Preschool emergent literacy skills as predictors of reading and spelling in Grade 2 and the role of migration background in Germany.

Children's emergent literacy skills are essential for the development of later literacy abilities and school success. However, children with migration background often show poorer language skills in the majority language and are at a greater risk of developing literacy deficits. In addition, there is evidence for the predictive role of emergent literacy skills in reading comprehension, but there has been relatively little research concerning the association between preschool emergent literacy skills and word reading and spelling in Germany, especially for children with migration background. This study examines the associations of emergent literacy skills (vocabulary, phonological awareness [PA], letter knowledge, and rapid naming) with word reading and spelling from kindergarten to the end of Grade 2 and evaluates the role of migration background (i.e., use of the majority or minority language at home) in these associations. Data from 187 preschool children were obtained before school entry (Mage = 63.58 months, SD = 4.45). The results show that vocabulary and letter knowledge were strong predictors of word reading, whereas letter knowledge and PA were significant predictors of spelling. Furthermore, children's migration background was negatively associated with preschool vocabulary and PA. For children with migration background, vocabulary was a significant predictor of word reading, whereas letter knowledge was the best predictor of word reading for children without migration background. The results reflect the complexity of language development and the relevance of emergent literacy skills as predictors for word reading and spelling. Specific interventions should be developed to promote children's literacy abilities.

Designing the first culturally-sensitive stigma survey tailored for adolescents: RN-CSS.

AIMS: The Red Noses Culturally-Sensitive Stigma Survey (RN-CSS) contributes to the underexplored research domain of adolescents' stigmatising attitudes and behaviours towards peers with mental health difficulties and mental healthcare services. It also addresses the need for comprehensive and culturally-sensitive tools to assess stigma in this context. METHODS: Drawing on insights from focus groups and building upon the existing Stigma in Global Context-Mental Health Study, we have successfully developed and implemented the first culturally-sensitive stigma survey tailored for school-aged adolescents of different migration/cultural backgrounds. The questionnaire includes an unlabelled case vignette depicting a peer with symptoms of depression and gathers data on various domains, including (1) sociodemographic variables; (2) education-related information; (3) COVID-19; (4) perceptions of mental health difficulties and mental healthcare services (i.e. severity assessment, causal attributions, care recommendations, personal stigma, perceived stigma, and service stigma); (5) subjective wellbeing and familiarity with mental health difficulties; (6) social support; (7) school context; (8) bullying; and (9) knowledge of anti-stigma campaigns. RESULTS: Our final sample comprises 5075 pupils from 38 secondary schools in Flanders, Belgium. CONCLUSIONS: In this article, we present the study's background and rationale, the development of the questionnaire, and the sampling and recruitment methods employed. Furthermore, we provide a summary of the sample characteristics and preliminary descriptive results of the RN-CSS. Subsequent empirical studies will address the research objectives outlined in this protocol paper. The research opportunities provided by the developed materials and dataset are being discussed.

Change in care needs of people with severe mental illness with and without a non-Western migration background: are their needs equally served throughout treatment?

BACKGROUND: People with a non-Western migration background living in Western countries are more likely to experience psychiatric problems and have more severe symptoms when they do. Patients of non-Western origin also have more unmet needs for care. This study focuses on differences between Western and non-Western patients in care needs being met during the course of mental health treatment. METHODS: The care needs of 1099 patients, 39% with and 61% without a non-Western migration background, recorded between 2017 and 2020 in Flexible Assertive Community Treatment, were compared. RESULTS: Non-Western migrants more often received psychotic disorder diagnoses, had more socio-economic problems, met, unmet and total needs for care and experienced less reduction in unmet needs during treatment. This was specifically the case for the rehabilitation areas: daily activities, treatment information, basic education, paid work and meaningful life and recovery. After controlling for socio-economic factors and diagnosis, group differences in change in number of unmet needs were no longer significant. However, the reduction in unmet needs in the areas of basic education, paid work and meaningful life and recovery remained significantly smaller for non-Western patients. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Except for the rehabilitation domains of basic education, paid work and meaningful life, the disadvantages in resolving the care needs of patients with a non-Western migration background do not remain significant after taking into account socioeconomic factors and diagnosis. Collaboration of mental health care and the social domain is warranted to improve socio-economic factors for patients with a non-Western migration background, to better address their unmet needs for care.

