The roles of employment status and income in the mental health of informal caregivers in Germany.

BACKGROUND: Informal caregivers often experience multiple negative consequences as a result of the informal care they provide. Among other factors, employment status, financial resources, and mental health are related to informal caregiving. This analysis examined the association between informal caregivers' employment status and their mental health, as well as the moderating effect of net household income on this relationship. METHODS: The research question was addressed with data from the German Socio-Economic Panel (SOEP) survey, comprising 3,053 informal caregivers (1,007 male; 2,046 female). Data were obtained through self-reports, and mental health was measured with the Summary Scale Mental Score. Stepwise adjusted multiple linear regression models were used to examine the association between employment status and mental health. The moderating effects were tested with interaction terms. All analyses were also stratified for gender. RESULTS: Informal caregivers with full-time jobs reported better mental health than unemployed or marginally employed caregivers (ß = 0.077, p < 0.001). The significant interaction term for full-time (ß=-0.066, p = 0.001) and part-time workers (ß=-0.066, p = 0.003) indicated a moderating effect of net household income on the association between employment status and mental health. This finding was especially evident in women. CONCLUSIONS: Employment appears to be a relevant protective factor for informal caregivers' mental health. However, if informal caregivers are not employed, a low net household income might additionally restrict their mental health. Therefore, welfare policy structures must be created to reduce the negative financial consequences for informal caregivers and enable them to achieve work-life-care balance.

While You Are Sleeping: Marital Ambivalence and Blunted Nocturnal Blood Pressure.

Marital relationships offer health benefits, including a lower risk of cardiovascular disease (CVD). However, quality of the relationship matters; ambivalent behaviors may increase CVD risk by affecting blunted nocturnal blood pressure (BP) dipping. This study tracked daytime and nocturnal SBP and DBP in 180 normotensive individuals (90 couples; participant mean age 25.04; 91.58% white) over a 24 h period using ambulatory blood pressure monitors to explore the impact of martial quality. Results showed that perceptions of spousal ambivalence were associated with blunted nocturnal BP dipping. Perceptions of one's own behavior as ambivalent also showed blunted nocturnal dipping. When in an ambivalent relationship, a gender interaction was found such that women were most likely to have blunted SBP dipping, but men were more likely to have blunted nocturnal DBP dipping. Overall, this study found an association between ambivalence and BP dipping, thus uncovering one virtually unexplored pathway by which marital relationships may have adverse effects on health.

The longitudinal directional associations of meaningful work with mental well-being - initial findings from an exploratory investigation.

BACKGROUND: An increasing number of studies reveal that more meaning in life is positively related to mental well-being. Meaning in life can be derived from different sources, including the workplace. The aim of this study was to explore the longitudinal directional association of meaningful work with mental well-being. METHODS: Prospective data from 292 persons at two timepoints (two-week interval) were used to estimate the cross-lagged relationship and directionality of meaningful work with mental well-being. RESULTS: The cross-lagged panel model had a good fit to the data (Chi2 ms(90) = 150.9; p < 0.001; RMSEA = 0.048; p = 0.576; CFI = 0.984; TLI = 0.979; SRMR = 0.040) and showed that levels of meaningful work at t1 had a positive effect on mental well-being at t2 (ß = 0.15, p = 0.010). But mental well-being at t1 did not affect meaningful work at t2 (ß = 0.02, p = 0.652). Sub-analyses revealed the effects to be mainly driven by women (as opposed to men) and white-collar workers (as opposed to blue-collar workers). CONCLUSION: This study confirmed a directional association of meaningful work on mental well-being, indicating that more meaningful work has beneficial mental well-being effects.

Socio-economic inequalities in body mass index among preschool children: do sports programs in early childhood education and care centers make a difference?

