Jantine Schuit

Personal and Environmental Characteristics Associated with Choice of Active Transport Modes versus Car Use for Different Trip Purposes of Trips up to 7.5 Kilometers in The Netherlands

Introduction This explorative study examines personal and neighbourhood characteristics associated with short-distance trips made by car, bicycle or walking in order to identify target groups for future interventions. Methods Data were derived from ‘Mobility Research Netherlands (2004–2009; MON)’, a dataset including information regarding trips made by household members (n = ±53,000 respondents annually). Using postal codes of household addresses, MON data were enriched with data on neighbourhood typologies. Multilevel logistic modelling was used to calculate odds ratio (OR) of active transport versus car use associated with four different trip purposes (shopping (reference), commuting, taking or bringing persons or sports). A total of 277,292 short distance trips made by 102,885 persons were included in analyses. Results Compared to women shopping, women less often take active transport to sports clubs (OR = 0.88) and men less often take active transport for shopping (OR = 0.92), or for bringing or taking persons (OR = 0.76). Those aged 25–34 years (OR = 0.83) and 35–44 years (OR = 0.96) were more likely to use active transport for taking or bringing persons than persons belonging to the other age groups (relative to trips made for shopping by those 65 years or over). A higher use of active transport modes by persons with an university or college degree was found and particularly persons living in urban-centre neighbourhoods were likely to use active transport modes. Conclusion In developing policies promoting a mode shift special attention should be given to the following groups: a) men making short distance trips for taking or bringing persons, b) women making short distance trips to sport facilities, c) persons belonging to the age groups of 25–44 years of age, d) Persons with a primary school or lower general secondary education degree and persons with a high school or secondary school degree and e) persons living in rural or urban-green neighbourhoods.

Manifestations of integrated public health policy in Dutch municipalities.

Integrated public health policy (IPHP) aims at integrating health considerations into policies of other sectors. Since the limited empirical evidence available may hamper its further development, we systematically analysed empirical manifestations of IPHP, by placing policy strategies along a continuum of less-to-more policy integration, going from intersectoral action (IA) to healthy public policy (HPP) to health in all policies (HiAP). Our case study included 34 municipal projects of the Dutch Gezonde Slagkracht Programme (2009-15), which supports the development and implementation of IPHP on overweight, alcohol and drug abuse, and smoking. Our content analysis of project application forms and interviews with all project leaders used a framework approach involving the policy strategies and the following policy variables: initiator, actors, policy goals, determinants and policy instruments. Most projects showed a combination of policy strategies. However, manifestations of IPHP in overweight projects predominantly involved IA. More policy integration was apparent in alcohol/drugs projects (HPP) and in all-theme projects (HiAP). More policy integration was related to broad goal definitions, which allowed for the involvement of actors representing several policy sectors. This enabled the implementation of a mix of policy instruments. Determinants of health were not explicitly used as a starting point of the policy process. If a policy problem justifies policy integration beyond IA, it might be helpful to start from the determinants of health (epidemiological reality), systematically transform them into policy (policy reality) and set broad policy goals, since this gives actors from other sectors the opportunity to participate.

How Combined Trip Purposes are Associated with Transport Choice for Short Distance Trips. Results from a Cross-sectional Study in the Netherlands

Background One way to increase physical activity is to stimulate a shift from car use to walking or cycling. In single-purpose trips, purpose was found to be an important predictor of transport choice. However, as far as known, no studies have been conducted to see how trips with combined purposes affect this decision. This study was designed to provide insight into associations between combined purposes and transport choice. Methods An online questionnaire (N = 3,663) was used to collect data concerning transport choice for four primary purposes: shopping, going to public natural spaces, sports, and commuting. Per combination of primary trip purpose and transport choice, participants were asked to give examples of secondary purposes that they combine with the primary purpose. Logistic regression analyses were used to model the odds of both cycling and walking versus car use. Results Primary trip purposes combined with commuting, shopping, visiting private contacts or medical care were more likely to be made by car than by cycling or walking. Combinations with visiting catering facilities, trips to social infrastructure facilities, recreational outings, trips to facilities for the provision of daily requirements or private contacts during the trip were more likely to be made by walking and/or cycling than by car. Conclusion Combined trip purposes were found to be associated with transport choice. When stimulating active transport focus should be on the combined-trip purposes which were more likely to be made by car, namely trips combined with commuting, other shopping, visiting private contacts or medical care.

The INHERIT Model: A Tool to Jointly Improve Health, Environmental Sustainability and Health Equity through Behavior and Lifestyle Change

The need for analysis and action across the interrelated domains of human behaviors and lifestyles, environmental sustainability, health and inequality is increasingly apparent. Currently, these areas are often not considered in conjunction when developing policies or interventions, introducing the potential for suboptimal or conflicting outcomes. The INHERIT model has been developed within the EU-funded project INHERIT as a tool to guide thinking and intersectoral action towards changing the behaviors and lifestyles that play such an important role in today’s multidisciplinary challenges. The model integrates ecological public health and behavioral change models, emphasizing inequalities and those parts of the causal process that are influenced by human behaviors and lifestyles. The model was developed through web-based and live discussions with experts and policy stakeholders. To test the model’s usability, the model was applied to aspects of food consumption. This paper shows that the INHERIT model can serve as a tool to identify opportunities for change in important −food-related behaviors and lifestyles and to examine how they impact on health, health inequalities, and the environment in Europe and beyond. The INHERIT model helps clarify these interrelated domains, creating new opportunities to improve environmental health and health inequality, while taking our planetary boundaries into consideration.

