Katrina Giskes

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education

Objective: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. Design: Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. Setting: Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. Participants: 451 386 non-institutionalised men and women 25–79 years old. Main outcome measures: Smoking status, daily quantity of cigarettes consumed by smokers. Results: Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. Conclusions: Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

A systematic review of environmental factors and obesogenic dietary intakes among adults: are we getting closer to understanding obesogenic environments?

This study examined whether physical, social, cultural and economical environmental factors are associated with obesogenic dietary behaviours and overweight/obesity among adults. Literature searches of databases (i.e. PubMed, CSA Illumina, Web of Science, PsychInfo) identified studies examining environmental factors and the consumption of energy, fat, fibre, fruit, vegetables, sugar‐sweetened drinks, meal patterns and weight status. Twenty‐eight studies were in‐scope, the majority (n= 16) were conducted in the USA. Weight status was consistently associated with the food environment; greater accessibility to supermarkets or less access to takeaway outlets were associated with a lower BMI or prevalence of overweight/obesity. However, obesogenic dietary behaviours did not mirror these associations; mixed associations were found between the environment and obesogenic dietary behaviours. Living in a socioeconomically‐deprived area was the only environmental factor consistently associated with a number of obesogenic dietary behaviours. Associations between the environment and weight status are more consistent than that seen between the environment and dietary behaviours. The environment may play an important role in the development of overweight/obesity, however the dietary mechanisms that contribute to this remain unclear and the physical activity environment may also play an important role in weight gain, overweight and obesity.

Socioeconomic differences in lack of recreational walking among older adults: the role of neighbourhood and individual factors

BackgroundPeople with a low socioeconomic status (SES) are more likely to be physically inactive than their higher status counterparts, however, the mechanisms underlying this socioeconomic gradient in physical inactivity remain largely unknown. Our aims were (1) to investigate socioeconomic differences in recreational walking among older adults and (2) to examine to what extent neighbourhood perceptions and individual cognitions regarding regular physical activity can explain these differences.MethodsData were obtained by a large-scale postal survey among a stratified sample of older adults (age 55–75 years) (N = 1994), residing in 147 neighbourhoods of Eindhoven and surrounding areas, in the Netherlands. Multilevel logistic regression analyses assessed associations between SES (i.e. education and income), perceptions of the social and physical neighbourhood environment, measures of individual cognitions derived from the Theory of Planned Behaviour (e.g. attitude, perceived behaviour control), and recreational walking for ≥10 minutes/week (no vs. yes).ResultsParticipants in the lowest educational group (OR 1.67 (95% CI, 1.18–2.35)) and lowest income group (OR 1.40 (95% CI, 0.98–2.01)) were more likely to report no recreational walking than their higher status counterparts. The association between SES and recreational walking attenuated when neighbourhood aesthetics was included in the model, and largely reduced when individual cognitions were added to the model (with largest effects of attitude, and intention regarding regular physical activity). The assiation between poor neighbourhood aesthetics and no recreational walking attenuated to (borderline) insignificance when individual cognitions were taken into account.ConclusionBoth neighbourhood aesthetics and individual cognitions regarding physical activity contributed to the explanation of socioeconomic differences in no recreational walking. Neighbourhood aesthetics may explain the association between SES and recreational walking largely via individual cognitions towards physical activity. Intervention and policy strategies to reduce socioeconomic differences in lack of recreational walking among older adults would be most effective if they intervene on both neighbourhood perceptions as well as individual cognitions.

A systematic review of studies on socioeconomic inequalities in dietary intakes associated with weight gain and overweight/obesity conducted among European adults.

This Review examined socioeconomic inequalities in intakes of dietary factors associated with weight gain, overweight/obesity among adults in Europe. Literature searches of studies published between 1990 and 2007 examining socioeconomic position (SEP) and the consumption of energy, fat, fibre, fruit, vegetables, energy‐rich drinks and meal patterns were conducted. Forty‐seven articles met the inclusion criteria. The direction of associations between SEP and energy intakes were inconsistent. Approximately half the associations examined between SEP and fat intakes showed higher total fat intakes among socioeconomically disadvantaged groups. There was some evidence that these groups consume a diet lower in fibre. The most consistent evidence of dietary inequalities was for fruit and vegetable consumption; lower socioeconomic groups were less likely to consume fruit and vegetables. Differences in energy, fat and fibre intakes (when found) were small‐to‐moderate in magnitude; however, differences were moderate‐to‐large for fruit and vegetable intakes. Socioeconomic inequalities in the consumption of energy‐rich drinks and meal patterns were relatively under‐studied compared with other dietary factors. There were no regional or gender differences in the direction and magnitude of the inequalities in the dietary factors examined. The findings suggest that dietary behaviours may contribute to socioeconomic inequalities in overweight/obesity in Europe. However, there is only consistent evidence that fruit and vegetables may make an important contribution to inequalities in weight status across European regions.

Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review.

BackgroundThis study systematically reviewed the evidence pertaining to socioeconomic inequalities in different domains of physical activity (PA) by European region.MethodsStudies conducted between January 2000 and December 2010 were identified by a systematic search in Pubmed, Embase, Web of Science, Psychinfo, Sportdiscus, Sociological Abstracts, and Social Service Abstracts. English-language peer-reviewed studies undertaken in the general population of adults (18–65 years) were classified by domain of PA (total, leisure-time including sport, occupational, active transport), indicator of socioeconomic position (education, income, occupation), and European region. Distributions of reported positive, negative, and null associations were evaluated.ResultsA total of 131 studies met the inclusion criteria. Most studies were conducted in Scandinavia (n = 47). Leisure-time PA was the most frequently studied PA outcome (n = 112). Considerable differences in the direction of inequalities were seen for the different domains of PA. Most studies reported that those with high socioeconomic position were more physically active during leisure-time compared to those with low socioeconomic position (68% positive associations for total leisure-time PA, 76% for vigorous leisure-time PA). Occupational PA was more prevalent among the lower socioeconomic groups (63% negative associations). Socioeconomic differences in total PA and active transport PA did not show a consistent pattern (40% and 38% positive associations respectively). Some inequalities differed by European region or socioeconomic indicator, however these differences were not very pronounced.ConclusionsThe direction of socioeconomic inequalities in PA in Europe differed considerably by domain of PA. The contradictory results for total PA may partly be explained by contrasting socioeconomic patterns for leisure-time PA and occupational PA.

A systematic review of associations between environmental factors, energy and fat intakes among adults: is there evidence for environments that encourage obesogenic dietary intakes?

OBJECTIVE To review the literature examining associations between environmental factors, energy and fat intakes among adults, and to identify issues for future research. METHODS Literature searches of studies published between 1980 and 2004 were conducted in major databases (i.e. PubMed, Human Nutrition, Web of Science, PsychInfo, Sociofile). Additional articles were located by citation tracking. RESULTS Twenty-one articles met the inclusion criteria. No study provided a clear conceptualisation of how environmental factors may influence these dietary intakes. Availability, social, cultural and material aspects of the environment were relatively understudied compared with other factors such as seasonal/day of the week variation and work-related factors. Few studies examined the specific environmental factors implicated in the obesity epidemic, and there was little study replication. All studies were observational and cross-sectional. CONCLUSIONS It is too premature to conclude whether or not environmental factors play a role in obesogenic and unhealthy dietary intakes. More studies need to examine associations with those environmental factors thought to contribute to obesogenic environments. There needs to be more development in theories that conceptualise the relationship between environmental factors and dietary intakes.

Food insecurity among adults residing in disadvantaged urban areas: potential health and dietary consequences

OBJECTIVE Food insecurity is the limited or uncertain availability or access to nutritionally adequate, culturally appropriate and safe foods. Food insecurity may result in inadequate dietary intakes, overweight or obesity and the development of chronic disease. Internationally, few studies have focused on the range of potential health outcomes related to food insecurity among adults residing in disadvantaged locations and no such Australian studies exist. The objective of the present study was to investigate associations between food insecurity, sociodemographic and health factors and dietary intakes among adults residing in disadvantaged urban areas. DESIGN Data were collected by mail survey (n 505, 53 % response rate), which ascertained information about food security status, demographic characteristics (such as age, gender, household income, education) fruit and vegetable intakes, takeaway and meat consumption, general health, depression and chronic disease. SETTING Disadvantaged suburbs of Brisbane city, Australia, 2009. SUBJECTS Individuals aged ≥ 20 years. RESULTS Approximately one in four households (25 %) was food insecure. Food insecurity was associated with lower household income, poorer general health, increased health-care utilisation and depression. These associations remained after adjustment for age, gender and household income. CONCLUSIONS Food insecurity is prevalent in urbanised disadvantaged areas in developed countries such as Australia. Low-income households are at high risk of experiencing food insecurity. Food insecurity may result in significant health burdens among the population, and this may be concentrated in socio-economically disadvantaged suburbs.

