Social Inequality in Early Childhood Health – Participation in the Preventive Health Care Program for Children

Becke , S en; Ku z, Ka in A icle Social Inequali y in Ea ly Childhood Heal h – Pa icipa ion in he P e en i e Heal h Ca e P og am o Child en Schmolle s Jah buch – Jou nal o Applied Social Science S udies. Zei sch i ü Wi scha s- und Sozialwissenscha en P o ided in Coope a ion wi h: Duncke & Humblo , Be lin Sugges ed Ci a ion: Becke , S en; Ku z, Ka in (2011) : Social Inequali y in Ea ly Childhood Heal h – Pa icipa ion in he P e en i e Heal h Ca e P og am o Child en, Schmolle s Jah buch – Jou nal o Applied Social Science S udies. Zei sch i ü Wi scha s- und Sozialwissenscha en, ISSN 1865-5742, Duncke & Humblo , Be lin, Vol. 131, Iss. 2, pp. 381-394, h ps://doi.o g/10.3790/schm.131.2.381 This Ve sion is a ailable a : h ps://hdl.handle.ne /10419/292342 S anda d-Nu zungsbedingungen: Die Dokumen e au EconS o dü en zu eigenen wissenscha lichen Zwecken und zum P i a geb auch gespeiche und kopie we den. 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I he documen s ha e been made a ailable unde an Open Con en Licence (especially C ea i e Commons Licences), you may exe cise u he usage igh s as speci ied in he indica ed licence. h ps://c ea i ecommons.o g/licenses/by/4.0/ Heal h Social Inequali y in Ea ly Childhood Heal h Pa icipa ion in he P e en i e Heal h Ca e P og am o Child en By S en Becke and Ka in Ku z Abs ac This pape asks how a socioeconomic di e ences in pa en al child heal h in es - men s can be explained by pe sonal and social esou ces wi hin he amily. Using SOEP da a om he 2003 o 2008 newbo n ques ionnai e, we es ima e mul iple logis ic eg es- sions o de e mine he e ec s o mig a ion s a us, educa ion, ime esou ces, coping com- pe encies, and social esou ces (in e ms o sha ed pa en hood and childca e suppo by he pa ne and ela i es) on pa icipa ion in he na ional Ge man p e en i e heal h ca e p og am o child en (U-Un e suchungen). Fi s , ou analyses e eal s ong in luences o ma e nal educa ion and mig a ion s a us, whe eas social class plays no signi ican ole o pa icipa ion in p e en i e heal h checkups o child en. Second, he likelihood o pa icipa ion is highe he be e mo he s cope wi h mo he hood and he mo e ime hey spend wi h hei o sp ing. Finally, we ind mixed e ec s o social esou ces anging om a posi i e in luence o pa en s li ing oge he , o e no e ec o childca e suppo p o ided by he a he o he child, o a seemingly nega i e impac o suppo om u he kin ela ions. All in all, pe sonal and social esou ces do no seem o play a c u- cial ole in explaining pa icipa ion in child heal h p og ams in e ms o social dispa i ies be ween educa ional and e hnic g oups. JEL Classi ica ion: I10 1. In oduc ion Al hough heal h as well as heal h- ela ed beha io a y g ea ly wi h socio- economic posi ion, he causal ela ionships behind his co ela ion a e s ill no ully unde s ood (Jungbaue -Gans, 2006). One o m o heal h- ela ed beha io is pa icipa ion in p e en i e heal h ca e p og ams o child en. Though li le is known abou he long- e m e ec s o missing ou heal h checkups (Ha ung e al., 2010, 411), p e ious esea ch has indica ed ha a ending hem gene ally Schmolle s Jah buch 131 (2011), 381 –394 Duncke & Humblo , Be lin Schmolle s Jah buch 131 (2011) 2 OPEN ACCESS | Licensed unde | h ps://c ea i ecommons.o g/abou /cclicenses/ DOI h ps://doi.o g/10.3790/schm.131.2.381 | Gene a ed on 2023-01-16 13:36:23 dec eases he isk o heal h p oblems o child en (Meye -Nü nbe ge , 2002; Minis e ium ü Jus iz, Gesundhei und Soziales, 2005; Langness, 2007). Mo e gene ally, ecen esea ch has shown ha pa en al unde in es men in child heal h makes a majo con ibu ion o he eme gence o heal h consequences in la e li e (e.g., Jungbaue -Gans/K