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Biomedical subjects

Frank J van Lenthe

Publications and source records attributed to Frank J van Lenthe.

At least 19 recordsLinked to original sources
PubMed2006

Revisiting Kurt Lewin: how to gain insight into environmental correlates of obesogenic behaviors.

Overweight and obesity are important determinants of population health. Prevention of weight gain is dependent on the successful balancing of eating and physical activity behaviors. Planned promotion of healthful behavior requires insights into important and changeable determinants and correlates of behavior change. The modest effects of health education have induced a shift in focus from personal to environmental correlates of eating and physical activity behaviors. Six systematic reviews were conducted in 2005 of observational studies of environmental correlates and environmental interventions for weight-related eating behaviors and physical activity for children, adolescents, and adults. The reviews of 297 observational studies showed that few investigations of environmental associations have been replicated, and that most studies used weak research designs and nonvalidated self-report measures, were restricted to micro-environmental factors, and failed to apply multilevel analyses. There is, therefore, very little evidence for an association between environmental factors and weight-related behaviors. However, the reviews of 112 intervention studies indicated much stronger evidence for positive effects of micro-physical and sociocultural environmental changes on eating and physical activity behaviors. Inspired by quotes from Kurt Lewin, we argue that before large-scale environmental change interventions are launched, better-designed and -conducted research on the true importance of environmental factors, including macrolevel factors, for obesogenic behavioral change is needed. Such research should (1) develop better measures of environmental exposure, (2) attempt to integrate personal and environmental correlates of obesogenic behaviors, (3) take a solution-oriented, rather then a problem-oriented approach, and (4) identify access points for inducing behavior change instead of finding explanations for existing behavioral patterns.

Health Behavior↗
PubMed2006

Differences in fruit and vegetable intake and determinants of intakes between children of Dutch origin and non-Western ethnic minority children in the Netherlands - a cross sectional study.

BACKGROUND: Fruit and vegetable consumption is low in the Netherlands and a key target in healthy diet promotion. However, hardly any information is available on differences in fruit and vegetable consumption between Dutch children and ethnic minority children. Therefore, the aim of present study was to determine differences in usual fruit and vegetable intake between native Dutch and non-Western ethnic minority children and to study differences in and mediating effects of potential psychosocial and environmental determinants. METHODS: Ethnicity, usual fruit and vegetable consumption, psychosocial and environmental determinants and mothers' educational level were measured with a self-administered questionnaire during school hours in primary schools in Rotterdam, the Netherlands. Complete data was available for 521 10-11 year-old-children, of which 50.5% of non-Western origin. Differences between the groups regarding potential determinants and fruit and vegetable intake were assessed with Mann Whitney tests or multiple regression analyses. Multiple regression analyses were also conducted to assess mediating effects. RESULTS: Ethnic minority girls ate fruit more frequently (1.41 +/- 1.0 times/day) than Dutch girls (1.03 +/- 0.82 times/day); no differences in frequency of intake were found for vegetables or among boys. Ethnic differences were found for almost all potential determinants. The Dutch children reported lower scores on these determinants than the ethnic minority children, except for perceived self-efficacy and barriers to eat fruit and vegetables. Knowledge of recommendations and facilitating behaviors of the parents mediated the association between ethnicity and fruit consumption among girls. CONCLUSION: Ethnic minority girls in the Netherlands appear to have more favorable fruit intakes than Dutch girls, and ethnic minority children in general show more positive prerequisites for fruit and vegetable consumption. Interventions addressing multi-ethnic populations of children must take such differences into account.

Journal Article↗
PubMed2006

Perceived environmental determinants of physical activity and fruit and vegetable consumption among high and low socioeconomic groups in the Netherlands.

A focus group study was conducted to explore how perceptions of environmental influences on health behaviours pattern across socioeconomic groups in the Netherlands. Participants perceived their spouse's and friend's health behaviour and support as highly important. People from lower socioeconomic backgrounds reported poor neighbourhood aesthetics, safety concerns and poor access to facilities as barriers for being physically active, while easy accessibility to sports facilities was mentioned by high socioeconomic participants. The availability of fruits and vegetables at home was perceived as good by all particpants. Overall, lower socioeconomic groups expressed more price concerns. Possible pathways between socioeconomic status, environmental factors and health behaviours are represented in a framework, and they should be investigated further in longitudinal research.

