespan. However, relatively little is known about how its effects are transmitted across generations. Aims of the study: To elucidate the effects of maternal migration status and socioeconomic status on stress-related maternal-placental-foetal (MPF) biological processes across gestation and on subsequent infant birth and health outcomes. Methods: We are conducting a longitudinal cohort study of N = 450 child-mother dyads with serial measures across gestation and birth through the first year of life. Our proposed study population will include approximately equal numbers of Turkish-origin women in Germany, German women in Germany, Turkish women living in Turkey and their offspring. Study visits are conducted from the second trimester of pregnancy to the end of the first year of life to assess maternal socio-economic and migration-related information, psychological well-being, nutrition, medical risk variables, and MPF stress biology markers from maternal blood and saliva samples. Infant anthropometric measures, developmental outcomes and stress markers in saliva are assessed throughout the first year of life. Analyses: We will test specific hypotheses regarding the association between migration background, socioeconomic status and MPF stress biology. We will furthermore quantify the association of maternal migration background- and social disadvantage-related MPF stress biology measures on pregnancy and child health outcomes. Discussion: This is the first study on foetal programming of health disparities with a focus on Turkish-origin women in Germany. The significance and impact of this study derives from the importance of achieving a better understanding of underlying mechanisms that alter disease vulnerability in minority and disadvantaged populations. KW - maternal stress KW - pregnancy KW - health disparity Y1 - 2018 U6 - https://doi.org/10.1093/eurpub/cky048.044 SN - 1464-360X SN - 1101-1262 N1 - 1st World Congress on Migration, Ethnicity, Race and Health VL - 28 IS - Suppl. 1 SP - S. 126 ER - TY - GEN A1 - Reeske-Behrens, Anna A1 - Schumann, Maria A1 - Spallek, Jacob T1 - Integrierte Strategien zur kommunalen Gesundheitsförderung in multikulturellen Gesellschaften T2 - Das Gesundheitswesen N2 - Hintergrund: Der Zusammenhang zwischen Migration und Gesundheit ist komplex. Aktuelle Erklärungsmodelle führen Faktoren an, die bei Migranten zu gesundheitlichen Vor- aber auch Nachteilen führen können. Angebote der Gesundheitsförderung müssen sich – neben gezielten Maßnahmen für Migranten – so ausrichten, dass sie der Diversität der Bevölkerung gerecht werden. Neue Chancen bieten dabei integrierte kommunale Strategien zur Gesundheitsförderung, die die Bedarfe der Menschen in ihren Lebenswelten adressieren. Methoden: Basierend auf theoretischen und empirischen Arbeiten sowie Praxisbeispielen aus dem Bereich Gesundheitsförderung und Prävention werden anhand von sechs Bausteinen Ansätze für eine migrationssensible, integrierte kommunale Gesundheitsförderung entwickelt. Ergebnisse: Wesentliche Bausteine einer integrierten Gesundheitsförderungsstrategie beinhalten: migrationssensible Gesundheitsberichterstattung, ressortübergreifende Vernetzung von lokalen Gesundheitsförderungsakteuren unter Einbindung von Migrantenorganisationen, strukturelle Verankerung von „Kümmererfunktionen“ (z.B. Koordinierungsstelle Migration & Gesundheit), Strukturentwicklung im Quartier, Qualifizierung von Fachkräften zu Diversität und Gesundheit, interkulturelle Öffnung der kommunalen Verwaltung. Schlussfolgerungen: Die strukturelle Verankerung von Gesundheit mittels integrierter kommunaler Strategien bietet neue Möglichkeiten für die Umsetzung von Diversity Mainstreamingprozessen, wie einer fachbereichsübergreifenden Vernetzung und interkulturellen Öffnung der Verwaltung. Neben den sechs Bausteinen erfordert integriertes Handeln bei der Entwicklung von gesunden Lebenswelten eine diversitätssensible Grundhaltung, interkulturelle Kompetenz und die Partizipation von Menschen mit Migrationshintergrund. Y1 - 2018 U6 - https://doi.org/10.1055/s-0038-1667612 SN - 1439-4421 VL - 80 IS - 08/09 SP - 772 EP - 773 ER - TY - GEN A1 - Fischer, Stefanie A1 - Hoffmann, Stephanie A1 - Löffler, Antje A1 - Spallek, Jacob T1 - Ergebnisse einer Querschnittsanalyse zur ärztlichen Gesundheitsversorgung im ländlichen Raum T2 - Das Gesundheitswesen N2 - Hintergrund: Herausforderungen, wie die geringste Hausarztdichte Deutschlands und eine ungünstige Altersstruktur beeinflussen die ärztliche Versorgung in strukturschwachen Regionen Brandenburgs. Das Forschungsprojekt DIGILOG untersucht im Rahmen des Gesundheitscampus Brandenburg die Zufriedenheit der älteren Bevölkerung mit dem Zugang zur Haus- und Facharztversorgung. Methoden: Anfang 2018 wurden per standardisiertem Fragebogen mit sowohl geschlossenen als auch offenen Fragen 3.006 zufällig ausgewählte 50 – 70-jährige Einwohner im Landkreis Oberspreewald-Lausitz zu soziodemografischen Merkmalen sowie zur aktuellen und künftigen Haus- und Facharztversorgung befragt. Die Response beträgt 17,5% und ergibt eine Stichprobe mit einem Durchschnittsalter von 62 Jahren (51% weiblich). Ergebnisse: Der Zugang gilt als zufriedenstellend (Hausarzt (HA) 93%, Facharzt (FA) 87,8%). Es werden künftig Berentung, mangelnde Nachfolge und lange Wartezeiten befürchtet. 84% haben im letzten Jahr einen FA konsultiert (häufigste: Augenarzt (93 ×), Urologe, Orthopäde (je 74 ×). Der HA ist in rund x̃ = 4 km [0 – 64] und 10 Min. [0 – 90], der FA in x̃ = 15 km [0 – 338] und 20 Min. [0 – 338] überwiegend mit dem Auto (HA 60,9%; FA 77%) erreichbar. Beim HA wird 59 Min. [0 – 180], beim FA 57 Min. [0 – 240] gewartet. Schlussfolgerungen: Obwohl derzeit der Zugang trotz offener Arztstellen insgesamt noch zufriedenstellend ist, drohen in naher Zukunft Versorgungsdefizite, zeitnah besonders in der fachärztlichen Versorgung. Neue Versorgungskonzepte, wie Community Nurses oder digitale Lösungen, könnten diese z.T. auffangen und Wartezeiten bei akuten Beschwerden verkürzen. Y1 - 2018 U6 - https://doi.org/10.1055/s-0038-1667814 SN - 1439-4421 VL - 80 IS - 08/09 SP - S. 833 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Mohwinkel, Lea-Marie A1 - Eckert, Sandra van A1 - Reder, Maren A1 - Kolip, Petra A1 - Spallek, Jacob T1 - Uptake of Gynecological Cancer Screening and Performance of Breast Self-Examination Among 50-Year-Old Migrant and Non-migrant Women in Germany: Results of a Cross-Sectional Study (InEMa) T2 - Journal of Immigrant and Minority Health N2 - Our aim was to provide data regarding uptake of gynecological early detection measures and performance of breast self-examinations among migrant women in Germany. Cross-sectional self-reported data were collected using paper-and-pencil questionnaires. Descriptive analyses, Chi square-tests, and logistic regression were applied. Results were adjusted for educational level. Of 5387 women, 89.9% were autochthonous, 4.1% German resettlers, 2.8% Turkish, 3.1% other migrants. Participation rates regarding cancer screening differed significantly, with the lowest proportion in Turkish migrants (65.0%), resettlers (67.8%), other migrants (68.2%) and autochthonous population (78.2%). No differences in performance of breast self-examinations were detected. When adjusted for education, results indicated only slight changes in the odds to participate in screening irregularly or not at all. Results support existing evidence by showing lower participation rates in cancer screening among migrant women, but there were no differences regarding breast self-examinations. Migrant women form a potential high-risk group for late-stage diagnosis of cervical or breast cancer. KW - Migrants KW - Non-migrants KW - Cervical and breast cancer KW - Cancer screening KW - Participation KW - Performance KW - Uptake Y1 - 2019 U6 - https://doi.org/10.1007/s10903-018-0785-7 SN - 1557-1920 VL - 21 IS - 3 SP - 674 EP - 677 ER - TY - CHAP A1 - Spallek, Jacob A1 - Schumann, Maria A1 - Yildirim, Tülan ED - Hurrelmann, Klaus ED - Klotz, Theodor ED - Richter, Matthias ED - Stock, Stephanie ED - Hurrelmann, Klaus T1 - Prävention und Gesundheitsförderung bei Menschen mit Migrationshintergrund T2 - Referenzwerk Prävention und Gesundheitsförderung : Grundlagen, Konzepte und Umsetzungsstrategien Y1 - 2018 SN - 3-456-85590-7 SN - 978-3-456-85590-5 SP - 433 EP - 448 PB - Hogrefe CY - Bern ET - 5., vollständig überarbeitete Auflage ER - TY - CHAP A1 - Spallek, Jacob A1 - Schumann, Maria A1 - Reeske-Behrens, Anna ED - Haring, Robert 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. Y1 - 2018 SN - 978-3-662-54179-1 U6 - https://doi.org/10.1007/978-3-662-54179-1 SP - 1 EP - 12 PB - Springer CY - Berlin ER - TY - GEN A1 - Spallek, Jacob A1 - Breckenkamp, Jürgen A1 - Kraywinkel, Klaus A1 - Schwabe, Wolfgang A1 - Krieg, Volker A1 - Greiner, Wolfgang A1 - Damm, Oliver A1 - Razum, Oliver T1 - Need for nursing care support in cancer patients: Registry-linkage study in Germany T2 - South Eastern European Journal of Public Health N2 - Aim: In Germany, very little is known about the need for assistance and nursing care support among cancer patients after hospitalization. The aim of this study was to describe nursing care support for cancer patients and to analyse whether these patients need more care assistance than other persons in need for care. Methods: This was a registry linkage study conducted in 2011. Cases were identified from the population-based cancer registry for the Muenster District in north-western Germany and in factually anonymised form linked by a semi-automatic probabilistic procedure (the standard procedure of the cancer registry) with medical examination records of patients applying for assistance and nursing care support from the regional statutory health insurance. The application records of 4,029 patients with colon, breast and prostate cancer were compared to a reference group of 13,104 non-cancer patients. Results: In only 41.7% of colon, 45.8% of breast and 37.4% of prostate cancer patients was the malignancy the main underlying diagnostic cause for the application of assistance and nursing care. These patients were on average younger (mean age 71.1 vs. 76.8 years) than the non-cancer reference group, required higher levels of support (79.5 vs. 58.1% “considerable” or higher level care need) and their applications were less likely to be rejected (odds ratios [ORs] 0.26, 0.28, and 0.31, respectively). By contrast, the proportion of successful applications and the level of support granted did not differ between multimorbid cancer patients with other main diagnoses as compared to non-cancer applicants. Conclusion: Patients with colon, breast or prostate cancer do not need per se more nursing care than non-cancer patients. Only if cancer is the main underlying diagnosis for nursing care support, higher levels of support are needed. KW - cancer patients KW - nursing care Y1 - 2018 U6 - https://doi.org/10.4119/UNIBI/SEEJPH-2018-204 SN - 2197-5248 IS - 11 SP - 1 EP - 10 ER - TY - GEN A1 - Weckmann, Gesine A1 - Stracke, Sylvia A1 - Haase, Annekathrin A1 - Spallek, Jacob A1 - Ludwig, Fabian A1 - Angelow, Aniela A1 - Emmelkamp, Jetske M. A1 - Mahner, Maria A1 - Chenot, Jean-François T1 - Diagnosis and management of non-dialysis chronic kidney disease in ambulatory care: a systematic review of clinical practice guidelines T2 - BMC Nephrology N2 - Background: Chronic kidney disease (CKD) is age-dependent and has a high prevalence in the general population. Most patients are managed in ambulatory care. This systematic review provides an updated overview of quality and content of international clinical practice guidelines for diagnosis and management of non-dialysis CKD relevant to patients in ambulatory care. Methods: We identified guidelines published from 2012-to March 2018 in guideline portals, databases and by manual search. Methodological quality was assessed with the Appraisal of Guidelines for Research and Evaluation II instrument. Recommendations were extracted and evaluated. Results: Eight hundred fifty-two publications were identified, 9 of which were eligible guidelines. Methodological quality ranged from 34 to 77%, with domains “scope and purpose” and “clarity of presentation” attaining highest and “applicability” lowest scores. Guidelines were similar in recommendations on CKD definition, screening of patients with diabetes and hypertension, blood pressure targets and referral of patients with progressive or stage G4 CKD. Definition of high risk groups and recommended tests in newly diagnosed CKD varied. Conclusions: Guidelines quality ranged from moderate to high. Guidelines generally agreed on management of patients with high risk or advanced CKD, but varied in regarding the range of recommended measurements, the need for referrals to nephrology, monitoring intervals and comprehensiveness. More research is needed on efficient management of patients with low risk of CKD progression to end stage renal disease. KW - Chronic kidney disease KW - Management KW - Clinical practice guideline KW - Systematic review Y1 - 2018 U6 - https://doi.org/10.1186/s12882-018-1048-5 SN - 1471-2369 IS - 19 ER - TY - GEN A1 - Weckmann, Gesine A1 - Haase, Annekathrin A1 - Spallek, Jacob A1 - Chenot, Jean-François A1 - Stracke, Sylvia A1 - Angelow, Aniela T1 - Public health implications of referral criteria for chronic kidney disease, population based analysis T2 - European Journal of Public Healt N2 - Background: Chronic Kidney Disease (CKD) has an age-dependent prevalence of 10% in adults. The majority of CKD patients are treated in general practice. Although international guidelines recommend referral in patients with GFR <30, the German Societies for Nephrology and Internal Medicine recommend specialist referral for all subjects with estimated glomerular filtration rate (eGFR) <45 or eGFR 45-59 ml/min/ 1,73m2 with additional risk factors. This analysis was performed to evaluate the public health implications of lowering the threshold value for referral. Methods: Data of the population based cohort Study of Health in Pomerania (SHIP-2) were analysed to estimate the proportion of subjects who meet different referral criteria, billing data to estimate actual referral rate and public health implications of implementing different referral criteria were estimated with regard to cost and health resources utilization. Results: Data of 2328 subjects from SHIP-2 (53% female; age M = 57 Jahre, SD = 14)were analyzed. 3% of subjects had eGFR<45ml/min/1,73m2. 6% had an eGFR between 45-59 ml/min/1,73m2. Proposed German referral criteria were met by 8% of subjects, with 41% in the age group 80+ meeting referral criteria, wheras NICE and KDIGO criteria limited referral to 1-2%. Yearly referral as estimated from billing data was ca.2%. Results are preliminary and data comparing cost and health resources utilization will be available at the conference. Conclusions: Adherence to the proposed German referral criteria would greatly increase the number of referrals, especially in the elderly. This can lead to a major increase in cost, as well as serious problems with respect to the capacity of the nephrological workforce. Because of lack of a specific nephrological therapy in earlier stages of CKD in patients without additional risk factors, the benefit of increasing referrals in this group seems doubtful. Referral criteria for common medical conditions should be evaluated rigorously. KW - patient referral KW - public health medicine KW - kidney failure KW - chronic Y1 - 2018 U6 - https://doi.org/10.1093/eurpub/cky218.167 SN - 1101-1262 SN - 1464-360X VL - 28 IS - 4 SP - 466 EP - 466 ER - TY - GEN A1 - Scholaske, Laura A1 - Brose, Annette A1 - Spallek, Jacob A1 - Entringer, Sonja T1 - The role of discrimination for the risk of preterm birth among Turkish immigrant women T2 - European Journal of Public Health N2 - Background: Preterm birth (PTB) is one of the most severe risk factors for early child death and developmental impairment. Epidemiological research suggests that immigrants from lower to higher income countries exhibit a health decline over time that is transmitted to the offspring generation in which health disparities become prevalent already at a very early age in terms of adverse birth outcomes. Perceived discrimination (PD) is discussed in the context of health disparities related to migration. The relationship between PD and health outcomes is still understudied among Turkish immigrants in Germany. We examined whether PD contributes to PTB risk in Turkish immigrant women. Methods: We used data from the German Socio-Economic Panel (SOEP). The newborn questionnaire (“Mother-Child: Age 0-1”, 2003 – 2016, v33) provided information on birth outcomes and we included information on maternal socioeconomic situation, migration background and PD due to origin (for Turkish immigrant women only) that were collected in the survey before birth. The final sample comprised N = 2,525 (8.60% Turkish immigrant women). A dummy variable indicating occurrence of PTB (0 = non PTB, i.e. ≥ 37 wks of gestation, 1 = PTB, i.e. < 37 weeks of gestation) was used as the outcome variable in logistic regression models. Results: Logistic regression models on the whole sample indicated a higher risk of PTB among Turkish compared to German native women (OR: 2.75) that remained after adjusting for socioeconomic status. Within the subsample of Turkish women, prenatal PD was related to a higher risk for PTB (OR: 4.91). Conclusions: Unlike in other studies we found evidence for a higher prevalence of PTB among Turkish immigrant women in the SOEP data. PD may explain the prevalence of PTB among Turkish immigrant women in Germany. There is a need for further research examining the impact of discrimination on the intergenerational transmission of health disparities among Turkish immigrants in Germany. KW - premature birth KW - immigrants KW - turkish Y1 - 2018 U6 - https://doi.org/10.1093/eurpub/cky213.566 SN - 1464-360X SN - 1101-1262 VL - 28 IS - 4 SP - 192 EP - 192 ER - TY - GEN A1 - Lampert, Thomas A1 - Kuntz, Benjamin A1 - Schneider, Sven A1 - Spallek, Jacob T1 - Soziale Ungleichheit und Gesundheit: die Entwicklung sozialepidemiologischer Forschung in Deutschland T2 - Public Health Forum N2 - Die Sozialepidemiologie befasst sich mit der sozialen Verteilung von Erkrankungsrisiken und Gesundheitschancen und den daraus resultierenden gesundheitlichen Ungleichheiten. Für die letzten 20 Jahre lässt sich ein kontinuierlicher Zuwachs an sozialepidemiologischen Forschungsbefunden in Deutschland konstatieren. Mit den gesundheitlichen Ungleichheiten und den sozialen Determinanten der Gesundheit adressiert die Sozialepidemiologie Kernbereiche von Public Health, deren Bearbeitung auch in Zukunft erheblichen Einfluss auf die wissenschaftlichen, politischen und praxisorientierten Perspektiven des Fachs haben dürfte. KW - gesundheitliche Ungleichheiten KW - Public Health KW - Sozialepidemiologie KW - soziale Ungleichheit Y1 - 2018 U6 - https://doi.org/10.1515/pubhef-2018-0062 SN - 0944-5587 SN - 1876-4851 VL - 26 IS - 3 SP - 212 EP - 215 ER - TY - GEN A1 - Hoffmann, Stephanie A1 - Spallek, Jacob T1 - Migration, Gesundheit und soziale Lage T2 - Public Health Forum N2 - Das Zusammenspiel zwischen Migration, Gesundheit und sozialer Lage ist durch verschiedene Wirkmechanismen gekennzeichnet. Die soziale Lage beeinflusst gesundheitliche Chancen und Risiken sowie die Migration selbst und trägt dazu bei, ob migrationsbedingte Einflüsse auf die Gesundheit verstärkt oder abgeschwächt werden. Migration ist bedeutend für die Erklärung gesundheitlicher Ungleichheit, obgleich Verzerrungen und Messartefakte bei Interpretationen berücksichtigt werden müssen. KW - Gesundheitliche Ungleichheit KW - Migration KW - Sozialstatus Y1 - 2018 U6 - https://doi.org/10.1515/pubhef-2018-0107 SN - 1876-4851 SN - 0944-5587 VL - 26 IS - 4 SP - 345 EP - 348 ER - TY - CHAP A1 - Zeeb, Hajo A1 - Hübner, W. A1 - Spallek, Jacob ED - Pundt, Johanna ED - Cacace, Mirella T1 - Migration und gesundheitliche Ungleichheit T2 - Diversität und gesundheitliche Chancengleichheit Y1 - 2019 SN - 978-3-943001-40-2 SN - 978-3-943001-45-7 PB - APOLLON University Press CY - Bremen ET - 1. Auflage ER - TY - GEN A1 - Reder, Maren A1 - Berens, Eva-Maria A1 - Spallek, Jacob A1 - Kolip, Petra T1 - Development of the Informed Choice in Mammography Screening Questionnaire (IMQ): factor structure, reliability, and validity T2 - BMC Psychology N2 - Background: Informed choice is of ethical and practical importance in mammography screening. To assess the level to which decisions regarding such screening are informed is thus imperative, but no specific instrument has been available to measure informed choice in the German mammography screening programme. The aims of this study were to develop the Informed Choice in Mammography Screening Questionnaire (IMQ) and to find first evidence for the factor structure, reliability and validity of its different components. Methods: The IMQ was sent to 17.349 women aged 50 in Westphalia-Lippe, Germany. The instrument has been developed after consideration of (1) the results of qualitative interviews on decision making in the mammography screening programme, (2) relevant literature on other informed choice instruments and (3) a qualitative study on influencing factors. The IMQ comprises 3 scales (attitude, norms, and barriers), 1 index (knowledge) and singular items covering intention to participate and sociodemographic variables. To assess the psychometric properties of the components of the IMQ, confirmatory factor and item response theory analyses were conducted. Additionally, reliability, validity and item statistics were assessed. Results: 5.847 questionnaires were returned (response rate 33.7%). For attitude, the confirmatory factor analysis supported a one-factor structure. For norms, the model fit was not acceptable. Reliability levels were good with a Cronbach‘s α of.793 for attitude (4 items) and.795 for norms (5 items). For barriers, 9 items were deleted because of low discrimination indices; 6 items remained. The hypothesised assumption-subscale and the importance-subscale were confirmed, but these subscales showed poor reliabilities with Cronbach‘s α=.525 (4 items) and.583 (2 items). For the knowledge index, item response theory analysis showed that 6 out of 7 items were