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Menassa M, Franco OH, Galenkamp H, Moll van Charante EP, van den Born BJH, Vriend EMC, Vidal PM, Stronks K. Healthy ageing in a multi-ethnic population: A descriptive cross-sectional analysis from the HELIUS study. Maturitas 2024; 184:107972. [PMID: 38507885 DOI: 10.1016/j.maturitas.2024.107972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE We investigated ethnic health disparities in the Healthy Life in an Urban Setting multi-ethnic cohort using the multidimensional Healthy Ageing Score. STUDY DESIGN We conducted a cross-sectional analysis of the study baseline data (2011-2015) collected through questionnaires/physical examinations for 17,091 participants (54.8 % women, mean (SD) age = 44.5 (12.8) years) from South-Asian Surinamese (14.8 %), African Surinamese (20.5 %), Dutch (24.3 %), Moroccan (15.5 %), Turkish (14.9 %), and Ghanaian (10.1 %) origins, living in Amsterdam, the Netherlands. MAIN OUTCOME MEASURES We computed the Healthy Ageing Score developed in the Rotterdam Study, which has seven biopsychosocial domains: chronic diseases, mental health, cognitive function, physical function, pain, social support, and quality of life. That score was used to discern between healthy, moderate, and poor ageing. We explored differences in healthy ageing by ethnicity, sex, and age group using multinomial logistic regression. RESULTS The Healthy Ageing Score [overall: poor (69.0 %), moderate (24.8 %), and healthy (6.2 %)] differed between ethnicities and was poorer in women and after midlife (cut-off 45 years) across ethnicities (all p < 0.001). In the fully adjusted models in men and women, poor ageing (vs. healthy ageing) was highest in the South-Asian Surinamese [adjusted odds ratios (95 % confidence intervals)] [2.96 (2.24-3.90) and 6.88 (3.29-14.40), respectively] and Turkish [2.80 (2.11-3.73) and 7.10 (3.31-15.24), respectively] vs. Dutch, in the oldest [5.89 (3.62-9.60) and 13.17 (1.77-98.01), respectively] vs. youngest, and in the divorced [1.48 (1.10-2.01) and 2.83 (1.39-5.77), respectively] vs. married. Poor ageing was inversely associated with educational and occupational levels, mainly in men. CONCLUSIONS Compared with those of Dutch ethnic origin, ethnic minorities displayed less healthy ageing, which was more pronounced in women, before and after midlife, and was associated with sociodemographic factors.
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Affiliation(s)
- Marilyne Menassa
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse, 43 3012 Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Mittelstrasse, 43 3012 Bern, Switzerland; Department of Global Public Health & Bioethics, Julius Center for Health Science and Primary Care, UMC Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse, 43 3012 Bern, Switzerland; Department of Global Public Health & Bioethics, Julius Center for Health Science and Primary Care, UMC Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Eric P Moll van Charante
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Esther M C Vriend
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Pedro Marques Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Basten M, Pan KY, van Tuijl LA, de Graeff A, Dekker J, Hoogendoorn AW, Lamers F, Ranchor AV, Vermeulen R, Portengen L, Voogd AC, Abell J, Awadalla P, Beekman ATF, Bjerkeset O, Boyd A, Cui Y, Frank P, Galenkamp H, Garssen B, Hellingman S, Huisman M, Huss A, Keats MR, Kok AAL, Krokstad S, van Leeuwen FE, Luik AI, Noisel N, Payette Y, Penninx BWJH, Rissanen I, Roest AM, Rosmalen JGM, Ruiter R, Schoevers RA, Soave D, Spaan M, Steptoe A, Stronks K, Sund ER, Sweeney E, Twait EL, Teyhan A, Verschuren WMM, van der Willik KD, Geerlings MI. Psychosocial factors, health behaviors and risk of cancer incidence: Testing interaction and effect modification in an individual participant data meta-analysis. Int J Cancer 2024; 154:1745-1759. [PMID: 38289012 DOI: 10.1002/ijc.34852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 03/14/2024]
Abstract
Depression, anxiety and other psychosocial factors are hypothesized to be involved in cancer development. We examined whether psychosocial factors interact with or modify the effects of health behaviors, such as smoking and alcohol use, in relation to cancer incidence. Two-stage individual participant data meta-analyses were performed based on 22 cohorts of the PSYchosocial factors and CAncer (PSY-CA) study. We examined nine psychosocial factors (depression diagnosis, depression symptoms, anxiety diagnosis, anxiety symptoms, perceived social support, loss events, general distress, neuroticism, relationship status), seven health behaviors/behavior-related factors (smoking, alcohol use, physical activity, body mass index, sedentary behavior, sleep quality, sleep duration) and seven cancer outcomes (overall cancer, smoking-related, alcohol-related, breast, lung, prostate, colorectal). Effects of the psychosocial factor, health behavior and their product term on cancer incidence were estimated using Cox regression. We pooled cohort-specific estimates using multivariate random-effects meta-analyses. Additive and multiplicative interaction/effect modification was examined. This study involved 437,827 participants, 36,961 incident cancer diagnoses, and 4,749,481 person years of follow-up. Out of 744 combinations of psychosocial factors, health behaviors, and cancer outcomes, we found no evidence of interaction. Effect modification was found for some combinations, but there were no clear patterns for any particular factors or outcomes involved. In this first large study to systematically examine potential interaction and effect modification, we found no evidence for psychosocial factors to interact with or modify health behaviors in relation to cancer incidence. The behavioral risk profile for cancer incidence is similar in people with and without psychosocial stress.
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Affiliation(s)
- Maartje Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviors and Chronic Diseases program, Amsterdam, The Netherlands
| | - Kuan-Yu Pan
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lonneke A van Tuijl
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, The Netherlands
| | - Joost Dekker
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adriaan W Hoogendoorn
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke Lamers
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Jessica Abell
- Department of Behavioural Science and Health, University College London, London, UK
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aartjan T F Beekman
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philipp Frank
- Department of Behavioural Science and Health, University College London, London, UK
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert Garssen
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sean Hellingman
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Martijn Huisman
- Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Melanie R Keats
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Almar A L Kok
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway
- Levanger hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | | | | | - Brenda W J H Penninx
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Annelieke M Roest
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - Judith G M Rosmalen
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Maasstad, Rotterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David Soave
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Mandy Spaan
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway
- Levanger hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emma L Twait
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Alison Teyhan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kimberly D van der Willik
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Personalized Medicine, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, The Netherlands
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3
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Nusselder WJ, Long D, Waterlander WE, Stronks K, Boshuizen HC. Estimating the contribution of overweight and obesity to ethnic inequalities in cardio-metabolic diseases in the Netherlands: a simulation study. Public Health 2024; 232:45-51. [PMID: 38733960 DOI: 10.1016/j.puhe.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES Overweight and obesity (OWOB) starts in childhood, influences adult cardiovascular risk, and is not equally distributed across ethnic groups. It is unclear which effects can be expected from reductions in OWOB across the life course on inequalities in cardio-metabolic diseases in a multi-ethnic population. This study aims to estimate the effects of three scenarios of changes in OWOB (the Normal-Weight-for-All scenario, the No-Ethnic-Difference-over-the-Life-Course scenario, the and No-Ethnic-Differences-in-Childhood scenario). STUDY DESIGN A simulation study. METHODS We combine data from multiple data sources and use the Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA) model to estimate the effects of three scenarios on the cumulative incidence of diabetes mellitus, ischaemic heart disease (IHD) and stroke between 18 and 70 years in the five largest ethnic groups in the Netherlands. RESULTS In the scenario where all individuals have normal weight, the cumulative incidence decreased in all ethnic minority groups for all diseases, with largest decreases among South-Asian Surinamese, where the reduction of diabetes incidence exceeded 50%. In the scenario where the prevalence of OWOB in each ethnic-minority group was reduced to the current level among the Dutch-origin population, ethnic inequalities in cardio-metabolic diseases were substantially reduced, particularly when lowered prevalence of OWOB persisted across the lifespan. Reductions were the largest for diabetes and for the Asian Surinamese population. CONCLUSIONS A substantial part of the well-known ethnic inequalities in incidence of diabetes, IHD, and stroke can be attributed to OWOB. Interventions aimed at reducing OWOB have clear potential to reduce the health inequalities in these outcomes, especially for diabetes, in particular when they have an impact across the lifespan.
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Affiliation(s)
- W J Nusselder
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - D Long
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - W E Waterlander
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - K Stronks
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - H C Boshuizen
- Department Statistics, Data Science and Mathematical Modelling, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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4
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Hagenaars LL, Schmidt LA, Groeniger JO, Bekker MPM, Ter Ellen F, de Leeuw E, van Lenthe FJ, Oude Hengel KM, Stronks K. Why we struggle to make progress in obesity prevention and how we might overcome policy inertia: Lessons from the complexity and political sciences. Obes Rev 2024; 25:e13705. [PMID: 38424004 DOI: 10.1111/obr.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 12/18/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
Despite evidence for the effectiveness of policies that target obesogenic environments, their adoption remains deficient. Using methods and concepts from complexity and political science (Stock-and-Flow analysis and Punctuated Equilibrium Theory) and a qualitative literature review, we developed system maps to identify feedback loops that hinder policymaking on mitigating obesogenic environments and feedback loops that could trigger and sustain policy change. We found numerous self-reinforcing feedback loops that buttress the assumption that obesity is an individual problem, strengthening the biomedical and commercial weight-loss sectors' claim to "ownership" over solutions. That is, improvements in therapies for individuals with obesity reinforces policymakers' reluctance to target obesogenic environments. Random events that focus attention on obesity (e.g., celebrities dismissing soda) could disrupt this cycle, when actors from outside the medical and weight-loss sector (e.g., anti-weight stigma activists) successfully reframe obesity as a societal problem, which requires robust and politically relevant engagement with affected communities prior to such events taking place. Sustained prioritization of policies targeting obesogenic environments requires shared problem ownership of affected communities and nonhealth government sectors, by emphasizing cobenefits of policies that target obesogenic environments (e.g., ultraprocessed food taxation for raising revenue) and solutions that are meaningful for affected communities.
