Mirte A. G. Kuipers

The association between neighborhood disorder, social cohesion and hazardous alcohol use: a national multilevel study.

BACKGROUND Evidence on associations of alcohol use with neighborhood disorder and social cohesion is limited. The aim of this study was to further investigate these associations. METHODS Individual data of 14,258 Dutch adults, living in 1546 neighborhoods across The Netherlands, were obtained from the 2006 to 2009 national health survey (POLS). Data on neighborhood disorder and social cohesion were derived from the 2006 Netherlands Housing Research (WoON). Hazardous drinking was measured as: ≥14, ≥21, and ≥28 drinks/week for women, and ≥21, ≥28, and ≥35 for men. Multilevel logistic regression models were adjusted for age, gender, ethnicity, marital status, education, income, wealth, predominant neighborhood religion, and population density. Potential mediation of psychological distress (depression and anxiety) and general mental health (MHI-5 score) was tested. RESULTS High neighborhood disorder was associated with more hazardous alcohol use for women (OR cut-off 3: 3.72 [2.03-6.83]), but not for men (OR cut-off 3: 1.08 [0.72-1.62]). There was no mediation by psychological distress, and modest mediation by general mental health. Social cohesion had no linear association with hazardous alcohol use, but for males moderate social cohesion was associated with more hazardous alcohol use (OR cut-off 1: 1.29 [1.08-1.53]). In predominantly Protestant neighborhoods this association seemed weaker. CONCLUSIONS Hazardous alcohol use seems to have a stronger and more consistent relationship with neighborhood disorder than with social cohesion. This suggests that negative aspects of the social environment have more impact on the prevalence of hazardous alcohol use than positive factors related to sociability and support.

Why residents of Dutch deprived neighbourhoods are less likely to be heavy drinkers: the role of individual and contextual characteristics

Background Earlier research has shown that residents of Dutch deprived neighbourhoods drink less alcohol than people in other areas. We aimed to assess the role of individual and neighbourhood characteristics in a cross-sectional, nationwide, multilevel study. Methods Individual data of 30 117 Dutch adults, living in 1722 neighbourhoods across the Netherlands, were obtained from the 2004 to 2009 national health survey (POLS). Chronic heavy alcohol consumption was measured as ≥14 drinks/week for women and ≥21 for men, and episodic heavy drinking as ≥6 drinks/day at least once a week. Neighbourhood deprivation was dichotomous; deprived districts as selected by the Dutch government versus other areas. Multilevel logistic regression models of the association between deprivation and heavy drinking were corrected for age, gender, household composition, population density and potential predictors ethnicity, socioeconomic status (education, income), neighbourhood-level social cohesion and percentage Muslims. Results The prevalence of heavy drinking was lower in deprived neighbourhoods than in the rest of the Netherlands. This association was found for both chronic and episodic heavy drinking (OR=0.58 (0.47 to 0.72) and OR=0.57 (0.45 to 0.72), respectively). Adding ethnicity to the model reduced these associations by approximately one half. Socioeconomic composition did not contribute to the relationship. The proportion of Muslims explained a small part, while social cohesion explained even less of the association. Stronger associations were observed for women and older adults than for men and younger adults. Conclusions The lower prevalence of heavy drinking occurring in deprived areas is largely explained by the ethnicity of neighbourhood residents.

Widening educational inequalities in adolescent smoking following national tobacco control policies in the Netherlands in 2003: a time-series analysis

BACKGROUND AND AIMS In 2003, the Netherlands introduced tobacco control policies, including bans on tobacco sales to minors, advertising and sponsoring and tobacco sales in government institutions. We examined the extent to which these policies were associated with a change in educational inequalities in adolescent smoking. DESIGN Repeated cross-sectional survey. SETTING The Netherlands, 1992-2011. PARTICIPANTS A total of 43 527 14-19-year-old adolescents. MEASUREMENTS Data were obtained from the national Youth Smoking Monitor. We used logistic regression analyses to model the immediate change in daily smoking prevalence in 2003, the trends and the changes in trends. Models included interactions between educational level (high versus low, based on the educational track of the respondent) and, respectively, period (after versus before 2003), time and time × period. FINDINGS Before 2003 the smoking trend declined slightly, and the decline was comparable for students of both high and low educational levels. Immediately after tobacco policies were introduced, daily smoking prevalence dropped for the total population [regression coefficient (β) = -0.340, 95% confidence interval (CI) = -0.445; -0.236]. This drop was larger for high educational level compared to low educational level (β interaction = -0.400, 95% CI = -0.623; -0.176). After 2003, trends in educational inequalities in smoking stabilized. CONCLUSIONS Following the introduction of new tobacco control policies in the Netherlands in 2003, smoking prevalence rates decreased among adolescents of both higher and lower educational levels. However, socio-economic inequalities in adolescent smoking increased.