Adult↗
PubMed2006

Stages of change for moderate-intensity physical activity in deprived neighborhoods.

BACKGROUND: This article describes the association of external and psychosocial factors with the stages of change for moderate-intensity physical activity among individuals with generally low socioeconomic positions. METHODS: A self-administered questionnaire among individuals aged 18-65 years (response rate 60%, n = 2781) in deprived neighborhoods in Eindhoven, The Netherlands, was conducted in September 2000. To identify factors associated with stages of change an ordinal logistic regression model, the "Threshold of Change model (TCM)", was used to analyze the data. RESULTS: Thirty-six percent of the respondents were in the pre-action stages, 15% was in action and 49% in maintenance. Individuals who were, older, lower educated, had low health locus of control, had less knowledge of physical activity issues, and presented other risky health behaviors, were more likely to be in a lower stage of change category. A positive attitude, high self-efficacy expectations, perceiving the physical activity level of others as high, and much social support were associated with the higher stages of change categories. CONCLUSION: The distribution across the stages of change supports the need to improve physical activity behavior in these deprived neighborhoods. Interventions need to be tailored to the psychosocial, and the external factors that are likely to play a role in the behavioral change process.

Adolescent↗
PubMed2006

Neighbourhood inequalities in health and health-related behaviour: results of selective migration?

We hypothesised that neighbourhood inequalities in health and health-related behaviour are due to selective migration between neighbourhoods. Ten-year follow-up data of 25-74-year-old participants in a Dutch city (Eindhoven) showed an increased probability of both upward and downward migration in 25-34-year-old participants, and in single and divorced participants. Women and those highly educated showed an increased probability of upward migration from the most deprived neighbourhoods; lower educated showed an increased probability of moving downwards. Adjusted for these factors, health and health-related behaviour were weakly associated with migration. Over 10 years of follow-up, selective migration will hardly contribute to neighbourhood inequalities in health and health-related behaviour.

Adult↗
PubMed2006

Process evaluation of a Dutch community intervention to improve health related behaviour in deprived neighbourhoods.

OBJECTIVES: To assess whether a community intervention on health related behaviour in deprived neighbourhoods was delivered as planned and the extent of exposure to the intervention programme. METHODS: Data were gathered throughout the intervention period using minutes of meetings, registration forms and a postal questionnaire among residents in intervention and comparison neighbourhoods. RESULTS: Overall, the intervention was delivered according to the key principles of a "community approach", although community participation could have been improved. Neighbourhood coalitions organized more than 50 health related activities in the neighbourhoods over a two-year period. Most activities were directed at attracting attention, providing information, and increasing awareness and knowledge, and at changing behaviours. Programme awareness and programme participation were 24% respectively 3% among residents in the intervention neighbourhoods. CONCLUSIONS: The process evaluation indicated that it was feasible to implement a community intervention according to the key principles of the "community approach" in deprived neighbourhoods. However, it is unlikely that the total package of intervention activities had enough strength and sufficient exposure to attain community-wide health behaviour change.

Adolescent↗
PubMed2006

A multilevel study of socio-economic inequalities in food choice behaviour and dietary intake among the Dutch population: the GLOBE study.

OBJECTIVE: To examine the influence of individual- and area-level socio-economic characteristics on food choice behaviour and dietary intake. SETTING: The city of Eindhoven in the south-east Netherlands. DESIGN: A total of 1339 men and women aged 25-79 years were sampled from 85 areas (mean number of participants per area = 18.4, range 2-49). Information on socio-economic position (SEP) and diet was collected by structured face-to-face interviews (response rate 80.9%). Individual-level SEP was measured by education and household income, and area-level deprivation was measured using a composite index that included residents' education, occupation and employment status. Diet was measured on the basis of (1) a grocery food index that captured compliance with dietary guidelines, (2) breakfast consumption and (3) intakes of fruit, total fat and saturated fat. Multilevel analyses were performed to examine the independent effects of individual- and area-level socio-economic characteristics on the dietary outcome variables. RESULTS: After adjusting for individual-level SEP, few trends or significant effects of area deprivation were found for the dietary outcomes. Significant associations were found between individual-level SEP and food choice, breakfast consumption and fruit intake, with participants from disadvantaged backgrounds being less likely to report food behaviours or nutrient intakes consistent with dietary recommendations. CONCLUSIONS: The findings suggest that an individual's socio-economic characteristics play a more important role in shaping diet than the socio-economic characteristics of the area in which they live. In this Dutch study, no independent influence of area-level socio-economic characteristics on diet was detected, which contrasts with findings from the USA, the UK and Finland.