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Affiliation(s)
- Luc L Hagenaars
- Department of Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Laura A Schmidt
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Erasmus School of Social and Behavioural Sciences, Erasmus MC, Rotterdam, The Netherlands
| | - Marleen P M Bekker
- Health and Society Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Fleur Ter Ellen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Evelyne de Leeuw
- Urban Health and Policy, University of New South Wales, Sydney, Australia
- École de Santé Publique, Université de Montréal, Montréal, Canada
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
| | - Karen M Oude Hengel
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Work Health Technology, Netherlands Organisation for Applied Scientific Research TNO, The Hague, The Netherlands
| | - Karien Stronks
- Department of Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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5
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Pan KY, van Tuijl L, Basten M, Rijnhart JJM, de Graeff A, Dekker J, Geerlings MI, Hoogendoorn A, Ranchor AV, Vermeulen R, Portengen L, Voogd AC, Abell J, Awadalla P, Beekman ATF, Bjerkeset O, Boyd A, Cui Y, Frank P, Galenkamp H, Garssen B, Hellingman S, Hollander M, Huisman M, Huss A, Keats MR, Kok AAL, Krokstad S, van Leeuwen FE, Luik AI, Noisel N, Payette Y, Penninx BWJH, Picavet S, Rissanen I, Roest AM, Rosmalen JGM, Ruiter R, Schoevers RA, Soave D, Spaan M, Steptoe A, Stronks K, Sund ER, Sweeney E, Teyhan A, Twait EL, van der Willik KD, Lamers F. The mediating role of health behaviors in the association between depression, anxiety and cancer incidence: an individual participant data meta-analysis. Psychol Med 2024:1-14. [PMID: 38680088 DOI: 10.1017/s0033291724000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers). METHODS Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs). RESULTS Smoking (HRs range 1.04-1.10) and physical inactivity (HRs range 1.01-1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03-1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01). CONCLUSIONS Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.
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Affiliation(s)
- Kuan-Yu Pan
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, the Netherlands
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lonneke van Tuijl
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maartje Basten
- Amsterdam Public Health, Mental Health program, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors and Chronic Diseases program, Amsterdam, the Netherlands
| | | | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, the Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Department of General Practice, Amsterdam UMC, location UvA, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging & Later Life, and Personalized Medicine, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Adelita V Ranchor
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Jessica Abell
- Department of Behavioral Science and Health, University College London, London, UK
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Philipp Frank
- Department of Behavioral Science and Health, University College London, London, UK
| | - Henrike Galenkamp
- Amsterdam Public Health, Health Behaviors and Chronic Diseases program, Amsterdam, the Netherlands
- Department of Public and Occupational Health, location University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Bert Garssen
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sean Hellingman
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Martijn Huisman
- Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Melanie R Keats
- Faculty of Health, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Almar A L Kok
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Steinar Krokstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Nolwenn Noisel
- CARTaGENE, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC, Canada
| | - Yves Payette
- CARTaGENE, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC, Canada
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, the Netherlands
| | - Susan Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Utrecht Bilthoven, the Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Annelieke M Roest
- Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
| | - Judith G M Rosmalen
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - David Soave
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Mandy Spaan
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Andrew Steptoe
- Department of Behavioral Science and Health, University College London, London, UK
| | - Karien Stronks
- Department of Public and Occupational Health, location University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Alison Teyhan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Twait
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Amsterdam Public Health, Aging & Later Life, and Personalized Medicine, Amsterdam, the Netherlands
- Department of General Practice, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kimberly D van der Willik
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, the Netherlands
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Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Ramachandra Rao S, Ramachandran A, Ramadan OPC, Ramires VV, Ramirez-Zea M, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Ramsay SE, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rashidi MM, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Reynolds A, Rezaei N, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Risérus U, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Roccaldo R, Rodrigues D, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Ruiz Moreno E, Rusakova IA, Rusek W, Russell Jonsson K, Russo P, Rust P, Rutkowski M, Saamel M, Saar CG, Sabanayagam C, Sabbaghi H, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saieva C, Sakata S, Saki N, Šalaj S, Salanave B, Salazar Martinez E, Salhanova A, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Sánchez Rodríguez I, Sandjaja, Sans S, Santa-Marina L, Santacruz E, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schaffrath Rosario A, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt B, Schmidt CO, Schmidt IM, Schneider A, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schultz G, Schulze MB, Schutte AE, Sebert S, Sedaghattalab M, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera G, Serra-Majem L, Servais J, Ševčíková Ľ, Sewpaul R, Shalnova S, Shamah-Levy T, Shamshirgaran SM, Shanthirani CS, Sharafkhah M, Sharma SK, Sharman A, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, Silva CRDM, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina EV, Skoblina NA, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Solovieva YV, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Sossa Jérome C, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Stang A, Starc G, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Steinsbekk S, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suarez-Ortegón MF, Suebsamran P, Sugiyama M, Suka M, Sulo G, Sun CA, Sun L, Sund M, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szponar L, Tabone L, Tai ES, Takuro F, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Taxová Braunerová R, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tessema M, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thrift AG, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Topór-Mądry R, Torheim LE, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Udoji N, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vatasescu R, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Viriyautsahakul N, Virtanen JK, Visser M, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Vourli G, Voutilainen A, Vrijheid M, Vrijkotte TGM, Vuletić S, Wade AN, Waldhör T, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang C, Wang H, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wartha O, Weber A, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
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Luna Pinzon A, Waterlander W, de Pooter N, Altenburg T, Dijkstra C, Emke H, van den Eynde E, Overman ML, Busch V, Renders CM, Halberstadt J, Nusselder W, den Hertog K, Chinapaw M, Verhoeff A, Stronks K. Development of an action programme tackling obesity-related behaviours in adolescents: a participatory system dynamics approach. Health Res Policy Syst 2024; 22:30. [PMID: 38429775 PMCID: PMC10908105 DOI: 10.1186/s12961-024-01116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 02/02/2024] [Indexed: 03/03/2024] Open
Abstract
System dynamics approaches are increasingly addressing the complexity of public health problems such as childhood overweight and obesity. These approaches often use system mapping methods, such as the construction of causal loop diagrams, to gain an understanding of the system of interest. However, there is limited practical guidance on how such a system understanding can inform the development of an action programme that can facilitate systems changes. The Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme combines system dynamics and participatory action research to improve obesity-related behaviours, including diet, physical activity, sleep and sedentary behaviour, in 10-14-year-old adolescents in Amsterdam, the Netherlands. This paper illustrates how we used a previously obtained understanding of the system of obesity-related behaviours in adolescents to develop an action programme to facilitate systems changes. A team of evaluation researchers guided interdisciplinary action-groups throughout the process of identifying mechanisms, applying the Intervention Level Framework to identify leverage points and arriving at action ideas with aligning theories of change. The LIKE action programme consisted of 8 mechanisms, 9 leverage points and 14 action ideas which targeted the system's structure and function within multiple subsystems. This illustrates the feasibility of developing actions targeting higher system levels within the confines of a research project timeframe when sufficient and dedicated effort in this process is invested. Furthermore, the system dynamics action programme presented in this study contributes towards the development and implementation of public health programmes that aim to facilitate systems changes in practice.
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Affiliation(s)
- Angie Luna Pinzon
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Wilma Waterlander
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Naomi de Pooter
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Teatske Altenburg
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Coosje Dijkstra
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Helga Emke
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Emma van den Eynde
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Meredith L Overman
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229ER, Maastricht, The Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Carry M Renders
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Jutka Halberstadt
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015CN, Rotterdam, The Netherlands
| | - Karen den Hertog
- Amsterdam Healthy Weight Approach, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Mai Chinapaw
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Arnoud Verhoeff
- Sarphati Amsterdam, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
- Department of Sociology, University of Amsterdam, 1018WV, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Campman SL, Boyd A, Coyer L, Schinkel J, Agyemang C, Galenkamp H, Koopman ADM, Chilunga FP, Schim van der Loeff MF, van Houtum L, Leenstra T, Stronks K, Prins M. SARS-CoV-2 vaccination uptake in six ethnic groups living in Amsterdam, the Netherlands: A registry-based study within the HELIUS cohort. Prev Med 2024; 178:107822. [PMID: 38103796 DOI: 10.1016/j.ypmed.2023.107822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Ethnic minority groups have experienced a disproportionate burden of COVID-19, and should therefore be especially encouraged to receive SARS-CoV-2 vaccination. This study compared first-dose uptake of the primary SARS-CoV-2 vaccination series across six ethnic groups in Amsterdam, the Netherlands in 2021. METHODS We analyzed data from participants of the population-based HELIUS cohort. We linked their data to the SARS-CoV-2 vaccination registry data of the Public Health Service of Amsterdam. We included registry data from January 6, 2021 (the start of the Dutch vaccination campaign) until September 6, 2021 (a date by which all adults in the Netherlands could have received one or two vaccine doses). SARS-CoV-2 vaccination uptake was defined as having received at least one vaccine dose of the primary vaccination series. We examined the association between ethnicity and vaccination uptake using multivariable logistic regression, while accounting for the age and sex distribution of ethnic groups in Amsterdam. RESULTS We included 19,006 participants (median age 53 years [interquartile range 41-62], 57% female). SARS-CoV-2 vaccination uptake was highest in the South-Asian Surinamese group (60.3%, 95%CI = 58.2-62.3%), followed by the Dutch (59.6%, 95%CI = 58.0-61.1%), Ghanaian (54.1%, 95%CI = 51.7-56.5%), Turkish (47.7%, 95%CI = 45.9-49.6%), African Surinamese (43.0%, 95%CI = 41.2-44.7%), and Moroccan (35.8%, 95%CI = 34.1-37.5%) groups. After adjusting for age, sex, perceived social support, and presence of relevant comorbidities, participants of African Surinamese, Ghanaian, Turkish and Moroccan origin were significantly less likely to be vaccinated than those of Dutch origin. CONCLUSIONS Prevention strategies should continue tailoring to specific ethnic groups to encourage vaccination uptake and reduce barriers to vaccination.
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Affiliation(s)
- Sophie L Campman
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands.