Background: Overweight in childhood is considered to be one of the most serious public health challenges. Many studies have investigated individual-level determinants of children's body mass index (BMI), yet studies exploring determinants at the meso-level are sparse. The aim of our study was to examine how a sports focus at early childhood education and care (ECEC) centers moderates the effect of parental socio-economic position (SEP) on children's BMI. Methods: We used data from the German National Educational Panel Study and included 1,891 children (955 boys and 936 girls) from 224 ECEC centers in our analysis. Linear multilevel regressions were used to estimate the main effects of family SEP and the ECEC center sports focus, as well as their interaction, on children's BMI. All analyses were stratified by sex and adjusted for age, migration background, number of siblings, and employment status of parents. Results: Our analysis confirmed the wellknown health inequalities in childhood overweight with a social gradient toward a higher BMI for children from lower SEP families. An interactive effect between family SEP and ECEC center sports focus was found. Boys with low family SEP not attending a sports-focused ECEC center had the highest BMI among all boys. In contrast, boys with low family SEP attending a sports-focused ECEC center had the lowest BMI. For girls, no association regarding ECEC center focus or interactive effects emerged. Girls with a high SEP had the lowest BMI, independent of the ECEC center focus. Conclusion: We provided evidence for the gender-specific relevance of sports-focused ECEC centers for the prevention of overweight. Especially boys from low SEP families benefited from a sports focus, whereas for girls the family's SEP was more relevant. As a consequence, gender differences in determinants for BMI at different levels and their interaction should be considered in further research and preventive measures. Our research indicates that ECEC centers may decrease health inequalities by providing opportunities for physical activity.

University Fairness Questionnaire (UFair): Development and Validation of a German Questionnaire to Assess University Justice-A Study Protocol of a Mixed Methods Study.

Distress is a widespread phenomenon in the general population, but also among university students, associated with poorer learning success and negative health consequences. A source of distress might be the experience of injustice. Theoretical and empirical work in the area of perceived fairness in the workplace ("organizational justice") has shown that perceived unfairness is related to various stress indicators and health outcomes. Preliminary evidence indicates that unfairness matters not only in the work context but also in the university context. However, an adapted and validated tool to assess perceived unfairness in the university context is hitherto missing. The goal of the proposed project is therefore to adapt the construct of organizational justice to the university context and to develop a corresponding questionnaire by means of established scientific procedures. An exploratory sequential mixed-methods design is applied in which qualitative and quantitative methods are combined. A valid and practicable measurement instrument ("UFair" University Fairness Questionnaire) will be developed and tested, and the relationship with various health outcomes will be examined. The UFair questionnaire will be made available free of charge to other researchers.

The Benefits of an Employee-Friendly Company on Job Attitudes and Health of Employees: Findings from Matched Employer-Employee Data.

BACKGROUND: This study explored the association of an employee-friendly work environment with employees' job attitudes (engagement, commitment, turnover intentions, and job satisfaction), and health (mental and general health), applying matched employer-employee data. METHODS: The German Linked Personnel Panel (LPP; n = 14,182) survey simultaneously captures the data of employees and the human resources (HR) management of companies. A two-step cluster analysis of 16 items of the HR valuation identified relatively more- and less-employee-friendly companies (EFCs). Logistic regressions tested differences between these companies in the assessment of job attitudes and health of their employees. RESULTS: Compared to less-EFCS, more-EFCS had a reduced risk of poorer job attitudes and substandard health of their employees. For example, the risk for higher turnover intentions was reduced by 33% in more-EFCS (OR = 0.683, 95% C.I. = 0.626-0.723), and more-EFCS had an 18% reduced chance of poor mental health reporting of their employees (OR = 0.822, 95% C.I. = 0.758-0.892). CONCLUSIONS: More-EFCS have more motivated and healthier employees. The most distinct factors for more-EFCS were: the existence of development plans for employees, opportunities for advancement and development, and personnel development measures.

Associations of individual factors and early childhood education and care (ECEC) centres characteristics with preschoolers' BMI in Germany.