Out of pocket health-care services in Germany during pregnancy under consideration of migration and acculturation.

PURPOSE: More than a quarter of the German population has a migration background (MB). As various studies in the healthcare sector have already shown, ethnic background and migration status can have an influence on individual patient care. The aim of our study was to evaluate whether there are differences in utilization of out of pocket health-care services and the consultation situation in the context of prenatal care, taking into account migration status, acculturation and socio-demographic aspects. METHODS: In the period from 01.03.21-01.03.22, a total of 511 women in childbed at the University Women's Hospital Ulm were interviewed in a retrospective survey using a standardized questionnaire translated into 9 languages and asked about their prenatal care. Due to the COVID pandemic, the study had to be terminated after one year. RESULTS: Women with MB-particularly 1st generation migrant women-used significantly fewer out of pocket prenatal care services (p < 0.001) and felt less informed and counselled regarding costs and benefits of possible prenatal care examinations (p < 0.001) compared to women without MB. Consistent with these results, there were associations between the assimilation index (AI) of patients with MB and both utilization and perception of individual healthcare services. CONCLUSION: Our study indicates that even today there are still differences in the treatment and perception of various health services in the context of prenatal care between women with and those without MB.

"As a psychiatry resident I am invited to explore my identity. But when I accept that invitation, I still encounter a wall." A qualitative study on inclusion experienced by psychiatry residents with a migration background, sexual minority identity and/or working-class background.

Diversity in terms of class, sexual identity and migration background among medical students in high income countries has increased greatly in recent decades. Some research into the experiences of these new groups of doctors has been performed. However, no previous research into the experiences of psychiatry residents specifically, is known. This qualitative study investigates how psychiatry residents, from these minoritized groups, experience their training regarding inclusion. Inclusion is defined as the degree to which one's needs for connection and for being valued in one's uniqueness, is satisfied. In-depth interviews with 16 psychiatry residents were conducted. These interviews were transcribed and coded using MaxQDA software. Initial themes that were constructed, were explored further in subsequent interviews and linked to literature. Finally, the developed themes were ordered in a model conceptualizing inclusion. Participants reported high belongingness within psychiatry training. Their experienced value in uniqueness, however, was generally quite low. Participants reported to experience little interest in and sensitivity for their perspectives and lived experiences from their co-workers. When faced with stigmatization and discrimination, participants reported lack of support from their colleagues. Assimilation was found to be the most frequently used coping strategy in dealing with diversity. Participants seemed to conform to the 'neutral' norm and experienced barriers in expressing themselves. Through this mechanism of assimilation, the added value that participants might bring with their unique knowledge and lived experiences was not used, both in patient care and in creating an inclusive climate within the organization. Moreover, assimilation is associated with psychological strain.

Barriers and facilitators in providing care for patients with a migration background.

AIMS AND OBJECTIVES: The aim of this study was to identify the barriers and facilitators experienced by healthcare professionals while caring for patients with a migration background. BACKGROUND: People with a migration background often face several structural inequalities and barriers in terms of accessibility to, and affordability of, healthcare. In order to provide quality care for patients with a migration background, it is important to understand which barriers healthcare professionals experience that prevent them from providing care and which factors can facilitate this. DESIGN AND METHODS: Qualitative research following the COREQ criteria. A total of six focus groups (n = 37) and 12 individual interviews were conducted with a multidisciplinary sample: doctors, nurses, social workers, and occupational therapists. Nursing and medical students were also included. Thematic content analysis was used. RESULTS: Key findings suggest that the main barrier is that healthcare professionals regard people with a migration background as "the other". Healthcare professionals do not feel secure or competent to provide care for these "others." According to the healthcare professionals, the hospital structures-and, particularly, the managerial instances-appear to be only slightly supportive. Structural barriers at the level of the healthcare system, such as limited implementation of care coordination and austerity measures (time pressure or economic restrictions), were also perceived as barriers. Facilitators can be the healthcare professionals' attitude or the flexibility of the management. CONCLUSIONS: Healthcare professionals experience barriers in caring for people with a migration background. Othering plays a key role in building or maintaining several barriers. A multilevel approach is necessary to tackle these barriers and enable facilitators. RELEVANCE TO CLINICAL PRACTICE: Raising awareness about "othering" in the educational programs of students and healthcare professionals is essential. Also, deploying support mechanisms and valuing the competences of multicultural and multi-lingual healthcare professionals can help facilitate quality care for patients with a migrant background. PATIENT OR PUBLIC CONTRIBUTION: Patients, informal and formal caregivers participated in the study at several stages (e.g.: by involving them during the research design phase or providing feedback and input at specific moments across the study). In addition, community participants played a key role also during the research design and data analysis phases as well as by facilitating patients' recruitment.