iwy, 2004, 15; Muelle /Heinzel-Gu enb un- ne , 2001, 9; Hu elmann, 2006; Hawe/Shiell, 2000, 875). Since 1971, child en in Ge many a e o e ed a diagnosis p og am consis ing o en heal h checks. Al hough his olun a y p e en i e heal h ca e p og am is ee o cha ge, lowe social classes a e signi ican ly less likely o pa icipa e in i (Lampe e al., 2005, 105; Lampe e al., 2010, 19). D awing on he Ge man Heal h In e iew and Examina ion Su ey o Child en and Adolescen s (KiGGS), Kam siu is e al. (2007, 839) epo ha only 72% o he low-s a us child en ook ad an age o all a ailable checkups compa ed o 84% o he mid- dle and 85% o he high social s a us g oups. In addi ion, pa en s wi h low educa ion (Kalies/ on K ies, 2000) as well as mig an amilies (Kam siu is e al., 2007; S ich e al., 2009) end o ha e lowe pa icipa ion a es. The mecha- nisms behind he di e en ial pa icipa ion o di e en g oups a e, howe e , no ye well unde s ood (S ich e al., 2009; Ha ung e al., 2010). Wi h ou con ibu ion, we wan o desc ibe he main social s uc u al pa e ns wi h espec o he pa icipa ion in he p e en i e heal h ca e p og ams o new- bo ns and gain a be e unde s anding o he ac o s and mechanisms ha help o explain he di e en ial pa icipa ion in his p e en i e heal h p og am. Follo- wing Klocke/Hu elmann (1995), we assume ha he ele an a iables a e he ma e ial, pe sonal, and social esou ces. The SOEP da a o e a unique oppo u- ni y o examine he impac o some o hese esou ces on p og am pa icipa- ion. We shall p oceed as ollows: The nex sec ion ou lines heo e ical a gumen s ha aim o explain he ela ionship be ween social class and heal h. Sec ion 3 desc ibes he da a and a iables used in ou analyses. Sec ion 4 p esen s ou empi ical esul s om logis ic eg ession models, and Sec ion 5 closes wi h a b ie summa y and discussion o ou indings. 2. Theo e ical Conside a ions We s a om he assump ion ha he ma e ial, pe sonal, and social esou ces o pa en s acili a e heal h-p omo ing beha io (Klocke/Hu elmann, 1995; Jungbaue -Gans, 2002, 37–39). Ma e ial esou ces a e impo an inso a as heal h- ela ed beha io equi es mone a y in es men s. Howe e , because he p e en i e heal h ca e p og am o child en is ee o cha ge, we do no expec adi ec e ec o pa en al income on p og am pa icipa ion. I is su ely pe sonal esou ces such as knowledge on heal h issues and on he ele ance o heal h checkups o babies ha a e mo e impo an along wi h gene al compe encies 382 S en Becke and Ka in Ku z Schmolle s Jah buch 131 (2011) 2 OPEN ACCESS | Licensed unde | h ps://c ea i ecommons.o g/abou /cclicenses/ DOI h ps://doi.o g/10.3790/schm.131.2.381 | Gene a ed on 2023-01-16 13:36:23 in ca ing o an in an and coping wi h he s esses and s ains o ha ing a new- bo n child. Pe sonal esou ces hus e e o heal h- ela ed cul u al capi al as well as o compe encies in coping wi h pa en hood. Based on he a gumen s o amily economics (Becke , 1981), one could add ime as a u he pe sonal e- sou ce (and es ic ion) ha is likely o in luence pa icipa ion in p e en i e heal h ca e p og ams. Finally, social esou ces –in he sense o being embedded in social ela ions- hips –can also be expec ed o exe an in luence. The e a e se e al ways in which social ela ionships can impac on heal h- ela ed beha io (c ., e.g., Jungbaue -Gans 2002): Fi s , hey p o ide suppo in managing he daily asks o pa en hood. Second, hey migh ac as egula i e measu es ha help o p o- mo e socially expec ed beha io such as heal h-p omo ing ac i i ies. None he- less, social ela ionships migh also exe ad e se e ec s by inducing s ess and s ain o he indi iduals in ol ed in he in e ac ion. The e m ‘social esou ces’ hus e e s o he no ion o social capi al in he sense o an indi idual esou ce based on being embedded in social ne wo ks o social ela ionships (c . Bou - dieu, 1983; Coleman, 1988, 1991; Po es, 1998). Indeed, nume ous s udies in- dica e a obus associa ion be ween social capi al and heal h-p omo ing beha- io o good heal h (Mohensi/Linds om, 2007; Linds om, 2005; Lundbo g, 2005; D ukke e al., 2005; Klocke, 2004; K oll/Lampe , 2007). When s u- dying pa icipa ion in he p e en i e heal h ca e p og am o child en, i is no all o ms o social capi al ha a e ele an , bu p ima ily ela ionships wi hin amily and kin (Rich e , 2005, 144; Jungbaue -Gans/K iwy, 2004, 18; Pe e - mann e al., 2000, 27). A he same ime, because mo he s a e empi ically he p ime ca egi e s o in an s, we iew he mo he ’s(and much less so he a- he ’s) social esou ces as being o p ima y impo ance. Hence, he cen al a gumen s guiding ou empi ical analyses a e as ollows: Mo he s wi h mo e pe sonal esou ces in e ms o (a) educa ion and heal h- ela- ed knowledge, (b) compe encies in coping wi h mo he hood, and (c) ime a e mo e likely o pa icipa e in p e en i e heal h ca e p og ams o child en. Fu - he mo e, ha ing suppo i e amily membe s and ela i es should also inc ease he p obabili y o he mo he ’s p og am pa icipa ion. Wi h espec o gene al social s uc u al pa e ns, we expec ha pa icipa ion in p e en i e heal h ca e p og ams o child en is no ela ed o income di e ences be ween amilies, bu o educa ional le el. This is because heal h- ela ed knowledge and compe en- cies in p ocessing complex in o ma ion a e acqui ed du ing he cou se o an ex ended educa ional ca ee (Jungbaue -Gans, 2002, 37). Pa icipa ion should also be associa ed wi h social class due o i s co ela ion wi h educa ion. Follo- wing ea lie s udies, we also expec o ind a lowe pa icipa ion a e o mig an amilies. On he one hand, his migh be due o he gene ally lowe educa ional le el among mig an s. Howe e , o he mechanisms –such as less knowledge o he Ge man heal h sys em o di e en heal h concep s –migh also be a wo k (c . Ha ung e al., 2010). Social Inequali y in Ea ly Childhood Heal h 383 Schmolle s Jah buch 131 (2011) 2 OPEN ACCESS | Licensed unde | h ps://c ea i ecommons.o g/abou /cclicenses/ DOI h ps://doi.o g/10.3790/schm.131.2.381 | Gene a ed on 2023-01-16 13:36:23 3. Da a and Va iables1 We use da a om he Ge man Socio-economic Panel (SOEP) co e ing he pe iod om 2003 o 2008 (Wagne e al., 2007). Ou analyses d aw on he mo he -child-ques ionnai e (age: 0–1) ga he ing a a ie y o in o ma ion on he newbo n’s heal h. Some mo he s ga e bi h o se e al child en du ing he obse a ion pe iod and he e o e ook pa epea edly in he mo he -child in e - iew. Because ou uni o analysis is he mo he , we selec ed only one mo he - child in e iew o each mo he ( he i s in e iew), esul ing in n= 1,179 in e iews. Fo 151 indi iduals, he e we e missing da a on cen al independen a iables. This educed ou sample size o 1,028 mo he s wi h newbo ns aged 0 o 18 mon hs (on a e age 7.03 mon hs). We use he child’s pa icipa ion in he p e en i e heal h ca e p og am as he dependen a iable. Mo he s we e asked he ollowing ques ion: “Which was he las checkup ha ook place?”2We use his i em o cons uc a dicho omous measu e. The ou come a iable equals 1 when he child had pa icipa ed in he la es age-app op ia e medical checkup; o he wise 0. The explana o y a iables a e he ollowing: Because he SOEP con ains no di ec measu es on heal h- ela ed knowledge, we simply ely on he mo he ’s educa ional le el. We dis inguish h ee ca ego ies: basic deg ee (‘Haup - schule’), in e media e deg ee (‘Mi le e Rei e’), and uni e si y en ance quali i- ca ion (‘Fach-/Hochschul ei e’). In addi ion, we measu e social class by using he a he ’s posi ion acco ding o he EGP-class scheme (E ikson/Gold ho pe, 1992). I he e is missing in o ma ion o i he mo he is no cohabi ing wi h he child’s a he , he ma e nal