BACKGROUND: The number of obese children is rising worldwide. Many studies have investigated single determinants of children's body mass index (BMI), yet studies measuring determinants at different potential levels of influence are sparse. The aim of this study is to investigate the independent role of parental socioeconomic position (SEP), additional family factors at the micro level, as well as early childhood education and care (ECEC) centre characteristics at the meso level regarding BMI. METHODS: Analyses used the baseline data of the PReschool INtervention Study (PRINS) including up to 1,151 children from 53 ECEC centres. Multi-level models first estimated the associations of parental SEP indicators (parental school education, vocational training, and household income) with the children's standard deviation scores for BMI (SDS BMI, standardised for age and gender). Second, structural (number of siblings), psychosocial (strained family relationships), and nutrition behavioural (soft-drink consumption, frequency of fast-food restaurant visits) family factors at the micro level were included. Third, characteristics of the ECEC centre at the meso level in terms of average group size, the ratio of overweight children in the group, ECEC centre type (all-day care), and the location of the ECEC centre (rural vs urban) were included. All analyses were stratified by gender and adjusted for age, migration background, and parental employment status. RESULTS: Estimates for boys and girls appeared to differ. In the full model, for boys the parental SEP indicators were not related to SDS BMI. Factors related to SDS BMI in boys were: two or more siblings; B = -.55; p = 0.045 [ref.: no sibling]), the characteristics of the ECEC centre in terms of average group size (20 - 25 children; B = -.54; p = 0.022 [ref.: < 20 children]), and the ratio of overweight children (more overweight children B = -1.39; p < 0.001 [ref.: few overweight children]). For girls the number of siblings (two and more siblings; B = .67; p = 0.027 [ref.: no sibling]) and average group size (> 25 children; B = -.52; p = 0.037 [ref.: < 20 children]) were related to SDS BMI. CONCLUSIONS: The BMI of preschool children appears to be associated with determinants at the micro and meso level, however with some gender differences. The identified factors at the micro and meso level appear largely modifiable and can inform about possible interventions to reduce obesity in preschool children.

The association between supportive social ties and autonomic nervous system function-differences between family ties and friendship ties in a cohort of older adults.

Supportive family and friendship ties can serve different functions and thus might show different associations with an individual's health. Particularly, older adults might show varying health benefits of different types of supportive ties depending on their marital and retirement status. Our aim is to analyze relationships between different types of supportive social ties and autonomic nervous system (ANS) function, a physiological indicator of health that can help to establish the biological plausibility of the association-measured by heart rate variability (HRV). We present cross-sectional linear regression analyses of a German cohort of community-dwelling older adults (2008-2010; n = 1,548; mean age = 68.7 years). Our findings indicate that supportive friendship ties show significant positive associations (i.e., higher HRV) in individuals that are either not married or above retirement age. Supportive family ties show significant positive associations in individuals below retirement age. Significant results vanish or are reduced after accounting for behavioral/physical and psychological/cognitive indicators. We conclude that programs supporting the development or maintenance of friendship ties might be especially beneficial in unmarried older adults and adults above retirement age. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00638-2.

Associations Between Work Characteristics, Engaged Well-Being at Work, and Job Attitudes - Findings from a Longitudinal German Study.

Objective: The Job Demand & Resources model suggests work characteristics are related to mental well-being and work engagement. Previous work describes the development of a combined construct 'engaged well-being at work' (EWB). To what extent changes in measures of this construct are responsive to changes in job demands and resources or associated with changes in job-related attitudes has not been established. Methods: Longitudinal employee-level data from three waves (German Linked Personnel Panel) were used. Logistic and linear fixed effects regression analyses explored longitudinal associations between changes in EWB for participants over a three-year period with changes in job demands and resources and job-related attitudes (job commitment, satisfaction, and turnover intentions). Results: While job resources were associated with increased odds for a change into a healthier and/or more engaged category of EWB, job demands reduced them. Job resources were more strongly related to higher EWB (ORrange = 1.22 - 1.61) than job demands (ORrange = 0.79 - 0.96). Especially psychological job demands showed negative associations with improved EWB (OR = 0.79). A change from the least desirable category 'disengaged strain' to any other category of EWB was associated with greater odds by up to 20.6 % for increased commitment and job satisfaction and lower odds for turnover intentions. Discussion: Improving work characteristics, especially job resources, could increase employees' EWB, emphasizing the importance of job characteristics for a healthy workplace. Because EWB seems to be associated with job attitudes, an improvement of this indicator would be relevant for employees and employers.