Health in All Policies? The case of policies to promote bicycle use in the Netherlands

To gather insight on how Health in All Policies (HiAP) is applied in practice, we carried out a case study on transport policies intended to stimulate a shift from car use to bicycling. We reviewed 3 years (2010, 2011, and 2012) of national budgets and policy documents in the Netherlands, followed by two focus group sessions and a second round of document analysis. We found to our surprise, given the country’s history of bicycle promotion, that no HiAP approaches for bicycle promotion remain in place in national transport policies. The Netherlands may face serious challenges in the near future for facilitating bicycle use. Inclusion of health goals requires that the health sector work towards acquiring a better understanding of core values in other sector’s policies.

Evidence-based medicine en de integrale gezonde wijkaanpak

Het model van Evidence-based medicine (EBM) wordt steeds vaker toegepast buiten de spreekkamer, in de publieke gezondheid. Er verschenen hierover in TSG diverse artikelen. In dit artikel gaan we systematisch na in hoeverre het EBM-model is te verplaatsen van de spreekkamer van de dokter naar de complexe praktijk van gezondheidsbevordering. We kijken daarbij eerst naar de essentiële onderdelen van het EBM-model: 1) de interventie; 2) het wetenschappelijke bewijs en de richtlijn; 3) de professional met zijn klinische blik; 4) de patiënt met waarden en voorkeuren en 5) het gesprek. Het EBM-model blijkt in principe over te zetten naar de public health; maar dat gaatnietzomaar. Naast de beperkte beschikbaarheid van harde evidentie uit Randomized Controlled Trials (RCT’s) en het ontbreken van richtlijnen, zien we als grootste uitdaging de vergaande taakverdeling bij gezondheidsbevordering. Daardoor moet extra worden geïnvesteerd in het vormgeven van het gesprek waarin naast de evidentie ook de klinische blik van de uitvoerders en de voorkeuren van de doelgroep meewegen bij het nemen van beslissingen.AbstractEvidence-based medicine and the integrated community-based publichealth approach The model of Evidence-based medicine (EBM) is increasingly applied outside the clinical setting, i.e. in the public health. In this journal, several articles have been published about the role of EBM in public health. In the present article, we will systematically explore the extent to which the EBM model can be transferred from the doctor’s office to the complex practice of health promotion. We will address all essential components of the EBM-model: 1) the intervention, 2) the scientific evidence and the guidelines, 3) the professional with his clinical view, 4) the patient with his values and preferences, and 5) the dialogue. The EBM-model appears to be transferable to the public health. Besides the limited availability of sound evidence from randomised controlled trials (RCT) and the absence of guidelines, a main challenge in health promotion is the far-reaching distribution of responsibilities. Thereby, it requires an extra investment in the dialogue, in which both the evidence and the clinical view of the practitioners and preferences of the target groupshouldbe incorporated in the decision-making process.

PS14 - 4. Associations between health literacy, diabetes knowledge, self-management and health among adults with type 2 diabetes in The Netherlands

Since self-management support is a crucial element of diabetes care, it is important to obtain a better understanding of how individuals’ health literacy skills and diabetes knowledge are related to involvement in self-management and health status.

PHP38 COST-EFFECTIVENESS OF PREVENTION: OPPORTUNITIES FOR PUBLIC HEALTH POLICY IN THE NETHERLANDS?

OBJECTIVE To gain insight into the cost-effectiveness of new preventive interventions. DESIGN Systematic review and interviews. METHOD Based on literature search, a search of the project database of ZonMw and interviews with experts, the National Institute for Public Health and the Environment drew up a long list of preventive interventions that are potentially cost-effective but are not yet systematically carried out in the Netherlands. From this long list, 21 interventions were selected for each of which, at least 3 economic evaluations were available that indicate favourable cost-effectiveness (< Euro 20,000,--per QALY gained). RESULTS The majority of the interventions concerned vaccination and screening programmes (7 and 5 respectively). Only a small minority concerned health promotion or health protection (1 respectively 3). There was strong evidence that 5 interventions were both cost-effective, and feasible. These were: screening for Chlamydia, screening for diabetic retinopathy in type 2 diabetes, screening for neonatal group beta streptococcal infections through a combination strategy, prevention of recurrent myocardial infarction through heart habilitation, and prevention of head injuries by wearing of bicycle helmets by children. CONCLUSION Before implementation of preventive interventions, it is necessary to investigate whether these interventions are also cost-effective in the Dutch context.