Mariëlle A. Beenackers

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.

Taking up cycling after residential relocation: Built environment factors

BACKGROUND To successfully stimulate cycling, it is necessary to understand the factors that facilitate or inhibit cycling. Little is known about how changes in the neighborhood environment are related to changes in cycling behavior. PURPOSE This study aimed to identify environmental determinants of the uptake of cycling after relocation. METHODS The RESIDential Environment Project (RESIDE) is a longitudinal natural experiment of people moving into new housing developments in Perth (Western Australia). Self-reported usual transport and recreational cycling behavior, as well as self-reported and objective built environmental factors were measured before and after residential relocation. Participants who did not usually cycle at baseline in 2003-2004 were included in the study. Logistic regression models were used to relate changes in built environmental determinants to the probability of taking up cycling after relocation (2005-2006). Analyses were carried out in 2010-2011. RESULTS At baseline, 90% (n=1289) of the participants did not cycle for transport and 86% (n=1232) did not cycle for recreation. After relocation, 5% of the noncyclists took up transport-related cycling, and 7% took up recreational cycling. After full adjustment, the uptake of transport-related cycling was determined by an increase in objective residential density (OR=1.54, 95% CI=1.04, 2.26) and self-reported better access to parks (OR=2.60, 95% CI=1.58, 4.27) and other recreation destinations (OR=1.57, 95% CI=1.12, 2.22). Commencing recreational cycling mostly was determined by an increase in objective street connectivity (OR=1.20, 95% CI=1.06, 1.35). CONCLUSIONS Changes in the built environment may support the uptake of cycling among formerly noncycling adults.

Why some walk and others don't: exploring interactions of perceived safety and social neighborhood factors with psychosocial cognitions

Although physical activity is often believed to be influenced by both environmental and individual factors, little is known about their interaction. This study explores interactions of perceived safety and social neighborhood factors with psychosocial cognitions for leisure-time walking. Cross-sectional data were obtained from residents (age 25-75 years) of 212 neighborhoods in the South-East of the Netherlands, who participated in the Dutch GLOBE study in 2004 (N = 4395, survey response 64.4%). Direct associations of, and interactions between perceived neighborhood safety, social neighborhood factors (social cohesion, social network and feeling at home) and psychosocial cognitions (attitude, self-efficacy, social influence and intention) on two outcomes of leisure-time walking [yes versus no (binary), and among walkers: minutes per week (continuous)] were analyzed in multilevel regression models. The association between attitude and participating in leisure-time walking was stronger in those who felt less at home in their neighborhood. Social influence and attitude were stronger associated with participation in leisure-time walking in those who sometimes felt unsafe in their neighborhood. A positive intention was associated with more minutes walked in those who perceived their neighborhood as unsafe among those who walked. Only limited support was found for interactions between neighborhood perceptions and psychosocial cognitions for leisure-time walking.

Cohort Profile: Understanding socioeconomic inequalities in health and health behaviours: The GLOBE study

The main aim of the Gezondheid en Levens Omstandigheden Bevolking Eindhoven en omstreken (GLOBE) study (the letters of whose name represent the first letters of the Dutch acronym for Health and Living Conditions of the Population of Eindhoven and surroundings) is to quantitatively assess mechanisms and factors explaining socio-economic inequalities in health in the Netherlands. Baseline data for the study were collected by postal survey in 1991 among 18,973 respondents ranging in age from 15-75 years from the city of Eindhoven and its surrounding municipalities. Subsamples (total N=5667) were interviewed and/or surveyed in 1991, 1997, 2004 (also including a new sample), and most recently in 2011. Information was asked on indicators of socio-economic position, a range of potential explanatory factors (material, behavioural, psychosocial, and environmental) and health outcomes. From 2004 onwards, special emphasis was given to the identification of physical, social, and cultural environmental factors in the explanation of socio-economic inequalities in health behaviours. Information from the baseline postal survey onwards can and has been linked to several registries of causes of death, hospital admissions, and cancer. Researchers are cordially invited to contact the project leader (f.vanlenthe@erasmusmc.nl) to propose research based on the data.

Sports participation, perceived neighborhood safety, and individual cognitions: How do they interact?

