Search

Background Parental health literacy may explain the relationship between parental socioeconomic status (SES) and paediatric metabolic syndrome (MetS). For this reason, we assessed to what extent parental health literacy mediates the relationships between parental SES and paediatric MetS. Methods We used data from the prospective multigenerational Dutch Lifelines Cohort Study. Our sample consisted of 6683 children with an average follow-up of 36.2 months (SD 9.3) and a mean baseline age of 12.8 years (SD 2.6). We used natural effects models to assess the natural direct, natural indirect and total effects of parental SES on MetS. Results On average, an additional 4 years of parental education, e.g. university instead of secondary school, would lead to continuous MetS (cMetS) scores that were 0.499 (95% confidence interval (CI): 0.364–0.635) units lower, which is a small effect (d: 0.18). If parental income and occupational level were 1 SD higher, on average cMetS scores were 0.136 (95% CI: 0.052–0.219) and 0.196 (95% CI: 0.108–0.284) units lower, respectively; these are both small effects (d: 0.05 and 0.07, respectively). Parental health literacy partially mediated these pathways; it accounted for 6.7% (education), 11.8% (income) and 8.3% (occupation) of the total effect of parental SES on paediatric MetS. Conclusions Socioeconomic differences in paediatric MetS are relatively small, the largest being by parental education. Improving parental health literacy may reduce these inequalities. Further research is needed into the mediating role of parental health literacy on other socioeconomic health inequalities in children.

Background Limited health literacy (LHL) is associated with multiple adverse health outcomes in chronic kidney disease (CKD). Interventions are needed to improve this situation, but evidence on intervention targets and strategies is lacking. This systematic review aims to identify potential targets and strategies by summarizing the evidence on: (i) patient- and system-level factors potentially mediating the relation between LHL and health outcomes; and (ii) the effectiveness of health literacy interventions customized to CKD patients. Methods We performed a systematic review of peer-reviewed research articles in Medline, Embase and Web of Science, 2009–19. We assessed the quality of the studies and conducted a best-evidence synthesis. Results We identified 860 publications and included 48 studies. Most studies were of low quality (n = 26) and focused on dialysis and transplantation (n = 38). We found strong evidence for an association of LHL with smoking and having a suboptimal transplantation process. Evidence was weak for associations between LHL and a variety of factors related to self-care management (n = 25), utilization of care (n = 23), patient–provider interaction (n = 8) and social context (n = 5). Six interventions were aimed at improving knowledge, decision-making and health behaviours, but evidence for their effectiveness was weak. Conclusions Study heterogeneity, low quality and focus on kidney failure largely impede the identification of intervention targets and strategies for LHL. More and higher quality studies in earlier CKD stages are needed to unravel how LHL leads to worse health outcomes, and to identify targets and strategies to prevent disease deterioration. Healthcare organizations need to develop and evaluate efforts to support LHL patients.

Background We assessed to what extent parental depression and parenting style mediate the relationships between different measures of parental socioeconomic status (SES) and both depression and metabolic syndrome (MetS) in adolescents, and whether these mechanisms differ by sex. Methods Data were from the prospective multigenerational Dutch Lifelines Cohort Study. Our sample consisted of 1,217 adolescents with an average follow-up of 33.3 (SD = 7.33) months and a median baseline age of 13 (IQR:13-14) years. We used structural equation models to assess the direct and indirect effects of SES on baseline and changes at follow-up in both depression and MetS, and to assess moderation by sex. Results Parental education had a small direct effect on adolescent cMetS. For each additional year of education, cMetS scores were 0.098 (95%CI: 0.020; 0.184) units lower at baseline and decreased 0.079 (95%CI: 0.004; 0.158) units at follow-up. No indirect effects via parenting style or parental depression were found, and there was no moderation by sex. Additionally, parenting style was consistently associated with baseline cMetS and depression, and improvements in parenting style were consistently associated with decreasing depression scores. Conclusions The results indicate that improving parenting style may improve health for all adolescents. However, in this study parental depression and parenting style did not account for adolescent socioeconomic health inequalities. This may be partly due to good access to social services within the Netherlands. Key messages Improvements in parenting style may improve adolescent health. Additionally, pathways to counteract socioeconomic differences require further elucidation.