suitable. Hypotheses concerning the correlations between the different components were confirmed, which supported their convergent and divergent validity. Conclusion: The results of this study demonstrated that the IMQ is a multidimensional instrument. Further development of the barriers and norms scales is necessary. The IMQ can be utilised to assess the level of informed choices as well as influencing factors. KW - Mammography screening KW - Informed choice KW - Confirmatory factor analysis KW - Reliability KW - Validity Y1 - 2019 U6 - https://doi.org/10.1186/s40359-019-0291-2 SN - 2050-7283 VL - 7 IS - 1 ER - TY - GEN A1 - Berens, Eva-Maria A1 - Kaucher, Simone A1 - Eckert, Sandra van A1 - Reder, Maren A1 - Kolip, Petra A1 - Spallek, Jacob T1 - Knowledge about mammography screening in Germany by education and migrant status – results of a cross-sectional study (InEMa) T2 - Applied Cancer Research N2 - Background: The population-based mammography screening program (MSP) is aimed to reduce breast cancer mortality, to detect breast cancer at an early stage, and to allow for less invasive treatment. However, it also has some potential harms, such as overdiagnosis and overtreatment. Therefore, it is necessary that women receive sufficient and balanced information to enable informed decision-making. We examined knowledge about benefits and harms of the MSP in Germany among first-time invitees of different socio-demographic backgrounds. Methods: This observational study assessed knowledge about benefits and harms of the MSP among women who were invited to the MSP for the first time by six multiple choice items, using a postal survey. We investigated (i) single items of knowledge, (ii) the distribution of sufficient knowledge stratified by education, migration status and invitation, and (iii) possible determinants of sufficient knowledge by analyzing Odds Ratios (ORs) using bivariate and multivariate logistic regression. Results: In total, 5397 women included in the analyses. 46.1% of the study population had sufficient knowledge about benefits and harms of the MSP. However, women with low educational level and migration background had higher proportions of insufficient knowledge and used most frequently the option “don’t know”. Women had the most difficulties answering the numeric question and the question about the target group correctly. Results from the logistic regression showed that the odds of having sufficient knowledge were higher among well-educated women (OR 3.84, 95%CI 3.24–4.55), among women who already received the MSP invitation (OR 1.38, 95%CI 1.20–1.59) and lowest among Turkish women (OR 0.14, 95%CI 0.07–0.25). Conclusions: Women with low education and migration background need adapted information regarding benefits and harms of the MSP and are important target groups for further developing the information material about mammography screening to reduce disparities in knowledge and enable informed decision-making. KW - Mammography screening program, Knowledge, Education, Migrants, Benefits, Harms Y1 - 2019 U6 - https://doi.org/10.1186/s41241-019-0076-1 SN - 1980-5578 VL - 39 IS - 6 ER - TY - GEN A1 - Scholaske, Laura A1 - Brose, Annette A1 - Spallek, Jacob A1 - Entringer, Sonja T1 - Perceived discrimination and risk of preterm birth among Turkish immigrant women in Germany T2 - Social Science & Medicine N2 - Background: Health disparities, including adverse birth outcomes, exist between Turkish immigrants and the autochthonous population in Germany. The state of research on the risk of preterm birth (PTB, defined as <37 weeks of gestation), the leading cause of infant mortality and morbidity, among Turkish immigrant women is mixed. Perceived discrimination is discussed in the context of health disparities related to migration. We examined whether PTB risk is also increased in Turkish immigrant women in Germany and whether perceived discrimination due to origin contributes to this risk. Methods: We selected a sample from the German Socio-Economic Panel (SOEP) study of German autochthonous and Turkish immigrant women who recently gave birth (between 2002 and 2016) (N = 2,525, incl. n = 217 Turkish immigrant women of which n = 111 completed an item on perceived discrimination). The included variables of central interest were immigrant status, perceived discrimination, gestational age, and socioeconomic situation. Results: Logistic regression models indicated that PTB risk was significantly higher for Turkish immigrant women than autochthonous women (OR: 2.75, 95% CI [1.79–4.16]), even when adjusting for socioeconomic status. Within the subsample of Turkish immigrant women, perceived discrimination was related to a significantly higher PTB risk (OR: 4.91, 95% CI [1.76–15.06]). Conclusions: Our study provides evidence for a higher PTB risk in Turkish immigrant women compared to autochthonous women in Germany. Perceived discrimination may contribute to this higher risk. The findings represent an important first step towards developing targeted interventions to improve pregnancy and birth outcomes in minority groups. KW - Perceived discrimination KW - Preterm birth KW - Turkish immigrants KW - Health disparities Y1 - 2019 U6 - https://doi.org/10.1016/j.socscimed.2019.112427 SN - 0277-9536 SN - 1873-5347 SN - 0037-7856 VL - 236 ER - TY - GEN A1 - Löffler, Antje A1 - Grosser, Angelique A1 - Miani, Celine A1 - Doyle, Ina-Merle A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Einflussfaktoren auf die Einführung von Beikost bei Säuglingen – Ergebnisse der BaBi-Geburtskohorte in Deutschland T2 - Gesundheitswesen 2019 N2 - Hintergrund: Im ersten Lebensjahr erfolgt ein schrittweiser Übergang von Muttermilch bzw. Säuglingsmilchnahrung zur Familienkost, wobei die erste Gabe von Beikost zwischen 5. und 7. Lebensmonat erfolgen soll. Es ist wenig bekannt über soziodemographische bzw. klinische Einflussfaktoren auf die Beikosteinführung. Methodik: Datengrundlage der vorliegenden Untersuchung waren Baseline und erstes Follow-Up der Bielefelder Geburtskohorte BaBi (2013 – 2016, n = 777). Angaben zur Stilldauer, Einführung von Beikost sowie der Getränkegabe vor und während der Einführung von Beikost wurden telefonisch erhoben, als die Säuglinge zwischen neun und 12 Monaten alt waren. Einflussfaktoren auf die Beikosteinführung wurden mittels bi-und multivariater Datenanalyse untersucht. Ergebnisse: Bei Einführung der Beikost waren die Säuglinge im Mittel 5,4 ± 1,2 Monate alt. 2,6% der Säuglinge waren jünger als vier Monate, 12,5% der Säuglinge waren älter als 6,5 Monate. Lineare Regressionsanalysen zeigten eine direkte Assoziation zwischen der ausschließlichen Stilldauer bzw. dem Säuglingsalter bei letzter Mutter-/Säuglingsmilchgabe und dem Beikostbeginn (b = 0,31 [95%KI = 0,26 – 0,36; p ≤ 0,001; b = 0,12 [95% KI 0,07 – 0,18], p ≤ 0,001). Mütterliche Determinanten wie Alter, Bildungsstatus, Migrationsstatus, Familienstand, Parität, pränataler BMI und Rauchstatus vor und während der Schwangerschaft hatten keinen Einfluss auf den Beginn der Beikostgabe. 73,6% der befragten Frauen gaben an, schon einmal Probleme mit dem Füttern seit Beginn der Beikosteinführung gehabt zu haben. Diskussion: In der vorliegenden Analyse erfolgte der Beikostbeginn unabhängig von soziodemographischen und klinischen Parametern, jedoch führte längeres ausschließliches Stillen bzw. längere Mutter-/Säuglingsmilchgabe zu einem späteren Beikostbeginn. Weitere Untersuchungen sind notwendig, um Art, Umfang und mögliche Auswirkungen berichteter Probleme bei der Beikosteinführung bzw. eines verzögerten Beikostbeginns auf Mutter und Kind zu quantifizieren. KW - Beikost Y1 - 2019 U6 - https://doi.org/10.1055/s-0039-1694423 VL - 81 IS - 08/09 SP - 686 EP - 686 PB - Georg Thieme Verlag KG CY - Stuttgart ER - TY - GEN A1 - Schneider, Sven A1 - Spallek, Jacob A1 - Maul, Holger A1 - Schilling, Laura T1 - Schwangere, Nikotin und E-Zigaretten T2 - Gesundheitswesen 2019 N2 - Einleitung: In Deutschland raucht noch immer etwa jede fünfte junge Frau Tabakzigaretten. Gleichzeitig erfreuen sich E-Zigaretten auch in Deutschland insbesondere unter jungen Erwachsenen zunehmender Beliebtheit. Maternaler Nikotinkonsum birgt schwerwiegende Risiken für die Schwangere und das Kind. Das Ziel dieser Studie war es, den Konsum von Tabak- und E-Zigaretten sowie die Risikowahrnehmung bezüglich E-Zigaretten unter Schwangeren zu erfassen. Methode: In der STudy on E-cigarettes and Pregnancy (STEP) wurden im Rahmen eines quantitativen Studienteils für 575 Schwangere an einer Geburtsklinik in Hamburg von April 2018 bis Januar 2019 die Tabak- und die E-Zigarettennutzung erfasst. In einem qualitativen netnographischen Studienteil wurden insgesamt über 1.000 Posts in webbasierten Schwangerschaftsforen inhaltsanalytisch ausgewertet. Ergebnisse: Unmittelbar vor der Schwangerschaft nutzten 26,9% der Schwangeren Tabakzigaretten und 7,8% E-Zigaretten. Die Prävalenzen reduzierten sich dann im ersten Trimenon auf 9,0% für Tabakzigaretten und 0,5% für E-Zigaretten. Am Ende der Schwangerschaft rauchten noch 3,1% aller Befragten Tabakzigaretten – darunter jede Vierte mehr als 10 Zigaretten/Tag – und 0,2% nutzten durchgängig E-Zigaretten. Die netnographische Analyse zeigte eine große Verunsicherung bei Schwangeren hinsichtlich der Risiken der E-Zigarettennutzung. Diskussion: Die Ergebnisse zeigten für das hier untersuchte Kollektiv, dass noch immer etwa jede zehnte Schwangere zu Beginn der Schwangerschaft Tabakzigaretten raucht. Dagegen ist E-Zigarettenkonsum in der Schwangerschaft nur wenig verbreitet, wenngleich er im Internet teilweise als unschädlich, harmlos und als Alternative zur Tabakzigarette diskutiert wird. Im Rahmen der Prävention sollten die potenziellen Gesundheitsgefahren und die umstrittene Wirksamkeit der E-Zigarette als Tabakentwöhnungshilfe thematisiert und von der E-Zigarettennutzung in der Schwangerschaft dringend abgeraten werden. KW - Nikotin KW - E-Zigaretten KW - Schwangerschaft Y1 - 2019 U6 - https://doi.org/10.1055/s-0039-1694440 VL - 81 IS - 08/09 SP - 691 EP - 691 PB - Georg Thieme Verlag KG CY - Stuttgart ER - TY - GEN A1 - Schröder, Sara Lena A1 - Hoebel, Jens A1 - Spallek, Jacob A1 - Knesebeck, Olaf von dem A1 - Richter, M. T1 - Sozioökonomische Unterschiede in der Inanspruchnahme haus- und fachärztlicher Versorgung – Ergebnisse einer systematischen Literaturrecherche T2 - Gesundheitswesen 2019 N2 - Hintergrund: Sozioökonomische Ungleichheiten in der gesundheitlichen Versorgung werden häufig krankheitsspezifisch untersucht, während die Evidenz zu Unterschieden in der Inanspruchnahme in der Gesamtbevölkerung bislang unzureichend ist. Ziel der Arbeit ist es, den internationalen Stand zum Zusammenhang zwischen dem Sozialstatus und der Inanspruchnahme von Haus- und Fachärzten systematisch aufzubereiten. Methode: In den Datenbanken Medline und Web of Science wurde eine systematische Literaturrecherche durchgeführt, um quantitative Studien aus den Jahren 2003 bis 2018 zu identifizieren. Von 1214 Treffern werden aktuell 69 Volltexte in Hinblick auf die Einschlusskriterien überprüft. Ergebnisse: Die Inanspruchnahme wird entweder als „Anzahl der Arztkontakte“ gemessen oder zwischen Nutzung und Nicht-Nutzung