TY - GEN A1 - Hoffmann, Stephanie A1 - Schulze, Susanne A1 - Löffler, Antje A1 - Becker, Juliane A1 - Hufert, Frank A1 - Gremmels, Heinz-Detlef A1 - Holmberg, Christine A1 - Rapp, Michael A. A1 - Entringer, Sonja A1 - Spallek, Jacob T1 - Depressive Symptome bei Beschäftigten im Gesundheitswesen während der COVID-19-Pandemie: Ergebnisse einer Kohortenstudie in einem Krankenhaus der Regelversorgung in Deutschland T2 - Gesundheitswesen N2 - Einleitung Bisher liegen in Deutschland wenig empirische Ergebnisse zu den Auswirkungen der COVID-19 Pandemie auf die seelische Gesundheit von Beschäftigten im Gesundheitswesen vor. In dieser Studie wird die zeitliche Entwicklung depressiver Symptome und der Zusammenhang mit a) der Stresswahrnehmung, b) der eigenen COVID-19-Infektion und c) der arbeitsplatzbezogenen COVID-19-Exposition untersucht. Methoden Die Kohortenstudie mit 91 Beschäftigten (90% wbl, x̅=45 Jr) eines Krankenhauses schloss (1) medizinisches, pflegerisches und therapeutisches sowie (2) administratives Personal im Zeitraum von Juli 2020 bis Dezember 2020 ein. Gemischte Modelle analysierten zeitliche Depressionswerte ('Allg. Depressionsskala‘) mit wahrgenommenem Stress ('Perceived Stress Scale'). Eine eigene COVID-19-Infektion (Laborbefund) wurde als Moderator getestet. Die zeitliche Entwicklung von Symptommodalitäten (u.a. somatisch) wurde nach beruflicher Exposition analysiert. Ergebnisse Die Depressionswerte stiegen insgesamt während des Studienzeitraums an (b=.03, .02-.05). Stressempfinden war mit depressiven Symptomen assoziiert (b=.12, .10-.14). Eine eigene Infektion war mit einem höheren Anstieg assoziiert (b=.06, .01-.10). Somatische Depressionssymptome nahmen nur bei beruflichem Kontakt mit COVID-19 zu (b=.25, .13-.38). Schlussfolgerung Die Zunahme somatischer depressiver Symptome bei Beschäftigten mit beruflichem Kontakt zu COVID-19 zeigt einen Bedarf an Forschung über und Ressourcen für Gesundheitsschutz und -förderung. Das Bewusstsein für Schutzmaßnahmen sollte gestärkt werden. Y1 - 2023 UR - https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0043-1770597 U6 - https://doi.org/10.1055/s-0043-1770597 VL - 85 IS - 809 ER - TY - CHAP A1 - Tetzlaff, Laura A1 - Purohit, Anne-Maria A1 - Spallek, Jacob A1 - Holmberg, Christine A1 - Schrader, Thomas T1 - Evaluating Interoperability in German Critical Incident Reporting Systems T2 - German Medical Data Sciences 2023 – Science. Close to People, Proceedings of the 68th Annual Meeting of the German Association of Medical Informatics, Biometry, and Epidemiology e.V. (gmds) 2023 in Heilbronn, Germany N2 - Introduction: In industrialised countries, one in ten patients suffers harm during hospitalization. Critical Incident Reporting Systems (CIRS) aim to minimize this by learning from errors and identifying potential risks. However, a lack of interoperability among the 16 CIRS in Germany hampers their effectiveness. Methods: This study investigates reports' syntactic and semantic interoperability across seven different reporting systems. Syntactic interoperability was examined using WHO's Minimal Information Models (MIM), while semantic interoperability was evaluated with SNOMED concepts. Results: The findings reveal a low structural overlap, with only two terms correctly represented in the SNOMED CT terminology. In addition, most systems showed no syntactic interoperability. Conclusion: Improving interoperability is essential for increasing the effectiveness and usability of CIRS. The study suggests a unified data model such as MIM or using Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) resources and expanding SNOMED CT with patient safety-relevant terms for semantic interoperability. Given the current lack of both syntactic and semantic interoperability in CIRS, developing a patient safety ontology is recommended for efficient critical incident analysis too. KW - CIRS KW - Interoperability KW - SNOMED CT KW - semantic KW - syntactic Y1 - 2023 SN - 978-1-64368-429-1 SN - 978-1-64368-428-4 U6 - https://doi.org/10.3233/SHTI230722 SP - 249 EP - 257 PB - IOS Press CY - Amsterdam [u.a.] 