97 research outputs found
Socioeconomic differences in health related behaviour
Health related behaviours are an important determinant of health and part of the causal
explanation for socioeconomic differences in morbidity and mortality. The fact is that a
lower socioeconomic status is generally associated with higher rates of health damaging
behaviour, such as smoking or poor diet and lower rates of health promoting activities,
like physical activity. Socioeconomic differences in unhealthy lifestyles already appear
during adolescence and also tend to grow during adulthood, because people from lower
socioeconomic groups more often make unhealthy behavioural choice
Neighborhood characteristics as determinants of healthcare utilization – a theoretical model
Background: We propose using neighborhood characteristics as demand-related morbidity adjusters to improve prediction models such as the risk equalization model.
Results: Since the neighborhood has no explicit ‘place’ in healthcare demand models, we have developed the “Neighborhood and healthcare utilization model” to show how neighborhoods matter in healthcare utilization. Neighborhood may affect healthcare utilization via (1) the supply-side, (2) need, and (3) demand for healthcare – irrespective of need. Three pathways are examined in detail to explain how neighborhood characteristics influence healthcare utilization via need: the physiological, psychological and behavioral pathways. We underpin this theoretical model with literature on all relevant neighborhood characteristics relating to health and healthcare utilization.
Conclusion: Potential neighborhood characteristics for the risk equalization model include the degree of urbanization, public and open space, resources and facilities, green and blue space, environmental noise, air pollution, social capital, crime and violence, socioeconomic status, stability, and ethnic composition. Air pollution has already been successfully tested as an important predictive variable in a healthcare risk equalization model, and it might be opportune to add more neighborhood characteristics
Occupational level of the father and alcohol consumption during adolescence; patterns and predictors
STUDY OBJECTIVE: This paper describes and attempts to explain the
association between occupational level of the father and high alcohol
consumption among a cohort of New Zealand adolescents from age 11 to 21.
DESIGN: Data were obtained from the longitudinal Dunedin multidisciplinary
health and development study. At each measurement wave, those who then
belonged to the quartile that reported the highest usual amount of alcohol
consumed on a typical drinking occasion were categorised as high alcohol
consumers. Potential predictors of high alcohol consumption included
environmental factors, individual factors, and educational achievement
measured at age 9, 11, or 13. Longitudinal logistic GEE analyses described
and explained the relation between father's occupation and adolescent
alcohol consumption. SETTING: Dunedin, New Zealand. PARTICIPANTS: About
1000 children were followed up from birth in 1972 until adulthood. MAIN
RESULTS: A significant association between fathers' occupation and
adolescent alcohol consumption emerged at age 15. Overall adolescents from
the lowest occupational group had almost twice the odds of being a large
consumer than the highest occupational group. The association between
father's occupation and high alcohol consumption during adolescence was
explained by the higher prevalence of familial alcohol problems and
friends approving of alcohol consumption, lower intelligence scores, and
lower parental attachment among adolescents from lower occupational
groups. CONCLUSIONS: Socioeconomic background affects adolescent alcohol
consumption substantially. This probably contributes to cumulation of
disadvantage. Prevention programmes should focus on adolescents from lower
socioeconomic groups and make healthier choices the easier choices by
means of environmental change
Community social capital and suicide mortality in the Netherlands: A cross-sectional registry-based study
Background: Evidence on the effect of community social capital on suicide mortality rates is fragmentary and inconsistent. The present study aims to determine whether geographic variations in suicide mortality across the Netherlands were associated with community social capital. Methods. We included 3507 neighbourhoods with 6207 suicide deaths in the period 1995-2000. For each neighbourhood, we measured perceived social capital using information from interview surveys, and we measured structural aspects of social capital using population registers. Associations with mortality were determined using Poisson regression analysis with control for confounders at individual level (age, sex, marit
What Moves Them? Active Transport among Inhabitants of Dutch Deprived Districts
Background. Active modes of transport like walking and cycling have been shown to be valuable contributions to daily physical activity. The current study investigates associations between personal and neighbourhood environmental characteristics and active transport among inhabitants of Dutch deprived districts. Method. Questionnaires about health, neighbourhoods, and physical activity behaviour were completed by 742 adults. Data was analysed by means of multivariate linear regression analyses. Results. Being younger, female, and migrant and having a normal weight were associated with more walking for active transport. Being younger, male, and native Dutch and having a normal weight were associated with more cycling for active transport. Neighbourhood characteristics were generally not correlated with active transport. Stratified analyses, based on significant person-environment interactions, showed that migrants and women walked more when cars did not exceed maximum speed in nearby streets and that younger people walked more when speed of traffic in nearby streets was perceived as low. Among migrants, more cycling was associated with the perceived attractiveness of the neighbourhood surroundings. Discussion and Conclusion. Results indicated that among inhabitants of Dutch deprived districts, personal characteristics were associated with active transport, whereas neighbourhood environmental characteristics were generally not associated with active transport. Nevertheless, interaction effects showed differences among subgroups that should be considered in intervention development
Do inhabitants profit from integrating a public health focus in urban renewal programmes?:A Dutch case study
