The role of weight- and appearance-related discrimination on eating disorder symptoms among adolescents and emerging adults

BACKGROUND

Eating disorder symptoms (EDs) have been discussed as a prominent problem among late adolescent girls with serious health risks and long-term consequences. However, there is a lack of population-based evidence on EDs comprising the age range from early adolescence to emerging adulthood as well as considering both females and males equally. Additionally, the differential role of a comprehensive set of several relevant risk factors and particularly weight- and appearance-related discrimination warrants further attention. Thus, we aimed to contribute to a better understanding of sex- and age-related differences in associations between discrimination experience and other relevant personal risk factors (body image, social media use, self-efficacy, social support) with EDs. Furthermore, we were interested in the exploration of underlying mechanisms enhancing the risk of EDs by taking discrimination experience into account.

METHODS

Based on a logistic regression model, we investigated associations between weight- and appearance-related discrimination and EDs while controlling for other relevant personal risk factors in a subsample of N = 8504 adolescents and emerging adults (54.4% female, mean age = 20.71 years, SD = 4.32 years) drawn from a German representative health survey (KiGGS Wave 2). In a second step, we investigated the mediating role of discrimination experience between the other risk factors and EDs with the help of a path model.

RESULTS

While controlling for other relevant personal risk factors, weight- and appearance-related discrimination was significantly related to EDs. Whereas the risk of EDs was significantly enhanced in males and emerging adults frequently experiencing weight-related discrimination, adolescents showed a higher risk of EDs when experiencing appearance-related discrimination. Moreover, discrimination experience partly explained the associations between body image dissatisfaction, low self-efficacy, high media use and ED symptoms.

CONCLUSIONS

The results highlight weight- and appearance-related discrimination as one central factor to be considered in the pathogeneses of EDs and underpin the need for discrimination prevention as well as the promotion of adaptive coping with discrimination experience to reduce the risk of developing ED symptoms. Males and emerging adults need particular attention when facing weight-related discrimination whereas risk constellations and EDs particularly affecting females need further investigation.

Sports participation of children and adolescents in Germany: disentangling the influence of parental socioeconomic status

BACKGROUND

Participation in sports and physical activity (PA) is a critical resource for children's health and social development. This study analyzes how the parental socioeconomic status (SES) of children and adolescents affects their PA in sports clubs (organized sports) and outside of sports clubs (unorganized sports) and tests whether the potential impact of parental SES is mediated by the opportunity structure of their residential area (walkability, infrastructure, etc.) and by family and peer support for PA. Furthermore, PA is analyzed respecting differences by gender and migration background.

METHODS

Using representative data from the MoMo/KiGGS study (2009-2012 and 2014-2017), we take into account about 8000 measurements from about 7000 subjects. We estimate hurdle regression models to analyze the minutes per week spent on sports activities.

RESULTS

Results show that children with a higher parental SES, children living in areas with many opportunities for PA, and children receiving family and peer support are more physically active than children without these features. Controlled for opportunities and support, status effects are small but visible. The differences regarding parental SES are much more apparent for organized sports than for unorganized sports, indicating the relevance of economic resources. Boys are more active than girls, whereas there is no clear effect of migration background.

CONCLUSIONS

The coefficient of parental SES on organized sports most probably relates to the resources needed to participate in sports clubs, including fees and equipment. Lower membership fees might potentially help to integrate children with low parental SES into sports clubs and thereby make organized sports more accessible to all social classes.

Serology- and PCR-based cumulative incidence of SARS-CoV-2 infection in adults in a successfully contained early hotspot (CoMoLo study), Germany, May to June 2020

Three months after a coronavirus disease (COVID-19) outbreak in Kupferzell, Germany, a population-based study (n = 2,203) found no RT-PCR-positives. IgG-ELISA seropositivity with positive virus neutralisation tests was 7.7% (95% confidence interval (CI): 6.5-9.1) and 4.3% with negative neutralisation tests. We estimate 12.0% (95% CI: 10.4-14.0%) infected adults (24.5% asymptomatic), six times more than notified. Full hotspot containment confirms the effectiveness of prompt protection measures. However, 88% naïve adults are still at high COVID-19 risk.