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 - 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 - RPRT A1 - Wachtler, Benjamin A1 - Hoffmann, Stephanie A1 - Rattay, Petra A1 - Sander, Lydia T1 - Systematic review of qualitative and quantitative studies on the mediating and moderating role of family characteristics on health inequalities in school-aged children and adolescents in countries with developed economies N2 - PROSPERO International prospective register of systematic reviews: registered study protocol. Review question: Which family characteristics mediate or moderate the association between the family’s socioeconomic position and health in school-aged children and adolescents in countries with developed economies? KW - Systematic review KW - family characteristics KW - health inequalities KW - children KW - adolescents KW - developed economies Y1 - 2020 UR - https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020165614 PB - National Institute for Health Research - PROSPERO ER - TY - GEN A1 - Hoffmann, Stephanie A1 - Sander, Lydia A1 - Blume, Miriam A1 - Schneider, Sven A1 - Herke, Max A1 - Matos Fialho, Paula M. 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 - 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 - 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 M. 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 - Blume, Miriam A1 - Rattay, Petra A1 - Hoffmann, Stephanie A1 - Spallek, Jacob A1 - Sander, Lydia A1 - Herr, Raphael A1 - Moor, Irene A1 - Pischke, Claudia R. A1 - Iashchenko, Iryna A1 - Hövener, Claudia T1 - Zusammenhang zwischen der sozioökonomischen Position der Familie und Adipositas bei Jugendlichen in Deutschland – welche Rolle hat die Familie? T2 - Gesundheitswesen N2 - Einleitung Die gesundheitlichen Folgen von Adipositas für junge Menschen können schwerwiegend sein. Bei der Entwicklung verschiedener Gesundheitsoutcomes wie Adipositas spielt für junge Menschen die Familie als auch ihre sozioökonomische Position (SEP) eine große Rolle. In dieser Analyse wird untersucht, welche familiäre Determinanten den Zusammenhang zwischen SEP der Familie und Adipositas bei Jugendlichen erklären. Methoden Die vorliegende Analyse wurde mit Daten der "Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland" (KiGGS) (Basiserhebung, Welle 1 und 2) durchgeführt (1301 weibliche und 1232 männliche 11- bis 17-Jährige). Mittels logistischer Regressionsmodelle (KHB-Methode) wurden für den Zusammenhang zwischen der SEP der Familie (Einkommen, berufliche Stellung, Bildung, SES-Index) und Adipositas (Ja/Nein) bei Jugendlichen die mediierenden Effekte von familiären Determinanten (elterliches Rauchen, elterliche sportliche Aktivitäten, elterliches Übergewicht, familiärer Stress und familiärer Zusammenhalt) analysiert. Ergebnisse Die Prävalenz von Adipositas betrug 7,9 % bei den weiblichen und 8,4 % bei den männlichen Jugendlichen. Es zeigen sich signifikante Zusammenhänge zwischen Adipositas und SEP zu Ungunsten von jenen mit niedriger sozioökonomischer Position. Familiäre Determinanten erklären teilweise oder vollständig den Zusammenhang zwischen SEP und Adipositas bei Jugendlichen. Es wurden geschlechtsspezifische Unterschiede im Ausmaß der Mediation der Familie gefunden. Bei Jungen erklären familiäre Determinanten vollständig den Zusammenhang zwischen Adipositas und Einkommen sowie zwischen Adipositas und der beruflichen Stellung der Eltern. Bei männlichen Jugendlichen lässt sich der indirekte Effekt abhängig von der jeweiligen SEP-Variable zu 20,8 – 27,9 % auf das elterliche Rauchen, zu 14,8 – 26,3 % auf die elterliche sportliche Aktivität und zu 42,6 – 63,6 % auf das elterliche Übergewicht zurückführen. Bei Mädchen wurde der Zusammenhang zwischen der SEP und Adipositas teilweise durch familiäre Determinanten erklärt. Bei weiblichen Jugendlichen lässt sich der indirekte Effekt abhängig von der jeweiligen SEP-Variable zu 26,0 – 52,2 % auf das elterliche Rauchen und zu 41,6 – 67,6 % auf das elterliche Übergewicht zurückführen. Schlussfolgerung Die Adipositas-Prävalenz von Jugendlichen variiert nach dem SEP. Familiäre Determinanten sind wichtige mediierende Faktoren für gesundheitliche Ungleichheiten bei Adipositas von Jugendlichen. Es zeigt sich, dass sich Unterschiede in der Adipositas nach SEP insbesondere durch das elterliche Gesundheitsverhalten (v.a. elterliches Rauchen, elterliches Übergewicht und elterliche sportliche Aktivität) erklären lassen. Die Berücksichtigung und Einbindung der Familie bei der Planung und Umsetzung von Gesundheitsförderungs- und Präventionsprogrammen für gesundheitliche Chancengleichheit bei Jugendlichen ist essentiell. KW - sozioökonomische Position KW - Familie KW - Adipositas KW - Jugendliche Y1 - 2022 UR - https://www.thieme-connect.de/products/ejournals/html/10.1055/s-0042-1753866 U6 - https://doi.org/10.1055/s-0042-1753866 VL - 84 IS - 08/09 SP - 826 ER - TY - GEN A1 - Herr, Raphael A1 - Diehl, Katharina A1 - Schneider, Sven A1 - Osenbruegge, Nina A1 - Memmer, Nicole A1 - Sachse, Steffi A1 - Hoffmann, Stephanie A1 - Wachtler, Benjamin A1 - Herke, Max A1 - Pischke, Claudia R. A1 - Novelli, Anna A1 - Hilger-Kolb, Jennifer T1 - Which