The relationship between ambivalence towards supervisor's behavior and employee's mental health.

Ambivalence in social interactions has been linked to health-related outcomes in private relationships and recent research has started to expand this evidence to ambivalent leadership at the workplace by showing that ambivalent supervisor-employee relationships are related to higher stress levels in employees. However, the mental health consequences of ambivalent leadership have not been examined yet. Using a multilevel approach, this study estimated associations of ambivalent leadership with mental health indicators (depression, anxiety, vital exhaustion, fatigue) in 993 employees from 27 work groups. A total effect of ambivalent leadership was found for all four mental health measures, as well as within-group and between-group effects. The consistent relationships of ambivalent leadership with higher symptoms of mental ill-health at the individual- (i.e., within-group) and the group-level (i.e., between-group) support the existence of an un-confounded association, as well as group effects of collective ambivalence.

Which Meso-Level Characteristics of Early Childhood Education and Care Centers Are Associated with Health, Health Behavior, and Well-Being of Young Children? Findings of a Scoping Review.

Characteristics of early childhood education and care (ECEC) centers might be relevant for children's health. This scoping review aims to provide an overview of the association between meso-level characteristics (MLCs) of ECEC centers with children's health, health behavior, and wellbeing. Five databases were searched for quantitative and qualitative research articles published in English or German since 1 January 2000 on health, health behavior, and wellbeing of children aged 0 to 6 years considering MLCs of ECEC centers. Two authors screened 10,396 potentially eligible manuscripts and identified 117 papers, including 3077 examinations of the association between MLCs and children's health indicators (Kappas > 0.91). Five categories of MLCs were identified: (1) structural characteristics, (2) equipment/furnishings, (3) location, (4) facilities/environment, (5) culture/activities/policies/practices, and 6) staff. Only very few studies found an association of MLCs with body weight/obesity, and general health and wellbeing. Especially physical activity and mental health were related to MLCs. In general, the location (rural vs. urban, neighborhood status) seemed to be a relevant health aspect. MLCs of ECEC centers appeared relevant for child health indicators to different degrees. Future research should focus on these associations, in detail, to identify concrete ECEC indicators that can support health promotion in early childhood.

Creating a measure to operationalize engaged well-being at work.

BACKGROUND: Mental well-being and work engagement are both desirable, positive states of mind that help employees to better function in the workplace. While occupational researchers have argued in favor of considering both states concurrently, it is less clear how this might be translated to provide an instrument characterizing the workforce accordingly. The present study describes empirical efforts to operationalize a construct called engaged well-being. METHODS: We used employee-level data (n = 13,538) from three waves of the German linked personnel panel (LPP; 2012-2017). Exploratory factor analysis and a combination of hierarchical and non-hierarchical cluster analyses linked with within-sum-of-squares statistics were used to identify distinct profiles describing mental well-being and work engagement concurrently. These profiles were then used as the basis to identify cut-offs to create replicable categories of engaged well-being. Using the longitudinal data from a subgroup providing data across more than one wave, we observed whether the newly constructed indicator changed over time. RESULTS: The exploratory factor analysis suggested that both states were two distinct factors. Cluster analysis linked with within-sum-of-squares statistics suggested a four-cluster solution: engaged well-being (46.9%), disengaged well-being (27.5%), engaged strain (8.8%), and disengaged strain (16.8%). One cut-off for each state was identified to replicate the cluster solution. Across observation periods, we could observe changes in engaged well-being. CONCLUSIONS: Our measure of engaged well-being can be used to simultaneously characterize a workforce's mental well-being and work engagement. Changes in this measure over time suggest its potential utility in organizational interventions. Future studies are needed to further explore both the antecedents, correlates, and potential effects of engaged well-being.

The association of cortisol levels with leukocyte distribution is disrupted in the metabolic syndrome.