EGP-class posi ion is used. We dis inguish he uppe and lowe se ice class (1), ou ine whi e-colla wo ke s (2), sel -em- ployed pe sons (3), skilled wo ke s (4), and semiskilled and unskilled wo ke s (5). In addi ion, we cons uc a dummy a iable o indica e whe he he child’s a he is no employed (and he e o e he class posi ion canno be asce ained). To measu e he mo he ’s compe encies in coping wi h mo he hood, we ans- o m a 4-poin scale (mo he s’ag eemen o he s a emen “I do no eel up o he new asks and demands”) in o a dummy a iable wi h he alues 1 (ag ee comple ely) and 0 (o he wise). In addi ion, we use an indica o measu ing how sa is ied he mo he is wi h he ole as a mo he (dummy a iable, ag ee com- ple ely = 1, o he wise = 0). To cap u e ime cons ain s, we employ he in o ma ion on whe he he mo- he is on pa en al lea e (yes = 1, no = 0) and whe he she has mo e han one 384 S en Becke and Ka in Ku z Schmolle s Jah buch 131 (2011) 2 1Sample summa y s a is ics a e p esen ed in Table A1, in he appendix. 2O e all, he e a e 10 olun a y medical checkups o child en (S ich e al., 2009). Se en o hese a e o e ed in ea ly childhood: Checkup 1: a e gi ing bi h; Checkup 2: Day 3–10; Checkup 3: Week 4 o 5; Checkup 4: Mon h 3–4; Checkup 5: Mon h 6–7; Checkup 6: Mon h 10–12; Checkup 7: Mon h 21–24. OPEN ACCESS | Licensed unde | h ps://c ea i ecommons.o g/abou /cclicenses/ DOI h ps://doi.o g/10.3790/schm.131.2.381 | Gene a ed on 2023-01-16 13:36:23 child (yes = 1, no = 0). Mo he s on pa en al lea e a e assumed o ha e mo e ime o hei child en. Fu he , he ime a mo he can de o e o a child is ex- pec ed o dec ease wi h he numbe o child en (Coleman, 1988). To measu e amily s uc u e and social suppo by he pa ne and by ela i- es, we d aw on he ollowing cha ac e is ics: Fi s , we dis inguish cohabi ing om noncohabi ing mo he s wi h he i em “Does he a he li e in he house- hold?”(yes = 1, no = 0). We iew cohabi ing wi h he child’s a he as an indi- ec indica o o ecei ing suppo om he pa ne in daily childca e. Fo mo- he s ha ing a pa ne , we cap u e he amoun o suppo wi h bo h a quali a i e measu e (how s ongly he mo he eels suppo ed by he pa ne in childca e: e y s ongly/s ongly = 1, no e y/no a all/no pa ne = 0) and a quan i a- i e measu e ( o how many hou s a week a pa ne p o ides childca e: 0–5 hou s = 0, >5 hou s = 1). Addi ionally, mo he s we e asked whe he ela i es such as g andpa en s, olde siblings, o o he ela i es look a e he child on a egula basis. F om his i em, we c ea e a dummy a iable, indica ing whe he kin suppo exceeds 5 hou s a week (= 1) o is less o equal o 5 hou s (= 0). When analyzing he likelihood o pa icipa ion in he p e en i e heal h ca e p og am o child en, we migh un in o he p oblem ha pa icipa ion is pe - haps no only a unc ion o he ac o s and mechanisms spelled ou in ou heo- e ical conside a ions, bu also a unc ion o he ini ial heal h s a us o he child. We assume ha pa icipa ion in he checkup p og am is mo e likely when he child is se iously ill. The e o e we use a bina y indica o o he child’s objec- i e heal h du ing he i s h ee mon hs a e bi h. I he child su e ed om se ious heal h p oblems equi ing a hospi al isi , o i any e a da ions, diso - de s, o disabili ies had been iden i ied, he child heal h indica o equals 1 and o he wise 0. In addi ion, we us a bina y indica o o p egnancy diso de s (mo- he ’s physical and men al heal h in he las hi d o p egnancy). Child’s heal h as well as mo he ’s heal h du ing p egnancy is expec ed o exe di ec e ec s on he u iliza ion o medical checkups o child en. Sociodemog aphics aken in o accoun in he analyses a e mig a ion s a us (whe he he mo he has a di ec o indi ec mig a ion backg ound) and egion (eas s. wes Ge many). Fu he mo e, he ollowing con ol a iables a e inc- luded: age o mo he a bi h (me ic), whe he he p egnancy was planned o no , and sex o child. 