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands; Stichting hiv monitoring, Amsterdam, the Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Janke Schinkel
- Amsterdam UMC location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Meibergdreef 15, Amsterdam, the Netherlands
| | - Charles Agyemang
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Henrike Galenkamp
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health, Health Behaviors and Chronic Diseases, Amsterdam, the Netherlands
| | - Anitra D M Koopman
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health, Health Behaviors and Chronic Diseases, Amsterdam, the Netherlands
| | - Felix P Chilunga
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health, Health Behaviors and Chronic Diseases, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Lieke van Houtum
- Department of Healthy Living, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Tjalling Leenstra
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Karien Stronks
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health, Health Behaviors and Chronic Diseases, Amsterdam, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
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Menassa M, Wesenhagen K, Stronks K, Franco OH, Verschuren W, Picavet H. Individual mental health patterns and the role of lifestyle among ageing adults over 20 years - the Doetinchem Cohort Study. Arch Gerontol Geriatr 2023; 115:105222. [PMID: 37839196 DOI: 10.1016/j.archger.2023.105222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We explored the prevalence of individual mental health patterns and the role of lifestyle factors over 20 years. STUDY DESIGN We used data from the Doetinchem Cohort Study (1995-2019), a population-based study amongst adults (26-90 years) examined every five years in the Netherlands. Participants were classified in five pre-defined mental health patterns (persistent good, persistent poor, worsening, improving, varying) over 20 years (five rounds) using the MHI-5 questionnaire. BMI, sleep, smoking, alcohol consumption, and physical activity were dichotomised as healthy/unhealthy based on guidelines. The role of lifestyle at baseline (t1), 20 years later (t5), and longitudinally over 20 years (using pre-defined patterns) was explored using logistic regression. RESULTS Most participants had good mental health at t1 (85 %) and t5 (88 %). Over 20 years, 67 % followed a persistent good mental health pattern, 30 % a changing pattern, and 3 % a persistent poor pattern. Persistent poor and changing patterns were associated with unhealthy sleep and smoking at t1, t5, and with the 20-year unhealthy patterns. Persistent poor mental health was associated with stable unhealthy and changing sleep (OR=5.58(2.48-12.54) and OR=2.07(1.14-3.74), respectively), and with stable unhealthy and changing smoking (OR=3.35(1.58-7.11) and OR=2.53(1.40-4.57), respectively). Changing mental health was associated with changing (OR=1.54(1.26-1.88) and OR=1.64(1.30-2.07), respectively) and stable unhealthy (OR=1.80(1.23-2.64) and OR=2.24(1.60-3.14), respectively) sleep and smoking, respectively. CONCLUSIONS Persistent good and changing mental health patterns were more common than poor mental health in adults and were associated with smoking and sleep. Clarifying the underlying mechanisms and directionality between mental health and lifestyle could improve interventions.
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Affiliation(s)
- M Menassa
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern 3012, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland; Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Kej Wesenhagen
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, the Netherlands
| | - K Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - O H Franco
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wmm Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hsj Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, the Netherlands
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Crielaard L, Quax R, Sawyer ADM, Vasconcelos VV, Nicolaou M, Stronks K, Sloot PMA. Using network analysis to identify leverage points based on causal loop diagrams leads to false inference. Sci Rep 2023; 13:21046. [PMID: 38030634 PMCID: PMC10687004 DOI: 10.1038/s41598-023-46531-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Network analysis is gaining momentum as an accepted practice to identify which factors in causal loop diagrams (CLDs)-mental models that graphically represent causal relationships between a system's factors-are most likely to shift system-level behaviour, known as leverage points. This application of network analysis, employed to quantitatively identify leverage points without having to use computational modelling approaches that translate CLDs into sets of mathematical equations, has however not been duly reflected upon. We evaluate whether using commonly applied network analysis metrics to identify leverage points is justified, focusing on betweenness- and closeness centrality. First, we assess whether the metrics identify the same leverage points based on CLDs that represent the same system but differ in inferred causal structure-finding that they provide unreliable results. Second, we consider conflicts between assumptions underlying the metrics and CLDs. We recognise six conflicts suggesting that the metrics are not equipped to take key information captured in CLDs into account. In conclusion, using betweenness- and closeness centrality to identify leverage points based on CLDs is at best premature and at worst incorrect-possibly causing erroneous identification of leverage points. This is problematic as, in current practice, the results can inform policy recommendations. Other quantitative or qualitative approaches that better correspond with the system dynamics perspective must be explored.
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Affiliation(s)
- Loes Crielaard
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands.
| | - Rick Quax
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Computational Science Lab, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Alexia D M Sawyer
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Vítor V Vasconcelos
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Computational Science Lab, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
- POLDER, Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter M A Sloot
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Computational Science Lab, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
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Yildirim V, Sheraton VM, Brands R, Crielaard L, Quax R, van Riel NA, Stronks K, Nicolaou M, Sloot PM. A data-driven computational model for obesity-driven diabetes onset and remission through weight loss. iScience 2023; 26:108324. [PMID: 38026205 PMCID: PMC10665812 DOI: 10.1016/j.isci.2023.108324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/22/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Obesity is a major risk factor for the development of type 2 diabetes (T2D), where a sustained weight loss may result in T2D remission in individuals with obesity. To design effective and feasible intervention strategies to prevent or reverse T2D, it is imperative to study the progression of T2D and remission together. Unfortunately, this is not possible through experimental and observational studies. To address this issue, we introduce a data-driven computational model and use human data to investigate the progression of T2D with obesity and remission through weight loss on the same timeline. We identify thresholds for the emergence of T2D and necessary conditions for remission. We explain why remission is only possible within a window of opportunity and the way that window depends on the progression history of T2D, individual's metabolic state, and calorie restrictions. These findings can help to optimize therapeutic intervention strategies for T2D prevention or treatment.
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Affiliation(s)
- Vehpi Yildirim
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Vivek M. Sheraton
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
- Computational Science Lab, University of Amsterdam, 1098 XH Amsterdam, the Netherlands
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, 1100 DD Amsterdam, the Netherlands
| | - Ruud Brands
- AMRIF B.V., Agro Business Park, 6708 PW Wageningen, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, 3584 CL Utrecht, the Netherlands
| | - Loes Crielaard
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Rick Quax
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
- Computational Science Lab, University of Amsterdam, 1098 XH Amsterdam, the Netherlands
| | - Natal A.W. van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, the Netherlands
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, 1100 DD Amsterdam, the Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Peter M.A. Sloot
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
- Computational Science Lab, University of Amsterdam, 1098 XH Amsterdam, the Netherlands
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Zhou B, Sheffer KE, Bennett JE, Gregg EW, Danaei G, Singleton RK, Shaw JE, Mishra A, Lhoste VPF, Carrillo-Larco RM, Kengne AP, Phelps NH, Heap RA, Rayner AW, Stevens GA, Paciorek CJ, Riley LM, Cowan MJ, Savin S, Vander Hoorn S, Lu Y, Pavkov ME, Imperatore G, Aguilar-Salinas CA, Ahmad NA, Anjana RM, Davletov K, Farzadfar F, González-Villalpando C, Khang YH, Kim HC, Laatikainen T, Laxmaiah A, Mbanya JCN, Narayan KMV, Ramachandran A, Wade AN, Zdrojewski T, Abbasi-Kangevari M, Rahim HFA, Abu-Rmeileh NM, Adambekov S, Adams RJ, Aekplakorn W, Agdeppa IA, Aghazadeh-Attari J, Agyemang C, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed SH, Ajlouni K, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Asfoor DA, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Ali MM, Alinezhad F, Alkandari A, Alomirah HF, Aly E, Amarapurkar DN, Andersen LB, Anderssen SA, Andrade DS, Ansari-Moghaddam A, Aounallah-Skhiri H, Aris T, Arlappa N, Aryal KK, Assah FK, Assembekov B, Auvinen J, Avdičová M, Azad K, Azimi-Nezhad M, Azizi F, Bacopoulou F, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Baretić M, Barrera L, Basit A, Batieha AM, Batista AP, Baur LA, Belavendra A, Ben Romdhane H, Benet M, Berkinbayev S, Bernabe-Ortiz A, Berrios Carrasola X, Bettiol H, Beybey AF, Bhargava SK, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boggia JG, Bonaccio M, Bonilla-Vargas A, Borghs H, Bovet P, Brajkovich I, Brenner H, Brewster LM, Brian GR, Briceño Y, Brito M, Bugge A, Buntinx F, Cabrera de León A, Caixeta RB, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardoso VC, Carlsson AC, Casanueva FF, Censi L, Cervantes‐Loaiza M, Chamnan P, Chamukuttan S, Chan Q, Charchar FJ, Chaturvedi N, Chen H, Cheraghian B, Chirlaque MD, Chudek J, Cifkova R, Cirillo M, Claessens F, Cohen E, Concin H, Cooper C, Costanzo S, Cowell C, Crujeiras AB, Cruz JJ, Cureau FV, Cuschieri S, D’Arrigo G, d’Orsi E, Dallongeville J, Damasceno A, Dastgiri S, De Curtis A, de Gaetano G, De Henauw S, Deepa M, DeGennaro V, Demarest S, Dennison E, Deschamps V, Dhimal M, Dika Z, Djalalinia S, Donfrancesco C, Dong G, Dorobantu M, Dörr M, Dragano N, Drygas W, Du Y, Duante CA, Duboz P, Dushpanova A, Dziankowska-Zaborszczyk E, Ebrahimi N, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eghtesad S, El-Khateeb M, El Ati J, Eldemire-Shearer D, Elosua R, Enang O, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Esmaeili A, Evans RG, Fakhradiyev I, Fall CH, Faramarzi E, Farjam M, Farzi Y, Fattahi MR, Fawwad A, Felix-Redondo FJ, Ferguson TS, Fernández-Bergés D, Ferrari M, Ferreccio C, Ferreira HS, Ferrer E, Feskens EJM, Flood D, Forsner M, Fosse S, Fottrell EF, Fouad HM, Francis DK, Frontera G, Furusawa T, Gaciong Z, Garnett SP, Gasull M, Gazzinelli A, Gehring U, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gianfagna F, Gill TK, Gironella G, Giwercman A, Goltzman D, Gomula A, Gonçalves H, Gonçalves M, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando ME, Gonzalez AR, Gottrand F, Grafnetter D, Grodzicki T, Grøntved A, Guerrero R, Gujral UP, Gupta R, Gutierrez L, Gwee X, Haghshenas R, Hakimi H, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hantunen S, Hao J, Hari Kumar R, Harooni J, Hashemi-Shahri SM, Hata