Adult↗
PubMed2006

Neighbourhood and individual socioeconomic inequalities in smoking: the role of physical neighbourhood stressors.

OBJECTIVE: To explore the association between physical neighbourhood stressors and smoking, and the contribution of these stressors to neighbourhood and individual socioeconomic inequalities in smoking. METHODS: Data were analysed of participants of the baseline measurement of the Dutch GLOBE study (1991), aged 20 years and older, who lived in 79 neighbourhoods of the city of Eindhoven (n = 9062). The neighbourhood socioeconomic environment was assessed from aggregated self reported information of participants' education and occupation level, and employment status. Neighbourhood stressors included were the physical quality (decay), required police attention, noise pollution from traffic, and population density in neighbourhoods. Current smokers were distinguished from previous and never smokers. RESULTS: Compared with those living in the most advantaged neighbourhoods, residents living in the socioeconomically most disadvantaged neighbourhoods were more likely to smoke (adjusted for age, sex, education, occupation, and employment status) (OR = 1.24, 95% CI 1.05 to 1.46). An increase in a summary neighbourhood stressor score was associated with smoking, independently of the neighbourhood socioeconomic environment (OR = 1.57, 95% CI 1.11 to 2.21, in the neighbourhoods with the highest stress score). Adjustment for the score substantially reduced the odds ratio for living in the socioeconomic most disadvantaged neighbourhoods (OR = 1.03, 95% CI 0.84 to 1.28, for those in the most disadvantaged neighbourhoods). Neighbourhood stressors contributed 10% to the increased probability of smoking in the lowest educated persons. CONCLUSIONS: Physical neighbourhood stressors are related to smoking and contribute substantially to neighbourhood inequalities in smoking over and above individual level characteristics.

Adolescent↗
PubMed2006

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.

Educational Status↗
PubMed2006

Environmental determinants of fruit and vegetable consumption among adults: a systematic review.

The current ecological approach in health behaviour research recognises that health behaviour needs to be understood in a broad environmental context. This has led to an exponential increase in the number of studies on this topic. It is the aim of this systematic review to summarise the existing empirical evidence pertaining to environmental influences on fruit and vegetable (FV) consumption. The environment was defined as 'all factors external to the individual'. Scientific databases and reference lists of selected papers were systematically searched for observational studies among adults (18-60 years old), published in English between 1 January 1980 and 31 December 2004, with environmental factor(s) as independent factor(s), and fruit intake, vegetable intake or FV intake combined as one outcome measure as dependent factor(s). Findings showed there was a great diversity in the environmental factors studied, but that the number of replicated studies for each determinant was limited. Most evidence was found for household income, as people with lower household incomes consistently had a lower FV consumption. Married people had higher intakes than those who were single, whereas having children showed mixed results. Good local availability (e.g. access to one's own vegetable garden, having low food insecurity) seemed to exert a positive influence on intake. Regarding the development of interventions, improved opportunities for sufficient FV consumption among low-income households are likely to lead to improved intakes. For all other environmental factors, more replicated studies are required to examine their influence on FV intake.

Adolescent↗
PubMed2005

Impact evaluation of a Dutch community intervention to improve health-related behaviour in deprived neighbourhoods.

This study investigates the impact of a 2-year community intervention on health-related behaviour among adults aged 18-65 years living in deprived neighbourhoods in Eindhoven, The Netherlands. The intervention is evaluated in a community intervention trial with a quasi-experimental design in a longitudinal cohort survey (n=1926 and attrition rate: 31%) using postal questionnaires. In the 2-year implementation phase, more than 40 intervention activities were planned and delivered by intersectoral neighbourhood coalitions. Outcome measures were fruit consumption, vegetable consumption, physical activity, smoking, alcohol consumption and intermediate outcomes of behaviour (i.e. attitudes, self-efficacy, awareness, knowledge and stages of change). The intervention demonstrated no evidence for an impact on vegetable consumption, physical activity, smoking and alcohol consumption and weak evidence for a small impact on (intermediate) outcomes of fruit consumption.