4. Resul s We begin ou empi ical analyses by p esen ing bi a ia e associa ions be- ween s anda d socioeconomic indica o s and pa icipa ion in he p e en i e checkup p og am o child en. Figu e 1 shows he well-known posi i e associa- ion wi h ma e nal educa ion le el ( = 0.148, p<0.001): O hose wi h he lowes deg ee, 74.5% pa icipa e in he p e en i e heal h ca e p og am; wi h Social Inequali y in Ea ly Childhood Heal h 385 Schmolle s Jah buch 131 (2011) 2 OPEN ACCESS | Licensed unde | h ps://c ea i ecommons.o g/abou /cclicenses/ DOI h ps://doi.o g/10.3790/schm.131.2.381 | Gene a ed on 2023-01-16 13:36:23 an in e media e deg ee he p opo ion ises o 84.2%; and wi h a high deg ee, o 89.4%. O e all, 84.7% o all mo he s had aken hei child o he la es age- app op ia e p e en i e heal h checkup. In con as , as Figu e 2 shows, he e is no consis en s a is ical associa ion be ween social class and he ou come a i- able. Howe e , p og am pa icipa ion is somewha less likely o child en when he a he is an unskilled o semiskilled manual wo ke o no gain ully employed. In addi ion, Figu e 3 illus a es ha child en wi h a mig a ion back- g ound a e signi ican ly less likely o pa icipa e in a p e en i e heal h checkup (Chi² = 23.1733, p <0.01). Figu e 1: Pa icipa ion in p e en i e heal h checkups o child en depending on ma e nal educa ion Figu e 2: Pa icipa ion in p e en i e heal h checkups o child en depending on pa en s’social class Figu e 3: Pa icipa ion in p e en i e heal h checkups o child en depending on mo he s’mig a ion backg ound We shall now epo he esul s om mul iple logis ic eg ession models on pa icipa ion in p e en i e child heal h checkups (Table 1). The i s model inc- 386 S en Becke and Ka in Ku z Schmolle s Jah buch 131 (2011) 2 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% All Lowes deg ee In e media e deg ee Uni e si y en ance quali ica ion 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Se ice class Non-manual employee Sel -employed pe sons Skilled wo ke Un-/semi-skilled wo ke No employed 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Na i e Mig an OPEN ACCESS | Licensed unde | h ps://c ea i ecommons.o g/abou /cclicenses/ DOI h ps://doi.o g/10.3790/schm.131.2.381 | Gene a ed on 2023-01-16 13:36:23 ludes mo he ’s educa ional le el and mig a ion s a us as cen al socios uc u al a iables while addi ionally con olling o age and sex o child, yea o child’s bi h, age o mo he a child’s bi h, and eas /wes Ge man o igin.3We le ou social class because i is no longe ele an o p edic ing pa icipa ion in he p e en i e heal h ca e p og am a e con olling o educa ion (model no shown). Model 2 adds a iables on he mo he ’s coping compe encies, indica- o s o ime cons ain s and social suppo , as well as con ol a iables e e - ing o he child’s and he mo he ’s heal h. The s epwise modeling p ocedu e allows us o examine how a he e ec s o he social s uc u al a iables in Model 1 a e b ough abou by he media ing e ec s o pe sonal and social e- sou ces. The coe icien s p esen ed a e, on he one hand, odds a ios –exp(b i )– and, on he o he hand, y-s anda dized coe icien s –b i . In con as o he odds a ios, he la e coe icien s can be compa ed be ween hie a chical models such as Models 1 and 2 (Winship/Ma e, 1984; Mood, 2009). When conside ing he e ec s o educa ion (Model 1), we again ind child- en wi h low o medium educa ed mo he s o be less likely o pa icipa e in he heal h p og am compa ed o hose wi h highly educa ed mo he s. Besides his amilia esul , mig a ion backg ound ma e s (p<0.01). Ha ing a di ec o indi ec mig a ion backg ound esul s in a mo e han 50% educed pa ici- pa ion chance –ne o he e ec o educa ion, which means ha he lowe pa icipa