BACKGROUND: Leukocyte glucocorticoid sensitivity (GCS) pertains to the responsivity of leukocytes to the regulating actions of glucocorticoids, such as cortisol. Impaired endocrine regulation may link the metabolic syndrome (MetS) to the development of cardiovascular disease. We tested if the physiological association between endogenous cortisol levels and peripheral leukocyte composition becomes disrupted in individuals with MetS. METHODS: MetS was assessed among 689 German industrial employees. The covariance between cortisol levels and hematologic parameters (i.e., proportions of neutrophils and lymphocytes) and their ratio was explored, which has been proposed as a proxy for GCS in vivo. Cortisol level before blood collection was assessed by repeated saliva collection, and the area under the curve was calculated. Linear regression models were adjusted for potential confounders including age, gender, BMI, income, and lifestyle factors. RESULTS: Cortisol levels did not differ between subgroups. Participants without MetS (n = 552) showed the expected association of cortisol with hematologic parameters (ß = 0.207 to 0.216; p values < 0.001). No association (ß = 0.078 to 0.083; p values > 0.10) was found among those with MetS (n = 137), consistent with a reduced GCS. Analyses of separate MetS components showed that reduced GCS was associated specifically with decreased high-density lipoprotein and elevated fasting plasma glucose. CONCLUSIONS: Utilizing a novel statistical approach to infer GCS, this study provided first epidemiological evidence of aberrant physiological regulation of leukocyte distribution by endogenous cortisol levels among individuals with MetS. These findings underline the idea that MetS may involve disruption of endocrine-immune regulation.

[Social Inequalities in Health and Health Behaviors among University Students]. / Sozialbedingte Ungleichheiten von Gesundheit und Gesundheitsverhalten bei Studierenden.

AIM OF THE STUDY: Disease prevention and health science research have focused increasingly on students in recent years. However, students are usually perceived as a homogeneous group. The aim of this article was to examine if there exist health inequalities among students. METHODS: A nationwide student survey, the so-called NuPhA study, was used to answer this question (n=689, 69.5% female, average age: 22.69 years). RESULTS AND CONCLUSIONS: We found that socio-economic indicators were associated with health and health behavior. For instance, being a scholarship holder was associated with a better general, mental, and physical health. In particular, subjective social status was positively associated with better general, mental, and physical health as well as higher physical activity. The results indicate that while students initially appeared to form a homogenous group, health inequalities exist among them. This suggests the need for a differentiated view on the student group and the importance of examining and explaining health inequalities among students in depth and to finally reduce them.

Household Air Pollution and Angina Pectoris in Low- and Middle-Income Countries: Cross-Sectional Evidence from the World Health Survey 2002-2003.

The evidence regarding the effects of household air pollution on angina pectoris is limited in low-and middle-income countries (LMICs). We sought to examine the association between household air pollution and angina pectoris across several countries. We analyzed data of individuals from 46 selected countries participating in the cross-sectional World Health Survey (WHS) 2002-2003. Pooled and stratified (sex, continent) logistic regression with sampling weights was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to quantify associations between the use of different household fuels with angina pectoris. In the pooled sample, we observed lower odds of angina pectoris with electricity use (OR: 0.68, 95% CI: 0.56-0.83) compared to those households reporting the use of gas as a household fuel. Increased odds of angina pectoris were observed with the use of agriculture/dung/shrub/other (OR: 1.65, 95% CI: 1.30-2.09), mixed (solid and non-solid fuels) (OR: 1.31, 95% CI: 1.09-1.56), and mixed solid fuel use (OR: 1.59, 95% CI: 1.12-2.25). Higher odds of angina pectoris were observed mainly with solid fuel use. The results highlight the importance of addressing these issues, especially in regions with a high proportion of solid fuel users and increasing levels of cardiovascular disease.

Associations of Changes in Organizational Justice with Job Attitudes and Health-Findings from a Prospective Study Using a Matching-Based Difference-in-Difference Approach.