Adolescent↗
PubMed2005

A simultaneous analysis of neighbourhood and childhood socio-economic environment with self-assessed health and health-related behaviours.

Childhood socio-economic environment and neighbourhood socio-economic environment later in life are closely related. However, few studies have considered their effects simultaneously. Using cross-sectional data of approximately 8000 respondents in 86 neighbourhoods in the city of Eindhoven, The Netherlands, we study associations of both determinants with self-assessed health, smoking, alcohol consumption and overweight. Growing up in a low socio-economic environment increased the probability to live a more deprived neighbourhood in adulthood. Controlling for individual socio-economic characteristics, both childhood and neighbourhood socio-economic environment were related to smoking and overweight, but not with excessive alcohol consumption. Associations between childhood socio-economic environment and smoking and overweight are still substantial after controlling for neighbourhood socio-economic environment. Similarly, neighbourhood inequalities in smoking and overweight remain substantial after controlling for childhood socio-economic environment.

Adult↗
PubMed2005

The role of psychosocial factors in explaining socio-economic differences in mobility decline in a chronically ill population: results from the GLOBE study.

In chronically ill patients, mobility develops more unfavorably in persons with low socio-economic status (SES) than in their better-off counterparts. Using longitudinal data from the Dutch GLOBE study (a study of health and living conditions in Eindhoven and its surroundings), the present study examines whether psychosocial factors can explain socio-economic differences in mobility decline, independent of disease severity, co-morbidity, and health-related behavior in a chronically ill population. Data were from 1384 men and woman, aged 15-74 years, suffering from at least one of the four chronic diseases: asthma/COPD, heart disease, diabetes mellitus, and low back pain. Three indicators of SES were used: education, occupational class, and income. Change in physical mobility between 1991 and 1997 was measured with the Nottingham Health Profile (NHP). Psychosocial factors were measured extensively and included life events, long-term difficulties, coping styles, social support, and personality characteristics. Low occupational level and low income predicted an increased risk of mobility decline in comparison to people with a higher occupational level and income, even after controlling for sociodemographics, disease severity, co-morbidity, and health-related behavior. Additional adjustment for psychosocial factors hardly reduced the SES-related odds ratios of mobility decline. We conclude that psychosocial factors (and also health-related behaviors, disease severity and co-morbidity) cannot explain socio-economic differences in mobility decline in a chronically ill population. Our findings will not give us new tools for prevention and intervention strategies in order to reduce physical disability and particularly the SES differences therein.

Adolescent↗
PubMed2005

Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in The Netherlands.

STUDY OBJECTIVES: To assess the direct and indirect contributions of material, behavioural, and psychosocial factors to the explanation of educational inequalities in mortality simultaneously. DESIGN: Prospective observational study (1991-1998). SETTING: General population from south east Netherlands. PARTICIPANTS: 3979 men and women aged 15-74 years without severe chronic disease at baseline (1991). MAIN RESULTS: Material factors (type of health insurance, financial problems, and housing tenure), psychosocial factors (life events and external locus of control), and behavioural factors (smoking habits and physical activity) together reduced the relative risk of mortality of the lowest educated group from 2.57 (95%CI 1.43 to 4.64) to 1.01 (95%CI 0.50 to 2.03). Of these three groups of factors, material factors contributed most to the educational inequalities. Part of the contribution of material factors was via psychosocial factors and part via behavioural factors. Psychosocial factors contributed to educational inequalities, partly via behavioural factors. Behavioural and psychosocial factors contributed only marginally to the explanation independent of material factors. CONCLUSION: Educational inequalities in mortality were explained by material, psychosocial, and behavioural factors. Material factors contributed most to the explanation, partly via psychosocial and behavioural factors. Improving the material situation of lower educated people may substantially reduce educational inequalities in mortality, partly via the psychosocial and behavioural consequences of improved material circumstances.