ion p obabili y is no mainly due o educa ional di e ences be ween na i es and mig an s. The inding is in line wi h ecen esea ch iden i ying e hnic o igin as an impo an p edic o o pa icipa ion in he p e en i e child heal h p og am (S ich e al., 2009; Kam siu is e al, 2007). Fu he mo e, Mo- del 1 shows he well-es ablished esul ha he olde child en a e, he less likely i is ha hey will pa icipa e in he heal h check p og am (Lampe e al., 2010). Compa ing he y-s anda dized coe icien s o educa ion and mig a ion back- g ound be ween Models 1 and 2 e eals only mino changes. Thus, we con- clude ha nei he he mo he ’s social capi al no o he ma e nal esou ces, such as compe encies in coping wi h he mo he ole o he mo he ’s ime esou ces, can explain he a he lowe heal h p og am pa icipa ion a es o mo he s wi h a low educa ional le el o wi h a mig a ion backg ound. In addi ion, Model 2 indica es ha mo he s who a e be e able o cope wi h hei new ma e nal asks and demands a e mo e likely o use he p e en i e heal h checkups. Howe e , he e ec is only signi ican a he 10 pe cen le el. In con as , he less di ec indica o o coping compe encies, sa is ac ion wi h he ole o a mo he , does no seem o be ele an . Following Coleman (1988), we p edic ed highe pa icipa ion chances o child en whose mo he s spend mo e ime a home and who do no ha e many siblings o compe e wi h o Social Inequali y in Ea ly Childhood Heal h 387 Schmolle s Jah buch 131 (2011) 2 3No all coe icien s o he con ol a iables a e included in he able. OPEN ACCESS | Licensed unde | h ps://c ea i ecommons.o g/abou /cclicenses/ DOI h ps://doi.o g/10.3790/schm.131.2.381 | Gene a ed on 2023-01-16 13:36:23 Table 1 Logis ic Reg ession Models P edic ing he P obabili y o Pa icipa ing in P e en i e Checkups o Child en Model 1 Model 2 Exp(b) BS dYExp(b) BS dY Socios uc u al cha ac e is ics Mo he ’s educa ion (Re .: uni e si y en ance quali ica ion) Lowes deg ee 0.401 ** -0.476 0.414 ** -0.439 In e media e deg ee 0.597 *-0.268 0.591 *-0.262 Mo he ’s mig a ion s a us (Re .: na i e) Di ec o indi ec mig a ion backg ound 0.454 ** -0.411 0.470 ** -0.376 Age (child) 0.935 ** -0.035 0.940 *-0.031 Yea o bi h (child) 1.110 0.054 1.093 0.044 Coping compe encies and ime cons ain s Di icul ies coping wi h mo he hood 0.705 -0.174 Sa is ac ion wi h mo he ole 1.057 0.028 Ha ing mo e han one child 1.049 0.024 On ma e nal lea e 1.582 *0.228 Family s uc u e and social suppo Single mo he 0.524 *-0.322 S ong eeling o suppo h ough pa ne ’s childca e 0.958 -0.021 Childca e om pa ne (> 5 hou s pe week) 0.778 -0.125 Childca e om ela i es (> 5 hou s pe week) 0.678 *-0.194 Heal h- ela ed issues Child in poo heal h 2.041 *0.355 Mo he wi h e y good heal h in las hi d o p egnancy 1.747 *0.278 Cons an 22.910 ** 23.675 ** Pseudo R²0.06 0.10 Chi² 56.0 ** 94.1 ** Obse a ions 1028 1028 No e: Models 1 and 2 also con ol o sex o child, age o mo he a bi h o child, and eas /wes Ge man o igin; Model 2 addi ionally con ols whe he he p egnancy was planned o no . None o he con ol a iables exe s a signi ican e ec . Signi icance le el: **p< 0.01; *p< 0.05; p< 0.1. Sou ce: SOEP 2003–2008. hei mo he ’s ime. As expec ed, he coe icien o he mo he being on pa en- al lea e is posi i e and signi ican a he 5 pe cen le el. Howe e , he e is no signi ican e ec o he numbe o siblings. Thus, sha ed pa en al a en ion does no seem o ha e a nega i e in luence on he likelihood ha a child will ake pa in he ea ly examina ions o he p e en i e heal h p og am. In con- as , o he s udies ind child en wi h olde siblings o be mo e likely o miss 388 S en Becke and Ka in Ku z Schmolle s Jah buch 131 (2011) 2 OPEN ACCESS | Licensed unde | h ps://c ea i ecommons.o g/abou /cclicenses/ DOI h ps://doi.o g/10.3790/schm.131.2.381 | Gene a ed on 2023-01-16 13:36:23