Seroepidemiological study on the spread of SARS-CoV-2 in populations in especially affected areas in Germany - Study protocol of the CORONA-MONITORING lokal study

At a regional and local level, the COVID-19 pandemic has not spread out uniformly and some German municipalities have been particularly affected. The seroepidemiological data from these areas helps estimate the proportion of the population that has been infected with SARS-CoV-2 (seroprevalence), as well as the number of undetected infections and asymptomatic cases. In four municipalities which were especially affected, 2,000 participants will be tested for an active SARS-CoV-2 infection (oropharyngeal swab) or a past infection (blood specimen IgG antibody test). Participants will also be asked to fill out a short written questionnaire at study centres and complete a follow-up questionnaire either online or by telephone, including information on issues such as possible exposure, susceptability, symptoms and medical history. The CORONA-MONITORING lokal study will allow to determine the proportion of the population with SARS-CoV-2 antibodies in four particularly affected locations. This study will increase the accuracy of estimates regarding the scope of the epidemic, help determine risk and protective factors for an infection and therefore also identify especially exposed groups and, as such, it will be crucial towards planning of prevention measures.

Socioeconomic inequalities in the risk of SARS-CoV-2 infection - First results from an analysis of surveillance data from Germany

Experiences with acute respiratory diseases which caused virus epidemics in the past and initial findings in the research literature on the current COVID-19 pandemic suggest a higher SARS-CoV-2 infection risk for socioeconomically disadvantaged populations. Nevertheless, further research on such a potential association between socioeconomic status and SARS-CoV-2 incidence in Germany is required. This article reports on the results of a first Germany-wide analysis of COVID-19 surveillance data to which an area-level index of socioeconomic deprivation was linked. The analysis included 186,839 laboratory-confirmed COVID-19 cases, the data of which was transferred to the Robert Koch Institute by 16 June 2020, 00:00. During the early stage of the epidemic up to mid-April, the data show a socioeconomic gradient with higher incidence in less deprived regions of Germany. Over the course of the epidemic, however, this gradient becomes less measurable and finally reverses in south Germany, the region hardest hit by the epidemic, to the greater detriment of the more deprived regions. These results highlight the need to continue monitoring social epidemiological patterns in COVID-19 and analysing the underlying causes to detect dynamics and trends early on and countering a potential exacerbation of health inequalities.

Socioeconomic inequalities and COVID-19 - A review of the current international literature

Social epidemiological research describes correlations between socioeconomic status and the population's risk to become diseased or die. Little research of such correlations for SARS-CoV-2 and COVID-19 has so far been conducted. This scoping review provides an overview of the international research literature. Out of the 138 publications found, 46 were later included in the analysis. For the US and the UK, the reported findings indicate the presence of socioeconomic inequalities in infection risks as well as the severity of the course of the disease, with socioeconomically less privileged populations being hit harder. There are far fewer findings for Germany to date, as is the case for most other European countries. However, the scant evidence available so far already indicates that social inequalities are a factor in COVID-19. Most of these analyses have been ecological studies with only few studies considering socioeconomic inequalities at the individual level. Such studies at the individual level are particularly desirable as they could help to increase our understanding of the underlying pathways that lead to the development of inequalities in infection risks and the severity of disease and thereby could provide a basis to counteract the further exacerbation of health inequalities.

Interventions to Increase the Reachability of Migrants in Germany With Health Interview Surveys: Mixed-Mode Feasibility Study

BACKGROUND

Germany is a popular destination for immigrants, and migration has increased in recent years. It is therefore important to collect reliable data on migrants' health. The Robert Koch Institute, Berlin, Germany, has launched the Improving Health Monitoring in Migrant Populations (IMIRA) project to sustainably integrate migrant populations into health monitoring in Germany.

OBJECTIVE

One of IMIRA's objectives is to implement a feasibility study (the IMIRA survey) that focuses on testing various interventions to increase the reachability of migrants with health interview surveys. Possible causes of nonresponse should be identified so as to increase participation in future surveys.

METHODS

The survey target populations were Turkish, Polish, Romanian, Syrian, and Croatian migrants, who represent the biggest migrant groups living in Germany. We used probability sampling, using data from the registration offices in 2 states (Berlin and Brandenburg); we randomly selected 9068 persons by nationality in 7 sample points. We applied age (3 categories: 18-44, 45-64, and ≥65 years) and sex strata. Modes and methods used to test their usability were culturally sensitive materials, online questionnaires, telephone interviews, personal contact, and personal interviews, using multilingual materials and interviewers. To evaluate the effectiveness of the interventions, we used an intervention group (group A) and a control group (group B). There were also focus groups with the interviewers to get more information about the participants' motivation. We used the European Health Interview Survey, with additional instruments on religious affiliation, experience of discrimination, and subjective social status. We evaluated results according to their final contact result (disposition code).