eines Haus- oder Facharztes in einem bestimmten Zeitraum unterschieden. Die bisher gesichteten Studien deuten darauf hin, dass sich die sozioökonomischen Ungleichheiten in der Inanspruchnahme der haus- und fachärztlichen Versorgung unterscheiden. Während Fachärzte seltener von Menschen mit niedrigem Sozialstatus aufgesucht werden, sind die Ungleichheiten bei Hausärzten geringer und die Studien konnten entweder keine sozioökonomischen Unterschiede aufzeigen oder fanden, dass Menschen mit niedrigem Sozialstatus häufiger eine Primärversorgung in Anspruch nehmen. Diskussion: Sozioökonomische Unterschiede zu Ungunsten der sozial benachteiligten Bevölkerung bestehen möglicherweise deutlicher bei Fachärzten im Vergleich zu Hausärzten. Gerade in der Inanspruchnahme von Fachärzten besteht daher Handlungsbedarf zur Verringerung der Ungleichheiten, um eine bedarfsgerechte Inanspruchnahme der Versorgung zu gewährleisten. Mögliche Gründe für die Unterschiede sollen bei einem Vergleich der Studien untersucht werden, um Implikationen für eine Verbesserung der Versorgung abzuleiten. KW - Inanspruchnahme KW - Gesundheitsversorgung Y1 - 2019 U6 - https://doi.org/10.1055/s-0039-1694561 VL - 81 IS - 08/09 SP - 730 EP - 730 PB - Georg Thieme Verlag KG CY - Stuttgart ER - TY - GEN A1 - Richter, M. A1 - Dragano, Nico A1 - Lampert, Thomas A1 - Schneider, Sven A1 - Spallek, Jacob A1 - Sundmacher, Leonie T1 - Understanding the institutional context of health inequalities among young people: Study protocol for a multi-center research unit T2 - Gesundheitswesen 2019 N2 - Background: While health inequalities among young people are well described, the underlying mechanisms have been explored far less. Compositional and contextual characteristics of institutional contexts (e.g. kindergartens, schools) are likely to shape health inequalities among young people and may have an impact above and beyond individual-level determinants. The general research objectives of the research unit are to empirically study if characteristics of different institutional contexts are associated with the emergence of individual-level inequalities in health and c) to integrate findings from different life stages into a comprehensive theoretical model about the key mechanisms at individual and contextual levels. Methods and analysis: Building upon reviews of the existing evidence, each of the five subprojects of the research unit will analyse secondary data (cross-sectional and longitudinal surveys). The subprojects will focus on institutional contexts that serve as major socialization agents in society, such as the family, kindergarten, school, tertiary education/work, as well as the health care system. Linear or logistic multilevel modelling will be applied in order to examine the role of institutional characteristics for young people's health and health inequalities at the individual level. Ethics and dissemination: The dissemination activities include the publication of results in peer-reviewed journals, at international and national scientific conferences, as well as press releases in written and broadcast media to inform relevant stakeholders and the lay public. In the first funding stage, the research unit only uses secondary data of existing datasets. Therefore, ethical approval is not required. KW - Health inequalities KW - young people Y1 - 2019 U6 - https://doi.org/10.1055/s-0039-1694623 VL - 81 IS - 08/09 SP - 750 EP - 751 PB - Georg Thieme Verlag KG CY - Stuttgart ER - TY - GEN A1 - Wandschneider, Lisa A1 - Sauzet, Odile A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Kleinräumige Merkmale und ihr Einfluss auf ein niedriges Geburtsgewicht – eine theoriegeleitete Analyse T2 - 14. Jahrestagung der DGEpi, 11-13. September, Ulm N2 - Hintergrund: Der Wohnort kann eine Dimension sozialer Ungleichheiten darstellen, und es gibt Hinweise dafür, dass sich dieser bereits auf die perinatale Entwicklung auswirken könnte. Die zugrunde liegenden Wirkmechanismen sind nach wie vor unbekannt; theorie-basierte und hypothesengeleitete Analysen fehlen. Um diesen Herausforderungen zu begegnen, untersucht diese Studie, inwieweit kleinräumige Merkmale zu einem niedrigen Geburtsgewicht beitragen, unabhängig von individuellen Merkmalen. Auf der Grundlage eines konzeptionellen Modells1 wurden kleinräumige Merkmale ausgewählt, erhoben und deren Auswirkungen auf niedriges Geburtsgewicht analysiert. Methoden: Die Individualdaten stammen aus der Geburtskohortenstudie „Gesundheit von Babys und Kindern in Bielefeld“. Die Stichprobe besteht aus 958 Frauen und ihren Säuglingen, verteilt auf 80 statistische Bezirke in Bielefeld. Kleinräumige Daten wurden anhand von lokalen Lärmkarten, dem Emissionskataster, Google Street View und dem Melderegister erhoben. Zur Quantifizierung des Einflusses kleinräumiger Merkmale wurde eine lineare Mehrebenenanalyse mit einer Zwei-Ebenen-Struktur (Individuen, die in statistische Bezirke eingebettet sind) durchgeführt. Ergebnisse: Insgesamt sind die Auswirkungen der ausgewählten kleinräumigen Merkmale gering bis nicht existent, es zeigen sich keine signifikanten Effekten für niedriges Geburtsgewicht. Tendenziell weisen Neugeborene aus ästhetisch weniger ansprechenden und subjektiv unsicher wahrgenommenen Stadtteilen einen höheren Anteil an niedrigem Geburtsgewicht auf. Schlussfolgerungen: Die Analyse liefert keine eindeutigen Hinweise auf negative Auswirkungen kleinräumiger Faktoren auf ein niedriges Geburtsgewicht. Auf methodischer Seite bestätigt die Studie, dass ein angemessener Stichprobenumfang, eine zuverlässige Expositionsabschätzung und die Operationalisierung des kleinräumigen Kontextes mit Blick auf die verfügbaren Daten die zentralen Herausforderungen des Forschungsfeldes darstellen. KW - Geburtsgewicht Y1 - 2019 UR - https://www.eventclass.org/contxt_dgepi2019/online-program/session?s=AG13%7C1 SP - 113 EP - 113 ER - TY - GEN A1 - Schilling, Laura A1 - Spallek, Jacob A1 - Maul, Holger A1 - Schneider, Sven T1 - E-Zigaretten und Tabakzigaretten in der Schwangerschaft – eine Analyse von aktiver und passiver Exposition und Einstellung unter Schwangeren in Deutschland T2 - 14. Jahrestagung der DGEpi, 11.-13. Septmeber 2019, Ulm N2 - Hintergrund: In Deutschland greift ein Zehntel der Schwangeren zur Tabakzigarette. Gleichzeitig verbreiten sich E-Zigaretten insbesondere unter jungen Erwachsenen in Deutschland zunehmend. Das Ziel dieser Studie war es, die aktive und passive Exposition durch E-Zigaretten- und Tabakzigaretten sowie die Einstellung zur E-Zigarette unter Schwangeren in Deutschland zu erforschen. Methoden: Im Rahmen der STEP (STudy on E-cigarettes and Pregnancy) beantworteten 575 Schwangere an einer Geburtsklinik in Hamburg von April 2018 bis Januar 2019 Fragen zur E-Zigaretten- und Tabakzigarettenexposition sowie ihren Einstellungen zur E-Zigarette. Ergebnisse: Insgesamt nutzten 1,2% der Befragten ausschließlich E-Zigaretten, 6,7% E- und Tabakzigaretten und 20,3% ausschließlich Tabakzigaretten vor der Schwangerschaft. In der Schwangerschaft nutzten 0,5% E-Zigaretten und 9,1% Tabakzigaretten. 86,9% aller Schwangeren waren der Ansicht, dass E-Zigaretten nicht als Alternative zu Tabakzigaretten genutzt werden sollten. Befragte, die die Tabakzigarette während der Schwangerschaft nutzten, vertraten seltener diese Einstellung als Nichtnutzer (78,0% vs. 88,0%; p=0,045). Der aktuelle Konsum der E-Zigarette (bzw. Tabakzigarette) durch den Partner erfolgte bei 5,5% (bzw. 24,4%) der Befragten. 18,5% (bzw. 9,3%) der Partner mit E-Zigarettenkonsum (bzw. Tabakzigarettenkonsum) konsumierten zuhause. Schlussfolgerungen: Die aktive E-Zigarettenexposition ist – im Gegensatz zur aktiven Tabakzigarettenexposition - in der Schwangerschaft bisher gering. Gleichzeitig kommt eine passive Exposition durch den konsumierenden Partner von Schwangeren häufiger bei der E-Zigarette vor. Die Ergebnisse betonen die Wichtigkeit der weiterführenden Tabakprävention und der Erforschung der Gesundheitsrisiken des Passivdampfes in der Schwangerschaft. KW - E-Zigaretten KW - Tabakzigaretten KW - Schwangerschaft Y1 - 2019 UR - https://www.eventclass.org/contxt_dgepi2019/online-program/session?s=AG13%7C1 SP - 117 EP - 117 ER - TY - GEN A1 - Grosser, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi-Study. Analysis of a birth cohort study in Germany T2 - Gesundheitswesen 2019 N2 - Background: Breastfeeding is beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, which has only been reached by 34% in 2012. The WHO's aim of exclusively breastfeeding for six months was reached by 19% only. Socio-economic status and migration background have been identified to be associated with duration of breastfeeding but little is known about the impact of psychosocial factors e.g. personality traits and social support. We hypothesized that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding. Methods: Baseline and follow up data of the Bielefeld BaBi birth cohort (2013 – 16) were analysed. Bivariate and multivariate analyses were performed in order to identify psychosocial determinants for fully breastfeeding for four and six months. Results: Out of 780 BaBi study participants, 548 fully breastfeed for four months (70.3%) and 279 continued until at least six months (35.8%). Logistic regression analyses shows that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed (OR 7.3 [C.I. 4.54.-11.21) and the attendance of antenatal class (OR 1.4 [C.I. 1.01.-2.06). Personality characteristics, social status und migration background showed no significant association with breastfeeding duration. Conclusion: Our study results suggest to promote individuals' breastfeeding intention and the attendance of antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in mother and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration. KW - Breastfeeding Y1 - 2019 U6 - https://doi.org/10.1055/s-0039-1694422 VL - 81 IS - 08/09 SP - 686 EP - 686 PB - Georg Thieme Verlag CY - Stuttgart ER - TY - GEN A1 - Schilling, Laura A1 - Schneider, Sven A1 - Karlheim, Christoph A1 - Maul, Holger A1 - Tallarek, Marie A1 - Spallek, Jacob T1 - Perceived threats, benefits and barriers of e-cigarette use during pregnancy. A qualitative analysis of risk perception within existing threads in online discussion forums T2 - Midwifery N2 - Objective Previous studies have shown that e-cigarettes are perceived as being less harmful than tobacco cigarettes by pregnant women and might be used to quit smoking during pregnancy. Our aim was to further explore and characterise perceived threats, benefits and barriers of e-cigarette use during pregnancy. Methods Our STudy on E-cigarettes and Pregnancy (STEP) was, among others, based on a netnographic approach of analysing existing threads in German-speaking online discussion forums dealing with perceived threats and benefits of e-cigarette use during pregnancy. For the analysis, we used an inductive-deductive qualitative content analysis. Findings Based on 25 online discussion threads containing 1552 posts, we identified perceived threats, perceived benefits and perceived barriers to e-cigarette use during pregnancy, among others, as main themes. Subthemes identified within the main theme perceived