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Institute
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.
Health inequalities during school-to-work transitions among young adults: Mapping the evidence
(2020)
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.
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.
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.
Introduction: Early childhood is an important life stage which is crucial for determining health and health inequalities in later life. At the meso-level (institutional-level), early childcare facilities (eg, kindergartens, preschools) are the most important agent of socialisation next to families in young children aged 06 years. In recent years, an increasing amount of studies has focused on contextual and compositional characteristics of early childcare facilities and their association with health (eg, self-rated health), health behaviour (eg, physical activity) and well-being (eg, emotional well-being) in this age group. However, as currently no overview of the available literature on this topic exists, we will conduct a scoping review including various study designs (eg, cross-sectional studies, prospective studies, qualitative studies).
Methods and analysis: We will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A systematic search of the following scientific databases will be conducted: PubMed/Medline, PsycInfo, Sociological Abstracts, Education Resources Information Center and The Cochrane Library. During the selection process, we will follow a two-step process. First, two reviewers will independently screen titles/abstracts of all potentially eligible articles by applying a set of previously defined inclusion and exclusion criteria. After the completion of the title/abstract screening, full texts of the remaining articles will be screened following the same procedure. To determine inter-rater agreement between reviewers, we will calculate Cohen’s Kappa after both steps. Key characteristics (eg, country of origin, sample size, study design) of included articles will be extracted. We will map the evidence available by providing a summary table on the key characteristics extracted and by presenting the associations using various types of illustrations.
Ethics and dissemination: Since no primary data will be collected for this review, ethical approval is not required. Our findings will be published in an international peer-reviewed journal and presented at national and international conferences.
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?
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.
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.
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.
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.