Partner’s and own education: does who you live with matter for self-assessed health, smoking and excessive alcohol consumption?

This study analyses the importance of partner status and partner’s education, adjusted for own education, on selfassessed health, smoking and excessive alcohol consumption. The relationship between socio-economic factors and health-related outcomes is traditionally studied from an individual perspective. Recently, applying social–ecological models that include socio-economic factors on various social levels is becoming popular. We argue that partners are an important influence on individual health and health-related behaviour at the household level. Therefore, we include partners in the analysis of educational health inequalities. Using data of almost 40,000 individuals (with almost 15,000 Dutch cohabiting couples), aged 25–74 years, who participated in the Netherlands Health Interview Survey between 1989 and 1996, we test hypotheses on the importance of own and partner’s education. We apply advanced logistic regression models that are especially suitable for studying the relative influence of partners’ education. Controlled for own education, partner’s education is significantly associated with self-assessed health and smoking, for men and women. Accounting for both partners’ education the social gradient in self-assessed health and smoking is steeper than based on own or partner’s education alone. The social gradient in health is underestimated by not considering partner’s education, especially for women.

Environmental Determinants of Fruit and Vegetable Consumption Among Adults: A Systematic Review

The current ecological approach in health behaviour research recognises that health behaviour needs to be understood in a broad environmental context. This has led to an exponential increase in the number of studies on this topic. It is the aim of this systematic review to summarise the existing empirical evidence pertaining to environmental influences on fruit and vegetable (FV) consumption. The environment was defined as ‘all factors external to the individual’. Scientific databases and reference lists of selected papers were systematically searched for observational studies among adults (18–60 years old), published in English between 1 January 1980 and 31 December 2004, with environmental factor(s) as independent factor(s), and fruit intake, vegetable intake or FV intake combined as one outcome measure as dependent factor(s). Findings showed there was a great diversity in the environmental factors studied, but that the number of replicated studies for each determinant was limited. Most evidence was found for household income, as people with lower household incomes consistently had a lower FV consumption. Married people had higher intakes than those who were single, whereas having children showed mixed results. Good local availability (e.g. access to one's own vegetable garden, having low food insecurity) seemed to exert a positive influence on intake. Regarding the development of interventions, improved opportunities for sufficient FV consumption among low-income households are likely to lead to improved intakes. For all other environmental factors, more replicated studies are required to examine their influence on FV intake

Social participation and depression in old age: a fixed-effects analysis in 10 European countries

We examined whether changes in different forms of social participation were associated with changes in depressive symptoms in older Europeans. We used lagged individual fixed effects models based on data from 9,068 individuals aged 50+ in wave 1 (2004/05), wave 2 (2006/07) and wave 4 (2010/11) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Controlling for a wide set of confounders, increased participation in religious organizations predicted a decline in depressive symptoms four years later (β =-0.190 units, 95% confidence interval: -0.365, -0.016), while participation in political/community organizations was associated with an increase in depressive symptoms (β =0.222, 95% confidence interval: 0.018, 0.428). There were no significant differences between European regions in these associations. Our findings suggest that social participation is associated with depressive symptoms, but the direction and strength of the association depends on the type of social activity. Participation in religious organizations may offer benefits to mental health beyond those offered by other forms of social participation

The effects of small-scale physical and social environmental interventions on walking behaviour among Dutch older adults living in deprived neighbourhoods: Results from the quasi-experimental NEW.ROADS study

