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Weil MT, Spinler K, Lieske B, Dingoyan D, Walther C, Heydecke G, Kofahl C, Aarabi G. An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach. JMIR Form Res 2023; 7:e36815. [PMID: 37166956 DOI: 10.2196/36815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 02/02/2023] [Accepted: 03/08/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app. OBJECTIVE This study aims to describe the development process of the MuMi app. METHODS For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation. RESULTS On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group. CONCLUSIONS The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background.
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Affiliation(s)
- Marie-Theres Weil
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristin Spinler
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Berit Lieske
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Demet Dingoyan
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Walther
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Kofahl
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Spinler K, Kofahl C, Ungoreit E, Heydecke G, Dingoyan D, Aarabi G. Access Barriers to Dental Treatment and Prevention for Turkish Migrants in Germany – A Qualitative Survey. Front Public Health 2022; 10:862832. [PMID: 35692338 PMCID: PMC9178233 DOI: 10.3389/fpubh.2022.862832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The worldwide migration movement is growing and thereby challenging the health care systems of immigration countries like Germany to make health care equally accessible for all people. Due to their low oral health status and low uptake rates of dental treatment and prevention, migrants were detected as a vulnerable group. Data regarding dental care access barriers of this group is limited. Therefore, the following study established a deeper understanding of unknown access barriers. Methods Nine expert interviews and one focus group interview were conducted semi-structured via interview guideline in the period of August until October 2018. The experts were persons with strong vocational interactions and experiences with the sector oral health care and migration. The focus group participants had a Turkish migration background. Results The expert and focus group interviews revealed a variety of barriers that exist toward dental treatment and prevention for migrants. Language, perceived significance of oral health, oral health knowledge, health socialization and patient-dentist interaction were detected to be the main barriers with underlying subthemes and interactions. Furthermore, a predominantly not precaution-oriented dental service utilization of migrants was underlined by the interviewees. Additionally, ways to reach a higher cultural sensitivity in oral health care were stated. Conclusion With respect for research, there is a need for the integration of migrant-specific items when collecting health data from people. With respect for policy, there is a need for more structural and individual attention for promoting equal access to oral health care and prevention measures for people with a migrant background.
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Affiliation(s)
- Kristin Spinler
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erik Ungoreit
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Demet Dingoyan
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Ghazal Aarabi
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Lauritano D, Moreo G, Carinci F, Campanella V, Della Vella F, Petruzzi M. Oral Health Status among Migrants from Middle- and Low-Income Countries to Europe: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212203. [PMID: 34831957 PMCID: PMC8624247 DOI: 10.3390/ijerph182212203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
Introduction. Economic inequality, political instability and globalization have contributed to the constant growth of the migration phenomenon in recent years. In particular, a total of 4.2 million people migrated to Europe during 2019 and most of them settled in Germany, France and Italy. Objectives. The objective of this study was to conduct a systematic review of studies analyzing the oral health condition among migrants from middle- and low-income countries to Europe and assessing the eventual association between their sociodemographic and socioeconomic characteristics and oral health status. Materials and Methods. A systematic review was conducted in PubMed, Cochrane Library, Scopus and Science Direct databases. After titles, abstracts and full-text examination, only 27 articles were selected on the basis of inclusion criteria and consequently included for quality assessments and data extraction. Results. Most of the studies reported a higher prevalence of caries experience, a poorer periodontal health and more difficulties in accessing dentalcare services among migrant groups compared with the non-migrant population. Inequalities were mostly associated with ethnic background, economic condition and social grade. Conclusion. Our review demonstrates the lack of dental health among migrants, underlining that their cultural beliefs and their social and economic living conditions could influence their oral health.
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Affiliation(s)
- Dorina Lauritano
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy;
- Correspondence: ; Tel.: +39-335-679-0163
| | - Giulia Moreo
- Dental and Maxillo-Facial Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy;
| | - Francesco Carinci
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy;
| | - Vincenzo Campanella
- Department of Clinical Science and Translational Medicine, University of Rome “Tor Vergata”, 00113 Rome, Italy;
| | - Fedora Della Vella
- Interdisciplinary Department of Medicine, University of Bari, 70121 Bari, Italy; (F.D.V.); (M.P.)