Meso-Level Characteristics of Early Childhood Education and Care Centers Are Associated with Health, Health Behavior, and Well-Being of Young Children? Findings of a Scoping Review T2 - International Journal of Environmental Research and Public Health N2 - Characteristics of early childhood education and care (ECEC) centers might be relevant for children’s health. This scoping review aims to provide an overview of the association between meso-level characteristics (MLCs) of ECEC centers with children’s health, health behavior, and wellbeing. Five databases were searched for quantitative and qualitative research articles published in English or German since 1 January 2000 on health, health behavior, and wellbeing of children aged 0 to 6 years considering MLCs of ECEC centers. Two authors screened 10,396 potentially eligible manuscripts and identified 117 papers, including 3077 examinations of the association between MLCs and children’s health indicators (Kappas > 0.91). Five categories of MLCs were identified: (1) structural characteristics, (2) equipment/furnishings, (3) location, (4) facilities/environment, (5) culture/activities/policies/practices, and 6) staff. Only very few studies found an association of MLCs with body weight/obesity, and general health and wellbeing. Especially physical activity and mental health were related to MLCs. In general, the location (rural vs. urban, neighborhood status) seemed to be a relevant health aspect. MLCs of ECEC centers appeared relevant for child health indicators to different degrees. Future research should focus on these associations, in detail, to identify concrete ECEC indicators that can support health promotion in early childhood. KW - scoping review KW - early childhood education and care (ECEC) centers KW - kindergarten KW - young children KW - meso-level characteristics KW - health KW - health behavior KW - socioeconomic position KW - health inequalities Y1 - 2021 UR - https://www.mdpi.com/1660-4601/18/9/4973 U6 - https://doi.org/10.3390/ijerph18094973 VL - 18 IS - 9 SP - 4973 ER - TY - GEN A1 - Iashchenko, Iryna A1 - Schüttig, Wiebke A1 - Bammert, Philip A1 - Spallek, Jacob A1 - Rattay, Petra A1 - Schneider, Sven A1 - Moor, Irene A1 - Pischke, Claudia R. A1 - Sundmacher, Leonie T1 - The role of regional health policy for socioeconomic inequality in health services utilization T2 - European Journal of Public Health N2 - Background “J1” is a preventative routine examination in Germany recommended for adolescents at the age of 12-14 years. In contrast to the well-established U1-U9 examinations for younger children, with participation rates above 90%, the attendance of the J1 examination is approximately only 40%. The most frequent reason for not attending J1 is the unawareness of this examination. “Ticket to J1” is an intervention including an information leaflet introduced in Bavaria in 2017 to inform adolescents about J1. The aims of the present analysis are to investigate (1) if the regional policy was effective in increasing the attendance in J1, (2) if the effects vary by family socioeconomic status (SES), and (3) which meso-level characteristics of the healthcare system correlate with attendance rates in J1. Methods We used anonymised data of a large statutory health insurance in Germany for the timeframe of 2016-2018. To investigate the effect of the policy, a difference-in-differences design at the individual level was used. Assuming a parallel trend at the level of federal states, the likelihood of attendance in J1 of 13- and 14-year-olds was compared between Bavaria and other federal German states before and after policy introduction. All analyses were additionally stratified by SES. Results The introduction of “Ticket to J1” increased participation in J1 by 1% after controlling for all confounders. Furthermore, the effect was stronger for children from families with lower SES (an increase of 5%). Density of pediatricians was positively significantly correlated with participation in J1. Discussion Regional health policy intervention had a significant positive impact on attendance of J1 and appears to have the potential to reduce socioeconomic inequalities in healthcare utilization. Informing adolescents about J1 seems to increase the attendance, in particular for children from families with lower SES. KW - regional health policy KW - socioeconomic inequality KW - health services KW - utilization Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.584/6765537?