RESULTS

We collected data from January to May 2018 in Berlin and Brandenburg, Germany. The survey had an overall response rate of 15.88% (1190/7494). However, final disposition codes varied greatly with regard to citizenship. In addition to the quantitative results, interviewers reported in the focus groups a "feeling of connectedness" to the participants due to the multilingual interventions. The interviewers were particularly positive about the home visits, because "if you are standing at the front door, you will be let in for sure."

CONCLUSIONS

The IMIRA survey appraised the usability of mixed-mode or mixed-method approaches among migrant groups with a probability sample in 2 German states. When conducting the survey, we were confronted with issues regarding the translation of the questionnaire, as well as the validity of some instruments in the survey languages. A major result was that personal face-to-face contact was the most effective intervention to recruit our participants. We will implement the findings in the upcoming health monitoring study at the Robert Koch Institute.

The concept of acculturation in epidemiological research among migrant populations: A systematic review

•Acculturation is a widely used concept in epidemiological research.•There are various ways to measure acculturation using proxies or scales; often an acculturation score is calculated.•Studies often show inconsistencies in operationalization and measurement of the concept of acculturation.•The exact outcome is often unclear; this creates a lack of comparability, generalizability and transferability of the results.•Health relevant proxies such as language skills or feeling of belonging should be measured without calculating a score.

Knowledge, information needs and behavior regarding HIV and sexually transmitted infections among migrants from sub-Saharan Africa living in Germany: Results of a participatory health research survey

BACKGROUND

A total of 3,419 new HIV diagnoses were reported in Germany in 2016, with migrants from sub-Saharan Africa (misSA) accounting for 14.1%. To understand the driving factors behind the epidemiological situation, we conducted a quantitative cross-sectional survey on knowledge, attitudes, behavior, and practices regarding HIV and sexually transmitted infections (STIs) among misSA living in six German cities utilizing participatory health research.

METHODS

Participants were recruited by peer researchers. Levels of knowledge, information needs, and preferred methods of information dissemination were analyzed to inform future prevention planning. Additionally, we analyzed sexual behavior and other risk factors for contracting HIV and STIs. The results may facilitate the formulation of targeted prevention messages in the future.

RESULTS

We included 2,432 participants in the analysis. General knowledge about HIV was adequate, as 86.9% were aware of the presented information. Statements about HIV co-infections were prior knowledge for 53.4% of the participants and about German HIV policies and HIV testing for 54.7%. Knowledge about other STIs differed, ranging from 69.6% who have ever heard of gonorrhea to 23.8% who have ever heard of genital warts. Groups with particular knowledge gaps were i) younger misSA, ii) recent migrants, iii) misSA without regular access to the German health care system, iv) misSA of lower socioeconomic status, and v) misSA with Muslim religious affiliation. The majority of participants reported information needs (72.8%), and 71.3% wanted to obtain this information from health professionals. Male misSA were more likely to report five or more sexual partners compared to females. Less than half of participants reported always using condoms with non-steady sexual partners (46.8%). Reasons for not using condoms differed between males and females. A considerable proportion of females (16.3%) and males (6.8%) experienced sexualized violence. More than one fourth of women (26.9%) were affected by female genital mutilation/cutting.

DISCUSSION

Future prevention planning should focus on sub-groups with particular knowledge gaps, recognizing their preferred methods of information dissemination. Prevention messages for male misSA should focus on their own risk perception and for female misSA on empowerment, e.g. to negotiate condom use.

Subjective status comparisons and depressive symptoms among migrants and refugees to Germany

Background

Prior research has identified perceptions of relative social status to affect mental health. We investigated whether migrants to Germany who perceive that they would have a higher relative social status if they were still in their country of origin experience more depressive symptoms than those who perceive no such status discrepancy.

Methods

Cross-sectional data were derived from a random sample of residents in the Berlin-Brandenburg region with a Croatian, Polish, Romanian, Syrian and/or Turkish citizenship (n = 728). Participants’ perception of their relative social status in Germany was measured using the MacArthur Scale of subjective social status (SSS). An adapted version of this scale was used to assess respondents’ hypothetical SSS in their country of origin if they had not migrated. Depressive symptoms were measured with the eight-item depression scale of the Patient Health Questionnaire. Diagonal reference models were used to examine whether discrepancies between the two status ratings were associated with depressive symptom severity.