J, Heidemann C, Henrique RDS, Herrala S, Herzig KH, Heshmat R, Ho SY, Holdsworth M, Homayounfar R, Hopman WM, Horimoto ARVR, Hormiga C, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Huerta JM, Huhtaniemi IT, Huisman M, Husseini A, Huybrechts I, Iacoviello L, Iakupova EM, Iannone AG, Ibrahim Wong N, Ijoma C, Irazola VE, Ishida T, Isiguzo GC, Islam SMS, Islek D, Ittermann T, Iwasaki M, Jääskeläinen T, Jacobs JM, Jaddou HY, Jadoul M, Jallow B, James K, Jamil KM, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jimenez RO, Jöckel KH, Jokelainen JJ, Jonas JB, Joshi P, Josipović J, Joukar F, Jóźwiak J, Kafatos A, Kajantie EO, Kalmatayeva Z, Karki KB, Katibeh M, Kauhanen J, Kazakbaeva GM, Kaze FF, Ke C, Keinänen-Kiukaanniemi S, Kelishadi R, Keramati M, Kersting M, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Kingston A, Klakk H, Klanova J, Knoflach M, Kolsteren P, König J, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kowlessur S, Koziel S, Kriemler S, Kristensen PL, Kromhout D, Kubinova R, Kujala UM, Kulimbet M, Kurjata P, Kyobutungi C, La QN, Labadarios D, Lachat C, Laid Y, Lall L, Lankila T, Lanska V, Lappas G, Larijani B, Latt TS, Laurenzi M, Lehmann N, Lehtimäki T, Lemogoum D, Leung GM, Li Y, Lima-Costa MF, Lin HH, Lind L, Lissner L, Liu X, Lopez-Garcia E, Lopez T, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lustigová M, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maestre GE, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Makdisse M, Malekpour MR, Malekzadeh F, Malekzadeh R, Mallikharjuna Rao K, Malyutina S, Maniego LV, Manios Y, Mannix MI, Mansour-Ghanaei F, Manzato E, Margozzini P, Mariño J, Marques LP, Martorell R, Mascarenhas LP, Masinaei M, Mathiesen EB, Matsha TE, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, Mediene Benchekor S, Mehlig K, Mehrparvar AH, Melgarejo JD, Méndez F, Menezes AMB, Mereke A, Meshram II, Meto DT, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Modesti PA, Moghaddam SS, Mohamed MK, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohd Yusoff MF, Mohebbi I, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Moosazadeh M, Moradpour F, Morejon A, Moreno LA, Morgan K, Morin SN, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Motlagh ME, Motta J, Msyamboza KP, Mu TT, Muiesan ML, Mursu J, Musa KI, Mustafa N, Muyer MTMC, Nabipour I, Nagel G, Naidu BM, Najafi F, Námešná J, Nangia VB, Naseri T, Neelapaichit N, Nejatizadeh A, Nenko I, Nervi F, Ng TP, Nguyen CT, Nguyen QN, Ni MY, Nie P, Nieto-Martínez RE, Ninomiya T, Noale M, Noboa OA, Noto D, Nsour MA, Nuhoğlu I, O’Neill TW, Odili AN, Oh K, Ohtsuka R, Omar MA, Onat A, Ong SK, Onodugo O, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostovar A, Otero JA, Ottendahl CB, Otu A, Owusu-Dabo E, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Park S, Parsaeian M, Patel ND, Pechlaner R, Pećin I, Pedro JM, Peixoto SV, Peltonen M, Pereira AC, Pessôa dos Prazeres TM, Peykari N, Phall MC, Pham ST, Phan HH, Pichardo RN, Pikhart H, Pilav A, Piler P, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Plata S, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Providencia R, Puder JJ, Puhakka S, Punab M, Qorbani M, Quintana HK, Quoc Bao T, Rahimikazerooni S, Raitakari O, Ramirez-Zea M, Ramke J, Ramos R, Rampal L, Rampal S, Rangel Reina DA, Rashidi MM, Redon J, Renner JDP, Reuter CP, Revilla L, Rezaei N, Rezaianzadeh A, Rigo F, Roa RG, Robinson L, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Romeo EL, Rosengren A, Rubinstein A, Rust P, Rutkowski M, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Salonen JT, Salvetti M, Sánchez-Abanto J, Santos DA, Santos LC, Santos MP, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Sbaraini M, Scazufca M, Schaan BD, Scheidt-Nave C, Schipf S, Schmidt CO, Schöttker B, Schramm S, Sebert S, Sedaghattalab M, Sein AA, Sepanlou SG, Sewpaul R, Shamah-Levy T, Shamshirgaran SM, Sharafkhah M, Sharma SK, Sharman A, Shayanrad A, Shayesteh AA, Shimizu-Furusawa H, Shiri R, Shrestha N, Si-Ramlee K, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Soumaré A, Sousa-Poza A, Sparrenberger K, Staessen JA, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stessman J, Stokwiszewski J, Stronks K, Suarez-Ortegón MF, Suebsamran P, Sundström J, Suriyawongpaisal P, Sylva RC, Szklo M, Tamosiunas A, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tello T, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thrift AG, Timmermans EJ, Tjandrarini DH, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Torres-Collado L, Traissac P, Triantafyllou A, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tuomainen TP, Tzala E, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Uusitalo HMT, Valdivia G, van den Born BJ, Van der Heyden J, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Vasan SK, Vega T, Velasquez-Melendez G, Verstraeten R, Viet L, Villalpando S, Vioque J, Virtanen JK, Viswanathan B, Voutilainen A, Wan Bebakar WM, Wan Mohamud WN, Wang C, Wang N, Wang Q, Wang YX, Wang YW, Wannamethee SG, Webster-Kerr K, Wedderkopp N, Wei W, Westbury LD, Whincup PH, Widhalm K, Widyahening IS, Więcek A, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong A, Wong EB, Woodward M, Wu FC, Xu H, Xu L, Yaacob NA, Yan L, Yan W, Yoosefi M, Yoshihara A, Younger-Coleman NO, Yu YL, Yu Y, Yusoff AF, Zainuddin AA, Zamani F, Zambon S, Zampelas A, Zaw KK, Zeljkovic Vrkic T, Zeng Y, Zhang ZY, Zholdin B, Zimmet P, Zitt E, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c. Nat Med 2023; 29:2885-2901. [PMID: 37946056 PMCID: PMC10667106 DOI: 10.1038/s41591-023-02610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
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van Tuijl LA, Basten M, Pan KY, Vermeulen R, Portengen L, de Graeff A, Dekker J, Geerlings MI, Hoogendoorn A, Lamers F, Voogd AC, Abell J, Awadalla P, Beekman ATF, Bjerkeset O, Boyd A, Cui Y, Frank P, Galenkamp H, Garssen B, Hellingman S, Huisman M, Huss A, de Jong TR, Keats MR, Kok AAL, Krokstad S, van Leeuwen FE, Luik AI, Noisel N, Onland-Moret NC, Payette Y, Penninx BWJH, Rissanen I, Roest AM, Ruiter R, Schoevers RA, Soave D, Spaan M, Steptoe A, Stronks K, Sund ER, Sweeney E, Twait EL, Teyhan A, Verschuren WMM, van der Willik KD, Rosmalen JGM, Ranchor AV. Depression, anxiety, and the risk of cancer: An individual participant data meta-analysis. Cancer 2023; 129:3287-3299. [PMID: 37545248 DOI: 10.1002/cncr.34853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/16/2023] [Accepted: 04/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Depression and anxiety have long been hypothesized to be related to an increased cancer risk. Despite the great amount of research that has been conducted, findings are inconclusive. To provide a stronger basis for addressing the associations between depression, anxiety, and the incidence of various cancer types (overall, breast, lung, prostate, colorectal, alcohol-related, and smoking-related cancers), individual participant data (IPD) meta-analyses were performed within the Psychosocial Factors and Cancer Incidence (PSY-CA) consortium. METHODS The PSY-CA consortium includes data from 18 cohorts with measures of depression or anxiety (up to N = 319,613; cancer incidences, 25,803; person-years of follow-up, 3,254,714). Both symptoms and a diagnosis of depression and anxiety were examined as predictors of future cancer risk. Two-stage IPD meta-analyses were run, first by using Cox regression models in each cohort (stage 1), and then by aggregating the results in random-effects meta-analyses (stage 2). RESULTS No associations were found between depression or anxiety and overall, breast, prostate, colorectal, and alcohol-related cancers. Depression and anxiety (symptoms and diagnoses) were associated with the incidence of lung cancer and smoking-related cancers (hazard ratios [HRs], 1.06-1.60). However, these associations were substantially attenuated when additionally adjusting for known risk factors including smoking, alcohol use, and body mass index (HRs, 1.04-1.23). CONCLUSIONS Depression and anxiety are not related to increased risk for most cancer outcomes, except for lung and smoking-related cancers. This study shows that key covariates are likely to explain the relationship between depression, anxiety, and lung and smoking-related cancers. PREREGISTRATION NUMBER: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157677.
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Affiliation(s)
- Lonneke A van Tuijl
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maartje Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Kuan-Yu Pan
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, the Netherlands
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Aging & Later Life and Personalized Medicine, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Neurodegeneration and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Jessica Abell
- Department of Behavioural Science and Health, University College London, London, UK
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philipp Frank
- Department of Behavioural Science and Health, University College London, London, UK
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Bert Garssen
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sean Hellingman
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Melanie R Keats
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Almar A L Kok
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Steinar Krokstad
- Department of Public Health and Nursing, Trøndelag Health Study Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | | | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Yves Payette
- CARTaGENE, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Annelieke M Roest
- Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Maasstad, Rotterdam, the Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - David Soave
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Mandy Spaan
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Public Health and Nursing, Trøndelag Health Study Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emma L Twait
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Aging & Later Life and Personalized Medicine, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alison Teyhan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Utrecht Bilthoven, the Netherlands
| | - Kimberly D van der Willik
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adelita V Ranchor
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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14
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Crielaard L, Motazedi E, Galenkamp H, van de Werfhorst HG, Hulvej Rod N, Kuipers MAG, Nicolaou M, Stronks K. Socioeconomic Inequalities in Type 2 Diabetes: Mediation Through Status Anxiety? Int J Public Health 2023; 68:1606069. [PMID: 37849688 PMCID: PMC10577225 DOI: 10.3389/ijph.2023.1606069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/04/2023] [Indexed: 10/19/2023] Open
Abstract
Objectives: While status anxiety has received attention as a potential mechanism generating health inequalities, empirical evidence is still limited. Studies have been ecological and have largely focused on mental and not physical health outcomes. Methods: We conducted individual-level analyses to assess status anxiety (feelings of inferiority resulting from social comparisons) and resources (financial difficulties) as mediators of the relationship between socioeconomic status (SES) (education/occupation/employment status) and type 2 diabetes (T2D). We used cross-sectional data of 21,150 participants (aged 18-70 years) from the Amsterdam-based HELIUS study. We estimated associations using logistic regression models and estimated mediated proportions using natural effect modelling. Results: Odds of status anxiety were higher among participants with a low SES [e.g., OR = 2.66 (95% CI: 2.06-3.45) for elementary versus academic occupation]. Odds of T2D were 1.49 (95% CI: 1.12-1.97) times higher among participants experiencing status anxiety. Proportion of the SES-T2D relationship mediated was 3.2% (95% CI: 1.5%-7.0%) through status anxiety and 10.9% (95% CI: 6.6%-18.0%) through financial difficulties. Conclusion: Status anxiety and financial difficulties played small but consistent mediating roles. These individual-level analyses underline status anxiety's importance and imply that status anxiety requires attention in efforts to reduce health inequalities.