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.584 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - GEN A1 - Matos Fialho, Paula M. A1 - Dragano, Nico A1 - Reuter, Marvin A1 - Deindl, Christian A1 - Schleberger, Sarah A1 - Metzendorf, Maria-Inti A1 - Hoffmann, Stephanie A1 - Diehl, Katharina A1 - Wachtler, Benjamin A1 - Schüttig, Wiebke A1 - Herke, Max A1 - Richter, Matthias A1 - Pischke, Claudia R. T1 - School-to-work and school-to-university transition and health inequalities among young adults: a scoping review T2 - BMJ Open N2 - Objectives The main objective was to systematically map evidence regarding the emergence of health inequalities in individuals aged 16–24 years during school-to-work and school-to-university transition (STWT). Second, we aimed to summarise the evidence on potential effects of contextual and compositional characteristics of specific institutional contexts entered during STWT on health and health behaviours. Design Scoping review. Study selection Relevant literature was systematically searched following the methodological framework proposed by Arksey and O’Malley. Ovid MEDLINE and Web of Science, and websites of the International Labour Organization and National Institute for Occupational Safety and Health were searched, using a predetermined search strategy. Articles in English or German published between 1 January 2000 and 3 February 2020 were considered. Data extraction To collect the main information from the selected studies, a data extraction spreadsheet was created. Data were summarised and grouped into five health outcomes and five institutional contexts (school, vocational training, university, work, unemployment). Results A total of 678 articles were screened for inclusion. To be able to draw a picture of the development of various health outcomes over time, we focused on longitudinal studies. Forty-six prospective studies mapping health-related outcomes during STWT were identified. Higher family socioeconomic position (SEP) was associated with higher levels of health behaviour and lower levels of health-damaging behaviour, but there was also some evidence pointing in the opposite direction. Disadvantaged family SEP negatively impacted on mental health and predicted an adverse weight development. There was limited evidence for the outcomes physical/somatic symptoms and self-rated health. Meso-level characteristics of the institutional contexts identified were not systematically assessed, only individual-level factors resulting from an exposure to these contexts, rendering an analysis of effects of contextual and compositional characteristics on health and health behaviours impossible. Conclusions This scoping review demonstrated a wide range of health inequalities during STWT for various health outcomes. However, knowledge on the role of the core institutional contexts regarding the development of health inequalities is limited. KW - School-to-work transition KW - school-to-university transition KW - health inequalities KW - young adults KW - scoping review Y1 - 2022 UR - https://bmjopen.bmj.com/content/12/7/e058273 U6 - https://doi.org/10.1136/bmjopen-2021-058273 SN - 2044-6055 VL - 12 IS - 7 SP - e058273 ER - TY - GEN A1 - Reuter, Marvin A1 - Pischke, Claudia R. A1 - Rigo, Mariann A1 - Diehl, Katharina A1 - Spallek, Jacob A1 - Richter, Matthias A1 - Hövener, Claudia A1 - Dragano, Nico T1 - Health inequalities among young workers: the mediating role of working conditions and company characteristics T2 - International Archives of Occupational and Environmental Health N2 - Objective Few studies have investigated health inequalities among young workers. The objectives of this study are to assess the extent of health inequalities in a sample of job starters and to explore the contribution of job demands and organisational factors. Methods We analyze data from the BIBB/BAuA Youth Employment Survey 2012. The cross-sectional survey includes a representative sample of 3214 German employees, apprentices, and trainees aged 15–24 years. Individuals were grouped by their years of schooling into low (< 12 years) and high levels of education (≥ 12 years). Regression analysis estimated the link between education and four health outcomes: self-rated health, number of health events, musculoskeletal symptoms, and mental health problems over the last 12 months. Counterfactual mediation analysis tested for indirect effects of education via working conditions (i.e., physical and psychosocial job demands) and company characteristics (i.e., company size, health prevention measures, financial situation, downsizing). All analyses were adjusted for age, sex, nationality, region, working hours, job tenure, employment relationship, and economic sector. Results Highly educated workers reported better