H. van de Mheen

Educational differences in leisure-time physical inactivity: a descriptive and explanatory study

In this study we aim to explain educational differences in leisure-time physical inactivity in terms of psychosocial and material factors. Cross-sectional data were obtained from the baseline of the Dutch GLOBE study in 1991, including 2598 men and women, aged 15-74 years. Physical inactivity during leisure time was defined as not participating in any activity, such as sports, gardening, walking or cycling. Psychosocial factors included in the study were coping resources, personality, and stressors. Material factors were financial situation, employment status, and living conditions. Logistic regression models were used to calculate educational differences in physical inactivity. Physical inactivity was more prevalent in lower educational groups. Psychosocial factors related to physical inactivity were locus of control, parochialism, neuroticism, emotional social support, active problem focussing, optimistic and palliative coping styles. Material factors associated with physical inactivity were income, employment status and financial problems. All correlates of physical inactivity were unequally distributed over educational groups, except optimistic and palliative coping. Personality and coping style were the main contributors to the observed educational differences in physical inactivity. That is to say, parochialism, locus of control, neuroticism and active problem focussing explained about half of elevated odds ratios of physical inactivity in the lower educational groups. The material factors, equivalent income and employment status explained about 40% of the elevated odds ratios. Psychosocial and material correlates together reduced the odds ratios of lower educational groups by on average 75%. These results have practical consequences for the design of more effective interventions to promote physical activity. In particular, personality and coping style of risk groups, such as lower educational groups, should be taken into consideration at the future development of these interventions, as well as inequalities in material restrictions related to engaging in physical activity. Supplementary interventions focussing on childhood conditions which, partly, influence both personality and physical inactivity may also contribute to a reduction of socio-economic differences in physical inactivity.

The influence of adult ill health on occupational class mobility and mobility out of and into employment in The Netherlands

In the debate about the explanation of socio-economic health inequalities one of the important issues is the relative importance of health selection. The aim of this study was to investigate to what extent occupational class mobility and mobility out of and into employment are health-related, and in addition, to estimate the contribution of health-related social mobility to socio-economic health differences in the working population. Data were taken from the Longitudinal Study on Socio-Economic Health Differences in the Netherlands, which started in 1991; follow-up data were collected in 1995. The analysis is based on 2533 persons aged 15-59 at baseline. The influence of health problems in 1991 (perceived general health, health complaints and chronic conditions) on changes in occupational class between 1991 and 1995 was negligible. Neither upward nor downward mobility was affected by health problems. However, health problems in 1991 were significantly associated with a higher risk of mobility out of employment and a lower risk of mobility into employment in 1995. For example, for mobility out of employment among persons that reported at least one chronic condition in 1991, the odds ratio was 1.46. Health-related mobility out of employment substantially influences the estimate of socio-economic health inequalities in the working population (measured by current occupation). For manual workers, as compared to non-manual workers, the odds ratio for a less-than-good perceived general health was underestimated by 34% in 1995. Selective mobility into employment overestimates socio-economic inequalities in health in the working population by 9%. Respondents that moved into and out of employment were healthier than those that remained economically inactive, but their health was worse than of those that remained employed (both manual and non-manual). Implications for health policy are that the prospects for people with health problems to stay in paid employment should be improved.

The importance of psychosocial stressors for socio-economic inequalities in perceived health

The uneven distribution of psychosocial stressors as well as their differential health impact have been suggested as a possible explanation for socio-economic inequalities in health. We assessed the importance of both explanations, using data from the baseline of a Dutch longitudinal study. The outcome measure was the prevalence of perceived health problems. Educational level was used as an indicator of socio-economic status, whilst both life-events and long-term difficulties were included as stressors. We controlled for educational differences in neuroticism in order to eliminate any bias which might arise from the fact that people in lower educational groups are more inclined to report both stressors and health problems. The higher exposure to stressors was found to contribute to the increased risk of perceived health problems, even after differences in neuroticism were taken into account. Long-term difficulties, especially those related to material conditions, account for most of the effect. The impact of stress on health was hardly found to be moderated by educational level. The implications for future research are discussed.

Education and the incidence of dementia in a large population-based study: The Rotterdam Study

Article abstract We assessed the risk of dementia by educational level in a prospective population-based study. In the Rotterdam Study, 6,827 nondemented participants with known education level were followed for an average of 2.1 years. During this period, 137 new cases of dementia occurred. Low education was associated with higher dementia risk in women but not in men, suggesting that the association is modified by sex. Our data indicate that cross-sectional studies may overrate the association between education and risk of dementia.

The contribution of intermediary factors to marital status differences in self-reported health

The aim of this study is to estimate the relative contributions of psychosocial conditions, material circumstances, and health behaviors to differences in physical and mental health by marital status. Data on 3,510 Dutch persons who were part of the GLOBE study, aged 25-74 years, are used. Multiple logistic regression models show that never-married, divorced, and widowed men have higher morbidity rates than married men. For women, the health differences are almost solely due to excess morbidity among divorced women. We found that psychosocial conditions contributed most to the explanation of morbidity differences among men (25%-50%), but material circumstances contributed most among women (50%-100%)

The contribution of childhood environment to the explanation of socio-economic inequalities in health in adult life: A retrospective study

In this study the contribution of childhood environment to the explanation of socio-economic inequalities in health in adulthood is examined. Childhood environment was measured using indicators of social, socio-economic and material aspects. Retrospective data obtained from an oral interview, part of the Longitudinal Study on Socio-Economic Health Differences (a longitudinal study in the South East of the Netherlands), were used. Indicators for socio-economic status at adult age were educational and occupational level, whilst health indicators included perceived general health and self-reports of chronic conditions. The percentage reduction in odds ratios of education and occupation after adjustment for childhood environment was used to estimate the contribution of childhood environment. The results suggest that a substantial part of differences in health between educational and occupational groups can be attributed to differences in childhood environment. Educational level of the mother, occupation of the father and financial situation of the family are the most important childhood characteristics in the explanation of socio-economic health differences in adult life. Different mechanisms of explanation concerning the contribution of childhood environment to socio-economic differences in adult life are discussed.