Influence of educational status and migration background on the long-term health-related quality of life after stroke.

BACKGROUND AND PURPOSE: Acute stroke treatment and secondary prevention have tremendously improved functional outcomes after stroke. However, this does not always imply a likewise improvement in health-related quality of life (HRQoL). Knowledge on factors influencing HRQoL after stroke is still scarce, especially regarding social aspects like the level of education and the presence of migration background. METHODS: In the present stroke cohort study, participants were interviewed during their hospital stay and completed a postal questionnaire at 3 and 12 months post stroke. Functional outcomes were assessed by the modified Rankin Scale and HRQoL by evaluating the detailed Stroke Impact Scale (SIS). Logistic regression models were used to determine associations between education, migration background and quality of life end-points. RESULTS: A total of 945 (mean age 69 years; 56% male) stroke patients were enrolled. After adjusting for confounders, a lower educational level was associated with worse functional outcomes in the SIS domain 'strength' (odds ratio 2.67, 95% confidence interval 1.6-4.4, p < 0.001). Migration background was associated with worse outcomes in the SIS domain 'emotion' (p = 0.007, odds ratio 1.71, 95% confidence interval 1.2-2.5). Additionally, for female patients worse HRQoL outcomes were found in multiple other SIS domains. CONCLUSIONS: Migration background and a lower educational level were significantly associated with lower long-term HRQoL after stroke. These aspects should be considered in targeted rehabilitation programmes and follow-up support of stroke patients.

Factors associated with polypharmacy and the high risk of medication-related problems among older community-dwelling adults in European countries: a longitudinal study.

BACKGROUND: Polypharmacy can be defined as using five or more medications simultaneously. "Medication-related problems", an extension of polypharmacy, includes inappropriate prescribing, poor adherence, overdosage, underdosage, inappropriate drug selection, inadequate monitoring, adverse drug effects, and drug interactions. Polypharmacy and the high risk of medication-related problems among older people are associated with adverse health consequences due to drug-drug interactions, drug-disease interactions, and adverse drug effects. This study aims to assess the factors associated with polypharmacy and the high risk of medication-related problems among community-dwelling older people in the Netherlands, Greece, Croatia, Spain, United Kingdom. METHOD: This longitudinal study used baseline and follow-up data from 1791 participants of the Urban Health Center European project. Polypharmacy and the risk of medication-related problems were evaluated at baseline and follow-up using the Medication Risk Questionnaire. We studied factors in the domains (a) sociodemographic characteristics, (b) lifestyle and nutrition, and (c) health and health care use. Hierarchical logistic regression analyses were used to examine the factors associated with polypharmacy and the high risk of medication-related problems. RESULTS: Mean age was 79.6 years (SD ± 5.6 years); 60.8% were women; 45.2% had polypharmacy, and 41.8% had a high risk of medication-related problems. Women participants had lower odds of polypharmacy (OR = 0.55;95%CI:0.42-0.72) and a high risk of medication-related problems (OR = 0.50; 95%CI:0.39-0.65). Participants with a migration background (OR = 1.67;95%CI:1.08-2.59), overweight (OR = 1.37; 95%CI:1.04-1.79) and obesity (OR = 1.78;95%CI:1.26-2.51) compared to 'normal weight', with lower physical HRQoL (OR = 0.96, 95%CI:0.95-0.98), multi-morbidity (OR = 3.73, 95%CI:2.18-6.37), frailty (OR = 1.69, 95%CI:1.24-2.30), visited outpatient services (OR = 1.77, 95%CI: 1.09-2.88) had higher odds of polypharmacy. The associations with the high risk of medication-related problems were similar. CONCLUSIONS: Multiple factors in demography, lifestyle, nutrition, and health care use are associated with polypharmacy and the high risk of medication-related problems. Polypharmacy is a single element that may reflect the number of medications taken. The broader content of medication-related problems should be considered to assess the context of medication use among older people comprehensively. These provide starting points to improve interventions to reduce polypharmacy and high risk of medication-related problems. In the meantime, health professionals can apply these insights to identify subgroups of patients at a high risk of polypharmacy and medication-related problems. TRIAL REGISTRATION: The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952. The date of registration is 13/03/2017.