Results

Most respondents reported a higher (35.6%) or similar (49.0%) hypothetical SSS in their country of origin compared to their SSS in Germany. Respondents whose SSS in Germany was lower than their hypothetical SSS in their country of origin experienced the most severe depressive symptoms. In the diagonal reference models, this association remained statistically significant (p < 0.05), even after adjusting for objective socioeconomic position and other covariates. The pattern was similar for both refugees and non-refugees.

Conclusions

Our findings indicate that perceptions of having a lower social status in Germany than hypothetically in one’s country of origin are concomitant with poorer mental health among migrants. Prospective data are needed to address questions of causation and the direction of effects.

Key messages

Migrants who perceived that they would have a higher social status if they had not left their country of origin reported higher depressive symptoms than those with no such status discrepancy. This association persisted after adjusting for objective socioeconomic position in Germany.

The IMIRA (Improving Health Monitoring in Migrant Populations) - project in Germany – Lessons learned und implications for health monitoring

Background

A quarter of the population living in Germany are people with a migration background (PMB). In this context, the Robert Koch Institute (RKI) has the task of designing the health monitoring system that has been established in recent years in such a way that PMB are adequately taken into account in statements on the health situation of the German population.

Methods

The Improving Health Monitoring in Migrant Populations (IMIRA) project was initiated at the end of 2016 with the aim of improving the inclusion of MMH in health monitoring. Literature research, expert interviews and feasibility studies were carried out to identify strategies for access routes, recruitment measures, the dismantling of language barriers and the inclusion of MHH, which are incorporated into the concept of Monitoring 4.0, the further development of RKI health monitoring.

Results

In order to sustainably improve the accessibility of PMB in RKI health monitoring, a sequential study design with multilingual administration modes is planned within interview surveys. Personal contact through home visits and face-to-face interviews as well as the use of interpretation are essential to increase the willingness to participate. Strengthening the diversity sensitivity of the staff, as well as anti-discriminatory reporting, and promoting the participation of PMB and practitioners are additional components.

Conclusions

The IMIRA project has led to important findings that will be implemented in the long-term health monitoring of the RKI. The improved accessibility of PMB for health surveys enables a reflected presentation of the health situation of PMB, which does justice to the heterogeneity of the population living in Germany.

Main messages

• In order to include PMB sustainably in health monitoring we need to, develop dynamic study designs, bridge language gaps, establish personal contact, increase diversity sensibility and encourage participation of PMB in development of research processes.

Co-Creation in participatory epidemiology

Background

Participatory epidemiology aims to involve public health professionals, health activists, and community representatives in epidemiological studies. Paramount are equitable research partnerships for identifying the causes of health problems, generating data, and finding ways to address health related issues. Alongside the research process, co-creation informs various aspects of participatory epidemiology.

Methods

A scoping review was conducted to develop the conceptual foundations of participatory epidemiology. Workshops with staff from public health administration and public health practitioners were held to check feasibility of the concept for public health monitoring, policy making and the development of relevant public health recommendations. From this research, principles and practices of co-creation were identified.

Results

Co-creation is of importance for participatory epidemiology. 1) Methodologically: Co-creation asks to apply multiple perspectives (research, practice, communities) in data collection and synthesis, what may require the adaption of a given study design. 2) Research practice: Co-creation in participatory epidemiology means producing epidemiologic evidence while contributing to concrete public health interventions, two goals that have to be balanced. 3) Personal attitudes: In participatory epidemiology academic researchers, practitioners, and community representatives are requested to acknowledge each other as co-researching partners, which can be challenging for each of them.

Conclusions

Co-creation is a prerequisite for establishing equitable research partnerships. In participatory epidemiology, co-creation offers ways to produce meaningful knowledge for research and practice.

Main messages

Participatory epidemiology offers ways of producing epidemiologic evidence while contributing to public health practice. Co-creation is a prerequisite, way, and attitude to conduct meaningful research, hopefully for all of those who are involved.

