Eleonore M. Veldhuizen

Assessing Associations between Socio-Economic Environment and Self-Reported Health in Amsterdam Using Bespoke Environments

Background The study of the relationship between residential environment and health at micro area level has a long time been hampered by a lack of micro-scale data. Nowadays data is registered at a much more detailed scale. In combination with Geographic Information System (GIS)-techniques this creates opportunities to look at the relationship at different scales, including very local ones. The study illustrates the use of a ‘bespoke environment’ approach to assess the relationship between health and socio-economic environment. Methods We created these environments by buffer-operations and used micro-scale data on 6-digit postcode level to describe these individually tailored areas around survey respondents in an accurate way. To capture the full extent of area effects we maximized variation in socio-economic characteristics between areas. The area effect was assessed using logistic regression analysis. Results Although the contribution of the socio-economic environment in the explanation of health was not strong it tended to be stronger at a very local level. A positive association was observed only when these factors were measured in buffers smaller than 200 meters. Stronger associations were observed when restricting the analysis to socioeconomically homogeneous buffers. Scale effects proved to be highly important but potential boundary effects seemed not to play an important role. Administrative areas and buffers of comparable sizes came up with comparable area effects. Conclusions This study shows that socio-economic area effects reveal only on a very micro-scale. It underlines the importance of the availability of micro-scale data. Through scaling, bespoke environments add a new dimension to study environment and health.

The impact of extended closing times of alcohol outlets on alcohol‐related injuries in the nightlife areas of Amsterdam: a controlled before‐and‐after evaluation

BACKGROUND AND AIMS The municipality of Amsterdam implemented a new alcohol policy allowing alcohol outlets in two of the five nightlife areas to extend their closing times from 1 April 2009 onwards. We investigated how levels and trends of alcohol-related injuries changed after implementation of this alcohol policy, by comparing areas with extended closing times to those without. DESIGN A controlled before-and-after evaluation to compare changes in alcohol-related injuries between intervention and control areas. SETTING Central district of Amsterdam, The Netherlands. PARTICIPANTS Alcohol-related ambulance attendances for control and intervention areas between 1 April 2006 and 1 April 2009 (respectively, n = 544 and n = 499) and between 1 April 2009 and 1 April 2011 (respectively, n = 357 and n = 480). MEASUREMENTS Alcohol-related injuries were defined as ambulance attendances for people who suffered from direct or indirect consequences of alcohol consumption. Injuries were counted per month in two intervention and three control nightlife areas. We used Poisson regression to assess changes in injuries. FINDINGS After 1 April 2009, intervention areas showed a larger change in the level of alcohol-related injuries than control areas [incidence rate ratio 1.34, 95% confidence interval (CI) = 1.12, 1.61], but trends remained stable in all areas. This increase was only statistically significant for the following subgroups: 2.00-5.59 a.m., weekend days, men, individuals aged 25-34 years, and people transported to a hospital. However, the increase did not differ between subgroups with statistical significance. CONCLUSIONS A 1-hour extension of alcohol outlet closing times in some of Amsterdams nightlife areas was associated with 34% more alcohol-related injuries.

Association between Self-Rated Health and the Ethnic Composition of the Residential Environment of Six Ethnic Groups in Amsterdam

Background: Studies on the association between health and neighborhood ethnic composition yielded inconsistent results, possibly due to methodological limitations. We assessed these associations at different spatial scales and for different measures of ethnic composition. Methods: We obtained health survey data of 4673 respondents of Dutch, Surinamese, Moroccan, Turkish other non-Western and other Western origin. Neighborhood ethnic composition was measured for buffers varying from 50–1000 m. Associations with self-rated health were measured using logistic multilevel regression analysis, with control for socioeconomic position at the individual and area level. Results: Overall ethnic heterogeneity was not related to health for any ethnic group. The presence of other Surinamese was associated with poor self-rated health among Surinamese respondents. The presence of Moroccans or Turks was associated with poor health among some groups. The presence of Dutch was associated with better self-rated health among Surinamese and Turks. In most cases, these associations were stronger at lower spatial scales. We found no other associations. Conclusions: In Amsterdam, self-rated health was not associated with ethnic heterogeneity in general, but may be related to the presence of specific ethnic groups. Policies regarding social and ethnic mixing should pay special attention to the co-residence of groups with problematic interrelations.