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Affiliation(s)
- Loes Crielaard
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Ehsan Motazedi
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mirte A. G. Kuipers
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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15
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Krasuska M, Davidson EM, Beune E, Jenum AK, Gill JM, Stronks K, van Valkengoed IG, Diaz E, Sheikh A. A Culturally Adapted Diet and Physical Activity Text Message Intervention to Prevent Type 2 Diabetes Mellitus for Women of Pakistani Origin Living in Scotland: Formative Study. JMIR Form Res 2023; 7:e33810. [PMID: 37713245 PMCID: PMC10541642 DOI: 10.2196/33810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/20/2022] [Accepted: 01/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Individuals of South Asian origin are at an increased risk of developing type 2 diabetes mellitus (T2DM) compared with other ethnic minority groups. Therefore, there is a need to develop interventions to address, and reduce, this heightened risk. OBJECTIVE We undertook formative work to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. METHODS We used a stepwise approach that was informed by the Six Steps in Quality Intervention Development framework, which consisted of gathering evidence through literature review and focus groups (step 1), developing a program theory for the intervention (step 2), and finally developing the content of the text messages and an accompanying delivery plan (step 3). RESULTS In step 1, we reviewed 12 articles and identified 3 key themes describing factors impacting on diet and physical activity in the context of T2DM prevention: knowledge on ways to prevent T2DM through diet and physical activity; cultural, social, and gender norms; and perceived level of control and sense of inevitability over developing T2DM. The key themes that emerged from the 3 focus groups with a total of 25 women were the need for interventions to provide "friendly encouragement," "companionship," and a "focus on the individual" and also for the text messages to "set achievable goals" and include "information on cooking healthy meals." We combined the findings of the focus groups and literature review to create 13 guiding principles for culturally adapting the text messages. In step 2, we developed a program theory, which specified the main determinants of change that our text messages should aim to enhance: knowledge and skills, sense of control, goal setting and planning behavior, peer support, and norms and beliefs guiding behavior. In step 3, we used both the intervention program theory and guiding principles to develop a set of 73 text messages aimed at supporting a healthy diet and 65 text messages supporting increasing physical activity. CONCLUSIONS We present a theory-based approach to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. This study outlines an approach that may also be applicable to the development of interventions for other ethnic minority populations in diverse settings. There is now a need to build on this formative work and undertake a feasibility trial of a text message-based diet and physical activity intervention to prevent T2DM for women of Pakistani origin living in Scotland.
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Affiliation(s)
- Marta Krasuska
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Emma M Davidson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Erik Beune
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jason Mr Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Irene Gm van Valkengoed
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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16
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Chilunga FP, Campman S, Galenkamp H, Boyd A, Bolijn R, Leenstra T, Agyemang C, Uiters E, Prins M, Stronks K. Relative contributions of pre-pandemic factors and intra-pandemic activities to differential COVID-19 risk among migrant and non-migrant populations in the Netherlands: lessons for future pandemic preparedness. Int J Equity Health 2023; 22:127. [PMID: 37403097 DOI: 10.1186/s12939-023-01936-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/18/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Although risk factors for differences in SARS-CoV-2 infections between migrant and non-migrant populations in high income countries have been identified, their relative contributions to these SARS-CoV-2 infections, which could aid in the preparation for future viral pandemics, remain unknown. We investigated the relative contributions of pre-pandemic factors and intra-pandemic activities to differential SARS-CoV-2 infections in the Netherlands by migration background (Dutch, African Surinamese, South-Asian Surinamese, Ghanaians, Turkish, and Moroccan origin). METHODS We utilized pre-pandemic (2011-2015) and intra-pandemic (2020-2021) data from the HELIUS cohort, linked to SARS-CoV-2 PCR test results from Public Health Service of Amsterdam (GGD Amsterdam). Pre-pandemic factors included socio-demographic, medical, and lifestyle factors. Intra-pandemic activities included COVID-19 risk aggravating and mitigating activities such as physical distancing, use of face masks, and other similar activities. We calculated prevalence ratios (PRs) in the HELIUS population that was merged with GGD Amsterdam PCR test data using robust Poisson regression (SARS-CoV-2 PCR test result as outcome, migration background as predictor). We then obtained the distribution of migrant and non-migrant populations in Amsterdam as of January 2021 from Statistics Netherlands. The migrant populations included people who have migrated themselves as well as their offspring. We used PRs and the population distributions to calculate population attributable fractions (PAFs) using the standard formula. We used age and sex adjusted models to introduce pre-pandemic factors and intra-pandemic activities, noting the relative changes in PAFs. RESULTS From 20,359 eligible HELIUS participants, 8,595 were linked to GGD Amsterdam PCR test data and included in the study. Pre-pandemic socio-demographic factors (especially education, occupation, and household size) resulted in the largest changes in PAFs when introduced in age and sex adjusted models (up to 45%), followed by pre-pandemic lifestyle factors (up to 23%, especially alcohol consumption). Intra-pandemic activities resulted in the least changes in PAFs when introduced in age and sex adjusted models (up to 16%). CONCLUSION Interventions that target pre-pandemic socio-economic status and other drivers of health inequalities between migrant and non-migrant populations are urgently needed at present to better prevent infection disparities in future viral pandemics.
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Affiliation(s)
- Felix P Chilunga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
| | - Sophie Campman
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
- Department of Infectious Diseases, Amsterdam Infection, and Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Renee Bolijn
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Tjalling Leenstra
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
- Centre for Infectious Disease Control, National Coordination Centre for Communicable Disease Control, National Institute for Public Health, and the Environment, Bilthoven, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
- Department of Infectious Diseases, Amsterdam Infection, and Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
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17
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Rod NH, Broadbent A, Rod MH, Russo F, Arah OA, Stronks K. Complexity in Epidemiology and Public Health. Addressing Complex Health Problems Through a Mix of Epidemiologic Methods and Data. Epidemiology 2023; 34:505-514. [PMID: 37042967 DOI: 10.1097/ede.0000000000001612] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Public health and the underlying disease processes are complex, often involving the interaction of biologic, social, psychologic, economic, and other processes that may be nonlinear and adaptive and have other features of complex systems. There is therefore a need to push the boundaries of public health beyond single-factor data analysis and expand the capacity of research methodology to tackle real-world complexities. This article sets out a way to operationalize complex systems thinking in public health, with a particular focus on how epidemiologic methods and data can contribute towards this end. Our proposed framework comprises three core dimensions-patterns, mechanisms, and dynamics-along which complex systems may be conceptualized. These dimensions cover seven key features of complex systems-emergence, interactions, nonlinearity, interference, feedback loops, adaptation, and evolution. We relate this framework to examples of methods and data traditionally used in epidemiology. We conclude that systematic production of knowledge on complex health issues may benefit from: formulation of research questions and programs in terms of the core dimensions we identify, as a comprehensive way to capture crucial features of complex systems; integration of traditional epidemiologic methods with systems methodology such as computational simulation modeling; interdisciplinary work; and continued investment in a wide range of data types. We believe that the proposed framework can support the systematic production of knowledge on complex health problems, with the use of epidemiology and other disciplines. This will help us understand emergent health phenomena, identify vulnerable population groups, and detect leverage points for promoting public health.
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Affiliation(s)
- Naja Hulvej Rod
- From the Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
- Institute of Advanced Studies, University of Amsterdam, The Netherlands
| | - Alex Broadbent
- Department of Philosophy, Durham University, UK
- Department of Philosophy, University of Johannesburg, South Africa
| | - Morten Hulvej Rod
- Institute of Advanced Studies, University of Amsterdam, The Netherlands
- Health Promotion Research Unit, Steno Diabetes Center Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Federica Russo
- Institute of Advanced Studies, University of Amsterdam, The Netherlands
- Department of Philosophy & ILLC, Amsterdam University, The Netherlands
- Department of Science and Technology Studies, University College London, UK
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles, California, USA
- Department of Statistics, Division of Physical Sciences, UCLA, Los Angeles, California, USA
| | - Karien Stronks
- Institute of Advanced Studies, University of Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
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18
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Chilunga FP, Appelman B, van Vugt M, Kalverda K, Smeele P, van Es J, Wiersinga WJ, Rostila M, Prins M, Stronks K, Norredam M, Agyemang C. Differences in incidence, nature of symptoms, and duration of long COVID among hospitalised migrant and non-migrant patients in the Netherlands: a retrospective cohort study. Lancet Reg Health Eur 2023; 29:100630. [PMID: 37261215 PMCID: PMC10079482 DOI: 10.1016/j.lanepe.2023.100630] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/02/2023]
Abstract
Background Comprehensive data on long COVID across ethnic and migrant groups are lacking. We investigated incidence, nature of symptoms, clinical predictors, and duration of long COVID among COVID-19 hospitalised patients in the Netherlands by migration background (Dutch, Turkish, Moroccan, and Surinamese origin, Others). Methods We used COVID-19 admissions and follow up data (January 2021-July 2022) from Amsterdam University Medical Centers. We calculated long COVID incidence proportions per NICE guidelines by migration background and assessed for clinical predictors via robust Poisson regressions. We then examined associations between migration background and long COVID using robust Poisson regressions and adjusted for derived clinical predictors, and other biologically relevant factors. We also assessed long COVID symptom persistence at one-year post-discharge. Findings 1886 patients were included. 483 patients had long COVID (26%, 95% CI 24-28%) at 12 weeks post-discharge. Symptoms like dizziness, joint pain, insomnia, and headache varied by migration background. Clinical predictors of long COVID were female sex, hospital admission duration, intensive care unit admission, and receiving oxygen, or corticosteroid therapy. Long COVID risk was higher among patients with migration background than Dutch origin patients after adjustments for derived clinical predictors, age, smoking, vaccination status, comorbidities and remdesivir treatment. Only 14% of long COVID symptoms persisted at one-year post-discharge. Interpretation There are significant differences in occurrence, nature of symptoms, and duration of long COVID by migration background. Studies assessing the spectrum of functional limitation and access to post-COVID healthcare are needed to help plan for appropriate and accessible healthcare interventions. Funding The Amsterdam UMC COVID-19 biobank is supported by the Amsterdam UMC Corona Research Fund and the Talud Foundation (Stichting Talud). The current analyses were supported by the Novo Nordisk Foundation [NNF21OC0067528].