Adult↗
PubMed2004

Education was associated with injuries requiring hospital admission.

OBJECTIVES: We describe educational inequalities in the incidence of injuries resulting in hospital admission and explore the contribution of exposure variables and chronic diseases, alcohol consumption, and sedative use to the observed inequalities. STUDY DESIGN AND SETTING: Data from the Dutch prospective GLOBE study were linked to the National Hospital Discharge Register after 7 years of follow-up. RESULTS: Significantly higher hazard ratios (HRs) of traffic injuries in lower compared with higher educational groups were substantially reduced after adjustment for differences in the use of cars and mopeds between these groups. Significantly increased HRs in occupational, home, and sports (OHS) injuries in lower compared with higher educational groups were reduced after adjustment for higher prevalence rates of chronic diseases, very excessive alcohol consumption, and sedative use in lower educational groups. CONCLUSION: Exposure variables, chronic diseases, alcohol consumption, and sedative use contribute to educational inequalities in traffic and OHS injuries resulting in hospital admission.

Accidents, Home↗
PubMed2004

Investigating explanations of socio-economic inequalities in health: the Dutch GLOBE study.

BACKGROUND: The GLOBE study is a prospective cohort study specifically aimed at the explanation of socio-economic inequalities in health in the Netherlands. The returns of the study are reviewed after ten years of follow-up, and the studies' contribution to the development of policy measures to reduce inequalities in health in the Netherlands are described. METHODS: The study started in 1991 with a baseline postal survey (response rate 70.1% or n=18973, 15-74 years of age). Two sub-samples of respondents to this survey were subsequently interviewed in 1991 (response 79.4% and 72.3%, n=5667). Baseline data collection included measures of socio-economic position, health and possible explanatory factors. Follow-up involved repeated postal surveys and interviews, and routinely collected data on hospital admissions, cancer incidence and mortality by cause of death. RESULTS: Compared with higher socio-economic groups, lower socio-economic groups showed higher prevalence rates of poor self-reported health (perceived general health, health complaints, chronic conditions, disabilities), higher incidence rates of specific conditions (myocardial infarction) and higher rates of all-cause mortality. The higher prevalence of adverse material circumstances, unhealthy behaviour, adverse psychosocial characteristics, and adverse childhood circumstances in the lower socio-economic groups was important in the explanation of socio-economic inequalities in health. Socio-economic differences in health care utilization did not contribute to the explanation. CONCLUSIONS: The GLOBE study contributed significantly to the understanding of the explanation of socio-economic inequalities in health in the Netherlands. Study results were a main source of information in the development of policy measures aimed at the reduction of socio-economic inequalities in health in the Netherlands.

Adolescent↗
PubMed2004

Socioeconomic inequalities in mobility decline in chronic disease groups (asthma/COPD, heart disease, diabetes mellitus, low back pain): only a minor role for disease severity and comorbidity.

OBJECTIVE: This study examined the association between socioeconomic status and mobility decline and whether this could be explained by disease severity and comorbidity in four different chronic disease groups (asthma/COPD, heart disease, diabetes mellitus, and low back pain). It is not clear, whether the adverse course of physical functioning in persons with a low socioeconomic status can be explained by a higher prevalence of more severe disease or comorbidity in these persons. DESIGN: Dutch GLOBE study: prospective cohort study. SETTING: Region of Eindhoven (south east of the Netherlands). PARTICIPANTS: 1384 persons suffering from at least one of the four chronic diseases were selected. The number of respondents in each group was: asthma/COPD 465, heart disease 788, diabetes mellitus 137, and low back pain 707. There were 580 respondents who suffered from more than one condition. MAIN RESULTS: Odds ratios of mobility decline between 1991 and 1997, adjusted for age, sex, marital status, and baseline mobility, were significantly higher in low socioeconomic groups in comparison with high socioeconomic groups. Only very little of this association could be explained by the higher disease severity and comorbidity in these patients. Findings were similar in patients with asthma/COPD, heart disease, diabetes mellitus, and chronic low back pain. CONCLUSION: These findings indicate that to reduce physical disabilities and particularly the socioeconomic differences therein, it may not be sufficient to solely intervene upon the risks of severe disease and comorbidities.

Activities of Daily Living↗