The health situation of children and adolescents with migration background in Germany

Introduction

Although more than one third of minors living in Germany have a migration background (MB), valid data on the health of this population are still lacking. The German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS wave 2, 2014-2017) provides population-based data to make reliable statements on the health of adolescents with and without MB.

Methods

Survey data from KiGGS wave 2 are used to describe the general health status, mental health and the prevalence of allergic diseases in 3-to 17-year-old children and adolescents (n = 13,568). To determine overweight, body height and weight are measured (n = 3,463). In addition to MB (without/one-sided/two-sided), the socio-economic status (SES) and the length of stay of the parents in Germany are taken into account.

Results

Children and adolescents with two-sided MB show a physician-diagnosed atopic dermatitis (3.5%vs.6.9%) and attention deficit hyperactivity disorder (ADHD) (1.5%vs.5.1%) less frequently than their peers without MB, but more often a moderate or poor general health status (6.1%vs.3.9%). Adolescents with two-sided MB are also more often affected by overweight than those without MB (22.1%vs.12.2%). If only participants with MB are considered, their health situation is often associated with the SES and partly also with the length of stay of the parents.

Discussion

Health differences between children and adolescents with and without MB vary by the observed indicator. The heterogeneity of children and adolescents with MB, which can be partly determined by the SES or the length of stay of the parents, should be considered in target-group-specific interventions.

Main messages

The vast majority of children and adolescents in Germany grow up healthy and a MB is not per se associated with a poorer health status. Our results suggest that considering MB as the sole determinant of health to reflect the impact of migration on health is insufficient.

Key messages

Migration background is not per se associated with a poorer health status. Socioeconomic status and parents’ length of stay are derminants associated with poorer health outcomes among children and adolescents with migration background.

Health of adolescents with migration background in Germany: cross-sectional results from KiGGS wave 2

Background

Although 36.5% of minors in Germany had a migration background (MB) in 2017, data on their health situation is scarce. The project ‘Improving Health Monitoring in Migrant Populations’ (IMIRA) initiated in 2016 aims to expand health reporting on the health situation of people with MB, for which a core indicator set was developed. We are describing the health situation of adolescents based on selected core indicators.

Methods

Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS wave 2) (2014-2017) are used; adolescents from 11 to 17 years are considered. Prevalences and 95% confidence intervals are calculated for the following indicators: General health status, overweight, hazardous alcohol consumption and use of pediatric or general practitioner’s services. These indicators are stratified along socio-demographic (gender, age, socio-economic status (SES)) and migration-related characteristics (MB, parents’ duration of stay, language spoken at home).

Results

There are hardly any migration-related differences in the general health status and the use of general medical services. While adolescents with MB are more often affected by overweight (without MB: 11.2%, one-sided: 18.9%, both-sided: 19.8%), they show less often risky alcohol consumption (without MB: 14.5%, one-sided: 7.8%, both-sided: 4.4%). There are differences in health behavior according to SES, parents’ duration of stay in Germany and language spoken at home.

Conclusions

Overall, the health of adolescents is good, regardless of their MB, and general medical services are used equally. Differences in health behavior cannot be reduced solely to the (non-)existence of a MB, but need a deeper consideration of more specific migration-related characteristics and the SES.

Key messages

The general health status and health care utilization do not differ between adolescents with and without MB. In contrast, the results on indicators of health behavior vary.

The health of children and adolescents with a migration background in Germany - Results of the cross-sectional KiGGS Wave 2 study

Over a third (36.5%) of young people living in Germany have a migration background. Based on the data of the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), the health situation of 11- to 17-year-olds with and without a migration background is described using selected indicators. In order to account for the diversity among children and adolescents with a migration background, the health indicators used in this study are stratified by migration background but also by additional migration-related characteristics. In addition, the results from the various subgroups are also stratified by sociodemographic characteristics. No differences in self-assessed general health or the outpatient utilisation of paediatric and general medical services were identified between 11- to 17-year-olds with and without a migration background. However, migration-related differences were identified in health behaviour: whereas children and adolescents with a one- or two-sided migration background are more frequently overweight (including obesity), they consume risky amounts of alcohol less often than those of the same age without a migration background. Finally, the outcomes of the indicators also vary according to migration-related and sociodemographic characteristics.