Purpose: Improving the physical and social conditions of residential neighbourhoods may increase walking, especially among older people. Evidence on the effects of physical and social environmental interventions, and particularly the combination of both, on walking behaviour is scarce. We evaluated the effects of a small-scale physical environmental intervention (designated walking route), a social environmental intervention (neighbourhood walking group) and the combination of both on walking behaviour of older adults living in deprived neighbourhoods. Methods: Survey data of 644 older adults residing in four deprived neighbourhoods of Rotterdam, the Netherlands, were used to compare changes in walking behaviour over time (weekly minutes spent recreational walking, utilitarian walking and total walking) of those exposed to 1) a designated walking route (physical condition), 2) walking groups (social condition), 3) walking routes and walking groups (combined condition), and 4) no intervention (control condition). Measurements took place at baseline (T0), and 3 months (T1) and 9 months (T2) after the intervention. Data were analysed on a multiple imputed dataset, using multi-level negative binomial regression models, adjusting for clustering of observations within individuals. All models were adjusted for demographic covariates. Results: Total time spent walking per week increased between T0 and T1 for all conditions. The Incidence Rate Ratio (IRR) for the physical condition was 1.46 (95% CI:1.06;2.05) and for the social intervention 1.52 (95%CI:1.07;2.16). At T2, these differences remained significant for the physical condition, but not for the social condition and the combined condition. These findings were mirrored for utilitarian walking. No evidence was found for an effect on recreational walking. Conclusion: Implementing small scale, feasible, interventions in a residential neighbourhood may increase total and utilitarian walking behaviour among older adults

Determinants of participation in worksite health promotion programmes: a systematic review

Background The workplace has been identified as a promising setting for health promotion, and many worksite health promotion programmes have been implemented in the past years. Research has mainly focused on the effectiveness of these interventions. For implementation of interventions at a large scale however, information about (determinants of) participation in these programmes is essential. This systematic review investigates initial participation in worksite health promotion programmes, the underlying determinants of participation, and programme characteristics influencing participation levels. Methods Studies on characteristics of participants and non-participants in worksite health promotion programmes aimed at physical activity and/or nutrition published from 1988 to 2007 were identified through a structured search in PubMed and Web of Science. Studies were included if a primary preventive worksite health promotion programme on PA and/or nutrition was described, and if quantitative information was present on determinants of participation. Results In total, 23 studies were included with 10 studies on educational or counselling programmes, 6 fitness centre interventions, and 7 studies examining determinants of participation in multi-component programmes. Participation levels varied from 10% to 64%, with a median of 33% (95% CI 25-42%). In general, female workers had a higher participation than men (OR = 1.67; 95% CI 1.25-2.27]), but this difference was not observed for interventions consisting of access to fitness centre programmes. For the other demographic, health- and work-related characteristics no consistent effect on participation was found. Pooling of studies showed a higher participation level when an incentive was offered, when the programme consisted of multiple components, or when the programme was aimed at multiple behaviours. Conclusions In this systematic review, participation levels in health promotion interventions at the workplace were typically below 50%. Few studies evaluated the influence of health, lifestyle and work-related factors on participation, which hampers the insight in the underlying determinants of initial participation in worksite health promotion. Nevertheless, the present review does provide some strategies that can be adopted in order to increase participation levels. In addition, the review highlights that further insight is essential to develop intervention programmes with the ability to reach many employees, including those who need it most and to increase the generalizability across all workers

The contribution of health behaviors to depression risk across birth cohorts

Background: More recent birth cohorts are at a higher depression risk than cohorts born in the early twentieth century. We aimed to investigate to what extent changes in alcohol consumption, smoking, physical activity and obesity, contribute to these birth cohort variations. Methods: We analyzed panel data from US adults born 1916-1966 enrolled in the Health and Retirement Study (N=163,760 person-years). We performed a counterfactual decomposition analysis by combining age-period-cohort models with g-computation. This allowed us to compare the predicted probability of elevated depressive symptoms (CES-D 8 score ≥3) in the natural course to a counterfactual scenario where all birth cohorts had the health behavior of the 1945 birth cohort. We stratified analyses by sex and race/ethnicity. Results: Depression risk of the 1916-1949 and 1950-1966 birth cohort would be on average 2% (-2.3 to -1.7) and 0.5% (-0.9 to -0.1) higher had they had the alcohol consumption levels of the 1945 cohort. In the counterfactual with the 1945 BMI distribution, depression risk is on average 2.1% (1.8 to 2.4) higher for the 1916-1940 cohorts and 1.8% (-2.2 to -1.5) lower for the 1950-1966 cohorts. We find no cohort variations in depression risk for smoking and physical activity. The contribution of alcohol is more pronounced for Whites than for other race/ethnicity groups, and the contribution of BMI more pronounced for women than for men. Conclusion: Increased obesity levels exacerbated depression risk in recent birth cohorts in the US, while drinking patterns only played a minor role