BackgroundLittle is known about the interaction between individual and environmental determinants of physical activity, although this may be important information for the development of effective interventions. The goal of this paper is to investigate whether perceived neighborhood safety modifies associations between individual cognitions and sports participation.MethodsCross-sectional data were obtained from residents (age 25-75) of 87 neighborhoods in the city of Eindhoven, who participated in the Dutch GLOBE study in 2004 (N = 2474). We used multilevel logistic regression to analyze the interactions between perceived neighborhood safety and individual cognitions (attitude, self-efficacy, social influence, and intention) on sports participation (yes/no).ResultsIn its association with sports participation, perceived neighborhood safety interacted significantly with self-efficacy and attitude (p < 0.05). Among persons who perceived their neighborhood as safe, a positive attitude was strongly associated with sports participation (OR = 2.00, 95%CI = 1.48-2.71). In contrast, attitude was not associated with sports participation in persons who perceived their neighborhood as unsafe (OR = 0.65, 95%CI = 0.34-1.24). Further, self-efficacy was significantly stronger associated with sports participation in persons who perceived their neighborhood as unsafe (OR = 1.85, 95%CI = 1.31-2.60) than in those who perceived their neighborhood as safe (OR = 1.19, 95%CI = 1.05-1.36). Social influence and intention did not interact with perceived neighborhood safety.ConclusionsAssociations between individual cognitions and sports participation depend on neighborhood circumstances, such as perceived neighborhood safety. Interventions to promote sports participation in adults should take the interaction between environmental and individual characteristics into account. More research is needed to find out the causal pathways in individual-environment interactions.

Systematic development of the YouRAction program, a computer-tailored physical activity promotion intervention for Dutch adolescents, targeting personal motivations and environmental opportunities

BackgroundIncreasing physical activity (PA) among adolescents is an important health promotion goal. PA has numerous positive health effects, but the majority of Dutch adolescents do not meet PA requirements. The present paper describes the systematic development of a theory-based computer-tailored intervention, YouRAction, which targets individual and environmental factors determining PA among adolescents.DesignThe intervention development was guided by the Intervention Mapping protocol, in order to define clear program objectives, theoretical methods and practical strategies, ensure systematic program planning and pilot-testing, and anticipate on implementation and evaluation. Two versions of YouRAction were developed: one that targets individual determinants and an extended version that also provides feedback on opportunities to be active in the neighbourhood. Key determinants that were targeted included: knowledge and awareness, attitudes, self-efficacy and subjective norms. The extended version also addressed perceived availability of neighbourhood PA facilities. Both versions aimed to increase levels of moderate-to-vigorous PA among adolescents. The intervention structure was based on self-regulation theory, comprising of five steps in the process of successful goal pursuit. Monitoring of PA behaviour and behavioural and normative feedback were used to increase awareness of PA behaviour; motivation was enhanced by targeting self-efficacy and attitudes, by means of various interactive strategies, such as web movies; the perceived environment was targeted by visualizing opportunities to be active in an interactive geographical map of the home environment; in the goal setting phase, the adolescents were guided in setting a goal and developing an action plan to achieve this goal; in the phase of active goal pursuit adolescents try to achieve their goal and in the evaluation phase the achievements are evaluated. Based on the results of the evaluation adolescents could revise their goal or choose another behaviour to focus on. The intervention is delivered in a classroom setting in three lessons. YouRAction will be evaluated in a cluster-randomized trial, with classes as unit of randomization. Evaluation will focus on PA outcomes, cognitive mediators/moderators and process measures.DiscussionThe planned development of YouRAction resulted in two computer-tailored interventions aimed at the promotion of PA in a Dutch secondary school setting.Trial registrationNTR1923

Urban form and psychosocial factors : Do they interact for leisure-time walking?

INTRODUCTION This cross-sectional study uses an adaptation of a social-ecological model on the hierarchy of walking needs to explore direct associations and interactions of urban-form characteristics and individual psychosocial factors for leisure-time walking. METHODS Questionnaire data (n = 736) from adults (25-74 yr) and systematic field observations within 14 neighborhoods in Eindhoven (the Netherlands) were used. Multilevel logistic regression models were used to relate the urban-form characteristics (accessibility, safety, comfort, and pleasurability) and individual psychosocial factors (attitude, self-efficacy, social influence, and intention) to two definitions of leisure-time walking, that is, any leisure-time walking and sufficient leisure-time walking according to the Dutch physical activity norm and to explore their interactions. RESULTS Leisure-time walking was associated with psychosocial factors but not with characteristics of the urban environment. For sufficient leisure-time walking, interactions between attitude and several urban-form characteristics were found, indicating that positive urban-form characteristics contributed toward leisure-time walking only in residents with a less positive attitude toward physical activity. In contrast, living in a neighborhood that was accessible for walking was stronger associated with leisure-time walking among residents who experienced a positive social influence to engage in physical activity compared with those who reported less social influence. CONCLUSIONS This study showed some evidence for an interaction between the neighborhood environment and the individual psychosocial factors in explaining leisure-time walking. The specific mechanism of interaction may depend on the specific combination of psychosocial factor and environmental factor. The lack of association between urban form and leisure-time walking could be partly due to the little variation in urban-form characteristics between neighborhoods.