self-rated health (b = 0.24, 95% CI 0.18–0.31) and lower numbers of health events (Rate Ratio (RR) = 0.74, 95% CI 0.67–0.82), musculoskeletal symptoms (RR = 0.73, 95% CI 0.66–0.80) and mental health problems (RR = 0.84, 95% CI 0.76–0.93). Total job demands explained between 21.6% and 87.2% of the educational differences (depending on health outcome). Unfavourable company characteristics were associated with worse health, but showed no or only small mediation effects. Conclusions Health inequalities are already present at the early working career due to socio-economically stratified working hazards. To enhance prevention measures that aim at reducing inequalities in workplace health, we propose shifting attention towards earlier stages of life. KW - Company leve Young workers KW - Health inequalities KW - Job demands KW - Mediation KW - Socio-economic position KW - Young workers Y1 - 2023 UR - https://link.springer.com/article/10.1007/s00420-023-02010-6 U6 - https://doi.org/10.1007/s00420-023-02010-6 SN - 1432-1246 VL - 96 IS - 10 SP - 1313 EP - 1324 ER - TY - GEN A1 - Bammert, Philip A1 - Schüttig, Wiebke A1 - Iashchenko, Iryna A1 - Spallek, Jacob A1 - Rattay, Petra A1 - Schneider, Sven A1 - Richter, Matthias A1 - Pischke, Claudia R. A1 - Dragano, Nico A1 - Sundmacher, Leonie T1 - The role of sociodemographic, psychosocial, and behavioral factors in the use of preventive healthcare services in children and adolescents: results of the KiGGS Wave 2 study T2 - BMC Pediatrics N2 - Background: In Germany, various preventive services are offered to children and adolescents. These include regular standardized examinations (so called U/J examinations) and several vaccinations. Although strongly recommended, most of them are not mandatory. Our aim is to identify factors associated with the use of U/J examinations and vaccination against diphtheria, hepatitis B, Hib, pertussis, polio, and tetanus. While previous research has focused on sociodemographic factors, we also include socioeconomic, behavioral, and psychosocial factors. Methods: We analyzed cross-sectional data from 15,023 participants (aged 0-17 years) of the nationwide representative KiGGS Wave 2 Survey. Participation in U/J examinations was assessed using a questionnaire, filled out by participants and/or their parents. Information on vaccination status was drawn from the participants' vaccination booklets. To identify relevant determinants for the use of preventive examinations and vaccinations, unadjusted and adjusted logistic regression models were employed with up to 16 different independent variables. Results: Various independent variables showed an association with the use of preventive services. Higher socioeconomic status, absence of migration background, and lower household size were associated with significantly higher utilization of U examinations. Parents' marital status, area of residence, behavioral and psychosocial factors yielded insignificant results for most U/J examinations. Higher vaccination rates were found for children with no migration background, with residence in eastern Germany, lower household size, and with married parents. Conclusion: This study attempted to depict the influence of sociodemographic, psychosocial, and behavioral factors on the use of several preventive services. Our results indicate that predominantly sociodemographic variables influence the use of preventive services. Further efforts should be made to investigate the interplay of different determinants of healthcare use in children and adolescents. KW - Healthcare use KW - Inequity KW - Pediatrics KW - Prevention KW - Vaccination Y1 - 2024 UR - https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04650-0 U6 - https://doi.org/10.1186/s12887-024-04650-0 SN - 1471-2431 VL - 24 ER - TY - GEN A1 - Reuter, Marvin A1 - Herke, Max A1 - Richter, Matthias A1 - Diehl, Katharina A1 - Hoffmann, Stephanie A1 - Pischke, Claudia R. A1 - Dragano, Nico T1 - Young people’s health and well-being during the school-to-work transition: a prospective cohort study comparing post-secondary pathways T2 - BMC Public Health N2 - Background: At the end of secondary education, young people can either start vocational training, enter university, directly transition to employment or become unemployed. Research assumes that post-secondary pathways have immediate and/or long-term impacts on health and well-being, but empirical investigations on this are scarce and restricted to few countries. Therefore, this study traced the development of health and well-being throughout the highly institutionalised school-to-work transition (STWT) in Germany. Methods: We