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Affiliation(s)
- Felix Patience Chilunga
- Department of Public and Occupational Health, Amsterdam Public Health, University of Amsterdam Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Brent Appelman
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity (AII), University of Amsterdam, Amsterdam, The Netherlands
| | - Michele van Vugt
- Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Institute for Infection and Immunity (AII), University of Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Kirsten Kalverda
- Department Pulmonary Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick Smeele
- Department Pulmonary Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Josien van Es
- Department Pulmonary Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem Joost Wiersinga
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity (AII), University of Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Institute for Infection and Immunity (AII), University of Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Maria Prins
- Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Institute for Infection and Immunity (AII), University of Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health, University of Amsterdam Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie Norredam
- Section for Health Services Research, Department of Public Health, Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, University of Copenhagen, Copenhagen, Denmark
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health, University of Amsterdam Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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van Baar JM, Shields-Zeeman L, Stronks K, Hagenaars LL. Lifestyle versus social determinants of health in the Dutch parliament: An automated analysis of debate transcripts. SSM Popul Health 2023; 22:101399. [PMID: 37114238 PMCID: PMC10127107 DOI: 10.1016/j.ssmph.2023.101399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/12/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Although public health scholars increasingly recognize the importance of the social determinants of health (SDOH), health policy outputs tend to emphasize downstream lifestyle factors instead. We use an automated corpus research approach to analyse fourteen years of health policy debate in the Dutch House of Representatives' Health Committee, testing three potential causes of the lack of attention for SDOH: political ideology, by which members of parliament (MPs) from some political orientations may prioritize lifestyle factors over SDOH; lifestyle drift, by which early attention for SDOH during problem analysis is replaced by a lifestyle focus in the development of solutions as the challenges in addressing SDOH become clear; and focusing events, by which political or societal chance events, known to the public and political elites simultaneously, bolster the lifestyle perspective on health. Our analysis shows that overall, the committee spent most of its time discussing neither SDOH nor lifestyle: healthcare financing and service delivery dominated instead. When SDOH or lifestyle were referenced, left-leaning MPs referred significantly more to SDOH and right-leaning MPs significantly more to lifestyle. Temporal effects related to election cycles yielded inconsistent evidence. Finally, peak attention for both lifestyle and SDOH coincided with ongoing political debate instead of exogenous, unforeseen focusing events, and these peaks were rendered relatively insignificant by the larger and more consistent attention for health care. This paper provides a first step toward automated analysis of policy debates at scale, opening up new avenues for the empirical study of health political discourse.
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Affiliation(s)
- Jeroen M. van Baar
- Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, the Netherlands
- Corresponding author. Da Costakade 45, 3521 VS, Utrecht, the Netherlands.
| | - Laura Shields-Zeeman
- Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, the Netherlands
- Utrecht University, Faculty of Social and Behavioral Sciences, Utrecht, the Netherlands
| | - Karien Stronks
- Amsterdam University Medical Centers, Department of Public and Occupational Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Luc L. Hagenaars
- Amsterdam University Medical Centers, Department of Public and Occupational Health, University of Amsterdam, Amsterdam, the Netherlands
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, United States
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20
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Luna Pinzon A, Stronks K, Emke H, van den Eynde E, Altenburg T, Dijkstra SC, Renders CM, Hermans R, Busch V, Chinapaw MJM, Kremers SPJ, Waterlander W. Understanding the system dynamics of obesity-related behaviours in 10- to 14-year-old adolescents in Amsterdam from a multi-actor perspective. Front Public Health 2023; 11:1128316. [PMID: 37304107 PMCID: PMC10248031 DOI: 10.3389/fpubh.2023.1128316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction and Methods To develop an understanding of the dynamics driving obesity-related behaviours in adolescents, we conducted systems-based analysis on a causal loop diagram (CLD) created from a multi-actor perspective, including academic researchers, adolescents and local stakeholders. Results The CLD contained 121 factors and 31 feedback loops. We identified six subsystems with their goals: (1) interaction between adolescents and the food environment, with profit maximisation as goal, (2) interaction between adolescents and the physical activity environment, with utility maximisation of outdoor spaces as goal, (3) interaction between adolescents and the online environment, with profit maximisation from technology use as goal, (4) interaction between adolescents, parenting and the wider socioeconomic environment, with a goal focused on individual parental responsibility, (5) interaction between healthcare professionals and families, with the goal resulting in treating obesity as an isolated problem, and (6) transition from childhood to adolescence, with the goal centring around adolescents' susceptibility to an environment that stimulates obesity-related behaviours. Discussion Analysis showed that inclusion of the researchers' and stakeholders' perspectives contributed to an understanding of how the system structure of an environment works. Integration of the adolescents' perspective enriched insights on how adolescents interact with that environment. The analysis further showed that the dynamics driving obesity-related behaviours are geared towards further reinforcing such behaviours.
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Affiliation(s)
- Angie Luna Pinzon
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Karien Stronks
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Helga Emke
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Emma van den Eynde
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Teatske Altenburg
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - S. Coosje Dijkstra
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Carry M. Renders
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Roel Hermans
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands
| | - Mai J. M. Chinapaw
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Wilma Waterlander
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
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EP, Jérome CS, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suka M, Sun CA, Sun L, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szklo M, Szponar L, Tabone L, Tai ES, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Braunerová RT, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thuesen BH, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Mądry R, Torheim LE, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tsao YH, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Voutilainen A, Vrijheid M, Vrijkotte TGM, Wade AN, Waldhör T, Walton J, Wambiya EOA, Bebakar WMW, Mohamud WNW, de Souza Wanderley Júnior R, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Webster-Kerr K, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wojciech R, Wojtyniak B, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, García MY, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Cisneros JZ, Zuziak M, Bhutta ZA, Black RE, Ezzati M. Diminishing benefits of urban living for children and adolescents' growth and development. Nature 2023; 615:874-883. [PMID: 36991188 PMCID: PMC10060164 DOI: 10.1038/s41586-023-05772-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Abstract
Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
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22
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Havdal HH, Fosse E, Gebremariam MEK, Stronks K, Andersen OK, Lien N. Does the socioeconomic positioned neighbourhood matter? Norwegian adolescents' perceptions of barriers and facilitators for physical activity. Scand J Public Health 2023; 51:275-287. [PMID: 35000501 PMCID: PMC9969305 DOI: 10.1177/14034948211066673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS A higher proportion of adolescents from lower socioeconomic position families tend to be less physically active than their counterparts from higher socioeconomic position families. More research is needed to understand the causes of these differences, particularly the influence of the neighbourhood environment. This qualitative study aims to explore how adolescents and their parents from higher and lower socioeconomic neighbourhoods perceive the social, organisational and physical environment influencing adolescents' physical activity behaviours. METHOD We conducted six semi-structured focus groups with 35 13-14-year-olds and eight interviews with some of their parents. The interviewees were recruited from one higher and two lower socioeconomic neighbourhoods in Oslo, Norway. Theme-based coding was used for analysis, and the results discussed in light of an ecological framework. RESULTS The results indicate that factors like social norms in a neighbourhood could shape adolescents' physical activity behaviour, and a social norm of an active lifestyle seemed to be an essential facilitator in the higher socioeconomic neighbourhood. Higher availability of physical activity and high parental engagement seemed to facilitate higher physical activity in this neighbourhood. In the lower socioeconomic neighbourhoods, the availability of local organised physical activity and volunteer engagement from parents varied. Programmes from the municipality and volunteer organisations seemed to influence and be essential for adolescents' physical activity behaviour in these neighbourhoods. CONCLUSIONS
The results illustrate the complexity of behaviour and environment interaction, and a limitation in explaining the phenomenon by focusing primarily on the individual level rather than an ecological perspective.
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Affiliation(s)
- Hanne Hennig Havdal
- Department of Nutrition, Institute of
Basic Medical Sciences, University of Oslo, Norway
- Hanne Hennig Havdal, Department of
Nutrition, University of Oslo, P.O Box 1046 Blindern, 0317 Oslo, Norway. E-mail:
| | - Elisabeth Fosse
- Department of Health Promotion and
Development, University of Bergen, Norway
| | | | - Karien Stronks
- Department of Public and Occupational
Health, University of Amsterdam, Netherlands
| | | | - Nanna Lien
- Department of Nutrition, Institute of
Basic Medical Sciences, University of Oslo, Norway
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23
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Rod MH, Rod NH, Russo F, Klinker CD, Reis R, Stronks K. Promoting the health of vulnerable populations: Three steps towards a systems-based re-orientation of public health intervention research. Health Place 2023; 80:102984. [PMID: 36773380 DOI: 10.1016/j.healthplace.2023.102984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/20/2022] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
This paper proposes a novel framework for the development of interventions in vulnerable populations. The framework combines a complex systems lens with syndemic theory. Whereas funding bodies, research organizations and reporting guidelines tend to encourage intervention research that (i) focuses on singular and predefined health outcomes, (ii) searches for generalizable cause-effect relationships, and (iii) aims to identify universally effective interventions, the paper suggests that a different direction is needed for addressing health inequities: We need to (i) start with exploratory analysis of population-level data, and (ii) invest in contextualized in-depth knowledge of the complex dynamics that produce health inequities in specific populations and settings, while we (iii) work with stakeholders at multiple levels to create change within systems.