threats were severe nicotine related health risks, potential health risks of additional ingredients, relative risks and lack of knowledge and research studies. As perceived benefits, we identified possibility and facilitation of smoking cessation, harm reduction and financial benefits. Perceived barriers were lack of satisfaction and social stigma. Conclusion Our qualitative results suggest that the perception of the health threats related to e-cigarette use during pregnancy varies according to the nicotine content and the perception of relative risks compared with tobacco cigarettes. In addition to this, risk perception is defined through further health and non-health related barriers and benefits (e.g. suitability of e-cigarettes as a smoking cessation aid, social stigma). KW - Electronic cigarette KW - Pregnancy KW - Risk perception KW - Health beliefs KW - Online forums Y1 - 2019 U6 - https://doi.org/10.1016/j.midw.2019.102533 SN - 0266-6138 VL - 79 ER - TY - GEN A1 - Löffler, Antje A1 - Hoffmann, Stephanie A1 - Fischer, Stefanie A1 - Spallek, Jacob T1 - Ambulante Haus- und Facharztversorgung im ländlichen Raum in Deutschland – Wie stellt sich die Versorgungssituation aus Sicht älterer Einwohner im Landkreis Oberspreewald-Lausitz dar? T2 - Das Gesundheitswesen N2 - Ziel der Studie: Die medizinische Versorgung der Bundesrepublik Deutschland ist von Verteilungsproblemen geprägt. Vor allem in ländlichen Regionen droht Unterversorgung. In dieser Studie wurde untersucht, wie ältere Bewohner des Landkreises Oberspreewald-Lausitz (OSL) des Bundeslandes Brandenburg ihre derzeitige medizinische Versorgungssituation einschätzen und welche Wünsche und Bedenken sie hinsichtlich deren zukünftigen Entwicklung im Jahr 2030 haben. Methodik: In der vorliegenden Querschnitterhebung wurden 3006 Einwohner im Alter von 50–56 Jahren und von 65–71 Jahren des Landkreises OSL befragt. Ein Fragebogen mit geschlossenem und offenem Antwortformat wurde zur Erfassung der Zielstellung eingesetzt. Ergebnisse: In der vorliegenden Untersuchung äußerten sich die Einwohner des Landkreises OSL aktuell zufrieden oder sehr zufrieden mit der hausärztlichen (93,1%) und der fachärztlichen Versorgung (83,3%). Innerhalb des Landkreises zeigen sich in einigen Regionen Defizite. Im Gebiet Lauchhammer/Schwarzheide äußerten sich insbesondere zur fachärztlichen Versorgung 27,1% der Befragten unzufrieden oder sehr unzufrieden. Alternative und ergänzende Versorgungsangebote wie die Community Nurse sind akzeptierte, jedoch derzeit unterrepräsentierte Maßnahmen zur Sicherstellung der zukünftigen medizinischen Versorgung. Schlussfolgerung: Derzeit zeigen sich Bewohner des ländlichen, metropolenfernen Landkreises OSL zufrieden mit der ambulanten medizinischen Versorgung, jedoch stellen sich in einigen Regionen Defizite, insbesondere bei der zukünftigen Facharztversorgung dar. Alternative Versorgungsangebote wie Telemedizin sind seitens der Bewohner gewünschte Maßnahmen zur Ergänzung und Sicherstellung der zukünftigen medizinischen Versorgung im ländlichen Raum. KW - Versorgung KW - Hausarzt KW - Facharzt KW - ländlicher Raum Y1 - 2019 U6 - https://doi.org/10.1055/a-1010-6277 SN - 0941-3790 VL - 83 (2021) IS - 1 SP - 47 EP - 52 ER - TY - GEN A1 - Miani, Celine A1 - Ludwig, A. A1 - Breckenkamp, Jürgen A1 - Sauzet, Odile A1 - Doyle, Ina-Merle A1 - Höller-Holtrichter, Chantal A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study T2 - BMC pregnancy and childbirth N2 - BACKGROUND: Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. METHODS: In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. RESULTS: Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01-3.81; and aOR: 2.36, CI: 1.27-4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups. CONCLUSIONS: Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care. KW - Acculturation KW - Birth cohort KW - Caesarean section KW - Education KW - Emergency KW - Germany KW - Income KW - Migration KW - Obstetric care KW - Socioeconomic determinants Y1 - 2020 U6 - https://doi.org/10.1186/s12884-020-2725-5 SN - 1471-2393 VL - 20 ER - TY - GEN A1 - Schilling, Laura A1 - Schneider, Sven A1 - Maul, Holger A1 - Spallek, Jacob T1 - STudy on E-Cigarettes and Pregnancy (STEP)–Study Protocolof a Mixed Methods Study on Risk Perception of E-Cigarette UseDuring Pregnancy and Sample Description T2 - Geburtshilfe und Frauenheilkunde N2 - Introduction: During pregnancy, the motherʼs healthy life-style is crucial for the health of the fetus. Potential risk factorsfor maternal and child health should therefore be identifiedand reduced as early as possible. The consumption of e-ciga-rettes represents one of these potential risk factors. Exploringrisk perceptions about e-cigarette use during pregnancy canprovide early indications of possible user motives. Therefore,our mixed methodsSTudy onE-cigarettes andPregnancy(STEP) aimed to comprehensively analyze risk perceptionsabout e-cigarette use during pregnancy based on anInte-gratedHealthBeliefModel (IHBM). This paper describes thestudy design, methods, sample population and limitations ofSTEP. Methods: Our sequential mixed methods study combinedqualitative and quantitative approaches. In the qualitativesection of the study which preceded the quantitative part ofthe study, we aimed to characterize risk perceptions aboute‑cigarette use during pregnancy. We used a netnographic re-search approach which analyzed discussion threads in onlineforums dealing with e-cigarette use during pregnancy. Theanalysis was based on an IHBM. Identified themes were incor-porated in the questionnaire which was developed for the quantitative part of the study. The quantitative section aimedto quantify, among other things, perceived threats, barriersand benefits and to explore differences in risk perception ac-cording to sociodemographic characteristics and tobacco ande-cigarette usage. Results: In the qualitative section, 1552 posts in 25 online dis-cussion threads dealing, inter alia, with e-cigarette use duringpregnancy were identified. The quantitative part looked atthe responses in the questionnaires handed in by 575 preg-nant women who attended a hospital in Hamburg (Germany)from April 2018 to January 2019 (response rate: 27.5%). Conclusion: Data collection was successful for both the qual-itative and quantitative parts of the study. When interpretingthe results of STEP, different limitations should be taken intoaccount. The results of STEP provide starting points for thedevelopment of tailored preventive measures for pregnantwomen. KW - e‑cigarette KW - pregnancy KW - risk perception KW - mixed methods study KW - Health Belief Model Y1 - 2020 UR - https://www.thieme-connect.de/products/ejournals/pdf/10.1055/a-1061-7288.pdf U6 - https://doi.org/10.1055/a-1061-7288 SN - 1438-8804 SN - 0016-5751 VL - 80 IS - 01 SP - 66 EP - 75 ER - TY - CHAP A1 - Tallarek, Marie A1 - Mlinarić, Martin A1 - Spallek, Jacob ED - Tiemann, Michael ED - Mohokum, Melvin T1 - Migration – Bedeutung und Implikationen für die Prävention und Gesundheitsförderung T2 - Prävention und Gesundheitsförderung. Springer Reference Pflege – Therapie – Gesundheit N2 - Die Bevölkerungsgruppe der Menschen mit Migrationshintergrund umfasst fast ein Viertel der Gesamtbevölkerung in Deutschland und ist höchst heterogen. Pauschalisierende Aussagen zum Gesundheitsstatus dieser Gruppe sind daher nicht möglich. Menschen mit Migrationshintergrund sind nicht grundsätzlich gesünder oder kränker als die Mehrheitsbevölkerung. Allerdings können sie sich aufgrund von Expositionen vor, während und nach der Migration in ihren Gesundheitschancen und -risiken von der Mehrheitsbevölkerung unterscheiden. Prävention und Gesundheitsförderung sollten daraus resultierende spezifische Bedarfe ebenso berücksichtigen wie die Diversität der Bevölkerung insgesamt. Erfolgversprechend ist eine Kombination aus diversitätssensiblen, für die Gesamtbevölkerung zugänglichen Angeboten und migrationsspezifischen Ansätzen in besonders risikoreichen Situationen. Kommunale, settingorientierte sowie soziokulturell angepasste Angebote verbessern die Erreichbarkeit der Zielgruppen maßgeblich. KW - Migration KW - Prävention KW - Gesundheitsförderung Y1 - 2019 UR - https://link.springer.com/referenceworkentry/10.1007%2F978-3-662-55793-8_28-1 SN - 978-3-662-55793-8 U6 - https://doi.org/10.1007/978-3-662-55793-8_28-1 SN - 2662-6942 SN - 2662-6950 SP - 1 EP - 13 PB - Springer CY - Berlin, Heidelberg ET - 1 ER - TY - GEN A1 - Miani, Céline A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Health of the offspring of immigrants: the BaBi birth cohort study T2 - Public Health Forum N2 - Children with a migration background are more at risk of health-related problems than those without a migration background. The German health system still does not adequately meet the challenges of on increasingly heterogeneous population, not least due to a lack of adequate epidemiological data and models. The BaBi study contributes to gaining new insights in the development of health inequalities due to cultural diversity in Germany, with a focus on pregnancy and early childhood. KW - cohort study KW - early childhood KW - migration KW - quantitative analysis KW - social epidemiology Y1 - 2019 UR - https://www.degruyter.com/view/j/pubhef.2019.27.issue-4/pubhef-2019-0062/pubhef-2019-0062.xml U6 - https://doi.org/10.1515/pubhef-2019-0062 SN - 1876-4851 SN - 0944-5587 VL - 27 IS - 4 SP - 298 EP - 300 ER - TY - GEN A1 - Grosser, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi cohort study, Germany T2 - European Journal of Public Health N2 - Background: Breastfeeding is considered beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, a goal reached by only 34% of mothers in 2012. The WHO’s recommendation of exclusively breastfeeding for six months was met by 19% only. Hardly modifiable factors such as socio-economic status and migration background have been associated with duration of breastfeeding but little is known about the impact of psychosocial factors such as personality traits and social support. We hypothesise that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding. Methods: We analyse baseline and follow-up data of the Bielefeld BaBi birth cohort (2013-16). They include detailed migration and socio-economic backgrounds, as well as three measures of psychological characteristics: the optimism scale, the Big Five inventory and the locus of control scales. We perform bivariate and multivariate analyses in order to identify psychosocial determinants of fully breastfeeding for four and six months. Results: Out of 780 BaBi study participants, 548 fully breastfed for four months (70.3%), of which 279 continued until at least six months (35.8%). Logistic regression analyses show that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed and the attendance of antenatal class during this or previous pregnancies. Personality characteristics, social status and migration background show however no significant association with breastfeeding duration. Conclusions: Our study results support the promotion of individuals’ breastfeeding intention and attendance to antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in maternal