Education and nutrient intake in Dutch elderly people. The Rotterdam Study.

Objective: Unfavourable dietary habits might explain a part of the increased cardiovascular morbidity and mortality among the lower socioeconomic groups. The aim of the study was to describe differences in dietary intake in older subjects by socioeconomic status, as indicated by educational level.Design: A cross-sectional analysis of socioeconomic status in relation to dietary intake.Setting: The Rotterdam Study.Subjects: 2213 men and 3193 women, aged 55 y and over living between 1990 and 1993 in a district of Rotterdam, The Netherlands.Methods: Dietary data were assessed with a semiquantitative food frequency questionnaire, containing 170 food items in 13 food groups.Results: In general, the dietary differences between socioeconomic groups were small. Lower educated subjects had a higher intake of almost all macronutrients compared with higher educated subjects. The total energy intake of men/women with the lowest educational level differed from those with the highest education in the following respect: 9.60/7.54 vs 8.94/7.17 MJ/day. Furthermore, fat composition was more adverse in the lower educated strata; in lower educated subjects, relatively more energy was derived from saturated fat (14.5/14.6 vs 13.8/13.8 energy%), the ratio of polyunsaturated saturated fat was lower (for men: 0.50 vs 0.55) and the intake of cholesterol higher (271/220 vs 240/204 mg/day). These differences could be explained by a higher intake of visible fat (46/37 vs 44/34 g/day) and more meat consumption (130/100 vs 116/86 g/day). In addition, the composition of these products differed: the higher educated used relatively more lean meat and low-fat milk products. Furthermore, the intake of fibre was lower among the lower educated (1.88/2.17 vs 2.03/2.29 g/MJ). Among lower educated groups there were more abstainers (15.5/31.5 vs 12.3/26.9%) and the type of alcoholic beverages also differed between the groups. Intake of antioxidant vitamins from food alone did not differ between educational groups.Conclusions: In Dutch elderly people, there are socioeconomic differences in dietary intake. Although these differences are small, these findings support the role of diet in the explanation of socioeconomic inequalities in cardiovascular health.Sponsorship: Erasmus Centre for Research on Aging, Erasmus University Rotterdam.European Journal of Clinical Nutrition (2000) 54, 159–165

Differences in overweight and obesity among children from migrant and native origin: a systematic review of the European literature

To review the prevalence regarding overweight and obesity among children and adolescents from migrant and native origin within Europe, a systematic review (1999–2009) was performed, using Embase, PubMed and citation snowballing. Literature research resulted in 19 manuscripts, reporting studies in six countries, mostly situated in Western and Central Europe.

Socioeconomic Differences in Self-Assessed Health in a Chronically Ill Population: The Role of Different Health Aspects

We investigated the role that different health aspects play in the explanation of socioeconomic differences in self-assessed health. Socioeconomic differences in self-assessed health were investigated in relation to chronic disease, functional limitations, psychosomatic symptoms, and perceived discomfort/distress. In multiple logistic regression analyses, for three cutoff points of self-assessed health, significant socioeconomic differences in self-assessed health could be observed after adjusting for age and gender. After separate adjustment for each of the four health aspects, the analyses showed that for a health assessment as less-than-good and less-than-fair, psychosomatic symptoms were the most powerful explanatory factor. Perceived discomfort/distress proved to be the most powerful factor for a poor health assessment. We found that socioeconomic differences in self-assessed health could, to a large extent (72–80%), be explained through socioeconomic differences in the prevalence of the four types of health problems included in the study. For all cutoff points, objective health aspects accounted for a relatively small part of the socioeconomic variability in self-assessed health. More subjective aspects of health accounted for more of the variability.

Recall Bias in Self‐reported Childhood Health: Differences by Age and Educational Level

This study examines the impact of recall bias on self-reported childhood health. In a population of people aged from 25 to 74 years, childhood health was assessed retrospectively to explore its influence on socio-economic inequalities in adult health. Data were obtained from a postal survey in the baseline of a prospective cohort-study (the Longitudinal Study on Socio-Economic Health Differences in The Netherlands). Childhood health was measured as self-reported periods of severe disease in childhood. Relationships between childhood health on the one hand and adult educational level on the other were analysed using logistic regression models. A negative association between childhood health problems and adult educational level was found in the youngest age group (25-34 years). In the older age groups, however, a lower adult socio-economic status was not clearly associated with more health problems in childhood. In view of what we know about socio-economic inequalities in childhood health in the past, it is likely that the lack of association between educational level and childhood health in the older age groups is (partly) caused by a recall bias. Using simple questions on self-reported childhood health problems, the measurement of childhood health in older age groups will be biased by differential recall between socio-economic groups. Other possibilities in the use of retrospective data in studying childhood health problems should be explored