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Affiliation(s)
- Morten Hulvej Rod
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands.
| | - Naja Hulvej Rod
- Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Federica Russo
- Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands; Department of Philosophy & ILLC, Amsterdam University, Amsterdam, the Netherlands
| | - Charlotte Demant Klinker
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Ria Reis
- Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Karien Stronks
- Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam University Medical Centers, Locatie AMC, Amsterdam, the Netherlands
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24
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Menassa M, Stronks K, Khatmi F, Roa Díaz ZM, Espinola OP, Gamba M, Itodo OA, Buttia C, Wehrli F, Minder B, Velarde MR, Franco OH. Concepts and definitions of healthy ageing: a systematic review and synthesis of theoretical models. EClinicalMedicine 2023; 56:101821. [PMID: 36684393 PMCID: PMC9852292 DOI: 10.1016/j.eclinm.2022.101821] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Healthy ageing (HA) has been defined using multiple approaches. We aim to produce a comprehensive overview and analysis of the theoretical models underpinning this concept and its associated normative terms and definitions. METHODS We conducted a systematic review of peer-reviewed HA models in Embase.com, Medline (Ovid), Cochrane CENTRAL, CINAHL, PsycINFO, and Web of Science until August 2022. Original theoretical papers, concept analyses, and reviews that proposed new models were included. Operational models/definitions, development psychology theories and mechanisms of ageing were excluded. We followed an iterative approach to extract the models' characteristics and thematically analyze them based on the approach of Walker and Avant. The protocol was registered in PROSPERO (CRD42021238796). FINDINGS Out of 10,741 records, we included 59 papers comprising 65 models/definitions, published in English (1960-2022) from 16 countries in Europe, Asia, and America. Human ageing was described using 12 normative terms, mainly (models (%)): successful (34 (52%)), healthy (eight (12%)), well (five (8%)), and active (four (6%)). We identified intrinsic/extrinsic factors interacting throughout the life course, adaptive processes as attributes, and outcomes describing ageing patterns across objective and subjective dimensions (number of models/definitions): cognitive (62), psychological (53), physical (49), social (49), environmental (19), spiritual (16), economic (13), cultural (eight), political (six), and demographic (four) dimensions. Three types of models emerged: health-state outcomes (three), adaptations across the life course (31), or a combination of both (31). Two additional sub-classifications emphasized person-environment congruence and health promotion. INTERPRETATION HA conceptualizations highlight its multidimensionality and complexity that renders a monistic model/definition challenging. It has become evident that life long person-environment interactions, adaptations, environments, and health promotion/empowerment are essential for HA. Our model classification provides a basis for harmonizing terms and dimensions that can guide research and comparisons of empirical findings, and inform social and health policies enabling HA for various populations and contexts. FUNDING MM, ZMRD, and OI are supported by the European Union's Horizon 2020 Marie Skłodowska-Curie grant No 801076, and MM is also supported by the Swiss National Foundation grant No 189235.
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Affiliation(s)
- Marilyne Menassa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Corresponding author. Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Farnaz Khatmi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Community Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Zayne Milena Roa Díaz
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Octavio Pano Espinola
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Magda Gamba
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Oche Adam Itodo
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Chepkoech Buttia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Faina Wehrli
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Minerva Rivas Velarde
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Public Health, Julius Center for Health Science and Primary Care, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
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25
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Willemen FEM, Heuschen CBBCM, Zantvoord JB, Galenkamp H, de Wit MAS, Zwinderman AH, Denys DAJP, Bockting CLH, Stronks K, Lok A. Perceived ethnic discrimination, suicidal ideation and mastery in a multi-ethnic cohort: the HELIUS study. BJPsych Open 2023; 9:e21. [PMID: 36660955 PMCID: PMC9885336 DOI: 10.1192/bjo.2022.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The association between perceived ethnic discrimination (PED) and mental health conditions is well studied. However, less is known about the association between PED and suicidal ideation, or the role of positive psychosocial factors in this association. AIMS To examine the association between PED and suicidal ideation among ethnic minority groups in Amsterdam, The Netherlands, and investigate whether ethnicity and mastery (people's extent of feeling in control of their lives and environment) moderate this association. METHOD Cross-sectional data from the multi-ethnic HELIUS study were analysed (n = 17 053) for participants of South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin. PED was measured using the Everyday Discrimination Scale, suicidal ideation using item 9 of the Patient Health Questionnaire-9 and mastery using the Pearlin-Schooler Mastery Scale. RESULTS Logistic regression analyses demonstrated a small positive association between PED and suicidal ideation (OR = 1.068, 95% CI 1.059-1.077), which did not differ among ethnic minority groups. Mastery did not moderate the association between PED and suicidal ideation among the ethnic minority groups. CONCLUSIONS Our findings support the hypothesis that PED is associated with suicidal ideation and this association does not significantly vary between ethnic minority groups. Although higher levels of mastery were associated with lower suicidal ideation, mastery did not moderate the relationship between PED and suicidal ideation. Besides targeting ethnic discrimination as a societal problem, future longitudinal research is needed to investigate whether interventions aimed at improving mastery could reduce suicidal ideation in ethnic minority groups.
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Affiliation(s)
- Fabienne E M Willemen
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centres (UMC), Amsterdam, The Netherlands
| | - Caroline B B C M Heuschen
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centres (UMC), Amsterdam, The Netherlands
| | - Jasper B Zantvoord
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centres (UMC), Amsterdam, The Netherlands; and Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam University Medical Centres (UMC), Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, University of Amsterdam, Amsterdam University Medical Centres (UMC), Amsterdam, The Netherlands
| | - Matty A S de Wit
- Department of Epidemiology, Health Promotion and Care Innovation, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Center for Urban Mental health, University of Amsterdam, Amsterdam, The Netherlands
| | - Damiaan A J P Denys
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centres (UMC), Amsterdam, The Netherlands
| | - Claudi L H Bockting
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centres (UMC), Amsterdam, The Netherlands; and Center for Urban Mental health, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, University of Amsterdam, Amsterdam University Medical Centres (UMC), Amsterdam, The Netherlands; and Center for Urban Mental health, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centres (UMC), Amsterdam, The Netherlands; and Center for Urban Mental health, University of Amsterdam, Amsterdam, The Netherlands
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26
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Bolijn R, Muilwijk M, Nicolaou M, Galenkamp H, Stronks K, Tan HL, Kunst AE, van Valkengoed IG. The contribution of smoking to differences in cardiovascular disease incidence between men and women across six ethnic groups in Amsterdam, the Netherlands: The HELIUS study. Prev Med Rep 2023; 31:102105. [PMID: 36820382 PMCID: PMC9938300 DOI: 10.1016/j.pmedr.2022.102105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/14/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023] Open
Abstract
It is unclear to what extent differences in cardiovascular disease (CVD) risk between men and women are explained by differences in smoking, and whether this contribution to risk is consistent across ethnic groups. In this prospective study, we determined the contribution of smoking to differences in CVD incidence between men and women, also in various ethnic groups. We linked baseline data of 18,058 participants of six ethnic groups from the HELIUS study (Amsterdam, the Netherlands) to CVD incidence data, based on hospital admission and death records from Statistics Netherlands (2013-2019). The contribution of smoking to CVD incidence, as estimated by the population attributable fraction, was higher in men than in women, overall (24.1% versus 15.6%) and across most ethnic groups. Among Dutch participants, however, the contribution of smoking was higher among women (21.0%) than men (16.2%). Using Cox regression analyses, we observed that differences in smoking prevalence explained 22.0% of the overall lower hazard for CVD in women compared to men. Smoking contributed minimally to the lower hazards for CVD in women among participants of Dutch (0%), Ghanaian (4.9%) and Moroccan origin (0%), but explained 28.6% and 48.6% of the lower hazards in women in South-Asian Surinamese and African Surinamese groups, respectively. While smoking prevention and cessation may lead to lower CVD incidence in most groups of men and women, it may not substantially reduce disparities in CVD risk between men and women in most ethnic groups.
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Affiliation(s)
- Renee Bolijn
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands,Corresponding author at: Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Mirthe Muilwijk
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Anton E. Kunst
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Irene G.M. van Valkengoed
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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27
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van de Vijver S, Tensen P, Asiki G, Requena-Méndez A, Heidenrijk M, Stronks K, Cobelens F, Bont J, Agyemang C. Digital health for all: How digital health could reduce inequality and increase universal health coverage. Digit Health 2023; 9:20552076231185434. [PMID: 37434727 PMCID: PMC10331232 DOI: 10.1177/20552076231185434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
Digital transformation in health care has a lot of opportunities to improve access and quality of care. However, in reality not all individuals and communities are benefiting equally from these innovations. People in vulnerable conditions, already in need of more care and support, are often not participating in digital health programs. Fortunately, numerous initiatives worldwide are committed to make digital health accessible to all citizens, stimulating the long-cherished global pursuit of universal health coverage. Unfortunately initiatives are not always familiar with each other and miss connection to jointly make a significant positive impact. To reach universal health coverage via digital health it is necessary to facilitate mutual knowledge exchange, both globally and locally, to link initiatives and apply academic knowledge into practice. This will support policymakers, health care providers and other stakeholders to ensure that digital innovations can increase access to care for everyone, leading towards Digital health for all.
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Affiliation(s)
- Steven van de Vijver
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
- Family Medicine Department, OLVG Hospital, Amsterdam, The Netherlands
| | - Paulien Tensen
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Ana Requena-Méndez
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Barcelona Institute for Global Health, ISGlobal, University of Barcelona, Barcelona, Spain
| | - Michiel Heidenrijk
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
- Joep Lange Institute, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Cobelens
- Department of Global Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jettie Bont
- Department of Family Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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28
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Djojosoeparto SK, Kamphuis CBM, Harrington JM, Løvhaug AL, Roos G, Sawyer ADM, Stronks K, Terragni L, Torheim LE, Vandevijvere S, Poelman MP, van Lenthe FJ. How theory can help to understand the potential impact of food environment policies on socioeconomic inequalities in diet: an application of Bourdieu's capital theory and the scarcity theory. Eur J Public Health 2022; 32:iv66-iv70. [PMID: 36444101 PMCID: PMC9706114 DOI: 10.1093/eurpub/ckac052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Government policies that promote healthy food environments are considered promising to reduce socioeconomic inequalities in diet. Empirical evidence of effects on these inequalities, however, is relatively scarce and, with a few exceptions, tends to be inconclusive. We use two contemporary theories that help to understand socioeconomic inequalities in health and health-related behaviours (Bourdieu's capital theory and Mullainathan and Shafir's scarcity theory) to reason how policies influencing food environments may differentially impact lower and higher socioeconomic groups. In essence, these theories enable us to understand how specific elements of broader daily living conditions (e.g. social practices that lead to habitus formation, material conditions that shape experiences of scarcity) may lead to a greater benefit of certain food environment policies for the healthfulness of diets of lower or higher socioeconomic groups. We conclude that the application of theories on the mechanisms underlying socioeconomic inequalities in health can help to guide future empirical studies in testing theory-based hypotheses on differential effects of policies, and thereby enhance the development of effective policies tackling socioeconomic inequalities in dietary intakes.
