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Sarah Negash,1 Johannes Horn,1 Eileen Heumann,2 Christiane Stock,2 Hajo Zeeb,3,4 Claudia R Pischke,5 Paula M Matos Fialho,5 Stefanie M Helmer,6 Yasemin Niephaus,7 Rafael Mikolajczyk1 1Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; 2Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, Berlin, Germany; 3Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany; 4Health Sciences Bremen, University of Bremen, Bremen, Germany; 5Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany; 6Institute of Public Health and Nursing Research, Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany; 7Department of Social Sciences, University of Siegen, Siegen, GermanyCorrespondence: Rafael Mikolajczyk, Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, Halle (Saale), 06112, Germany, Email rafael.mikolajczyk@uk-halle.deBackground: The COVID-19 pandemic has had a major impact on students’ financial situation as well as on their mental health.Aim: To examine the reported change in the financial situation of German university students before and across two time points of the COVID-19 pandemic and to evaluate its associations with anxiety and depressive symptoms.Methods: We used data from the cross-sectional COVID-19 German Student Well-being Study conducted at five German universities (N = 7203). Linear regression models were used to analyze associations between a reported change in financial situation and anxiety and depressive symptoms.Results: Twenty-eight percent of the participants reported to have a worsened financial situation at the time of the survey compared to the time prior to the pandemic. A worsened financial situation at the time of the survey as compared to prior to the pandemic was associated with higher levels of anxiety and depressive symptoms reported in all three depression and anxiety scales [a 1.46 point increase on the CES-D 8 scale (95% confidence interval (CI): 1.19; 1.73), a 0.37-point increase in PHQ-2 (95% CI: 0.28; 0.46), and a 0.45-point increase in GAD-2 (95% CI: 0.35; 0.55)]. An improved financial situation, on the other hand, was associated with lower levels of anxiety and depressive symptoms. As for the second change, comparing the current financial situation with the situation during the first wave of the pandemic, the associations with anxiety and depressive symptoms were broadly similar.Conclusion: Our findings suggest that students are a vulnerable population in need of mental and financial support during times of crisis. Future research is needed to obtain insights into potential long-term effects of the pandemic on students’ mental health.Keywords: higher education, pandemic, financial situation, mental health, students’ well-being

Malte Braitmaier,1 Bianca Kollhorst,1 Miriam Heinig,2 Ingo Langner,2 Jonas Czwikla,3 Franziska Heinze,3 Laura Buschmann,4 Heike Minnerup,4 Xabiér García-Albéniz,5,6 Hans-Werner Hense,4 André Karch,4 Hajo Zeeb,7,8 Ulrike Haug,2,8 Vanessa Didelez1,9 1Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 2Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 3SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany; 4Institute for Epidemiology and Social Medicine, Faculty of Medicine, Westfälische Wilhelms University of Münster, Münster, Germany; 5Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; 6RTI Health Solutions, Barcelona, Spain; 7Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 8Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany; 9Faculty of Mathematics and Computer Science, University of Bremen, Bremen, GermanyCorrespondence: Vanessa Didelez, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Department of Biometry and Data Management, Achterstraße 30, Bremen, 28359, Germany, Tel +49-421-56939, Fax +49-421-56941, Email didelez@leibniz-bips.deBackground: The efficacy of mammography screening in reducing breast cancer mortality has been demonstrated in randomized trials. However, treatment options - and hence prognosis – for advanced tumor stages as well as mammography techniques have considerably improved since completion of these trials. Consequently, the effectiveness of mammography screening under current conditions is unclear and controversial. The German mammography screening program (MSP), an organized population-based screening program, was gradually introduced between 2005 and 2008 and achieved nation-wide coverage in 2009.Objective: We describe in detail a study protocol for investigating the effectiveness of the German MSP in reducing breast cancer mortality in women aged 50 to 69 years based on health claims data. Specifically, the proposed study aims at estimating per-protocol effects of several screening strategies on cumulative breast cancer mortality. The first analysis will be conducted once 10-year follow-up data are available.Methods and Analysis: We will use claims data from five statutory health insurance providers in Germany, covering approximately 37.6 million individuals. To estimate the effectiveness of the MSP, hypothetical target trials will be emulated across time, an approach that has been demonstrated to minimize design-related biases. Specifically, the primary contrast will be in terms of the cumulative breast cancer mortality comparing the screening strategies of “never screen” versus “regular screening as intended by the MSP”.Ethics and Dissemination: In Germany, the utilization of data from health insurances for scientific research is regulated by the Code of Social Law. All involved health insurance providers as well as the responsible authorities approved the use of the health claims data for this study. The Ethics Committee of the University of Bremen determined that studies based on claims data are exempt from institutional review. The findings of the proposed study will be published in peer-reviewed journals.Keywords: emulated target trial, cancer screening, effectiveness, claims data, mammography