Smokers living in deprived areas are less likely to quit: A longitudinal follow-up

Objective: To follow up smokers to examine whether the likelihood of quitting smoking varied by area deprivation, and whether smoking history, health status, personality characteristics, social support and stressful situations contributed to differences in area deprivation in quit rates. Design: Longitudinal data with a 6-year follow-up period were analysed using multilevel logistic regression. Area-level deprivation was characterised by a composite measure that was the sum of the proportion of unemployed residents, the percentage of residents in blue-collar occupations and the proportion with only elementary-level education. Previously established predictors of smoking cessation, including education, age at smoking initiation, self-assessed health, chronic illness, locus of control, neuroticism, negative life events, longlasting relationship difficulties, emotional social support and negative neighbourhood conditions were examined separately and in a combined model to assess whether they contributed to neighbourhood deprivation differences in quitting. Participants: 404 participants (residing in 83 areas) identified as smokers at baseline and who did not change their residential address over the follow-up period. Main outcome: Being a non-smoker at follow-up. Results: Odds ratios of quitting decreased with greater area-level deprivation, but differences reached significance only between the most and least deprived quartiles. Smoking history, health status, personality characteristics, social support and stressful situations did not contribute to the lower quitting rates seen among smokers in deprived areas. Conclusions: Living in a deprived area seems to reduce the likelihood of quitting smoking; hence individual-level tobacco control efforts should be complemented with area-based interventions. However, we need to identify and understand the underlying factors associated with living in a deprived area that contributes to lower quitting rates.

Neighborhood Disadvantage and Physical Activity: Baseline Results from the HABITAT Multilevel Longitudinal Study

PURPOSE To examine the association between neighborhood disadvantage and physical activity (PA). METHODS We use data from the HABITAT multilevel longitudinal study of PA among middle-aged (40-65 years) men and women (N = 11,037, 68.5% response rate) living in 200 neighborhoods in Brisbane, Australia. PA was measured using three questions from the Active Australia Survey (general walking, moderate, and vigorous activity), one indicator of total activity, and two questions about walking and cycling for transport. The PA measures were operationalized by using multiple categories based on time and estimated energy expenditure that were interpretable with reference to the latest PA recommendations. The association between neighborhood disadvantage and PA was examined with the use of multilevel multinomial logistic regression and Markov chain Monte Carlo simulation. The contribution of neighborhood disadvantage to between-neighborhood variation in PA was assessed using the 80% interval odds ratio. RESULTS After adjustment for sex, age, living arrangement, education, occupation, and household income, reported participation in all measures and levels of PA varied significantly across Brisbanes neighborhoods, and neighborhood disadvantage accounted for some of this variation. Residents of advantaged neighborhoods reported significantly higher levels of total activity, general walking, moderate, and vigorous activity; however, they were less likely to walk for transport. There was no statistically significant association between neighborhood disadvantage and cycling for transport. In terms of total PA, residents of advantaged neighborhoods were more likely to exceed PA recommendations. CONCLUSIONS Neighborhoods may exert a contextual effect on the likelihood of residents participating in PA. The greater propensity of residents in advantaged neighborhoods to do high levels of total PA may contribute to lower rates of cardiovascular disease and obesity in these areas.

Socioeconomic status, environmental and individual factors, and sports participation

PURPOSE To examine the contribution of neighborhood, household, and individual factors to socioeconomic inequalities in sports participation in a multilevel design. METHODS Data were obtained by a large-scale postal survey among a stratified sample of the adult population (age 25-75 yr) of Eindhoven (the fifth-largest city of the Netherlands) and surrounding areas, residing in 213 neighborhoods (N = 4785; response rate 64.4%). Multilevel logistic regression analyses were performed with sports participation as a binary outcome (no vs yes); that is, respondents not doing any moderate- or high-intensity sports at least once a week were classified as nonparticipants. RESULTS Unfavorable perceived neighborhood factors (e.g., feeling unsafe, small social network), household factors (material and social deprivation), and individual physical activity cognitions (e.g., negative outcome expectancies, low self-efficacy) were significantly associated with doing no sports and were reported more frequently among lower socioeconomic groups. Taking these factors into account reduced the odds ratios of doing no sports among the lowest educational group by 57%, from 3.99 (95% CI, 2.99-5.31) to 2.29 (95% CI, 1.70-3.07), and among the lowest income group by 67%, from 3.02 (95% CI, 2.36-3.86) to 1.66 (95% CI, 1.22-2.27). CONCLUSIONS A combination of neighborhood, household, and individual factors can explain socioeconomic inequalities in sports participation to a large extent. Interventions and policies should focus on all three groups of factors simultaneously to yield a maximal reduction of socioeconomic inequalities in sports participation.