Urban interventions in the built environment can improve the health of residents by impacting daily living patterns and lifestyles. Co-creation of these interventions with residents enhances their effectiveness. This pilot study investigates how the co-creation process can be developed, with elderly as a target group. The setting of the pilot is the area around a shopping centre in a post-war neighbourhood. Residents were recruited via the neighbourhood council and existing networks, via student-recruiters and via door-to-door flyers. They were asked to participate in the evaluation of proposed interventions, which aimed to increase physical activity. Virtual reality (VR) techniques were used as a tool to communicate current and redesigned environments. We organised three meetings for residents, where VR was used to: 1) collect data on current urban issues, 2) evaluate the different redesigns of the project location, and 3) present a final redesign. During meeting 1 and 2, VR was supported by questionnaires to collect data. We recruited 31 residents with an average age of 65, mostly through the neighbourhood council and existing networks. Recruitment with flyers resulted in only 1 participant ( Recruiting residents through existing networks, including the neighbourhood council, was most effective. VR technology is a very useful tool to communicate urban interventions and the residents were very capable of evaluating them while providing valuable input for the redesigns. Key messages Co-creating urban redesigns with residents to improve health is feasible, and virtual reality is of great added value as a co-creation supporting and communication tool. Urban interventions impact daily living patterns and lifestyles of residents and thereby public health.

Background The choice of pediatric metabolic syndrome (MetS) definition influences prevalence estimates, but further implications, especially on the association with socioeconomic status (SES), are not well-known. This hampers a synthesis of the evidence to help guide the relevant stakeholders. For this reason, we aim to assess the impact of alternative definitions on the prevalence of MetS, the children that are identified, and the association between SES and MetS. Methods Data were used from the Lifelines Cohort Study, a prospective multigenerational cohort in the Netherlands. At baseline 9,754 children participated, of which 5,085 (52.1%) were included in the longitudinal analyses. We computed the prevalence of MetS according to five published definitions and measured the observed positive agreement between pairs of definitions, indicating the proportion of agreement across the average number of MetS cases. Logistic regression was used to assess the association between SES and MetS. All models were adjusted for age and sex; the longitudinal models were also adjusted for baseline MetS status. Results The prevalence rates of MetS varied between definitions (0.7-3.0% at baseline), but positive agreement between MetS definitions was generally fair to good ranging from 0.34 (95% confidence interval (CI) 0.28; 0.41) to 0.66 (95%CI 0.58; 0.75) at baseline. At both assessments, we found an inverse association between baseline SES and MetS, which ranged from 0.81 (95%CI 0.70; 0.93) to 0.92 (95%CI 0.86; 0.98) per definition in the longitudinal analyses with a mean follow-up (SD) of 3.0 (0.75) years. Conclusions Alternative definitions of MetS lead to differing prevalence estimates, and they agreed on 50% of the average number of cases of MetS. The alternative definitions also lead to similar socioeconomic gradients; regardless of which definition was used we concluded low SES was a risk factor for developing MetS. Key messages Evidence regarding different definitions of metabolic syndrome in children can be combined because the agreement among definitions is generally fair to good. As low socioeconomic status is a consistent risk factor for developing metabolic syndrome, preventive interventions should preferentially target children from low socioeconomic backgrounds.

Background Many children experience parental separation and divorce. This experience is likely to negatively affect their wellbeing, conduct, psychological adjustment and social relations. Prevention of these problems thus has major priority but effective intervention programmes are still rare. This study therefore aimed to assess the effects of a 12-session preventive group intervention “Dappere Dinos™” for 6 to 8 year old children. Methods We performed a quasi-experimental study (registered as NTR 6788) on 105 children participating in the intervention group, 37 children with separated parents not participating (’divorce controls’) and 138 children from intact families (’intact controls’). Outcomes regarded children’s positive functioning (Parent Evaluation Form; Pedro-Carroll & Cowen, 1989), emotional and behavioral problems (Strengths and Difficulties Questionnaire; Goodman, 1997), and wellbeing (Cantril ladder, Cantril, 1965). Results Analyses showed that children’s positive functioning after participating in Dappere Dino’s increased according to mothers (MΔpre-post(SD) = 0.26 (0.32); p < .001). Also, children’s overall emotional and behavioral problems decreased after participation (MΔpre-post_mother(SD) = -2.02 (4.55); p < .01; MΔpre-post_trainer(SD) = -1.07 (4.34); p < .05; MΔpre-post_teacher(SD) = -1.64 (3.54); p < .01). Children’s wellbeing increased after participation (MΔpre-post_mother(SD) = 0.77 (1.02); p < .001; MΔpre-post_trainer(SD) = 0.69 (0.94); p < .001), or stayed the same (MΔpre-post_teacher(SD) = 0.19 (1.03); p = n.s.). No such changes were found in the two comparison groups. Conclusions After parental divorce, a 12-session preventive group intervention Dappere Dino’s™ for 6- to 8-year-olds can be efficacious in promoting children’s emotional well-being and positive functioning, and reducing their emotional and behavioral problems. Key messages Given the high prevalence of divorce and the potential risk for child well-being and functioning, prevention of problems for these children and helping them adapt to the divorce are major priorities. After parental divorce, preventive group support can be efficacious in promoting children’s emotional well-being and positive functioning, and reducing their emotional and behavioral problems.

