Changes in smoking prevalence among first- and second-generation Turkish migrants in Germany – an analysis of the 2005 Microcensus

Reeske A, Spallek J, Razum O. Changes in smoking prevalence among first- and second-generation Turkish migrants in Germany: an analysis of the 2005 Microcensus. International Journal for Equity in Health. 2009;8(1):26.Background: Compared to the majority population of a host country, migrants tend to have different health risks and health behaviour. We have hypothesised that these differences diminish with time passed since migration. We tested this hypothesis by examining smoking behaviour among Turkish migrants and their children born in Germany (second-generation migrants), stratified by educational level and, for the first generation, length of residence. Methods: We estimated the prevalence of smoking based on the representative 2005 Mikrozensus, an annual survey including 1% of Germany's households. The 2005 Microcensus was the first to provide information that makes it possible to differentiate between first- and second-generation Turkish migrants. In total, 12,288 Turkish migrants and 421,635 native-born Germans were included in our study. The unit non-response is generally low (about 6% in 2005) because participation in the Microcensus is obligatory. Results: We found the prevalence of smoking in second-generation male Turkish migrants to be lower than in the first-generation group: 47.0% of first-generation Turkish migrants with a high level of education were smokers, in contrast to only 37.6% in the second generation. Within the German reference population, 29.9% were smokers. The percentage of Turkish women in our sample who smoked was generally smaller, but was not significantly lower in the second generation. In fact, the prevalence of smoking was highest among Turkish women of the second generation with a low level of education (40.9%), similar to younger second-generation German women with the same level of education. Conclusion: We present the first representative data on changes in the prevalence of a risk factor for many chronic diseases among Turkish migrants in Germany. Male Turkish migrants (with a high level of education) showed a decrease over the generations while smoking prevalences of female Turkish migrants increased. In the second generation, prevalences partly converged with those of the German reference population or were even higher. Our hypothesis – that migration can be interpreted as a ''health transition'' – was thus partly confirmed

Gesundheitliche Ungleichheit bei Schwangeren und Säuglingen mit und ohne Migrationshintergrund. Ein Fokus auf frühe Risikofaktoren für kindliche Adipositas

The aim of this PhD thesis is to analyse the extent of ethnic inequalities among pregnant women and newborns in Germany focussing on early life risk factors for childhood obesity. The empirical analyses are based on data from the German perinatal database, pregnancy-related reimbursement data of a German statutory health insurance in Berlin and primary data from a population-based German sample of children in the IDEFICS study. The results indicate that migration background is an independent risk factor for pre- and postnatal outcomes and suggest that the onset of ethnic inequalities in overweight lies in fetal life and early infancy. Prevention approaches should focus on the reduction of obesity and start in early pregnancy with a special emphasis on (young) Turkish women. The findings should also stimulate discussion about the quality and appropriateness of antenatal and perinatal care of pregnant women and newborns with a migration background. A focus might be information on gestational diabetes during routine antenatal care

Care-Related and Maternal Risk Factors Associated with the Antenatal Nondetection of Intrauterine Growth Restriction: A Case-Control Study from Bremen, Germany

Objective. To identify care-related and maternal risk factors for the antenatal nondetection of IUGR. Methods. In this hospital-based case-control study we compared antenatally undetected IUGR neonates (cases) to detected IUGR neonates (controls). Data were collected using newborn documentation sheets and standardized personal interviews with the mothers. We calculated antenatal detection rates and used uni-and multivariable logistic regression models to assess the association of antenatal nondetection of IUGR and maternal and care-related factors. Results. A total of 161 neonates from three hospitals were included in the study. Suboptimal fetal growth was identified antenatally in = 77 pregnancies while in = 84 it was not detected antenatally (antenatal detection rate: 47.8%). Severity of IUGR, maternal complications, and a Doppler examination during the course of pregnancy were associated with IUGR detection. We did not find statistically significant differences regarding parental socioeconomic status and maternal migration background. Conclusions. In our study, about half of all pregnancies affected by suboptimal growth remained undetected. Future in-depth studies with larger study populations should further examine factors that could increase antenatal detection rates for IUGR

Stillbirth differences according to regions of origin: an analysis of the German perinatal database, 2004-2007