Smoking in school-aged adolescents: design of a social network survey in six European countries

BackgroundIn Western countries, smoking accounts for a large share of socio-economic inequalities in health. As smoking initiation occurs around the age of 13, it is likely that school context and social networks at school play a role in the origin of such inequalities. So far, there has been little generic explanation of how social ties at school contribute to socio-economic inequalities in smoking. The SILNE (Smoking Inequalities – Learning from Natural Experiments) survey was designed to test the hypothesis that a combination of peer effect, homophilous social ties, and school context may explain how smoking inequalities are magnified at school – a theory known as network-induced inequality. In this paper, the survey theory and design are presented.FindingsThe social network survey was carried out in 2013 in six medium-sized European cities with average incomes similar to the national average: Namur (Belgium), Tampere (Finland), Hannover (Germany), Latina (Italy), Amersfoort (The Netherlands), and Coimbra (Portugal). In each city, 6 to 8 schools were selected in a stratified sampling procedure. In each school, two grades in secondary education, corresponding to 14-16-year-olds, were selected. All adolescents in these two grades were invited to participate in the survey. Social ties were reported using the roster approach, in which each adolescent had to nominate up to 5 friends from a directory.The survey collected information from 11,015 adolescents in 50 schools, out of a total of 13,870 registered adolescents, yielding a participation rate of 79%. The SILNE survey yielded 57,094 social ties, 86.7% of which referred to friends who also participated in the survey.DiscussionThe SILNE survey was designed to measure the association between adolescents’ social ties at school, their socio-economic background, and their smoking behaviour. Two difficulties were encountered, however: legal privacy constraints made it impossible to apply the same parental consent procedure in all countries, leading to somewhat lower participation rates in two cities: Hannover and Latina. It was also difficult to match the 6 cities in terms of both age and type of education.The SILNE survey provided a comparable database for the study of smoking inequalities across European cities from a social network perspective.

Tobacco Control and Socioeconomic Inequalities in Adolescent Smoking in Europe

INTRODUCTION The strength of national tobacco control varies by country, but it is unclear how this relates to smoking in adolescents of high and low SES. This study examined the association between tobacco control policies and adolescent smoking and investigated the differences in this association between adolescents of high and low SES. METHODS Data of 90,351 adolescents aged 15-16 years from 13 European countries were obtained from the 2003, 2007, and 2011 European Survey Project on Alcohol and other Drugs databases. Logistic regression analyses were performed in 2014 with a random intercept at the country level and with daily smoking as the outcome. The Tobacco Control Scale was the score for national tobacco control policy. SES was based on parental education. RESULTS In all studied countries, except Portugal, adolescent smoking prevalence rates were highest among low-SES respondents. Stronger tobacco control policies were associated with lower smoking rates in all three survey waves (2003, OR=0.75, 95% CI=0.55, 1.01; 2007, OR=0.84, 95% CI=0.73, 0.98; 2011, OR=0.85, 95% CI=0.74, 0.98). The association was consistently stronger in high-SES than in low-SES individuals, but the difference was not statistically significant. CONCLUSIONS Countries with stronger tobacco control policies tend to have lower smoking rates. We are unable to demonstrate significant socioeconomic inequalities in the effect of tobacco control policies on adolescent smoking.

Smoking initiation, continuation and prevalence in deprived urban areas compared to non-deprived urban areas in The Netherlands.

Previous studies have shown that smoking prevalence is higher in deprived areas than in affluent areas. We aimed to determine whether smoking initiation or continuation contributes most to inequalities in current smoking, and in which population subgroups these area differences were largest. Therefore, we assessed the relationship between area deprivation and current smoking, initiation and continuation in urban areas, in subgroups defined by gender, generation and educational level. Cross-sectional data of 20,603 Dutch adults (18 years and over) living in 963 urban areas in The Netherlands were obtained from the annual national health survey (2003-2009). Three interrelated smoking outcomes were used: current smoking (smokers/total population), initiation (ever-smokers/total population) and continuation (smokers/ever-smokers). Area deprivation was dichotomised; deprived urban areas (as defined by the Dutch government) and non-deprived urban areas (reference group) were distinguished. Multilevel logistic regression models controlled for individual characteristics (including education and income) and tested for interaction with gender, generation and education. After controlling for individual characteristics, odds for smoking were not significantly higher in deprived areas (current smoking: OR = 1.04 [0.92-1.18], initiation: OR = 1.05 [0.93-1.18], continuation: OR = 1.03 [0.88-1.19]). For smoking initiation, significant differences between deprived areas and other areas remained in younger generations (OR = 1.19 [1.02-1.38]) and higher educated (OR = 1.23 [1.04-1.45]) respondents. For continuation and current smoking, after controlling for individual characteristics, no associations were found in any subgroups. In conclusion, area deprivation appears to be independently related to smoking initiation in, respectively, higher educated and younger generations. These results suggest that initiatives to reduce area-level inequalities in smoking should focus on preventing smoking initiation in deprived areas.