Background: An integrated community-based intervention was developed to stimulate physical activity (PA) and healthy eating in older adults in a socioeconomically disadvantaged area. This study aims to assess whether its short-term effects among older adults vary by sociodemographic, psychosocial and health-related variables. Methods: The study was a controlled pre-post quasi-experimental design (intervention condition n = 430; control condition n = 213), with a baseline measurement and a 9-month follow-up measurement. The intervention consisted of a local media campaign and environmental approaches. Changes in PA and fruit and vegetable consumption (FVC) were dependent variables assessed at 9-month follow-up. Sociodemographic, psychosocial and health-related variables at baseline were tested as potential moderators of the effects of the conditions. Results: We found different types of moderators in particular for transport-related PA and FVC. Regarding sociodemographic characteristics, gender was a moderator for household-related PA, and educational level for transport-related PA and FVC. Self-efficacy, as a psychosocial variable, was a moderator of transport-related PA and vegetable consumption. Concerning health-related outcomes, baseline levels of transport-related PA and fruit consumption were moderators for transport-related PA and fruit consumption. If adjusted for multiple testing, only three moderators persisted: educational level regarding vegetable consumption, and baseline levels regarding transport-related PA and fruit consumption. Conclusion: The effects of the community intervention vary somewhat by sociodemographic, psychosocial and health-related variables. The intervention seems to be especially beneficial to those who are most in need of more PA and healthy eating.

TAKECARE is a prospective cohort study designed in The Netherlands to obtain evidence on the care chain for children and adolescents with psychosocial problems, and its long-term outcomes. Little is known about the content of care as offered and on whether the care is adequate. The cohort consists of children and adolescents entering care for psychosocial problems (care sample, n = 1382) and a random sample of the general population (community sample, n = 666). Children were eligible for participation if they were aged 4-18 years (inclusive) and had estimated IQs of 70 and over. The care sample covers the fields of Preventive Child Healthcare (PCH), Child and Adolescent Social Care (CASC) and Child and Adolescent Mental Healthcare (CAMH). Children, parents or guardians and involved practitioners completed five questionnaires (baseline, and at 3, 12, 24 and 36 months thereafter). The main categories of data concern the sociodemographic characteristics of children and their parents or guardians, the characteristics of entry into care and care content, and intermediate and final treatment outcomes. Information about data access can be requested by e-mail: c4youth@umcg.nl.

BACKGROUND: Health-risk behaviours (HRB) increase the risk of disability and chronic diseases at an older age. This study aimed to compare Slovakia and the Netherlands regarding differences in the prevalence of HRB by neighbourhood and individual deprivation and to determine whether area differences could be explained by the socio-economic position (SEP) of the residents.METHODS: We obtained data on non-institutionalized residents aged ≥65 years from the EU-FP7: EURO-URHIS 2 project from Slovak (N = 665, response rate 44.0%) and Dutch cities (N = 795, response rate 50.2%). HRB concerned daily smoking, binge drinking, physical activity, consumption of fruits and vegetables and body mass index. Area deprivation was measured by the neighbourhood unemployment rate. Individual SEP was measured by education and household income with financial strain. We used multilevel logistic regression.RESULTS: In Slovakia, no HRB was associated with either neighbourhood unemployment or individual SEP. The elderly in the Netherlands from the least favourable neighbourhoods were more likely to be daily smokers [odds ratio (OR) 2.32; 95% confidence interval (CI) 1.25, 4.30] and overweight (OR 1.84; 95% CI 1.24, 2.75) than residents from the most favourable ones. For the Dutch elderly the gradients varied per HRB and per individual-level SEP indicator. Individual SEP explained country differences in the association of area unemployment with smoking and lack of physical activity but not that with overweight.CONCLUSION: Countries differed in the associations with HRB of both neighbourhood unemployment and individual SEP among the elderly urban residents. The local importance of socio-economic factors on both levels should be considered when developing health-promotion activities for the elderly.