Trends of overweight and obesity among preschool children from 2013 to 2018: a cross-sectional study in Rhine-Neckar County and the City of Heidelberg, Germany.

BACKGROUND: Early childhood overweight and obesity is a growing public health concern worldwide. Few recent studies have addressed how time trends varied by sociodemographic characteristics at the regional level using large and high-quality data. This study determines how time trends vary in the prevalence of early childhood overweight and obesity by age, gender, and migration background at the regional level. METHODS: We used a Kernel-density curve to describe the BMI distribution, and evaluated the trends of overweight and obesity by age, gender, and migration background using logistic regression. RESULTS: Mean BMI and the overall prevalence of overweight and obesity increased among preschool children aged 4-6 years in the Rhine-Neckar County and the City of Heidelberg. After adjusting for age, sex, and migration background, trends of overweight significantly increased only among male children in the age 5 year group with migration background (P < 0.05), and an upward trend of obesity was observed only among male children in the age 5 year group and female children in the age 6 year group with migration background (P < 0.05). CONCLUSIONS: BMI distribution as well as general prevalence of overweight and obesity are still increasing among preschool children. Children with migration backgrounds, particularly male children in the age 5 year groups and female children in the age 6 year group should be prioritized. Health promotion strategies for children with migration backgrounds will help address this challenge.

Transcultural differences in suicide attempts among children and adolescents with and without migration background, a multicentre study: in Vienna, Berlin, Istanbul.

While suicide can occur throughout the lifespan, worldwide suicide is the second leading cause of death among young people aged between 15 and 29 years. The aim of this multicentre study, conducted in Austria, Germany and Turkey, is to investigate the transcultural differences of suicide attempts among children and adolescents with and without migration background. The present study is a retrospective analyses of the records of 247 young people, who were admitted after a suicide attempt to Emergency Outpatient Clinics of Departments of Child and Adolescent Psychiatry of the collaborating Universities including Medical University of Vienna, Charité University Medicine Berlin and Cerrahpasa School of Medicine and Bakirkoy Training and Research Hospital for Mental Health in Istanbul over a 3-year period. The results of the present study show significant transcultural differences between minors with and without migration background in regard to triggering reasons, method of suicide attempts and psychiatric diagnosis. The trigger event "intra-familial conflicts" and the use of "low-risk methods" for their suicide attempt were more frequent among patients with migration background. Moreover among native parents living in Vienna and Berlin divorce of parents were more frequent compared to parents living in Istanbul and migrants in Vienna. These results can be partly explained by cultural differences between migrants and host society. Also disadvantages in socio-economic situations of migrants and their poorer access to the healthcare system can mostly lead to acute and delayed treatments. Larger longitudinal studies are needed to understand better the impact of migration on the suicidal behaviour of young people.

[Use of emergency rooms by so-called multiple users: results of a prospective study with special consideration of the migration status]. / Inanspruchnahme von Notaufnahmen durch sog. Mehrfachnutzer/-innen: Ergebnisse einer prospektiven Studie unter besonderer Berücksichtigung des Migrationsstatus.