Concepts for migration-sensitive health monitoring

According to microcensus data, nearly one quarter of the German population has a migration background. This means that either themselves or at least one parent was born without German citizenship. Based on the currently available data and due to the underrepresentation of specific population groups, representative findings on the health of the total population residing in Germany are only possible to a limited degree. Against this backdrop, the Robert Koch Institute initiated the Improving Health Monitoring in Migrant Populations (IMIRA) project. The project aims to establish a migration-sensitive health monitoring system and to better represent people with a migration background in health surveys conducted by the Robert Koch Institute. In this context it is crucial to review and further develop relevant migration-sensitive concepts and appropriate surveying instruments. To achieve this, the concepts of acculturation, discrimination, religion and subjective social status were selected. This article theoretically embeds these concepts. Furthermore, we describe their application in epidemiology as well as provide a proposal on how to measure and operationalise these concepts. Moreover, recommendations for action are provided regarding the potential application of these concepts in health monitoring at the Robert Koch Institute.

Health reporting on people with a migration background - Selection and definition of (core) indicators

As part of the project Improving Health Monitoring in Migrant Populations (IMIRA), a (core) set of indicators was developed to describe the health of people with a migration background. This work was underpinned by research into and assessment of relevant data sources in the field of migration and health. Initially, four fields of action were identified together with a number of associated topics and potential indicators for each of the area's individual topics. The choice of core indicators was based on (1) a systematic comparison of widely accepted indicator systems, (2) an assessment of public health relevance, (3) comprehensibility and (4) informative value, as well as (5) the availability of (largely) representative data that could properly account for the diversity of the migrant population. The (core) indicator set was finalised using an internal and external indicator development process that involved an interdisciplinary expert panel. This resulted in the selection of 25 core indicators; 41 additional indicators were documented as part of an 'extended' indicator set. The (core) set of indicators is to be continually developed in line with the work being undertaken to improve the integration of people with a migration background in the health monitoring conducted at the Robert Koch Institute. In the future, the indicator set is to be incorporated into an overall concept to regular, migration-related health reporting.

[What is participatory epidemiology? A definition]

Participatory epidemiology is a concept that promotes the active involvement and cooperation of researchers and researched populations. The collaboration may relate to individual sections or to the entire course of an epidemiologic study. Participatory epidemiology comprises the following aspects: a joint definition of research objectives and research questions, the cooperative definition of the population groups under study and their health-related contexts, the selection or development of appropriate survey instruments, and dialogical forms of interpreting the results. Participatory epidemiology aims to create knowledge with practical relevance to all stakeholders.

[Migration and health in Germany-available data sources]

BACKGROUND

Migration background plays an important role in analyses of health inequalities in Germany. The heterogeneity of people with and without migration background requires a differentiated recording of migration-related characteristics. The latest overview of representative data sources from the Health Reporting (GBE) that included information on migration background was compiled in 2008.

AIM

The aim of this article is to describe existing data sources reporting the health situation of people with and without a migration background.

MATERIALS AND METHODS

Starting from the websites and publications of owners of GBE data, representative studies and routine data sources were identified. All sources that consider at least one migration-related characteristic were included. For all included studies, migration-related characteristics, information on the social situation, and health-related indicators were collected.

RESULTS

A total of 46 data sources (including 19 routine data sources and 27 studies) were included. The most common indicators of the migration background are nationality (n = 36) and the country of birth (n = 29). Health-related indicators cover a wide range of issues.

DISCUSSION

Routine data sources continue to collect little information on the migration background (usually only nationality) and thus constrain migration-differentiated analyses of the health situation. Survey data allow for more nuanced analysis. However, the actual analysis possibilities and content knowledge of the respective data sources were not the subject of this article.

Improving the information base regarding the health of people with a migration background.Project description and initial findings from IMIRA

Germany is an immigration country and nearly a quarter of its population has a migration background. Thus, there is increasingly a need for reliable information on the health situation of people with a migration background. The Robert Koch Institute is in charge of expanding its health monitoring to improve the representation of people with a migration background in interview and examination surveys. Studies adequately need to reflect the health status of people with a migration background and currently the Robert Koch Institute’s representative interview and examination surveys for adults do not fully achieve this. At the end of 2016, therefore, the Improving Health Monitoring in Migrant Populations (IMIRA) project was initiated aiming to expand the Robert Koch Institute’s health monitoring to people with migration background and improve their involvement in health surveys in the long-term. This includes carrying out two feasibility studies to test strategies to reach and recruit people with migration background for interview surveys and develop measures to overcome language barriers in examination surveys. In order to expand health reporting on migration and health, a reporting concept and a core indicator set will be developed and the potential of (secondary) data sources will be tested. Furthermore, plans foresee the testing and further development of relevant specific migration sensitive survey instruments and indicators, as well as increasing networking with relevant stakeholders.