BACKGROUND: Prenatal healthcare is likely to prevent adverse outcomes, but an adequate review of utilization and its determinants is lacking. OBJECTIVE: To review systematically the evidence for the determinants of prenatal healthcare utilization in high-income countries. METHOD: Search of publications in EMBASE, CINAHL and PubMed (1992-2010). Studies that attempted to study determinants of prenatal healthcare utilization in high-income countries were included. Two reviewers independently assessed the eligibility and methodological quality of the studies. Only high-quality studies were included. Data on inadequate use (i.e. late initiation, low-use, inadequate use or non-use) were categorized as individual, contextual and health behaviour-related determinants. Due to the heterogeneity of the studies, a quantitative meta-analysis was not possible. RESULTS: Ultimately eight high-quality studies were included. Low maternal age, low educational level, non-marital status, ethnic minority, planned pattern of prenatal care, hospital type, unplanned place of delivery, uninsured status, high parity, no previous premature birth and late recognition of pregnancy were identified as individual determinants of inadequate use. Contextual determinants included living in distressed neighbourhoods. Living in neighbourhoods with higher rates of unemployment, single parent families, medium-average family incomes, low-educated residents, and women reporting Canadian Aboriginal status were associated with inadequate use or entering care after 6 months. Regarding health behaviour, inadequate use was more likely among women who smoked during pregnancy. CONCLUSION: Evidence for determinants of prenatal care utilization is limited. More studies are needed to ensure adequate prenatal care for pregnant women at risk.

Background: Area deprivation negatively affects health and lifestyles, among which child behaviours. The latter may aggravate the effects of area deprivation on parental health due to higher rates of parenting stress. However, evidence on the influence of the living environment on parenting stress is mostly lacking. The aim of this study was to examine the impact of area deprivation and urbanization on the occurrence of parenting stress. Methods: A cross-sectional multi-level study was conducted using both neighbourhood- and individual-level data. Living areas were categorized into tertiles of deprivation. Data on parenting stress (Parenting Stress Index), child psychosocial problems (Strengths and Difficulties Questionnaire) and family background were collected among 9453 parents prior to a routine health examination of their child (response: 65%). Results: In the deprived areas, parents reported parenting stress more often compared with the least deprived tertile (OR = 1.23; 95% CI 1.04-1.46). Adjusted for child problem behaviour, the association decreases (OR = 1.11; 95% CI 0.92-1.34). A small clustering of parenting stress by area was found which increased when child and family characteristics were taken into account. Conclusion: Parents from deprived areas were most likely to report parenting stress. Differences by area deprivation were partially accounted for by child problem behaviour and parental concerns about the behavioural and emotional problems of the child. This shows a rather large potential to improve both parental and child health by targeted parenting support in deprived areas.

Background Consumption of soft drinks and energy drinks is very popular among adolescents across Europe. High and regular intake of these beverages has been shown to be associated with negative health consequences among adolescents. Parental behaviour has been identified as a factor influencing eating behaviour of …

Background High and frequent soft drinks consumption (SDC) in adolescence has been found to be linked with higher rates of health problems. SDC seems to be connected with behavioural problems too, but evidence on this is inconclusive. Our aim was to assess the association SDC and aggressive behaviour among adolescents, and whether …

Background. In general, poor health and lifestyles occur more frequently among individuals of low socioeconomic status (SES) and in deprived areas. An explanation for the latter may simply be the on average lower SES of residents of these areas. It is possible, however, that living in a deprived area contributes to poor health and lifestyles. This study examines whether such an area-contribution exists in urban settings. Methods. Data on health, smoking, and individual SES were collected on 5121 residents of Amsterdam, the Netherlands, by face-to-face interviews (response: 61.4%). Area deprivation was measured by indicators used previously, on 22 areas. Odds ratios (OR) for poor health (poor self-rated health, long-term limitations, health complaints and obesity) and smoking were computed comparing tertiles of area deprivation. All analyses employed multilevel techniques, with residents hierarchically nested within areas. Results. The age- and gender-adjusted prevalences of poor health and smoking are higher in deprived urban areas. Most of the differences in poor health can be explained by the on average lower SES of residents of deprived areas. Only for long-term limitations and obesity, some statistically significant area-differences remain. The higher prevalence of smoking in deprived areas can only partially be explained by the SES of residents. Conclusions. Adverse health status in deprived areas is mainly due to a lower individual SES and not to contextual factors. For smoking, living in a deprived area contributes to a higher prevalence. This shows the necessity of community-based preventive interventions in deprived areas.