Objectives: Can we identify predictive factors for the group of so-called multiple users (MU; 4 and more uses of an emergency department [ED] in the past 12 months)? Are people with a migration background more likely to be classified in the MU group? Methodology: Included were consecutive patients who visited three EDs in Berlin from July 2017 to July 2018. Using a questionnaire, diseases, reasons for visiting the ED and socioeconomic factors were recorded. Comparisons between migrants (1st generation), their descendants (2nd generation) and nonmigrants were assessed using logistic regression. Results: A total of 2339 patients were included in the evaluation (repeat rate 56%), of which 901 had a migration background. Young women (<30 years), chronically ill, pregnant women, patients with severe complaints and people with (self-assessed) moderate and poor health quality as well as those without medical referral had a greater chance of multiple use of ED. Conclusion: MU burden the already increasing patient volume of ED. However, they represent a heterogeneous group of patients, among whom people with a migration background are not common. Further research is warranted to better understand the factors that lead to frequent use and to develop effective strategies to address the complex health needs of MUs.

No evidence to support the impact of migration background on treatment response rates and cancer survival: a retrospective matched-pair analysis in Germany.

BACKGROUND: Immigration has taken the central stage in world politics, especially in the developed countries like Germany, where the continuous flow of immigrants has been well documented since 1960s. Strikingly, emerging data suggest that migrant patients have a poorer response to the treatment and lower survival rates in their new host country, raising concerns about health disparities. Herein, we present our investigation on the treatment response rate and cancer survival in German patients with and without an immigrant background that were treated at our comprehensive cancer center in Germany. METHODS: Initially, we considered 8162 cancer patients treated at the Center for Integrated Oncology (CIO), University Hospital Bonn, Germany (April 2002-December 2015) for matched-pair analysis. Subsequently, the German patients with a migration background and those from the native German population were manually identified and catalogued using a highly specific name-based algorithm. The clinical parameters such as demographic characteristics, tumor characteristics, defined staging criteria, and primary therapy were further adjusted. Using these stringent criteria, a total of 422 patients (n = 211, Germans with migration background; n = 211, native German population) were screened to compare for the treatment response and survival rates (i.e., 5-year overall survival, progression-free survival, and time to progression). RESULTS: Compared to the cohort with migration background, the cohort without migration background was slightly older (54.9 vs. 57.9 years) while having the same sex distribution (54.5% vs. 55.0% female) and longer follow-up time (36.9 vs. 42.6 months). We did not find significant differences in cancer survival (5-year overall survival, P = 0.771) and the response rates (Overall Remission Rate; McNemar's test, P = 0.346) between both collectives. CONCLUSION: Contrary to prior reports, we found no significant differences in cancer survival between German patients with immigrant background and native German patients. Nevertheless, the advanced treatment protocols implemented at our comprehensive cancer center may possibly account for the low variance in outcome. To conduct similar studies with a broader perspective, we propose that certain risk factors (country-of-origin-specific infections, dietary habits, epigenetics for chronic diseases etc.) should be considered, specially in the future studies that will recruit new arrivals from the 2015 German refugee crisis.

Risk factors, physical and mental health burden of male and female pathological gamblers in the German general population aged 40-80.

BACKGROUND: Gambling Disorder (GD) has been associated with considerable mental and physical health risks in clinical samples. The paper determines risk factors, mental and physical health burden of probable GD for both men and women in the general population. METHODS: In the Gutenberg Health Study, a population-based sample of N = 11,875 aged 40-80 years was analyzed regarding lifetime probable GD prevalence (measured with the Lie/ Bet Questionnaire) and a wide array of health variables including standardized measures of depression, anxiety, and somatic symptoms. RESULTS: Probable GD lifetime prevalence was 2.1%, with higher rates among 1st generation migrants (5.5%; vs. non-migrants 1.6%), men (3.0%; vs. women 1.2%), and the sample's youngest age decade (40-49 y., 3.1%). Lifetime probable GD was associated with current work-related, family and financial stressors as well as unhealthy behavior (smoking, extended screen time), and lifetime legal offenses. In men, but not in women, increased rates of imprisonment, mental and somatic symptoms were found. CONCLUSIONS: GD is a major public health problem with serious social, mental and physical health burden. Epidemiological findings underscore the preponderance of GD among 1st generation migrants and men. Findings are consistent with a vicious cycle of family, work related and financial stress factors, and mental and physical burden, particularly in men. Demographic risk factors may help to target specific prevention and treatment efforts.