used longitudinal data of the National Educational Panel Study (NEPS), a representative sample of 11,098 school-leavers (50.5% girls) repeatedly interviewed between 2011 and 2020. We estimated the effect of post-secondary transitions on self-rated health and subjective well-being by applying fixed-effects (FE) regression, elimi-nating bias resulting from time-constant confounding and self-selection into different pathways. A multiple-sample strategy was used to account for the increasing diversity of STWTs patterns. Models were controlled for age, as well as household and residential changes to minimise temporal heterogeneity. Results: Findings indicate that leaving school was good for health and well-being. Compared with participants who did not find a training position after school, direct transitions to vocational training or university were linked to higher absolute levels of health and well-being, but also to a lower relative decline over time. Furthermore, upward transi-tions (e.g. to programs leading to better education or from unemployment to employment) were associated with improvements in health and well-being, while downward transitions were followed by deteriorations. Conclusion: Findings suggest that school-leave is a sensitive period and that post-secondary pathways provide young people with different abilities to maintain health and well-being. Youth health interventions might benefit when setting a stronger focus on unsuccessful school-leavers. KW - School-to-work transition KW - Institutional context KW - Vocational training KW - Apprenticeship KW - University KW - Prevocational preparation KW - Self-rated health KW - Subjective well-being KW - National Educational Panel Study KW - NEPS Y1 - 2022 U6 - https://doi.org/10.1186/s12889-022-14227-0 SN - 1471-2458 VL - 22 SP - 1 EP - 13 ER - TY - GEN A1 - Hoffmann, Stephanie A1 - Rattay, Petra A1 - Blume, Miriam A1 - Hövener, Claudia A1 - Schneider, Sven A1 - Moor, Irene A1 - Pischke, Claudia R. A1 - Schüttig, Wiebke A1 - De Bock, Freia A1 - Spallek, Jacob T1 - Do family characteristics explain a social gradient in overweight in early childhood? T2 - European Journal of Public Health N2 - Background Children's overweight is associated with many factors, including their living situation, in particular their family's socioeconomic position (SEP) and family characteristics. Research on the extent to which family characteristics account for a social gradient in overweight in early life is scarce. This study evaluated whether family characteristics explain SEP differences in the risk of overweight in early childhood. Methods The study used baseline data of 3-6 year-old children (n = 1,116) from the intervention ‘Ene mene fit’ conducted at kindergartens in Baden-Württemberg, Germany. Data included overweight (body mass index > 90 percentile) and parents’ reports on their education and family characteristics associated with overweight (child consumes: sweets in front of TV, soft drinks; family joined time: outdoor, breakfast, sports; cooking; child sets table; role model). Model-based single mediation analyses decomposed the total effect of highest parental education on overweight into direct (unmediated) and indirect (mediated) effects (OR, 95% CI). Results Girls and boys with low parental education had higher odds for overweight than children with high/medium education. Among boys, low education influenced the risk of overweight via indirect effects of i. ‘sweets consumption in front of TV’ (OR = 1.31, 1.05-1.59) and ii. ‘no joined sports’ (OR = 1.14, 1.00-1.44). The direct effect of low education only remained significant when ‘no joined sports’ was considered (OR = 2.19, 1.11-5.19). Among girls, family characteristics measured here did not explain SEP differences in overweight. Conclusions The family characteristics ‘sweets consumption in front of TV’ and ‘no joined sports’ contribute to inequalities in overweight among boys, but not among girls. Therefore, more gender-sensitive research is needed to identify family risk and protective characteristics that explain health inequalities among both boys and girls. KW - family characteristics KW - social gradient KW - obesity KW - early childhood Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.581/6765540?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.581 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - GEN A1 - 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 - 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 - 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 - Matos Fialho, Paula M. 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 -