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

The role of smoking in social networks on smoking cessation and relapse among adults: A longitudinal study

Understanding the spread of smoking cessation and relapse within social networks may offer new approaches to further curb the smoking epidemic. Whether smoking behavior among social network members determines smoking cessation and relapse of adults however, is less known. For this study, longitudinal data of 4623 adults participating in the Dutch Longitudinal Internet Studies for the Social sciences (LISS) panel were collected in March 2013 with a follow-up in 2014. Logistic regression was used to examine the association between the proportion of smokers in social networks, and (1) smoking cessation (n = 762) and (2) smoking relapse (n = 1905). Analyses were adjusted for the size of the network, age, sex, and education. Respondents with the largest proportion of smokers in their social network were less likely to quit smoking (OR = 0.25; 95% CI = 0.11–0.66) and more likely to experience a relapse (6.08; 3.01–12.00). Smoking cessation and relapse were most strongly associated with the proportion of smokers among household members and friends. The proportion of smokers in family outside the household was not related to smoking cessation and smoking relapse. In conclusion, smoking behavior in social networks, especially among household members and friends, is strongly associated with smoking cessation and relapse. These findings further support the spread of smoking within social networks, and provide evidence for network-based interventions, particularly including household members and friends

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

Environmental and cognitive correlates of adolescent breakfast consumption.

OBJECTIVE: This study aimed to identify cognitive and environmental correlates of daily adolescent breakfast consumption. METHODS: Adolescents (n=1089) aged 12-15 years in schools in Rotterdam, The Netherlands, completed a questionnaire measuring daily breakfast consumption, individual cognitions, and home environmental factors during the 2005-2006 school year. Multilevel logistic regression analysis was performed to determine the association between the environmental variables, cognitions and everyday breakfast consumption. Additionally, mediation of the effect of the environmental variables through the individual cognitions on breakfast consumption was explored. RESULTS: Attitude, perceived behavioral control, modeling by friends and parents, and intention were associated with daily breakfast consumption. Political (breakfast rules), physical (available breakfast products), and socio-cultural (having breakfast with a parent, having the evening meal with a parent, eating the evening meal in front of the TV) environments were also associated with daily breakfast consumption. Associations of the environmental factors were partly mediated by the individual cognitions. CONCLUSIONS: Individual cognitions and a supportive home environme

New physical activity spaces in deprived neighborhoods: Does it change outdoor play and sedentary behavior? A natural experiment

Background: We used the introduction of dedicated physical activity (PA) spaces in Rotterdam, the Netherlands, to study the impact of reducing distance to dedicated PA spaces on outdoor play and sedentary behavior, and to evaluate if these effects were similar between population subgroups. Methods: We included 1841 Dutch children from the Generation R Study who participated at two subsequent measurement waves when the children were, on average, 6.0 and 9.7 years old. None of these children lived within 600 m of a dedicated PA space at baseline, and during follow-up 171 children became exposed to 13 new PA spaces within 600 m from home. Individual-level fixed-effects models were used to evaluate changes in distances (determined by Geographical Information Systems (GIS)) from home to the nearest new dedicated PA space, to parent-reported outdoor play and sedentary behavior. Results: The introduction of a dedicated PA space within 600 m from home, and the reduction of the distance per 100 m, did not affect outdoor play or sedentary behaviors. At p < 0.1, significant interaction terms were found between the introduction of the PA spaces and indicators of family socioeconomic position. Although not statistically significant, stratified analyses showed a consistent pattern, suggesting that reducing the distance to the nearest PA space increased outdoor play for children from parents with lower levels of education. However, they also showed a non-significant increase in sedentary behaviors for children from families with net household income below average Dutch income, and for children from a non-Dutch ethnicity. Conclusions: Introducing dedicated PA spaces may be a promising approach to increase outdoor play for children from more socioeconomically disadvantaged families, but larger studies are needed to contribute to the evidence

Socio-economic inequalities in injury incidence in the Netherlands

Background: Interventions to reduce socio-economic inequalities in injury incidence should be tailored to specific priority areas that may be identified by descriptive studies. We aimed to provide an overview of exist

Assessing the impact of natural policy experiments on socioeconomic inequalities in health

Background: The scientific evidence-base for policies to tackle health inequalities is limited. Natural policy experiments (NPE) have drawn increasing attention as a means to evaluating the effects of policies on health. Several analytical methods can be used to evaluate the outcomes of NPEs in terms of average population health, but it is unclear whether they can also be used to assess the outcomes of NPEs in terms of health inequalities. The aim of this study therefore was to assess whether, and to demonstrate how, a number of commonly used analytical methods for the evaluation of NPEs can be applied to quantify the effect of policies on health inequalities. Methods: We identified seven quantitative analytical methods for the evaluation of NPEs: regression adjustment, propensity score matching, difference-in-differences analysis, fixed effects analysis, instrumental variable analysis, regression discontinuity and interrupted time-series. We assessed whether these methods can be used to quantify the effect of policies on the magnitude of health inequalities either by conducting a stratified analysis or by including an interaction term, and illustrated both approaches in a fictitious numerical example. Results: All seven methods can be used to quantify the equity impact of policies on absolute and relative inequalities in health by conducting an analysis stratified by socioeconomic position, and all but one (propensity score matching) can be used to quantify equity impacts by inclusion of an interaction term between socioeconomic position and policy exposure. Conclusion: Methods commonly used in economics and econometrics for the evaluation of NPEs can also be applied to assess the equity impact of policies, and our illustrations provide guidance on how to do this appropriately. The low external validity of results from instrumental variable analysis and regression discontinuity makes these methods less desirable for assessing policy effects on population-level health inequalities. Increased use of the methods in social epidemiology will help to build an evidence base to support policy making in the area of health inequalities

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