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.

Effects of the dementia care toolbox on personnel's self-reported confidence in patient care: a CRT in general practices.

BACKGROUND: In rapidly aging populations, general practitioners (GPs) are challenged in dementia care of patients with and without migration background. Uncertainties in treating dementia in migrant patients due to language barriers or information deficits are reported. To address these deficits, we developed the Dementia Care Toolbox which was judged helpful by GP practice personnel. This two-armed cluster-randomised trial (CRT) investigated the effects of this toolbox on German GPs' and practice assistants' (PrAs) attitudes and confidence in dementia care, especially in patients with migration background. METHODS: A total of 32 GP practices were recruited and randomised into intervention (toolbox use for 3 months) and waiting-list control (toolbox after follow-up). After 3 months all participating GPs and PrAs received a standardised questionnaire addressing their levels of self-reported confidence in dementia care for patients with and without migration background. A generalized estimating equation model that took practice cluster effects into account was applied to assess GPs and PrAs self-reported confidence in dementia care in patients with and without migration background. RESULTS: Overall, the intervention had no significant effect on self-reported confidence in dementia care. However, the use of the dementia care toolbox showed a tendency for a learning effect on knowledge about local support structures for migrant patients with dementia (odds ratio 1.43; 95% CI 0.68-3.03, p = 0.35) and for less communication difficulties with dementia patients in general (odds ratio 0.72; 95% CI 0.33-1.56; p = 0.40). Moreover, intervention practices showed a tendency towards more awareness of own limitations: less self-confidence regarding answering questions (odds ratio 0.82; 95% CI 0.36-1.86, p = 0.64) and providing information for patients with migration background (odds ratio 0.60; 95% CI 0.25-1.45, p = 0.26). CONCLUSION: The Toolbox Dementia Care increased awareness on the respective topic. Given a small sample size, further studies on its effectiveness in primary care are needed. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00014632. Registered 02/08/2018.

[Changes in binge drinking among adolescents and young adults in Germany depending on educational level and migration background]. / Veränderungen des Rauschtrinkens bei Jugendlichen und jungen Erwachsenen in Deutschland in Abhängigkeit von Bildungsniveau und Migrationshintergrund.

BACKGROUND: Studies show that the prevalence of binge drinking among young people in Germany is declining overall. This change is usually studied in more detail based on age and gender. This paper expands on these analyses and examines whether the decline in binge drinking among young people differs as a function of educational level and migration background. METHODS: Based on representative surveys conducted by the Federal Center for Health Education (BZgA), 30-day prevalences of binge drinking were determined for Germany between 2008 and 2019 for male and female 12- to 17-year-old adolescents and 18- to 25-year-old young adults. Logistic regression analyses were used to estimate trend patterns for the period from 2008 to 2019. This was also done as a function of education level and migration background. RESULTS: Across all surveys, more young adults than adolescents, more male than female young people, and more young people without a migration background get drunk. Between 2008 and 2019, the 30-day prevalence of binge drinking decreased overall among adolescents (male: from 23.0 to 16.4%; female: from 17.7 to 10.7%) and young men (from 53.0 to 43.9%), and it did not change statistically significantly among young women (2008: 28.1%; 2019: 24.5%). The trend analyses depending on the level of education and migration background show that at least among young women without a (technical) higher education entrance qualification there is a decrease in binge drinking. DISCUSSION: The decline in binge drinking may differ depending on social characteristics. Such differences should be taken into account in the prevention of binge drinking. In particular, young women with a higher level of education must be reached with prevention offers.

The adaptation of educational expectations in response to ability tracking: Variations by migration background.