Trends in socioeconomic differences in infant and perinatal mortality in Amsterdam were studied for the period 1854–1990, using published and unpublished material, at the aggregate and at the individual level. Absolute and relative socioeconomic mortality differences (SEMD) per data-set were calculated using inequality indices developed by Pamuk. The results show a decrease of the absolute differences in both infant and perinatal mortality. For infant mortality, this is mainly due to the overall decline of the infant mortality rate. Relative differences in infant mortality did not decrease during the study period. This is the result of separate developments in 3 time periods. From approximately 1850 to approximately 1910 an increase in relative differences can be seen, a trend which is reversed from approximately 1910 to the end of World War II. After World War II relative differences seem to stabilize at the same level. For perinatal mortality, for which only data from the post-World War II period are available, the decrease in the absolute differences is due both to the overall decline of the perinatal mortality rate and to a decline of relative differences between socioeconomic groups. It is conduded that although SEMD in infant and perinatal mortality have declined in an absolute sense, they still exist and that the relative position of deprived groups concerning infant mortality was not ameliorated during the study period.

Indicators of socio-economic status (SES) are associated with age. The aim of this paper is to analyse the modifying effects of age on the interpretation of a commonly used SES indicator, education level, in relation to health. A population-based health interview survey was conducted in 1992 and 1993 in Amsterdam, The Netherlands. Participants were members of the non-institutionalized population aged 16 years and over, selected randomly from the municipal population register after stratification for age and borough (N=5, 121; response rate 61.4%). The relative differences in poor self-rated health between educational levels vary strongly with age group. Among men the risk of poor health for the lowest education level relative to the mean for the age group concerned varies from 1.67 for the 16–34 years age group to 1.10 for the ≥65 years group. Logistic regression indicates that age modifies the relation of education level with self-rated health. We conclude that the interpretation of SES indicators differs by age group, especially if indicators are strongly associated with age. This modifying effect of age on the interpretation of SES needs to be corrected for in research on socio-economic health differences.

BACKGROUND. Socioeconomic mortality differences exist between parts of many cities. This study aims to identify causes of death associated with such mortality differences and which preventive or curative interventions can modify. METHODS. Associations were compared between socioeconomic status and age-standardized mortality by borough of Amsterdam, The Netherlands (n = 22) for causes of death grouped by feasible interventions. RESULTS. In men, mortality due to external and ill-defined causes occurs more frequently in low-income boroughs. In women, this holds for smoking-related and ill-defined causes. AIDS-related mortality is higher in boroughs with a high educational level. Mortality in low-income boroughs is generally higher for those causes of death which explain the relatively high urban mortality. CONCLUSIONS. Interventions to decrease urban socioeconomic mortality differences should be targeted on violence and accidents in men and smoking in women. Incomplete notification of deaths in low-income boroughs obscures some differences but also indicates problems in urban general practice and specific risks for immigrant residents. AIDS reduces the size of mortality differences among men, probably temporarily. Both feasibility and type of interventions are relevant for many urban areas. Language: en

This book aims to provide a summary of new developments in public health. Its contents are mostly based on presentations read at the 2004 meeting of the European Public Health Association in Oslo. These presentations constitute the 31 chapters of this book which have been subdivided into broader areas such as ‘Nutrition, physical activity and tobacco’ and ‘Health inequalities, culture and prevention’. Though not explicitly stated in its title, the book focuses on European public health. The approach followed by the editor, compiling presentations of a scientific meeting which he headed, directly explains the strengths and the weaknesses of the book. A major strength is that it provides the reader with an up-to-date overview of many of the … Email: s.a.reijneveld{at}med.umcg.nl

Mental health problems constitute a large and increasing part of the burden of disease worldwide.1 As such, their prevention and the provision of adequate mental health care facilities are important public health issues.1 Several papers in this issue of the European Journal of Public Health add to the evidence that is needed to support this area.2–4 First, Cuijpers and co-workers provide tools to increase the effectiveness of prevention of mental disorders in the community.2Their paper tackles a problem that many public health workers meet: can we apply the evidence on the effectiveness of preventive measures from other countries to our own society? In mental health prevention, by far the majority of interventions and majority of studies on effectiveness have … * Correspondence: S.A. Reijneveld, University Medical Center Groningen, Department of Health Sciences, Groningen, The Netherlands, Email: s.a.reijneveld{at}med.umcg.nl