and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration. KW - breastfeeding KW - cohort study KW - psychosocial Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz187.122 SN - 1464-360X SN - 1101-1262 VL - 29 IS - 4 ER - TY - GEN A1 - Sauzet, Odile A1 - Zolitschka, Kim Alexandra A1 - Spallek, Jacob A1 - Breckenkamp, Jürgen A1 - Razum, Oliver T1 - An ego-centred approach for the evaluation of health inequalities in urban areas T2 - European Journal of Public Health N2 - Background: Neighbourhood possesses attributes, structural, physical and social, for which pathways to health inequalities could be hypothesized. Hence, neighbourhood is a complex mixture of factors which cannot be simply defined by a delineation on a map, making common definitions of neighbourhood (e.g. administrative borders) problematic. We present a new concept for the evaluation of contextual health inequalities in an urban setting. Methods: An ego-centred approach to neighbourhood effects on health allows to establish to what degree the health outcomes of a person are on average correlated to the health outcomes of his/her neighbours. This approach does not necessitate the definition of what a neighbourhood is, or of its boundaries. Using data from the BaBi birth cohort following up 958 mother-child pairs in Bielefeld/Germany we illustrate how the method provides information about the spatial structure of a possible association between unmeasured neighbourhood factors and birthweight. Spatially correlated birthweight indicates a neighbourhood effect on maternal health. Results: A parametric model of the correlation structure gives two indicators: a distance after which health outcomes are no longer correlated (practical range), and the strength of correlation (RSV). We modelled birthweight directly and residuals after controlling for (spatially correlated) covariates. After adjusting for the mother’s demographics and neighbourhood characteristics, birthweights remained spatially correlated with RSV of 11% and a practical range of 128 m. Conclusions: Modelling the spatial correlation of a health outcome provides a measure of the degree of health correlation, thus offering new evidence on the production of health inequalities while incorporating current modelling approaches. Moreover, it measures heterogeneity in a city. This could be used as an indicator for policy makers or town planners to identify areas in need of socioeconomic investment. KW - health inequalities KW - urban KW - birth weight KW - child KW - demography KW - ego KW - Germany KW - socioeconomic factors KW - health disparity KW - towns KW - maternal health Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz186.243 SN - 1101-1262 SN - 1464-360X VL - 29 IS - 4 ER - TY - GEN A1 - Schröder, Sara Lena A1 - Hoebel, Jens A1 - Roick, Julia A1 - Markert, Jenny A1 - Spallek, Jacob A1 - Knesebeck, Olaf von dem A1 - Richter, Matthias T1 - Inequalities in the utilisation of primary and specialist physicians in Europe - a systematic review T2 - European Journal of Public Health N2 - Background: The evidence on inequalities in health clearly shows that people with lower socioeconomic status (SES) have poorer health and higher mortality. Nevertheless, generalized evidence for inequalities in healthcare is lacking. So far, the international literature was only summarised with regard to inequalities in the utilisation of disease-specific treatment. Therefore, our aim was to synthetize the literature on socioeconomic inequalities in the utilisation of primary and specialist physicians in the general population. Methods: This systematic review searched Medline und Web of Science from 2004 to 2018. Articles that reported quantitative data on the association of SES with utilisation of primary or specialist physicians in Europe were included. Title and abstract screening were performed by two independent researchers and 50 full texts are currently sifted whether they fulfil the inclusion criteria. Results: The studies analysed utilisation of physicians in terms of probability or frequency. The initial check of the studies indicates that socioeconomic inequalities in the utilisation of physicians differ between primary and specialist care. Specialist physicians were found to be visited with a higher probability and more often by the least disadvantaged in most studies. Inequalities in the utilisation of primary physicians revealed to be more diverse with a weak pattern of equally distributed probability of GP visits and more frequent utilisation by the disadvantaged. Conclusions: The preliminary results indicate that pro-rich utilisation seems to be more pronounced in visiting specialists compared to primary health care. Aiming to reduce inequalities in healthcare, public health actions might primarily focus on reaching a needs-based consultation of specialist physicians. KW - Inequalities KW - Review KW - Primary health care KW - specialist health care KW - utilization Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz186.377 SN - 1101-1262 SN - 1464-360X VL - 29 IS - 4 ER - TY - GEN A1 - Scholaske, Laura A1 - Rodriguez, Norma A1 - Sari, Nida Emel A1 - Spallek, Jacob A1 - Ziegler, Matthias A1 - Entringer, Sonja T1 - The German Version of the Multidimensional Acculturative Stress Inventory (MASI) for Turkish-Origin Immigrants. Measurement Invariance of Filter Questions and Validation T2 - European Journal of Psychological Assessment N2 - The Multidimensional Acculturative Stress Inventory (MASI) is an established measure of acculturative stress for people of Mexican origin living in the USA that has been associated with mental health outcomes in this population. We translated the MASI into German and adapted it for use with Turkish-origin immigrants in Germany. The MASI includes filter questions asking if a potentially stressful event had actually occurred before reporting the stress appraisal of these situations. Measurement invariance testing has become a standard practice to evaluate questionnaire translations, however, measurement invariance of filter questions has been scarcely studied. In Study 1, we evaluated measurement invariance of the filter questions between a German-based Turkish sample (N = 233) and the Mexican-origin sample from the original study (N = 174) and could show partial strong factorial invariance for three of the four factors. In Study 2, a validation study, relations between the German MASI scores and measures of acculturation and stress indicated discriminant validity. This study contributes to research on measurement invariance of filter questions, thereby providing a measure of acculturative stress that can be used in future research to understand the etiology of health disparities in Turkish-origin immigrants in Germany. KW - German Multidimensional Acculturative Stress Inventory KW - Measurement invariance KW - Validation KW - Filter questions KW - Turkish-origin immigrants Y1 - 2020 U6 - https://doi.org/10.1027/1015-5759/a000567 SN - 2151-2426 VL - 36 IS - 5 SP - 889 EP - 900 ER - TY - GEN A1 - Spallek, Jacob A1 - Scholaske, Laura A1 - Kurt, Medlin A1 - Lindner-Matthes, Denise A1 - Entringer, Sonja T1 - Intergenerational transmission of health disparities among Turkish-origin immigrants in Germany: study protocol of a multi-centric cohort study (BaBi-stress and BaBeK study) T2 - BMC pregnancy and childbirth N2 - Background: Immigrants in Germany exhibit higher levels of social disadvantage when compared to the non-immigrated population. Turkish-origin immigrants constitute an important immigrant group in Germany and show disparities in some health domains that are evident from birth onwards. Several studies have shown the mechanisms by which social disadvantage is biologically embedded to affect health over the lifespan. Relatively little, however, is still known about if and how the maternal social situation is transmitted to the next generation. This study therefore aims to analyse the effects of maternal socioeconomic status and migration status on stress-related maternal-placental-fetal (MPF) biological processes during pregnancy on infant birth and health outcomes. Methods: This longitudinal cohort study of N = 144 child-mother dyads is located at two study sites in Germany and includes pregnant women of Turkish origin living in Germany as well as pregnant German women. During pregnancy, MPF stress biology markers from maternal blood and saliva samples, maternal socio-economic and migration-related information, medical risk variables and psychological well-being are assessed. After birth, infant anthropometric measures and developmental outcomes are assessed. The same measures will be assessed in and compared to Turkish pregnant women based on a collaboration with BABIP study in Istanbul. Discussion: This is the first study on intergenerational transmission of health disparities in Germany with a focus on women of Turkish-origin. The study faces similar risks of bias as other birth cohorts do. The study has implemented various measures, e.g. culturally sensitive recruitment strategies, attempt to recruit and follow-up as many pregnant women as possible independent of their social or cultural background. Nevertheless, the response rate among lower-educated families is lower. The possibility to compare results with a cohort from Turkey is a strength of this study. However, starting at different times and with slightly different recruitment strategies and designs may result in cohort effects and may affect comparability of the sub-cohorts. KW - Transmission of health inequalities KW - Stress biology KW - Turkish immigrants KW - Pregnancy KW - Birth Y1 - 2020 U6 - https://doi.org/10.1186/s12884-020-2853-y VL - 20 IS - 1 SP - 158 ER - TY - GEN A1 - Ludwig, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi-Study. Analysis of a birth cohort study in Germany T2 - Midwifery N2 - Breastfeeding is beneficial for both mother and child. A breastfed child can benefit from improved mental developments, protection against infectious diseases and infectious disease mortality, and a decreased risk of overweight and obesity (Whalen and Cramton 2010)(Regional Office for Europe (World Health Organisation) 2019). Furthermore, there is evidence on protection against type 1 and 2 diabetes, allergic rhinitis, asthma or wheezing, atopic dermatitis, childhood leukemia, hypercholesterolemia later in life, sudden infant death syndrome (Whalen and Cramton 2010) and malocclusion (Victora et al. 2016). Breastfeeding women have a lower risk of breast and ovarian cancer, postpartum depression, and type 2 diabetes. They can, furthermore, benefit from prolonged lactational amenorrhea (Victora et al. 2016), improved postpartum sleep (Whalen and Cramton 2010) and postpartum weight loss (Kramer and Kakuma 2012). KW - psychosocial factors KW - breastfeeding duration KW - birth KW - cohort study Y1 - 2020 U6 - https://doi.org/10.1016/j.midw.2020.102688 SN - 1532-3099 SN - 0266-6138 VL - 86 ER - TY - GEN A1 - Wandschneider, Lisa A1 - Sauzet, Odile A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Small-Area Factors and Their Impact on Low Birth Weight—Results of a Birth Cohort Study in Bielefeld, Germany