Does social distinction contribute to socioeconomic inequalities in diet: the case of ‘superfoods’ consumption

BackgroundThe key mechanisms underlying socioeconomic inequalities in dietary intake are still poorly understood, hampering the development of interventions. An important, but sparsely mentioned mechanism is that of ‘social distinction’, whereby those in a higher socioeconomic position adopt dietary patterns by which they can distinguish themselves from lower socioeconomic groups. We investigated the importance of distinction as a mechanism, by testing the socioeconomic gradient in the consumption of so-called ‘superfoods’ and the contribution of a well-established indicator of distinction, cultural participation.MethodsData from participants (25–75 years) of the 2014 survey of the Dutch population-based GLOBE study were used (N = 2812). Multivariable regression models were used to analyse the association between education, income and cultural participation (e.g. visits to museums, opera, theatre, concerts) and the consumption of superfoods (spelt, quinoa and goji berries, chia seeds or wheatgrass).ResultsThe consumption of superfoods is far more prevalent among higher socioeconomic groups. Adjusting for cultural participation strongly attenuated the educational and income gradient in superfoods consumption, whereas cultural participation remained strongly associated with superfoods consumption. Those in the highest quintile of cultural participation reported the highest consumption of spelt products (OR = 2.97, 95% CI = 2.10;4.18), quinoa (OR = 3.50, 95% CI = 2.12;5.79) and goji berries, chia seeds or wheatgrass (OR = 2.69, 95% CI = 1.73;4.17).ConclusionsThe associations between socioeconomic position and the consumption of ‘superfoods’ seem to be partially driven by a process of social distinction. These findings suggest that distinction may be an important, but currently neglected mechanism in generating socioeconomic inequalities in dietary intake. It deserves a more prominent role in interventions to reduce these inequalities.

Explaining socio-demographic differences in disengagement from sports in adolescence

PURPOSE The purpose of this longitudinal study is to identify risk groups for disengagement from sports during adolescence. In addition, it will be explored whether cognitive and environmental factors can explain socio-demographic differences in disengagement from sports. METHODS Data were obtained from the Environmental Determinants of Obesity in Rotterdam Schoolchildren study, and 357 adolescents were eligible for analysis. Socio-demographics (gender, ethnicity, education), individual cognitions and neighbourhood perceptions were assessed at baseline (2005/2006), and sports participation at baseline and at follow-up (2007/2008). Two dichotomous outcome variables were constructed: (i) disengagement from sports (yes/no) and (ii) ceased compliance with the fitnorm (i.e. cease engaging in sports ≥3 times/wk) (yes/no). In logistic regression and mediation analyses, we identified socio-demographic differences in the two outcomes. Subsequently, we applied mediation analyses to identify the contribution of cognitive and environmental explanatory factors of the socio-demographic differences. RESULTS Girls [odds ratio (OR): 2.5, 95% confidence interval (CI): 1.5-4.5] were more likely than boys to disengage from sports. Girls (OR: 2.5, 95% CI: 1.4-4.2), adolescents of non-Western background (OR: 1.8, 95% CI: 1.0-3.0) and those in lower educational levels (OR: 1.7, 95% CI: 1.0-2.9) were more likely to cease compliance with the fitnorm. Perceived neighbourhood safety partly explained gender differences in disengagement from sports (8%). Intention partly explained ethnical (32%) and educational differences (37%) in ceasing compliance with the fitnorm. CONCLUSIONS Girls, lower-educated adolescents and those with a non-Western background showed more pronounced reductions in sports participation and compliance with the fitnorm. Intention and perceived neighbourhood safety could partially explain these differences.

Socioeconomic inequalities in dental health services in Sao Paulo, Brazil, 2003–2008

BackgroundAccess to, and use of, dental health services in Brazil have improved since 2003. The increase of private health care plans and the implementation of the “Smiling Brazil” Program, the largest public oral health care program in the world, could have influenced this increase in access. However, we do not yet know if inequalities in the use of dental health services persist after the improvement in access. The aims of this study are to analyze socioeconomic differences for dental health service use between 2003 and 2008 in São Paulo and to examine changes in these associations since the implementation of the Smiling Brazil program in 2003.MethodData was obtained via two household health surveys (ISA-Capital 2003 and ISA-Capital 2008) which investigated living conditions, lifestyle, health status and use of health care services. Logistic regression was used to analyze associations between socioeconomic factors and dental services use. Additionally, trends from 2003 to 2008 regarding socioeconomic characteristics and dental health service use were explored.ResultsOverall, dental health service use increased between 2003 and 2008 and was at both time points more common among those who had higher income, better education, better housing conditions, private health care plans and were Caucasian. Inequalities in use of dental health care did not decrease over time. Among the reasons for not seeking dental care, not having teeth and financial difficulty were more common in lower socioeconomic groups, while thinking it was unnecessary was more common in higher socioeconomic groups.ConclusionsThe Brazilian oral health policy is still in a period of expansion and seems to have contributed slightly to increased dental health service use, but has not influenced socioeconomic inequalities in the use of these services. Acquiring deeper knowledge about inequalities in dental health service use will contribute to better understanding of potential barriers to reducing them.