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari, 70121 Bari, Italy; (F.D.V.); (M.P.)
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Spinler K, Weil MT, Valdez R, Walther C, Dingoyan D, Seedorf U, Heydecke G, Lieske B, Kofahl C, Aarabi G. [Oral health literacy of persons with migration background-first results of the MuMi study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:977-985. [PMID: 34212208 PMCID: PMC8316185 DOI: 10.1007/s00103-021-03371-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/07/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND First investigations indicate a migration background of residents in Germany as a discrete risk factor for poor oral health. A lower level of oral health literacy among people with a migration background is considered a reason worthy of being investigated. AIM This article presents results on oral health literacy and oral health gained from the MuMi study (promoting oral health and oral health literacy of people with a migration background). METHODS The oral health and oral health literacy as well as the sociodemographics of patients with and without migration background were examined in 40 dental surgeries in Hamburg, Germany. Associations between migrant status, oral health, and oral health literacy were analyzed with logistic regressions. Potential confounders were gradually integrated into the multivariate analyses. RESULTS Patients with and without a migration background differed significantly in oral health literacy and clinical parameters of oral health (approximal plaque index and degree of caries restoration). The logistic regression analysis revealed highly significant associations between migration background, oral health literacy, and oral hygiene, while also accounting for education and socioeconomic status. DISCUSSION Migration background constitutes a discrete risk factor for lower oral health and oral health literacy for these relevant population groups. This fact needs stronger reflection in further research and political decision-making in order to promote equality of oral health opportunities.
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Affiliation(s)
- Kristin Spinler
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 58, 20246, Hamburg, Deutschland
- Institut für Medizinische Soziologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Marie-Theres Weil
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 58, 20246, Hamburg, Deutschland
| | - Richelle Valdez
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 58, 20246, Hamburg, Deutschland
- Institut für Medizinische Soziologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Carolin Walther
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 58, 20246, Hamburg, Deutschland
| | - Demet Dingoyan
- Institut für Medizinische Soziologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Udo Seedorf
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 58, 20246, Hamburg, Deutschland
| | - Guido Heydecke
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 58, 20246, Hamburg, Deutschland
| | - Berit Lieske
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 58, 20246, Hamburg, Deutschland
- Institut für Medizinische Soziologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Christopher Kofahl
- Institut für Medizinische Soziologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ghazal Aarabi
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 58, 20246, Hamburg, Deutschland.
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5
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Wiessner C, Keil T, Krist L, Zeeb H, Dragano N, Schmidt B, Ahrens W, Berger K, Castell S, Fricke J, Führer A, Gastell S, Greiser H, Guo F, Jaeschke L, Jochem C, Jöckel KH, Kaaks R, Koch-Gallenkamp L, Krause G, Kuss O, Legath N, Leitzmann M, Lieb W, Meinke-Franze C, Meisinger C, Mikolajczyk R, Obi N, Pischon T, Schipf S, Schmoor C, Schramm S, Schulze MB, Sowarka N, Waniek S, Wigmann C, Willich SN, Becher H. [Persons with migration background in the German National Cohort (NAKO)-sociodemographic characteristics and comparisons with the German autochthonous population]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:279-289. [PMID: 32034443 DOI: 10.1007/s00103-020-03097-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Persons with a migration background (PmM) as a population group usually differ from the autochthonous population in terms of morbidity, mortality, and use of the health care system, but they participate less frequently in health studies. The PmM group is very heterogeneous, which has hardly been taken into account in studies so far. OBJECTIVES Sociodemographic characteristics of PmM in the NAKO health study (age, sex, time since migration, education) are presented. In addition, it is examined through an example whether migration background is related to the use of cancer screening for colorectal cancer (hemoccult test). METHODS Data of the first 101,816 persons of the NAKO were analyzed descriptively and cartographically. The migration background was assigned on the basis of the definition of the Federal Statistical Office, based on nationality, country of birth, year of entry, and country of birth of the parents. RESULTS Overall, the PmM proportion is 16.0%. The distribution across the 18 study centers varies considerably between 6% (Neubrandenburg) and 33% (Düsseldorf). With 153 countries of origin, most countries are represented in the NAKO. All variables show clear differences between the different regions of origin. In the hemoccult test, persons of Turkish origin (OR = 0.67) and resettlers (OR = 0.60) have a lower participation rate. PmM born in Germany do not differ in this respect from the autochthonous population (OR = 0.99). CONCLUSION PmM in the NAKO are a very heterogeneous group. However, due to the sample size, individual subgroups of migrants can be studied separately with respect to region of origin.
