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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).
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.
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.
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.
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.
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.
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.
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.
Inequalities in the utilisation of primary and specialist physicians in Europe - a systematic review
(2019)
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.
The impact of psychosocial factors on breastfeeding duration in the BaBi cohort study, Germany
(2019)
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).