T2 - Frontiers in Public Health N2 - Introduction: The location of residence is a factor possibly contributing to social inequalities and emerging evidence indicates that it already affects perinatal development. The underlying pathways remain unknown; theory-based and hypothesis-driven analyses are lacking. To address these challenges, we aim to establish to what extent small-area characteristics contribute to low birth weight (LBW), independently of individual characteristics. First, we select small-area characteristics based on a conceptual model and measure them. Then, we empirically analyse the impact of these characteristics on LBW. Material and methods: Individual data were provided by the birth cohort study “Health of infants and children in Bielefeld/Germany.” The sample consists of 892 eligible women and their infants distributed over 80 statistical districts in Bielefeld. Small-area data were obtained from local noise maps, emission inventory, Google Street View and civil registries. A linear multilevel analysis with a two-level structure (individuals nested within statistical districts) was conducted. Results: The effects of the selected small-area characteristics on LBW are small to non-existent, no significant effects are detected. The differences in proportion of LBW based on marginal effects are small, ranging from zero to 1.1%. Newborns from less aesthetic and subjectively perceived unsafe neighbourhoods tend to have higher proportions of LBW. Discussion: We could not find evidence for negative effects of small-area factors on LBW, but our study confirms that obtaining adequate sample size, reliable measure of exposure and using available data for operationalisation of the small-area context represent the core challenges in this field of research. KW - low birth weight KW - small-area analysis KW - multilevel analysis KW - virtual audit KW - noise pollution KW - fine particulate matter KW - socioeconomic deprivation KW - cohort study Y1 - 2020 U6 - https://doi.org/10.3389/fpubh.2020.00136 SN - 2296-2565 VL - 8 ER - TY - GEN A1 - Kaucher, Simone A1 - Khil, Laura A1 - Kajüter, Hiltraud A1 - Becher, Heiko A1 - Reder, Maren A1 - Kolip, Petra A1 - Spallek, Jacob A1 - Winkler, Volker A1 - Berens, Eva-Maria T1 - Breast cancer incidence and mammography screening among resettlers in Germany T2 - BMC public health N2 - Background – European studies showed that women with a migration background are less likely to participate in mammography screenings than autochthonous women. However, the participation in the German mammography screening programme (MSP) among ethnic German migrants from countries of the former Soviet Union (called resettlers) is unclear so far. The aim of this study was to identify possible differences regarding MSP participation between resettlers from the FSU and the general German population. Methods – Data from two independent, complementary studies from North Rhine-Westphalia, Germany (a retrospective cohort study 1994–2013; a cross-sectional study 2013/14) were used for comparisons between resettlers and the general population: Odds Ratios (ORs) for MSP participation utilizing the cross-sectional data and time trends of breast cancer incidence rates as well as Chi-Square tests for breast cancer stages utilizing the cohort data. Results – Resettlers showed higher Odds to participate in the MSP than the general population (OR 2.42, 95% CI 1.08–5.42). Among resettlers, a large increase in incidence rates was observed during the MSP implementation (2005–2009), resulting in stable and comparable incidence rates after the implementation. Furthermore, pre-MSP implementation, the proportion of advanced breast cancer stages was higher among resettlers than in the German population, post-MSP implementation the proportion was comparable. Conclusions – MSP participating seems surprisingly high among resettlers. An explanation for the increased willingness to participate might be the structured invitation procedure of the MSP. However, the exact reasons remain unclear and future research is needed to confirm this hypothesis and rule out the possibility of selection bias in the cross-sectional study. KW - Resettlers KW - Migrants KW - Breast cancer KW - Stage at diagnosis KW - Mammography screening programme KW - Participation Y1 - 2020 U6 - https://doi.org/10.1186/s12889-020-08534-7 VL - 20 IS - 1 ER - TY - RPRT A1 - Hoffmann, Stephanie A1 - Wachtler, Benjamin A1 - Sander, Lydia A1 - Blume, Miriam A1 - Hilger-Kolb, Jennifer A1 - Herke, Max A1 - Matos Fialho, Paula Mayara A1 - Pischke, Claudia R. A1 - Novelli, Anna A1 - Lampert, Thomas A1 - Spallek, Jacob T1 - Health inequalities among infants and pre-school children: Protocol for a scoping review examining the moderating and mediating role of contextual and compositional family characteristics N2 - Background: Although early childhood is a life period of overall good health, research shows that families’ socioeconomic position (SEP) is affecting children’s health from pregnancy on, ultimately leading to health inequalities. Little is currently known about the pathways by which family SEP is influencing child health and health-related behaviour, and which role family characteristics play. The scoping review therefore aims to screen the international literature on the mediating and moderating effects of contextual and compositional family characteristics on socioeconomic health risks of pre-school children in developed countries. Methods: Following the PRISMA guidelines for scoping reviews, three online databases (Pubmed, PsycINFO, and Scopus) will be searched for literature in English or German published after year 2000. The two-step data screening approach and the subsequent data extraction will be conducted independently by two researchers in consideration of specific criteria and a previously tested standardized data extraction form. Due to the broad research question at hand, various study designs (e.g. cross-sectional, intervention, cohort studies, and qualitative studies), SEP measures (e.g. education, income) and compositional (e.g. family size, migration) or contextual (e.g. parenting, housing) family characteristics influencing children ́s health will be included. Since diverse definitions and reporting formats of subjective health, health behaviour, well-being, and diseases will be considered, a substantial heterogeneity in outcome measures focusing on the age group of 0-6 years is expected. Thus, a narrative synthesis of the findings will be performed according to the Centre for Reviews and Dissemination framework. Ethics and dissemination: Because no primary data will be collected, ethical clearance will not be required. Dissemination will include peer-reviewed publications and conferences. KW - Health inequalities KW - family institutional characteristics KW - family context KW - pre-school children KW - infants KW - health KW - health behaviour KW - compositional characteristics KW - contextual characteristics KW - socioeconomic position Y1 - 2020 UR - https://osf.io/k2phw/ U6 - https://doi.org/10.17605/OSF.IO/3U4ST PB - Open Science Framework ER - TY - GEN A1 - Ludwig, Angelique A1 - Miani, Céline A1 - Breckenkamp, Jürgen A1 - Sauzet, Odile A1 - Borde, Theda A1 - Doyle, Ina-Merle A1 - Brenne, Silke A1 - Höller-Holtrichter, Chantal A1 - David, Matthias A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies T2 - Maternal and Child Health Journal N2 - Objective: Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular. Methods: Baseline data of the Bielefeld BaBi birth cohort (2013–2016) and the Berlin perinatal study (2011–2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status.ResultsIn Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake. Conclusions for Practice: Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups. KW - Non-medical antenatal care KW - Migration background KW - Education KW - Socioeconomic status KW - Pregnancy Y1 - 2020 U6 - https://doi.org/10.1007/s10995-020-02937-z SN - 1573-6628 SN - 1092-7875 VL - 24 IS - 7 SP - 943 EP - 952 ER - TY - RPRT A1 - Bozorgmehr, Kayvan A1 - Hintermeier, Maren A1 - Razum, Oliver A1 - Mohsenpour, Amir A1 - Biddle, Louise A1 - Oertelt‐Prigione, Sabine A1 - Spallek, Jacob A1 - Tallarek, Marie A1 - Jahn, Rosa T1 - SARS‐CoV‐2 in Aufnahmeeinrichtungen und Gemeinschaftsunterkünften für Geflüchtete: Epidemiologische und normativ‐rechtliche Aspekte N2 - Ziel des Factsheets ist es, das „Ausbreitungspotential“ (als kumulatives Inzidenzrisiko) von SARSCoV‐ 2 in Aufnahmeeinrichtungen und Gemeinschaftsunterkünften bei Auftreten eines Falls zu ermitteln, Zusammenhänge mit Einrichtungstyp und Strategie des Ausbruchsmanagements zu explorieren und normativ‐rechtliche Aspekte zu diskutieren. Zusammengefasst kann gesagt werden: - Das Risiko, mit dem weitere Bewohner*innen nach einem ersten nachgewiesenen Fall von SARS‐CoV‐2 (mittels PCR) positiv getestet werden ist in Aufnahmeeinrichtungen und Gemeinschaftsunterkünften mit durchschnittlich 17% als hoch einzuschätzen, wobei es eine große Varianz zwischen den Einrichtungen gibt. - Eine Kollektivquarantäne hat bezogen auf das Infektionsrisiko der unter Quarantäne gestellten Bewohner*innen gegenüber anderen Strategien keinen messbaren Vorteil. Ist innerhalb der Quarantäne eine physische Distanzierung nur bedingt möglich, ist von einer Erhöhung des Infektionsrisikos für die nicht‐infizierten Bewohner*innen auszugehen. Studien zur Quarantäne unter den vergleichsweisen günstigen Bedingungen von Kreuzfahrtschiffen bestätigen dies. Es gibt keine Daten darüber, ob die Kollektivquarantäne einen gesundheitlichen Nutzen für die Bevölkerung außerhalb der Einrichtung bedeutet. Da sie allerdings erhebliche normativ‐rechtliche Probleme birgt, ist die Kollektivquarantäne nach aktuellem Kenntnisstand zu vermeiden. - Die Unterbringung von Geflüchteten sollte grundsätzlich coronaschutzkonform erfolgen, d.h. möglichst dezentral bzw. bei zentralen Einrichtungen möglichst in Einzelunterbringung in kleinen Wohneinheiten, damit bei Auftreten eines Falls eine rasche Ausbreitung vermieden wird und eine adäquate Kontaktnachverfolgung möglich ist. - Nationale Empfehlungen zum Umgang mit SARS‐CoV‐2 in Aufnahmeeinrichtungen und Gemeinschaftsunterkünften unter Berücksichtigung der bisher vor Ort entwickelten Präventions‐ und Lösungsansätze sowie epidemiologischer und normativ‐rechtlicher Überlegungen sind dringend notwendig, um die beteiligten Akteur*innen in ihrem Engagement für die Gesundheit der Bewohner*innen zu unterstützen. Dieses Papier richtet sich an: Politikverantwortliche sowie Akteur*innen der Flüchtlingsversorgung und der Wissenschaft. KW - SARS‐CoV‐2 KW - COVID-19 KW - Aufnahmeeinrichtungen KW - Gemeinschaftsunterkünfte KW - Geflüchtete KW - Ausbreitungspotential KW - kumulatives Inzidenzrisiko Y1 - 2020 UR - https://www.public-health-covid19.de/ergebnisse.html U6 - https://doi.org/10.4119/UNIBI/2943665 ER - TY - GEN A1 - Ulrich, Hanna-Sophie A1 - Kohler, Emma A1 - Fach, Eva-Maria A1 - Spallek, Jacob A1 - Richter, Matthias A1 - Mlinarić, Martin T1 - Healthcare needs among unaccompanied minor refugees: a study protocol of a qualitative study explaining access and utilisation