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Affiliation(s)
- Christian Wiessner
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland.
| | - Thomas Keil
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg, Deutschland.,Landesinstitut für Gesundheit, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Bad Kissingen, Deutschland
| | - Lilian Krist
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hajo Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland.,Health Sciences Bremen, Universität Bremen, Bremen, Deutschland
| | - Nico Dragano
- Institut für Medizinische Soziologie, Centre for Health and Society, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Börge Schmidt
- Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Medizinische Fakultät, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Wolfgang Ahrens
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland.,Institut für Statistik, Fachbereich Mathematik und Informatik, Universität Bremen, Bremen, Deutschland
| | - Klaus Berger
- Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, Deutschland
| | - Stefanie Castell
- Abteilung für Epidemiologie, Helmholtz-Zentrum für Infektionsforschung (HZI), Braunschweig, Deutschland
| | - Julia Fricke
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik (IMEBI), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Sylvia Gastell
- NAKO Studienzentrum, Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke, Nuthetal, Deutschland
| | - Halina Greiser
- Abteilung Epidemiologie von Krebserkrankungen, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Feng Guo
- Abteilung Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Lina Jaeschke
- Forschergruppe Molekulare Epidemiologie, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC), Berlin, Deutschland
| | - Carmen Jochem
- Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Regensburg, Deutschland
| | - Karl-Heinz Jöckel
- Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Medizinische Fakultät, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Rudolf Kaaks
- Abteilung Epidemiologie von Krebserkrankungen, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Lena Koch-Gallenkamp
- Abteilung Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Gérard Krause
- Abteilung für Epidemiologie, Helmholtz-Zentrum für Infektionsforschung (HZI), Braunschweig, Deutschland.,Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - Oliver Kuss
- Institut für Biometrie und Epidemiologie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Nicole Legath
- Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, Deutschland
| | - Michael Leitzmann
- Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Regensburg, Deutschland
| | - Wolfgang Lieb
- Institut für Epidemiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Claudia Meinke-Franze
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Christa Meisinger
- SFG Klinische Epidemiologie, Helmholtz Zentrum München, Neuherberg, Deutschland.,Lehrstuhl für Epidemiologie am UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Deutschland.,NAKO Studienzentrum, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik (IMEBI), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Nadia Obi
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
| | - Tobias Pischon
- Forschergruppe Molekulare Epidemiologie, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC), Berlin, Deutschland.,Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Partnerstandort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.,MDC/BIH Biobank, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC) und Berlin Institute of Health (BIH), Berlin, Deutschland
| | - Sabine Schipf
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Claudia Schmoor
- Zentrum Klinische Studien, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Sara Schramm
- Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Medizinische Fakultät, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Matthias B Schulze
- Abteilung Molekulare Epidemiologie, Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke, Nuthetal, Deutschland
| | - Nicole Sowarka
- NAKO Studienzentrum, Universitätsklinikum Augsburg, Augsburg, Deutschland.,Institut für Epidemiologie, Helmholtz Zentrum München, Neuherberg, Deutschland
| | - Sabina Waniek
- Institut für Epidemiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Claudia Wigmann
- IUF-Leibniz Institut für umweltmedizinische Forschung, Düsseldorf, Deutschland
| | - Stefan N Willich
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Heiko Becher
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
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