Background Urban renewal traditionally involves policy sectors such as housing, transport, and employment, which potentially can enhance the health of residents living in deprived areas. Additional involvement of the public health sector might increase the health impact of these urban renewal activities. This study evaluates the health impact of an additional focus on health, under the heading of Healthy District Experiments (HDE), within districts where an urban renewal programme was carried out. Methods We evaluated changes in health outcomes before the start of the HDE and after implementation, and compared these changes with health changes in control areas, e.g. districts from the urban renewal programme where no additional HDE was implemented. Additionally, we gathered information on the content of the experiments to determine what types of activities have been implemented. Results The additional activities from the HDE were mostly aimed at strengthening the health care in the districts and at promoting physical activity. When we compared the prevalence in general health, mental health, overweight, obesity, smoking, and physical activity during the study period between the HDE districts and control districts, we found no significant differences in the rate of change. The study is limited by a small sample size and the cross-sectional nature of the data. These and other limitations are discussed. Conclusion We found no evidence for a beneficial health impact of the activities that were initiated with a specific focus on health, within a Dutch urban renewal programme. Specific attention for network management and the integration of such activities in the wider programme, as well as an allocated budget might be needed in order to sort a health impact
Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study
Quantifying the impact of different modifiable behavioral and biological risk factors on socioeconomic disparities in coronary heart disease (CHD) may help inform targeted, population-specific strategies to reduce the unequal distribution of the disease. Previous studies have used analytic approaches that limit our ability to disentangle the relative contributions of these risk factors to CHD disparities. The goal of this study was to assess mediation of the effect of low education on incident CHD by multiple risk factors simultaneously. Analyses are based on 15,067 participants of the Dutch Monitoring Project on Risk Factors for Chronic Diseases aged 20–65 years examined 1994–1997 and followed for events until January 1, 2008. Path analysis was used to quantify and test mediation of the low education-CHD association by behavioral (current cigarette smoking, heavy alcohol use, poor diet, and physical inactivity) and biological (obesity, hypertension, diabetes, and hypercholesterolemia) risk factors. Behavioral and biological risk factors accounted for 56.6% (95% CI: 42.6%–70.8%) of the low education-incident CHD association. Smoking was the strongest mediator, accounting for 27.3% (95% CI: 17.7%–37.4%) of the association, followed by obesity (10.2%; 95% CI: 4.5%–16.1%), physical inactivity (6.3%; 95% CI: 2.7%–10.0%), and hypertension (5.3%; 95% CI: 2.8%–8.0%). In summary, in a Dutch cohort, the majority of the relationship between low education and incident CHD was mediated by traditional behavioral and biological risk factors. Addressing barriers to smoking cessation, blood pressure and weight management, and physical activity may be the most effective approaches to eliminating socioeconomic inequalities in CHD
Does the Health Impact of Exposure to Neighbourhood Green Space Differ between Population Groups? An Explorative Study in Four European Cities
It has been suggested that certain residents, such as those with
a low socioeconomic status, the elderly, and women, may benefit
more from the presence of neighbourhood green space than others.
We tested this hypothesis for age, gender, educational level,
and employment status in four European cities. Data were
collected in Barcelona (Spain; n = 1002), Kaunas (Lithuania; n =
989), Doetinchem (The Netherlands; n = 847), and Stoke-on-Trent
(UK; n = 933) as part of the EU-funded PHENOTYPE project.
Surveys were used to measure mental and general health,
individual characteristics, and perceived neighbourhood green
space. Additionally, we used audit data about neighbourhood
green space. In Barcelona, there were positive associations
between neighbourhood green space and general health among
low-educated residents. In the other cities and for the other
population groups, there was little evidence that the
association between health and neighbourhood green space
differed between population groups. Overall, our study does not
support the assumption that the elderly, women, and residents
who are not employed full-time benefit more from neighbourhood
green space than others. Only in the highly urbanised city of
Barcelona did the low-educated group benefit from neighbourhood
green spaces. Perhaps neighbourhood green spaces are more
important for the health of low-educated residents in
particularly highly urbanised areas
Urban densification in the Netherlands and its impact on mental health:An expert-based causal loop diagram
Urban densification is a key strategy to accommodate rapid urban population growth, but emerging evidence suggests serious risks of urban densification for individuals’ mental health. To better understand the complex pathways from urban densification to mental health, we integrated interdisciplinary expert knowledge in a causal loop diagram via group model building techniques. Six subsystems were identified: five subsystems describing mechanisms on how changes in the urban system caused by urban densification may impact mental health, and one showing how changes in mental health may alter urban densification. The new insights can help to develop resilient, healthier cities for all.</p
Urban densification in the Netherlands and its impact on mental health:An expert-based causal loop diagram
Urban densification is a key strategy to accommodate rapid urban population growth, but emerging evidence suggests serious risks of urban densification for individuals’ mental health. To better understand the complex pathways from urban densification to mental health, we integrated interdisciplinary expert knowledge in a causal loop diagram via group model building techniques. Six subsystems were identified: five subsystems describing mechanisms on how changes in the urban system caused by urban densification may impact mental health, and one showing how changes in mental health may alter urban densification. The new insights can help to develop resilient, healthier cities for all.</p
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