across place and gender T2 - BMJ Open N2 - Introduction: Several studies have identified that unaccompanied minor refugees (UMRs) are allegedly ‘vulnerable’ and belong to a high-risk group in terms of psychological distress and post-traumatic stress disorder due to their preflight, periflight and postflight experiences. Psychosocial care (PSC) is of high importance for UMRs, but little is known about barriers to access and utilisation of PSC across place and gender. The aims of this gender-sensitive qualitative study will be to build on the existing body of literature and to provide qualitative evidence on the contexts and mechanisms of PSC for male and female UMRs in Germany by comparing two German regions. Methods and analysis: Following the study preparing realist review, a qualitative study will be undertaken in Berlin and Central German cities. Approximately 24 experts from the field of PSC and 12 lay UMRs will participate in face-to-face, semistructured interviews. Data will be transcribed and analysed based on the grounded theory research paradigm. Ethics and dissemination: Only participants who have been informed in both German and their native tongue and who have signed a declaration of consent will be included in the study. The study will comply rigorously with German data protection standards. Approval from the Ethical Review Committee at Martin Luther University Halle-Wittenberg, Germany has been obtained and granted. The results of the study will be presented at several conferences and will be published in high-quality, peer-reviewed international journals. The results will display a differentiated picture of the PSC of UMRs in Germany. Such knowledge is a precondition for a ‘science of change’ that translates explanations into practical recommendations on how to improve healthcare policies. KW - Healthcare KW - unaccompanied minor refugees KW - access KW - utilisation KW - gender Y1 - 2020 UR - https://bmjopen.bmj.com/content/10/9/e038882 U6 - https://doi.org/10.1136/bmjopen-2020-038882 SN - 2044-6055 VL - 10 IS - 9 ER - TY - GEN A1 - Wachtler, Benjamin A1 - Hoffmann, Stephanie A1 - Blume, Miriam A1 - Rattay, Petra A1 - Herr, Raphael A1 - Deindl, Christian A1 - Sundmacher, Leonie A1 - Richter, Matthias A1 - Spallek, Jacob A1 - Lampert, Thomas T1 - The impact of the family on health inequalities in children – A systematic scoping review T2 - European Journal of Public Health N2 - Background Health inequalities in school-aged children and adolescents were repeatedly reported across Europe but less is known about the contextual and compositional factors of families that might influence and reproduce those health inequalities. In this systematic scoping review we aim to provide a comprehensive overview of the available international literature on the mediating and moderating influence of the family on health inequalities in children and adolescents in Europe and North America. Methods This review follows the PRISMA guidelines for scoping reviews. After defining the research question a search strategy was developed in cooperation with a scientific librarian and the study protocol was registered. A search of three databases (Pubmed, Scopus, PsycINFO) was conducted to identify relevant literature in English or German published between the year 2000 and 2019. A qualitative data charting process was used to extract the relevant data. Results In total 11.838 records were identified through the multi database search (Pubmed n = 6370, PsycINFO n = 3505, Scopus n = 1963). After elimination of duplicates and records from excluded countries, 8862 abstracts were screened by two researchers independently. Different cluster of evidence of family influences on health inequalities were identified: Parental behaviors and children's obesity, parents' smoking and drinking habits and adolescents' risk behaviors, parenting style and children's common mental disorders, parental resources and children's quality of life. Conclusions There are different aspects of family's contextual and compositional characteristics on health inequalities identifiable in the international literature. These characteristics might be new targets for family-focused health promotion strategies. Key messages: -A systematic scoping review found different family aspects that influence health inequalities in children and adolescents. - The identified family traits are promising targets for family-focused health promotion strategies to reduce health inequalities. KW - Health inequalities KW - family KW - scoping review KW - children KW - adolescents Y1 - 2020 U6 - https://doi.org/10.1093/eurpub/ckaa166.898 SN - 1101-1262 SN - 1464-360X VL - 30 IS - Supplement_5 PB - Univ. Press CY - Oxford ER - TY - GEN A1 - Matos Fialho, Paula Mayara A1 - Dragano, Nico A1 - Reuter, Matthias A1 - Metzendorf, Maria-Inti A1 - Richter, Bernd A1 - Richter, Matthias A1 - Spallek, Jacob A1 - Diehl, Katharina A1 - Lampert, Thomas A1 - Pischke, Claudia R. T1 - Health inequalities during school-to-work transitions among young adults: Mapping the evidence T2 - European Journal of Public Health N2 - Background School-to-work transition is a sensitive period that can have a substantial impact on health over the life course. Previous studies suggest pronounced health inequalities during this period but little is known about the determinants at the individual, meso- and macro-levels. We aim to further elucidate possible health inequalities during school-to-work transitions with a focus on multilevel determinants, e.g. evidence on potential effects of contextual and compositional factors of specific institutions involved. Methods We are currently conducting a scoping review (funded by the German Research Foundation) to map the evidence on the above mentioned topic among young adults (aged 16-24 years), following the methodological framework proposed by Arksey and ÓMalley and PRISMA. The literature search was performed in Ovid MEDLINE, Web of Science, ILO and NIOSH, using sensitive search strategy developed by text-analysis. Only articles published between January 2000 - February 2020 and written in English or German are considered. The selection process is conducted following a two-step approach:1) screening of titles and abstracts 2) screening of full-texts by two independent reviewers. Any discrepancies in the selection process are resolved by a third researcher. Preliminary Results Following the five stages of the methodological framework, the scoping review is currently in stage 3 (study selection-screening phase). We found 25,069 potentially relevant articles in our primary search. 15,508 articles remained after the duplicates were removed. Up to now, 8,825 papers were screened of which 7,629 were excluded and 1,176 included which qualified for full-text reading. Complete results of the scoping review will be presented at the conference. Conclusions This scoping review will improve our knowledge about the emergence and development of health inequalities during school-to-work transitions by examining health of individuals in different institutional contexts. Key messages - Improving our knowledge of health inequalities during school-to-work transitions. - the role of determinants at the individual, meso- and macro-levels during this stage will also be examined. KW - Health inequalities KW - school-to-work transition KW - young adults KW - life course Y1 - 2020 U6 - https://doi.org/10.1093/eurpub/ckaa166.278 VL - 30 IS - Supplement_5 ER - TY - GEN A1 - Schilling, Laura A1 - Spallek, Jacob A1 - Maul, Holger A1 - Tallarek, Marie A1 - Schneider, Sven T1 - Active and Passive Exposure to Tobacco and e-Cigarettes During Pregnancy T2 - Maternal and Child Health Journal N2 - Objectives Active and passive exposure to tobacco cigarettes during pregnancy is associated with multiple negative health outcomes for the fetus. In addition, exposure to e-cigarettes has been progressively discussed as a new threat to fetal health. Until now, there has been a lack of studies examining active and passive exposure to tobacco and e-cigarettes among pregnant women. The objective of our current STudy on E-cigarettes and Pregnancy (STEP) was to advance and complement the current knowledge regarding active and passive exposure to tobacco and e-cigarettes before pregnancy and during early and late pregnancy. Methods One element of the STEP study was a quantitative cross-sectional design: A sample of 540 pregnant women recruited at an obstetrician clinic in Hamburg from April 2018 to January 2019 were surveyed once via a standardized questionnaire and provided complete information regarding their consumption of tobacco and e-cigarettes. We performed a descriptive analysis of tobacco and e-cigarette use before pregnancy and during early and late pregnancy, as well as bivariate analysis of these variables with sociodemographic determinants. Passive exposure was assessed by asking the participating pregnant women about the consumption of tobacco and e-cigarettes by their partners, in general, and in their homes. Results Before pregnancy, 20.0% of the participants used tobacco cigarettes exclusively, 1.3% used e-cigarettes exclusively, and 6.5% were dual users. Educational level was significantly associated with tobacco cigarette use (p < 0.001) and dual use (p = 0.047) before pregnancy. During early (late) pregnancy, 8.7% (2.8%) used tobacco cigarettes and 0.4% (0.0%) used e-cigarettes exclusively. Twenty-point nine percent of women’s partners consumed tobacco cigarettes exclusively, 2.7% consumed e-cigarettes exclusively, and 2.7% consumed both. A total of 8.5% (16.7%) of the partners who consumed tobacco cigarettes exclusively (e-cigarettes exclusively) did so in the women’s homes. Conclusions for Practice Among pregnant women, the use of tobacco cigarettes remains prominent before and during pregnancy, while e-cigarette use predominately occurs before pregnancy. Our study shows that pregnant women are frequently exposed to their partners’ tobacco and e-cigarette use within their homes. Strategies to reduce such exposure should be further intensified. Significance In the last decade, e-cigarettes have become popular, and e-cigarette use has been increasing, even among pregnant women. However, there is a lack of knowledge concerning the exposure to e-cigarettes before pregnancy and during early and late pregnancy, as well as studies comparing e-cigarettes and tobacco cigarettes. The current study found that active exposure to e-cigarettes before pregnancy is high, while exposure during pregnancy is marginal. In contrast, exposure to tobacco cigarettes before and in early pregnancy is high but decreases during late pregnancy. In addition, the results of our study show that pregnant women are passively exposed to tobacco and e-cigarettes at home. Pregnant women should be advised against exposing themselves, actively or passively, to tobacco and e-cigarette smoke. KW - E-cigarette KW - Tobacco cigarette KW - Nicotine KW - Passive exposure KW - Pregnancy Y1 - 2020 U6 - https://doi.org/10.1007/s10995-020-03037-8 SN - 1092-7875 SN - 1573-6628 VL - 25 IS - 4 SP - 656 EP - 665 ER - 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 -