Socioeconomic Inequalities in Health: A Life-Course Perspective on Social Stratification, Cultural Capital and Health-Related Behaviors

The ultimate aim of this thesis is to explore the importance of cultural capital in the understanding of socioeconomic inequalities in health-related behaviors. This is accomplished by a stepwise approach in which the importance of social stratification, health-related behaviors, early-life environment and cultural capital in the distribution of health is successively explored. The first part examines the relationship between socioeconomic position and mortality, and the contribution of health-related behaviors to socioeconomic inequalities in mortality. The second part investigates whether earlylife environments have long lasting effects on health and health-related behaviors of adults. The third part explores whether cultural capital contributes to socioeconomic inequalities in health-related behaviors. And finally, the fourth part explores potential pathways in the relationship between cultural capital and health-related behaviors

Sugar tax and product reformulation proposals reduce the perceived legitimacy of health-promotion institutions:a randomized population-based survey experiment

Background Structural nutrition interventions like a sugar tax or a product reformulation are strongly supported among the public health community but may cause a considerable backlash (e.g. inspiring aversion to institutions initiating the interventions among citizens). Such a backlash potentially undermines future health-promotion strategies. This study aims to uncover whether such backlash exists.Methods We fielded a pre-registered randomized, population-based survey experiment among adults from the Longitudinal Internet Studies for the Social Sciences panel (n = 1765; based on a random sampling of the Dutch population register). Participants were randomly allocated to the control condition (brief facts about health-information provision/nudging), or one of two experimental groups (the same facts, expanded with either a proposed sugar tax on or reformulation of sugar-sweetened beverages). Ordinary least squares regression was used to estimate the proposed interventions' effects on four outcome variables: trust in health-promotion institutions involved; perceptions that these institutions have citizens' well-being in mind (i.e. benevolence); perceptions that these institutions' perspectives are similar to those of citizens (i.e. alignment of perspectives); and attitudes toward nutrition information.Results Trust, perceived benevolence and perceived alignment of perspectives were affected negatively by a proposed sugar tax (-0.24, 95% CI -0.38 to -0.10; -0.15, -0.29 to -0.01; -0.15, -0.30 to 0.00) or product reformulation (-0.32, -0.46 to -0.18; -0.24, -0.37 to -0.11; -0.18, 0.33 to -0.03), particularly among the non-tertiary educated respondents.Conclusions Sugar taxes or product reformulations may delegitimize health-promotion institutions, potentially causing public distancing from or opposition to these bodies. This may be exploited by political and commercial parties to undermine official institutions.Trial registration https://osf.io/qr9jy/?view_only=5e2e875a1fc348f3b28115b7a3fdfd90. Registered 3 February 2022

Receptive to an authoritative voice? Experimental evidence on how patronizing language and stressing institutional sources affect public receptivity to nutrition information

Common strategies to make official nutrition information more persuasive include highlighting its institutional sources and using simple and direct language. However, such strategies may be counterproductive, as institutions are no longer self-evidently deemed to be legitimate in contemporary societies and such language can be viewed as patronizing. Our preregistered, population-based survey experiment fielded among a high-quality Dutch probability sample in February 2022 (n = 1947) 1) examines whether these dominant strategies hold up when tested against suggestions of psychological reactance and source derogation, and 2) scrutinizes if such responses are stronger among less-educated citizens. Our experiment mirrored real-life examples of health-information campaigns concerning healthy and unhealthy beverages, with data collected on seven outcome measures to discern receptivity toward the information and its sources. We found that just highlighting institutional sources in the information did not lead to it being perceived more negatively. This was also the case when the language used could be perceived as patronizing, with reactance only present for one outcome measure. Moreover, while less-educated citizens were generally less receptive to nutrition information (six of seven outcome measures), versions that could possibly be perceived as patronizing or/and highlighted institutional sources did not make them less receptive systematically. Importantly, therefore, while our results show that the dominant health-communication strategies do not increase receptivity either, their use will probably not have a negative effect on the general public and so do not need to be discarded

Relaties van de fysieke omgeving met leefstijl, redzaamheid en sociale verbindingen

Onderzoeknaar de rol van de leefomgeving voor gezondheid en leefstijl is een relatief jong onderzoeksterrein. Ondanks een exponentiele toename in het aantal studies op dit terrein in de laatste twee decennia bestaat er

Urban population density and mortality in a compact Dutch city

We investigated the association and underlying pathways between urban population density and mortality in a compact mid-sized university city in the Netherlands. Baseline data from the GLOBE cohort study (N = 10,120 residents of Eindhoven) were linked to mortality after 23 years of follow up and analyzed in multilevel models. Higher population density was modestly related to increased mortality, independently of baseline socioeconomic position and health. Higher population density was related to more active transport, more perceived urban stress and smoking. Increased active transport suppressed the mortality-increasing impact of higher population density. Overall, in dense cities with good infrastructure for walking and cycling, high population density may negatively impact mortality

The role of the built environment in explaining educational inequalities in walking and cycling among adults in the Netherlands

Background: This study examined whether characteristics of the residential built environment (i.e. population density, level of mixed land use, connectivity, accessibility of facilities, accessibility of green) contributed to educational inequalities in walking and cycling among adults. Methods: Data from participants (32-82 years) of the 2011 survey of the Dutch population-based GLOBE study were used (N = 2375). Highest attained educational level (independent variable) and walking for transport, cycling for transport, walking in leisure time and cycling in leisure time (dependent variables) were self-reported in the survey. GIS-systems were used to obtain spatial data on residential built environment characteristics. A four-step mediation-based analysis with log-linear regression models was used to examine to contribution of the residential built environment to educational inequalities in walking and cycling. Results: As compared to the lowest educational group, the highest educational group was more likely to cycle for transport (RR 1.13, 95% CI 1.04-1.23), walk in leisure time (RR 1.12, 95% CI 1.04-1.21), and cycle in leisure time (RR 1.12, 95% CI 1.03-1.22). Objective built environment characteristics were related to these outcomes, but contributed minimally to educational inequalities in walking and cycling. On the other hand, compared to the lowest educational group, the highest educational group was less likely to walk for transport (RR 0.91, 95% CI 0.82-1.01), which could partly be attributed to differences in the built environment. Conclusion: This study found that objective built environment characteristics contributed minimally to educational inequalities in walking and cycling in the Netherlands