Neighbourhood safety and smoking in population subgroups: The HELIUS study

This study examines the associations between neighbourhood safety and three types of smoking behaviour, and whether these associations differ by sex, age, ethnicity and individual-level socio-economic position. Baseline data (2011-2015) from the The HEalthy LIfe in an Urban Setting (HELIUS) study (Amsterdam, the Netherlands) were used. Smoking behaviour was based on self-report. Heavy smoking was defined as smoking ≥10 cigarettes per day. Nicotine dependence was assessed using the Fagerström questionnaire. Geographic Information System techniques were used to construct local residential areas and to examine neighbourhood safety for these areas using micro-scale environmental data. Multilevel logistic regression analyses with 6-digit zip code area as a second level were used to assess the association between neighbourhood safety and smoking. In our study sample of 22,728 participants (18-70 years), 24.0% were current smokers, 13.7% were heavy smokers and 8.1% were nicotine dependent individuals. Higher levels of neighbourhood safety were significantly associated with less heavy smoking (OR = 0.88, 95% CI = 0.78-0.99) and less nicotine dependence (OR = 0.81, 95% CI = 0.69-0.95), but not with less current smoking (OR = 1.01, 95% CI = 0.91-1.11). The associations between neighbourhood safety and the three types of smoking behaviour varied by ethnicity. For instance, higher levels of neighbourhood safety were associated with less current smoking in participants of African Surinamese origin (OR = 0.71, 95% CI = 0.57-0.89), but not in those of Dutch (OR = 1.13, 95% CI = 0.91-1.39), South-Asian Surinamese (OR = 1.22, 95% CI = 0.95-1.55), Turkish (OR = 1.08, 95% CI = 0.84-1.38), Moroccan (OR = 1.53, 95% CI = 1.12-2.10) or Ghanaian (OR = 1.18, 95% CI = 0.47-2.94) origin. Policies that improve neighbourhood safety potentially contribute to less heavy smoking and nicotine dependence.

Visibility of tobacco products and advertisement at the point of sale: a systematic audit of retailers in Amsterdam

Objectives Visibility of tobacco products at the point of sale (PoS), in settings where open display of tobacco is allowed, is one of the last remaining ways in which the tobacco industry can legally promote their products. The aim of this study was to map the visibility of tobacco products and advertisement both inside and outside retailers, among different types of retailers. Setting The study was conducted in two districts in Amsterdam, the Netherlands. Participants All potential tobacco retailers were visited within the districts, and were mapped using Global Positioning System (GPS) coordinates. Intervention Observational data was collected for each tobacco retailer using a checklist with characteristics of the internal and external visibility of tobacco products and advertisement. Retailers were categorised into supermarkets, hospitality industry, tobacconists and ‘other retailers’ (convenience stores, office supply stores, gas stations, drug stores and telephone communication stores). Data were collected in April-May 2017. Results Eighty-two tobacco retailers were identified. Among all retailers, 52.4% had external and 91.5% internal visibility of tobacco products. Tobacconists had the highest level of internal and external visibility of tobacco products (both 100%), followed by ‘other retailers’ (100% and 56% respectively) and supermarkets (79% and 47%, respectively). Retailers in the hospitality industry had low external visibility (28%), but high internal visibility (90%), as 83% sold tobacco through vending machines. Conclusion Visibility of tobacco products was high among all types of retailers, including those previous studies show are commonly visited by youth.

The relationship between ethnic composition of the residential environment and self-reported health among Turks and Moroccans in Amsterdam

BackgroundPrevious studies from the US and UK suggest that neighbourhood ethnic composition is associated with health, positive or negative, depending on the health outcome and ethnic group. We examined the association between neighbourhood ethnic composition and self-reported health in these groups in Amsterdam, and we aimed to explore whether there is spatial variation in this association.MethodsWe used micro-scale data to describe the ethnic composition in buffers around the home location of 2701 Turks and 2661 Moroccans. Multilevel regression analysis was used to assess the association between three measures of ethnic composition (% co-ethnics, % other ethnic group, Herfindahl index) and three measures of self-reported health: self-rated health, Physical and Mental Component Score (PCS, MCS). We adjusted for socioeconomic position at individual and area level. We used geographically weighted regression and spatially stratified regression analyses to explore whether associations differed within Amsterdam.ResultsEthnic heterogeneity and own ethnic density were not related to self-rated health for both ethnic groups. Higher density of Turks was associated with better self-rated health among Moroccans at all buffer sizes, with the most significant relations for small buffers. Higher heterogeneity was associated with lower scores on PCS and MCS among Turks (suggesting worse health). We found spatial variation in the association of the density of the other ethnic group with self-rated health of Moroccans and Turks. We found a positive association for both groups, spatially concentrated in the sub-district Geuzenveld.ConclusionsOur study showed that the association of ethnic composition with self-reported health among Turks and Moroccans in Amsterdam differed between the groups and reveals mainly at small spatial scales. Among both groups, an association of higher density of the other group with better self-rated health was found in a particular part of Amsterdam, which might be explained by the presence of a relatively strong sense of community between the two groups in that area. The study suggests that it is important to pay attention to other-group density, to use area measurements at small spatial scales and to examine the spatial variation in these associations. This may help to identify neighbourhood characteristics contributing to these type of area effects on urban minority health.