Improving the inclusion and participation of children and adolescents with a migration background in KiGGS Wave 2

In the context of health monitoring at the Robert Koch Institute, the baseline study of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) surveyed a sample of children and adolescents with a migration background according to their share within the general population through extensive measures. Owing to less comprehensive efforts, this was not accomplished in the follow-up KiGGS Wave 1 study. For KiGGS Wave 2, the objective therefore was, through targeted measures, to increase the willingness of children and adolescents with a migration background to participate in the survey. This article describes the approaches to include children and adolescents with a migration background, the operationalisation of migration-specific variables and the effectiveness of field visits prior to the actual survey as a tool to increase the willingness of these groups to participate in the survey. Furthermore, data on participation and the sample of children and adolescents with a migration background in the cross-sectional KiGGS Wave 2 study is presented. Overall, 2,994 children with a migration background aged 0 to 17 years took part in KiGGS Wave 2. In the weighted sample this corresponds to 11.8% (n=1,436) with a one-sided and 17.0% (n=1,558) with a two-sided migration background. In sum, the share of children and adolescents surveyed with a migration background (28.8%) is almost that of their share in Microcensus 2013 (31.2%). Compared to children and adolescents without a migration background, barely any differences exist in age and gender distribution, while differences are seen regarding social status; children with a two-sided migration background are significantly more often found in the low social status group. In the sample, the most often represented countries of origin were the countries of Central and South Europe, of the former Soviet Union and Turkey. Regarding the length of time parents had lived in Germany, around 40.1% of migrant families have been living in the country for over 20 years, whereas nearly one in five families has been in Germany for less than five years. A total of 12.2% of children and adolescents with a migration background migrated themselves. By implementing a comprehensive set of measures, the degree after weighting to which children and adolescents with a migration background were included in KiGGS Wave 2 is nearly commensurate to their share in the overall population.

Knowledge, Attitude, Behavior, and Practices Regarding HIV, Viral Hepatitis, and Sexually Transmitted Infections Among Migrants From Sub-Saharan Africa Living in Germany: A Multicenter Survey Protocol

BACKGROUND

Migration has an impact on the epidemiology of viral hepatitis B and C (HEP) and HIV in Germany; migrants from sub-Saharan Africa (MisSA) in Germany are disproportionally affected by HIV. In the last 10 years, a total of 10%-15% of all newly diagnosed HIV cases were among MisSA; 20%-30% of them acquired HIV in Germany. Prevalence of HEP among MisSA in Germany is unknown, but Western Africa, from where most MisSA in Germany originate, reports the highest prevalence of hepatitis B worldwide. There is limited information on knowledge, attitudes, behaviors, and practices (KABP) regarding HIV, HEP, and sexually transmitted infections (STIs), as MisSA are not reached with surveys targeting the general population.

OBJECTIVE

Our objective was to determine the HIV, HEP, and STI information and prevention needs of MisSA in Germany.

METHODS

We conducted a multicenter, cross-sectional, KABP survey regarding HIV, HEP, and STIs among MisSA living in Germany using convenience sampling. The study design was developed as a community-based participatory health research (CBPHR) project; HIV/STI-prevention specialists, key persons from MisSA communities, and HIV/STI researchers were involved in all steps of the research process. Trained peer researchers recruited participants in six study cities. Potential modes of survey administration were interview or self-completion, and the questionnaire was available in English, French, and German. Questions on knowledge about HIV, HEP, and STIs were presented as true statements; participants were asked if they had known the information before. Focus groups with MisSA were conducted to interpret results. Data collection took place from October 2014 to November 2016.

RESULTS

Recruitment by peer researchers concluded with 3040 eligible participants. Data collection was completed in November 2016. We are currently analyzing the quantitative data and qualitative data from focus groups. We are conducting working group meetings to discuss the results in the respective study cities and to evaluate the application of participatory health research in epidemiological studies. First results are expected by the end of 2017.