Reeske A, Kutschmann M, Razum O, Spallek J. Stillbirth differences according to regions of origin: an analysis of the German perinatal database, 2004-2007. BMC Pregnancy and Childbirth. 2011;11(1): 63.Background: Stillbirth is a sensitive indicator for access to, and quality of health care and social services in a society. If a particular population group e. g. migrants experiences higher rates of stillbirth, this might be an indication of social deprivation or barriers to health care. This study examines differences in risk of stillbirth for women of different regions of origin compared to women from Germany in order to identify high risk groups/target groups for prevention strategies. Methods: We used the BQS dataset routinely compiled to examine perinatal outcomes in Germany nationwide. Participation of hospitals and completeness of data has been about 98% in recent years. Data on all live births and stillbirths were obtained for the period 2004 to 2007 (N = 2,670,048). We calculated crude and stratified mortality rates as well as corresponding relative mortality risks. Results: A significantly elevated stillbirth rate was found for women from the Middle East and North Africa (incl. Turkey) (RR 1.34, CI 1.22-1.55). The risk was slightly attenuated for low SES. An elevated risk was also found for women from Asia (RR 1.18, CI 1.02-1.65) and from Mediterranean countries (RR 1.14, CI 0.93-1.28). No considerable differences either in use and timing of antenatal care or preterm birth and low birthweight were observed between migrant and non-migrant women. After stratification for light for gestational age, the relative risk of stillbirth for women from the Middle East/North Africa increased to 1.63 (95% CI 1.25-2.13). When adjusted for preterm births with low birthweight, women from Eastern Europe and the Middle East/North Africa experienced a 26% (43%) higher risk compared with women from Germany. Conclusions: We found differences in risk of stillbirth among women from Middle East/North Africa, especially in association with low SES and low birthweight for gestational age. Our findings suggest a need for developing and evaluating socially and culturally sensitive health promotion and prevention programmes for this group. The findings should also stimulate discussion about the quality and appropriateness of antenatal and perinatal care of pregnant women and newborns with migrant backgrounds

Health inequalities among pregnant women and infants with migrant background: a focus on early life risk factors for childhood obesity.

The aim of this PhD thesis is to analyse the extent of ethnic inequalities among pregnant women and newborns in Germany focussing on early life risk factors for childhood obesity. The empirical analyses are based on data from the German perinatal database, pregnancy-related reimbursement data of a German statutory health insurance in Berlin and primary data from a population-based German sample of children in the IDEFICS study. The results indicate that migration background is an independent risk factor for pre- and postnatal outcomes and suggest that the onset of ethnic inequalities in overweight lies in fetal life and early infancy. Prevention approaches should focus on the reduction of obesity and start in early pregnancy with a special emphasis on (young) Turkish women. The findings should also stimulate discussion about the quality and appropriateness of antenatal and perinatal care of pregnant women and newborns with a migration background. A focus might be information on gestational diabetes during routine antenatal care

Changes in cardiovascular risk factors among first and second generation Turkish migrants in Germany - an analyses of the Mikrozensus 2005

Reeske A, Spallek J, Razum O. Changes in cardiovascular risk factors among first and second generation Turkish migrants in Germany - an analyses of the Mikrozensus 2005. EUROPEAN JOURNAL OF PUBLIC HEALTH. 2007;17(Suppl. 2):64

Cancer patterns in non-Western migrants to Europe: present knowledge/findings

Arnold M, Spallek J, Reeske A, Razum O. Cancer patterns in non-Western migrants to Europe: present knowledge/findings. Presented at the European Conference of Public Health, Lodz, Poland

Unterschiede in der Gestationsdiabetesinzidenz im Vergleich zwischen türkischstämmigen und deutschen Frauen: Eine Analyse von Abrechnungsdaten der AOK Berlin, 2005-2007

Reeske A, Zeeb H, Razum O, Spallek J. Differences in the Incidence of Gestational Diabetes between Women of Turkish and German Origin: An Analysis of Health Insurance Data From a Statutory Health Insurance in Berlin, Germany (AOK), 2005-2007. Geburtshilfe und Frauenheilkunde. 2012;72(04):305-310.Background: Gestational diabetes increases the risk of maternal and infant complications and long-term health effects. A study of differences in the incidence of gestational diabetes between women of Turkish and German origin can identify high risk groups and may indicate the need for culturally sensitive diabetes information and treatment during pregnancy. Method: We analysed all pregnancy related health insurance data from the AOK Berlin (a statutory health insurance in Berlin) based on data from 2005 to 2007, using a name algorithm to identify cases with Turkish migrant background. A group of German women insured with the AOK Berlin served as a comparison group. Results: After exclusion of miscarriages and multiple births the data set comprised 3338 pregnancies in total. The incidence of gestational diabetes was significantly higher in women of Turkish origin with 183 per 1000 pregnancies than in German women (138 per 1000 pregnancies). Regression analyses showed that women of Turkish origin with obesity were at the highest risk of gestational diabetes (OR = 2.67; 95% confidence interval 1.97-3.60). Conclusion: Obesity is an important factor in explaining the higher incidence of gestational diabetes in women of Turkish origin, especially among young Turkish women. These findings should stimulate discussion as to whether or not information about risk factors such as diabetes within the scope of prenatal care adequately addresses the needs of migrant women. Further research is needed to identify potential differences in undetected and primarily in insufficiently treated gestational diabetes between Turkish and German women