In various educational systems, students are sorted into separate secondary schools on the basis of their academic ability. Research suggests that this type of tracking impacts students' educational expectations, as expectations generally align with students' ability track. However, most research is cross-sectional and students with lower expectations are possibly also sorted into lower tracks. Moreover, the extent to which track placement influences expectations may vary across students. In this paper, we address the following research question: how does ability tracking impact the development of student expectations and how does this vary by students' migration background. Based on the literature on the immigrant aspiration-achievement paradox, we expect that students with a migration background are less likely to adapt expectations downwardly, and more likely to adapt expectations upward in response to track placement. Using German panel data, we examine the educational expectations of students with and without a migration background, before and after track placement. Moreover, we use variations in tracking procedures across German states to study how students who get tracked compare with students who do not get tracked in the development of their educational expectations. We show that students are more likely to upwardly adjust their expectations when their track placement exceeds their expectations and to downwardly adjust their expectations when their track placement is below their expectations. We find little support for the hypothesized variations by student migration background. Students whose parent(s) hold (a) Bachelor degree(s) are more likely to upwardly adjust their expectations when their track placement exceeds their expectations than students whose parent(s) maximally hold an upper secondary or vocational degree(s).

Reducing health disparities: key factors for successful implementation of social network testing with HIV self-tests among men who have sex with men with a non-western migration background in the Netherlands.

Improving testing uptake among men who have sex with men with a non-western migration background (MSM-NW) is a public health priority, as people who are unaware of their HIV infection are at higher risk of transmitting HIV and are unable to benefit from HIV treatment. Formative semi-structured interviews with 13 MSM-NW assessed key factors for the successful implementation of social network testing with HIV self-tests (SNT-HIVST). Interviews were thematically analysed. Participants mentioned that SNT-HIVST might overcome barriers to regular HIV testing including; being seen while testing, disclosure of sexual identity, and stigma related to HIV and sexual practices. Trust between the HIVST distributer and receiver was important. Finally, SNT-HIVST requires tailored peer support to address practical, informational, and emotional needs. MSM-NW distributing HIVST can have an important role in reducing health disparities in testing uptake among MSM-NW. Provided sufficient trust among MSM-NW; key factors found for successful implementation were education through an e-tool, and establishing quality support by a peer-coordinator for unanticipated questions. In conclusion, HIVST distribution has the potential to reduce health disparities in testing uptake, in particular, if adjusted to MSM-NWs individual preferences and the needs and preferences of the person they are inviting to test.

Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies.

OBJECTIVE: Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular. METHODS: Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011-2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status. RESULTS: In Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake. CONCLUSIONS FOR PRACTICE: Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups.

Acceptance and self-reported use of a dementia care toolbox by general practice personal: results from an intervention study in German practices.

BACKGROUND: Dementia is an age-related syndrome that is estimated to affect 46.8 million people worldwide (2015). In ageing populations, the prevalence of dementia is expected to increase. General practitioners (GPs) are often the first to be contacted when signs of dementia appear. This cluster-randomised trial (CRT) investigates the effects of a dementia care toolbox mailed to GP practices to facilitate dementia care. It contained patient brochures and posters for the waiting room in three languages, information cards for professionals and practical tools in three languages. The GPs' and practice assistants' (PrAs) use of and opinion about the toolbox is reported here. METHODS: Three months after receiving the toolbox, participating GPs and PrAs were sent a standardised, self-administered questionnaire asking about the use and helpfulness of the various toolbox items by mail. RESULTS: A total of 50 GPs and PrAs (14 GPs and 36 PrAs) from 15 practices completed the questionnaire. Of the participants, 82.0% reported using at least one of the tools, while 18.0% had used none. In descending order, the patient brochures (70.0%), the information card (58.0%) and the poster (40.0%) were used. In general, the brochures (52.1%), the information card (44.9%) as well as the poster (28.6%) were perceived as helpful. CONCLUSION: Overall, the dementia toolbox was widely accepted by both professional groups. Future research should investigate long-term effects of information strategies for GP practice settings. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00014632 . Registered 02 August 2018. Clinical register of the study coordination office of the University hospital of Bonn. Registered 05 September 2017.