CONCLUSIONS

Working with peer researchers to collect data allowed accessibility to a diverse sample of MisSA and, particularly, allowed us to reach vulnerable subgroups, such as MisSA without legal status. The ability to access hard-to-reach groups is one of the big advantages of CBPHR. The active inclusion of the persons under study in the design of the study resulted in higher acceptance and ownership of the research project in the target community; this ultimately lead to better quality of collected data. Furthermore, the participation of MisSA in the development of study design and data collection assures a better understanding of the interests, needs, and living conditions of this group.

Participatory epidemiology: the contribution of participatory research to epidemiology

Background

Epidemiology has contributed in many ways to identifying various risk factors for disease and to promoting population health. However, there is a continuing debate about the ability of epidemiology not only to describe, but also to provide results which can be better translated into public health practice. It has been proposed that participatory research approaches be applied to epidemiology as a way to bridge this gap between description and action. A systematic account of what constitutes participatory epidemiology practice has, however, been lacking.

Methods

A scoping review was carried out focused on the question of what constitutes participatory approaches to epidemiology for the purpose of demonstrating their potential for advancing epidemiologic research. Relevant databases were searched, including both the published and non-published (grey) literature. The 102 identified sources were analyzed in terms of comparing common epidemiologic approaches to participatory counterparts regarding central aspects of the research process. Exemplary studies applying participatory approaches were examined more closely.

Results

A highly diverse, interdisciplinary body of literature was synthesized, resulting in a framework comprised of seven aspects of the research process: research goal, research question, population, context, data synthesis, research management, and dissemination of findings. The framework specifies how participatory approaches not only differ from, but also how they can enhance common approaches in epidemiology. Finally, recommendations for the further development of participatory approaches are given. These include: enhancing data collection, data analysis, and data validation; advancing capacity building for research at the local level; and developing data synthesis.

Conclusion

The proposed framework provides a basis for systematically developing the emergent science of participatory epidemiology.

CD4-cell counts and presence of AIDS in HIV-positive patients entering specialized care-a comparison of migrant groups in the German ClinSurv HIV Cohort Study, 1999-2013

Background

Although early presentation to HIV-care is essential to ensure timely initiation of antiretroviral therapy, recent studies have shown that especially migrants present to HIV-care at a later stage of HIV-infection. Currently, thirty percent of all newly diagnosed HIV cases in Germany originate from abroad. So far it is unknown, which specific migrant groups in Germany are particularly at risk for late presentation to HIV-care.

Methods

We used data from the Clinical Surveillance of HIV Disease (ClinSurv) cohort, a multi-centre observational cohort (01/01/1999 and 31/07/2013) and included treatment-naïve patients with valid information on country of origin and date of enrolment. Migrants were patients with country of origin outside Germany. We compared time trends for percentage of AIDS (CDC Stage C) and mean CD4-count at enrolment between migrants from Western Europe (WE), Central Europe (CE), Eastern Europe (EE), Sub-Saharan Africa (SSA), South East Asia (SEA) and non-migrants using multivariable regressions. Male non-migrants with mean age of 38-years constituted the reference group.

Results

In total, 10,211 patients fulfilled the inclusion criteria, of which 2784 were migrants (SSA: 42%, CE: 17%, WE: 11%, EE: 10%, SEA: 9%). The percentage of patients with AIDS at enrolment was higher in SSA (Odds Ratio (OR)_SSA: 1.44, 95%-confidence interval (95%-CI):1.12–1.84) and SEA-migrants (OR_SEA:2.16, 95%-CI:1.43–3.27). In addition, female SEA-migrants, were more likely to present with AIDS than their male counterparts (OR:2.22, 95%-CI:1.18–4.17). Mean CD4-count at enrolment was lower for SSA- (Mean CD4-count ratio (IRR):0.72; 95%-CI:0.64-0.82) and SEA-migrants (IRR:0.62, 95%-CI:0.49-0.78). Over time, it increased in non-migrants and CE-migrants (by 1 and 3%/year, respectively), whereas no increase was seen for SEA and SSA.

Conclusions

SSA and SEA-migrants in Germany present to HIV-care at a later stage of HIV infection than non-migrants. Additionally, previous research found a higher risk for late HIV-testing for migrants. Collecting information about the arrival date of migrants in Germany in the HIV notification system would help to understand to which extent these problems could be tackled in Germany. Moreover, participatory approaches for HIV-testing and care as well as research regarding knowledge, behaviour and attitudes towards these topics for SSA and SEA migrants should be expanded.