BACKGROUND: Ample evidence indicates that unfairness at the workplace (organizational injustice) is associated with both job attitudes and health of employees. Several factors that influence these associations have been identified: e.g., personality traits, such as the Big Five traits, justice sensitivity, type of occupation (e.g., white-collar), and unobserved time-invariant factors. Previous studies only addressed parts of these issues, and the ideal research design to mitigate biases-an experiment with random assignment to a treatment and control group-is not feasible. This study therefore mimics a randomized experiment using two statistical techniques. METHODS: First, matching was implemented to balance the treatment and control group in confounding factors (demographics and personality) in two prospective waves (2012-2014) of observational data (4522 white-collar, 2984 blue-collar) taken from the Linked Personnel Panel, which is an employee survey representative for German private sector companies with more than 50 employees. Second, a difference-in-difference approach excludes unobserved time-invariant factors by estimating associations of changes in organizational justice (distributive, procedural, interactional) with job attitudes (job satisfaction, turnover intention) and health (general and mental) in these groups, separate for white- and blue-collar employees. RESULTS: A decrease in perceived justice was associated with lower job attitudes (less job satisfaction and higher turnover intentions), while an increase was associated with higher values. This pattern was found for white- and blue-collar workers and also for health indicators, with the latter, however, being less pronounced. CONCLUSIONS: Increased fairness at the workplace is related to better job attitudes and health for white- and blue-collar employees, independent of personality traits and unobserved time-invariant factors.

Transformational Leadership and Depressive Symptoms in Germany: Validation of a Short Transformational Leadership Scale.

OBJECTIVES: The objective of the present study was to validate a shortened transformational leadership (TL) scale (12 items) comprising core TL behaviour and to test the associations of this shortened TL scale with depressive symptoms. METHODS: The study used cross-sectional data from 1632 employees of the overall workforce of a middle-sized German company (51.6% men; mean age, 41.35 years; standard deviation, 9.4 years). TL was assessed with the German version of the Transformational Leadership Inventory and depressive symptoms with the Hospital Anxiety and Depression Scale (HADS). The structural validity of the core TL scale was assessed with confirmatory factor analysis. Associations with depressive symptoms were estimated with structural equation modelling and adjusted logistic regression. RESULTS: Confirmatory factor analysis and structural equation modelling showed better model fit for the core TL than for the full TL score. Logistic regression revealed 3.61-fold (95% confidence interval [CI], 2.20 to 5.93: women) to 4.46-fold (95% CI, 2.86 to 6.95: men) increased odds of reporting depressive symptoms (HADS score >8) for those in the lowest tertile of reported core TL. CONCLUSIONS: The shortened core TL seems to be a valid instrument for research and training purposes in the context of TL and depressive symptoms in employees. Of particular note, men reporting poor TL were more likely to report depressive symptoms.

Ambivalence in the Early Years of Marriage: Impact on Ambulatory Blood Pressure and Relationship Processes.

BACKGROUND: Marriage is associated with lower cardiovascular morbidity and mortality, but quality matters. Marriages characterized by ambivalent behaviors (containing both highly positive and highly negative behaviors concurrently) may not confer the same cardiovascular benefits as characterized by purely positive behavior. Ambivalence is assumed to take time to develop but couples in the early years of marriage may already exhibit ambivalent behaviors and thus be at increased risk for future cardiovascular events. PURPOSE: The purpose of this study was to determine the frequency of spouse and own ambivalent behavior, the impact on interpersonal (i.e., responsiveness, disclosure, affective interactions) processes, and ambulatory blood pressure (ABP) in individuals in the early years of marriage. METHODS: In 84 young married couples, objective and subjective ambivalence, interpersonal functioning, and ABP over a 24-hr period were assessed. RESULTS: As predicted, ambivalence developed early in marriage. Regarding interpersonal processes, spousal and own objective ambivalent behavior was associated with lower spousal responsiveness (p < .01), disclosure (p < .05), and more negative (p < .03) and less positive interactions (p < .001). Physiologically, ambivalent spousal behavior was associated with higher systolic blood pressure (p = .02) and higher diastolic blood pressure (p = .04). Measures of subjective ambivalence were congruent. CONCLUSIONS: Early marriages already contain ambivalent behavior; in such cases, individuals may not receive the cardiovascular protection of a supportive marriage.