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

Untangling the relationship between negative illness perceptions and worse quality of life in patients with advanced cancer:A study from the population-based PROFILES registry

Purpose Quality of life (QoL) is an important yet complex outcome of care in patients with advanced cancer. QoL is associated with physical and psychosocial symptoms and with patients’ illness perceptions (IPs). IPs are modifiable cognitive constructs developed to make sense of one’s illness. It is unclear how IPs influence patients’ QoL. A better understanding of this relationship can inform and direct high quality care aimed at improving patients’ QoL. We therefore investigated the mediating role of anxiety and depression in the association of IPs with QoL. Methods Data from 377 patients with advanced cancer were used from the PROFILES registry. Patients completed measures on IPs (BIPQ), QoL (EORTC QLQ-C30), and symptoms of anxiety and depression (HADS). Mediation analyses were conducted to decompose the total effect of IPs on QoL into a direct effect and indirect effect. Results All IPs but one (“Comprehensibility”) were negatively associated with QoL (p<0.001); patients with more negative IPs tended to have worse QoL. The effect was strongest for patients who felt that their illness affected their life more severely (“Consequences”), patients who were more concerned about their illness (“Concern”), and patients who thought that their illness strongly affected them emotionally (“Emotions”). Anxiety mediated 41–87% and depression mediated 39–69% of the total effect of patients’ IPs on QoL. Conclusion Negative IPs are associated with worse QoL. Anxiety and depression mediate this association. Targeting symptoms of anxiety and depression, through the modification of IPs, has the potential to improve QoL of patients with advanced cancer

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

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

Does cultural capital contribute to educational inequalities in food consumption in the Netherlands?

BACKGROUND: The importance of culture for food consumption is widely acknowledged, as well as the fact that culture-based resources ("cultural capital") differ between educational groups. Since current explanations for educational inequalities in healthy and unhealthy food consumption (e.g. economic capital, social capital) are unable to fully explain this gradient, we aim to investigate a new explanation for educational inequalities in healthy food consumption, i.e. the role of cultural capital. METHODS: Data were obtained cross-sectionally by a postal survey among participants of the GLOBE study in the Netherlands in 2011 (N = 2953; response 67.1%). The survey measured respondents' highest attained educational level, food-related cultural capital (institutionalised, objectivised and incorporated cultural capital), economic capital (e.g. home ownership, financial strain), social capital (e.g. social support, health-related social leverage, interpersonal relationships), and frequency of consumption of healthy and unhealthy food products. Two general outcomes (overall healthy food consumption, and overall unhealthy food consumption), and seven specific food consumption outcomes were constructed, and prevalence ratios (PR) were estimated in Poisson regression models with robust variance. RESULTS: Cultural capital was significantly associated with all food outcomes, also when social and economic capital were taken into account. Those with low levels of cultural capital were more likely to have a lower overall healthy food consumption (PR 1.35, 95% CI 1.22-1.49), a lower consumption of whole wheat bread (PR 1.21, 95% CI 1.05-1.38), vegetables (PR 1.55, 95% CI 1.40-1.71), and meat-substitutes and fish (PR 1.74, 95% CI 1.53-1.97), and a higher consumption of fried food (PR 1.59, 95% CI 1.31-1.93). Social capital was positively associated with overall healthy food consumption, whole wheat bread consumption, and the consumption of fish and meat-substitutes, and economic capital with none of the outcomes. The PR of the lowest educational group to have a low overall healthy food consumption decreased from 1.48 (95% CI 1.28-1.73) to 1.22 (95% CI 1.04-1.43) when cultural, social and economic capital were taken into account. CONCLUSI

Longitudinal effects of urban green space on walking and cycling: A fixed effects analysis

This study examined whether changes in green space within the living environment were associated with changes in walking and cycling frequencies in a cohort of 3,220 Dutch adults between 2004, 2011 and 2014. Data on self-reported weekly time spent walking and cycling for active commute and leisure were linked to geographic information system (GIS) measures of total green areas within 1000 m buffer zones around each participant's home address, and distance to the nearest green space. First, cross-sectional linear regression models showed no statistically significant associations between green space measures and walking and cycling. Second, fixed effects (FE) models were used to analyze whether changes in green space were associated with changes in walking and cycling, using longitudinal data from respondents who did not relocate over time. As distance to the nearest green area increased by 100 m, individuals spent 22.76 fewer (95% CI: −39.92, −5.60) minutes walking for leisure per week and 3.21 more (95% CI: 0.46, 5.96) minutes walking for active commute. Changes in distance to green space were not significantly related to changes in cycling measures. No clear associations between changes i

How does bridging social capital relate to health-behavior, overweight and obesity among low and high educated groups? A cross-sectional analysis of GLOBE-2014

Background: Social capital is an important determinant of health, but how specific sub-dimensions of social capital affect health and health-related behaviors is still unknown. To better understand its role for health inequalities, it is important to distinguish between bonding social capital (connections between homogenous network members; e.g. similar educational level) and bridging social capital (connections between heterogeneous network members). In this study, we test the hypotheses that, 1) among low educational groups, bridging social capital is positively associated with health-behavior, and negatively associated with overweight and obesity, and 2) among high educational groups, bridging social capital is negatively associated with health-behavior, and positively with overweight and obesity. Methods: Cross-sectional data on educational level, health-behavior, overweight and obesity from participants (25-75 years; Eindhoven, the Netherlands) of the 2014-survey of the GLOBE study were used (N = 2702). Social capital ("How