School smoking policies and educational inequalities in smoking behaviour of adolescents aged 14–17 years in Europe

Background Studies on the effects of school smoking policies are inconclusive and there is no research on whether the effects of school policies vary by educational level. We examined the association between school smoking policies and smoking behaviour among adolescents aged 14–17 years in Europe and assessed educational inequalities in these associations. Methods Data on 10 325 adolescents from 50 schools in six European cities were obtained from the 2013 SILNE survey. We measured student perceived policy, staff reported policy and its three subscales: regulations, communication and sanctions. The association between school policies and smoking outcomes (daily smoking and smoking on school premises) was adjusted for individual characteristics and for parental smoking. We tested interaction between school policies and educational level. Results Daily smoking was not associated with school smoking policies (eg, OR total policy=1.04, 95% CI 0.93 to 1.16 and OR student perceived policy=1.04, 95% CI 0.98 to 1.10). Smoking on school premises was less prevalent in schools with stronger staff reported total policy (OR=0.71, 95% CI 0.53 to 0.96). Other policy variables were also negatively associated with smoking on school premises, but not significantly (eg, OR student perceived policy=0.89, 95% CI 0.78 to 1.02). Associations between policy and smoking on school premises tended to be stronger in those with a low educational level, but none of the interactions tested were statistically significant. Conclusions Our results suggest that school smoking policies may not have a direct effect on daily smoking but may reduce smoking on the school premises. We found no clear evidence for the effects of school policies to differ by educational level.

The role of parental smoking on adolescent smoking and its social patterning: a cross-sectional survey in six European cities

Background Several studies have observed socio-economic (SE) inequalities in smoking among adolescents, but its causes are not fully understood. This study investigates the association between parental and adolescent smoking, and whether this association is socially patterned. Methods We used data from a survey administered in 2013 to students aged 14-17 years old of six European cities (n = 10 526). Using multilevel mixed-effects logistic regression, we modelled the probability of being a daily smoker as a function of parental smoking and SE status. We tested whether the smoking association differed across social strata. Results The prevalence of parental smoking was higher in low SE status adolescents. Boys and girls were more likely to smoke if they have a father [boys: adjusted odds ratio (AOR) = 1.90, 95% CI = 1.47-2.46; girls: AOR = 1.42, 95% CI = 1.09-1.86] and mother (boys: AOR = 1.77, 95% CI = 1.35-2.31; girls: AOR = 3.36, 95% CI = 2.56-4.40) who smoked. Among boys, the odds of smoking when having a smoking parent were higher in lower SE classes. However, this was not statistically significant, nor was it observed among girls. Conclusions Adolescents are more likely to smoke when their father and mother smoke. Although the susceptibility to parental smoking was similar across social classes, SE differences in parental smoking contribute to the transmission of SE inequalities in smoking.

Individual and contextual determinants of perceived peer smoking prevalence among adolescents in six European cities

BACKGROUND Young people perceiving a high peer smoking prevalence are more likely to initiate smoking. It is unclear which factors contribute to perceived peer smoking prevalence and if these factors vary according to education. This study aimed to assess the determinants of perceived smoking prevalence and assessed its variation at school and country-level. METHODS Data of 10,283 14-17-year-old students in 50 secondary schools in six European cities were derived from the 2013 SILNE survey. The outcome was the perceived smoking prevalence score among peers at school (0-10 scale, 10 represented 100% smoking prevalence). Multilevel linear regression models estimated the associations of factors with perceived prevalence score and variance at school and country-levels. Analyses were also stratified by academic achievement of the adolescent and parental education. RESULTS Determinants of a higher perceived prevalence score were female sex, ever smoking, having friends who smoke, low academic achievement, low parental educational level, and higher actual prevalence of smoking in the school. The perceived prevalence score was not associated with school policies or with the availability of cigarettes near the school. Determinants were very similar across levels of academic achievement and parental education. Perceived prevalence scores substantially varied between schools and countries: 10% and 11% of total variance was related to schools and countries respectively. CONCLUSION Across educational levels, perceptions of peer smoking are strongly determined by both individual characteristics and school and national contexts. Future studies should assess why perceived smoking prevalence varies between schools and countries and identify modifiable factors.

Did local smoke free policy in Indonesia prevent youth from smoking

Background: Although Indonesia has not ratified the WHO Framework Convention on Tobacco Control, it has developed a series of tobacco control policies at the local level. Strong presence of tobacco ...