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Affiliation(s)
- Sanne K Djojosoeparto
- Correspondence: Sanne K. Djojosoeparto, Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Vening Meinesz Building A, Princetonlaan 8a, Utrecht 3584 CB, The Netherlands, e-mail:
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet—Oslo Metropolitan University, Oslo, Norway
| | - Gun Roos
- Consumption Research Norway (SIFO), OsloMet—Oslo Metropolitan University, Oslo, Norway
| | - Alexia D M Sawyer
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laura Terragni
- Department of Nursing and Health Promotion, OsloMet—Oslo Metropolitan University, Oslo, Norway
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, OsloMet—Oslo Metropolitan University, Oslo, Norway,Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Frank J van Lenthe
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Chilunga FP, Stoeldraijer L, Agyemang C, Stronks K, Harmsen C, Kunst AE. Inequalities in COVID-19 deaths by migration background during the first wave, interwave period and second wave of the COVID-19 pandemic: a closed cohort study of 17 million inhabitants of the Netherlands. J Epidemiol Community Health 2022; 77:jech-2022-219521. [PMID: 36316152 DOI: 10.1136/jech-2022-219521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND It is not known how differences in COVID-19 deaths by migration background in the Netherlands evolved throughout the pandemic, especially after introduction of COVID-19 prevention measures targeted at populations with a migration background (in the second wave). We investigated associations between migration background and COVID-19 deaths across first wave of the pandemic, interwave period and second wave in the Netherlands. METHODS We obtained multiple registry data from Statistics Netherlands spanning from 1 March 2020 to 14 March 2021 comprising 17.4 million inhabitants. We estimated incidence rate ratios for COVID-19 deaths by migration background using Poisson regression models and adjusted for relevant sociodemographic factors. RESULTS Populations with a migration background, especially those with Turkish, Moroccan and Surinamese background, exhibited higher risk of COVID-19 deaths than the Dutch origin population throughout the study periods. The elevated risk of COVID-19 deaths among populations with a migration background (as compared with Dutch origin population) was around 30% higher in the second wave than in the first wave. CONCLUSIONS Differences in COVID-19 deaths by migration background persisted in the second wave despite introduction of COVID-19 prevention measures targeted at populations with a migration background in the second wave. Research on explanatory mechanisms and novel prevention measures are needed to address the ongoing differences in COVID-19 deaths by migration background.
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Affiliation(s)
- Felix P Chilunga
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | | | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | | | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
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Hagenaars L, Waterlander W, den Hertog K, Stronks K. Een veerkrachtige publieke gezondheid in 2030: #hoedan? TSG Tijdschr Gezondheidswet 2022. [PMCID: PMC9628456 DOI: 10.1007/s12508-022-00364-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
SamenvattingBij gamechangers in public health wordt vaak automatisch gedacht aan specifieke interventies of uitvindingen. Vroeger was dat het riool, later werden het vaccinaties en tegenwoordig gelden overspannen verwachtingen van leefstijlinterventies en (opnieuw) vaccinaties. Dit denken in termen van silver bullets heeft ons veel gebracht, maar loopt vast in de complexiteit van de huidige uitdagingen van de publieke gezondheid. In dit essay schetsen we het erkennen van en handelen vanuit die complexiteit als gamechanger. We beschrijven wat het denken in termen van complexiteit betekent voor de volksgezondheid, en wat dit vraagt van de publieke gezondheidszorg.
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Torensma M, Harting J, Boateng L, Agyemang C, Lassooy-Tekle Y, Jacob Y, van den Muijsenbergh M, el Fakiri F, Prins M, Stronks K. Uptake and impact of COVID-19 preventive measures amongst migrant populations in the Netherlands. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Uptake of preventive measures to reduce transmission of viruses such as SARS-CoV-2, is crucial in the control of pandemics. To ensure equitable uptake we explored contextual factors that shaped uptake of COVID-19 preventive measures amongst smaller, albeit substantial, migrant populations in the Netherlands. 39 persons of Eritrean, Ghanaian, Indonesian and Filipino origin, with diverse legal status and length of stay in the Netherlands, participated in five online focus group discussions. Thematic analysis of data was informed by concepts from the Precaution Adoption Process Model and Protection Motivation Theory. Awareness and knowledge of preventive measures was shaped by limited Dutch proficiency, access to understandable information and interference of misinformation. Engagement by preventive measures was subject to COVID-19 threat appraisal and the ease with which complex behavioural messages could be translated to individual situations. Perceived vulnerability of undocumented migrants in particular, motivated information-seeking. A strong social norm to keep with cultural and religious practices, and limited opportunity for preventive behaviour in work and home context hindered uptake of preventive behaviour. Preventive measures brought about job, food, and housing insecurity, and increased barriers in access to healthcare for undocumented migrants. Migration-related, sociocultural, and socioeconomic factors shape uptake of preventive measures. Preventive measures negatively impact work, housing and access to healthcare of undocumented migrants. Our results suggest importance of multilingual information tailored to literacy needs; education and modelling of behaviour; and, regulations to ensure continued access to financial and material resources to minimise negative spill-over effects. Results were incorporated in two policy briefs advising local and national government. Collaboration with municipal health services lead to multilingual public health information.
Key messages
• Migration-related, sociocultural, and socioeconomic factors shape uptake of preventive measures.
• Preventive measures negatively impact work, housing and access to healthcare of undocumented migrants.
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Affiliation(s)
- M Torensma
- Public and Occupational Health , Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute , Amsterdam, Netherlands
| | - J Harting
- Public and Occupational Health , Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute , Amsterdam, Netherlands
| | - L Boateng
- Public and Occupational Health , Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - C Agyemang
- Public and Occupational Health , Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute , Amsterdam, Netherlands
| | | | - Y Jacob
- Pharos Expertise Centre on Health Disparities , Utrecht, Netherlands
| | - M van den Muijsenbergh
- Primary and Community Care, Radboud University Medical Centre , Nijmegen, Netherlands
- Pharos Expertise Centre on Health Disparities , Utrecht, Netherlands
| | - F el Fakiri
- Epidemiology, Health Promotion and Care Innovation, Public Health Service of Amsterdam , Amsterdam, Netherlands
| | - M Prins
- Infectious Diseases, Public Health Service of Amsterdam , Amsterdam, Netherlands
- Infectious Diseases, Amsterdam UMC, Location AMC , Amsterdam, Netherlands
| | - K Stronks
- Public and Occupational Health , Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute , Amsterdam, Netherlands
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Chilunga FP, Stoeldraier L, Agyemang C, Stronks K, Harmsen H, Kunst AE. Ethnic differences in COVID-19 deaths across various waves of Coronavirus pandemic in Netherlands. Eur J Public Health 2022. [PMCID: PMC9594474 DOI: 10.1093/eurpub/ckac129.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is not known how ethnic differences in COVID-19 deaths in the Netherlands evolved throughout the pandemic, especially after introduction of ethnicity-oriented COVID-19 prevention measures. We investigated associations between ethnicity and COVID-19 deaths across first wave of the pandemic, inter-wave period, and second wave in the Netherlands. Methods We obtained multiple registry data from Statistics Netherlands spanning from 01 March 2020 to 14 March 2021 comprising of 17.4 million inhabitants. We estimated incidence rate ratios (IRRs) for COVID-19 deaths among ethnic groups using Poisson regression models and adjusted for relevant socio-demographic factors. We used similar models to estimate IRRs for non-COVID-19 deaths among ethnic groups. Results Ethnic minority populations exhibited higher risk of COVID-19 deaths than the Dutch origin population throughout various study periods. The most elevated risk of COVID-19 deaths was in populations originating from low- and middle-income countries, especially those with Turkish, Moroccan, and Surinamese background. The elevated risk of COVID-19 deaths among ethnic minority groups (as compared to Dutch origin population) was higher in inter-wave period (4 times higher) and second wave (2 times higher) when compared to the first wave (1.5 times as higher). Ethnic differences in COVID-19 deaths were larger compared to non-COVID-19 deaths. Conclusions Ethnic differences in COVID-19 deaths persisted across first wave, inter-wave period and second wave in the Netherlands despite introduction of ethnicity-oriented prevention measures. Research on explanatory mechanisms and novel prevention measures are needed to address the ongoing differences in COVID-19 deaths across ethnic groups. Key messages • Ethnic differences in COVID-19 deaths persisted in the Netherlands despite introduction of ethnicity-oriented prevention measures.We therefore call for better prevention measures. • Well known drivers of SARS-CoV-2 infection such as household wealth, did not explain our findings calling for an in-depth understanding of drivers of ethnic differences in COVID-19 deaths.
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Affiliation(s)
- FP Chilunga
- Public and Occupational Health, Amsterdam UMC , Amsterdam, Netherlands
| | - L Stoeldraier
- Demography Group, Central Bureau of Statistics , Den Haag, Netherlands
| | - C Agyemang
- Public and Occupational Health, Amsterdam UMC , Amsterdam, Netherlands
| | - K Stronks
- Public and Occupational Health, Amsterdam UMC , Amsterdam, Netherlands
| | - H Harmsen
- Demography Group, Central Bureau of Statistics , Den Haag, Netherlands
| | - AE Kunst
- Public and Occupational Health, Amsterdam UMC , Amsterdam, Netherlands
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van der Hijden EJE, de Bekker PJGM, Tjoa MW, Stronks K. [More focus on prevention in the health care system? Acknowledge the need for a programmatic approach]. Ned Tijdschr Geneeskd 2022; 166:D6644. [PMID: 35899732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE A sustainable healthcare system calls for strengthening the focus on prevention. In general, there is no articulated demand for preventive interventions by an individual. Prevention therefore requires a programmatic approach. Based on an empirical analysis of primary and secondary prevention in our healthcare system, we identify crucial elements of such an approach. DESIGN Desk research METHOD: The online publication is based on 41 preventive interventions that, according to US guidelines for adults, certainly will (grade A) or are very likely (grade B) to improve health. We investigated whether these interventions were implemented in a similar manner in clinical or public health practice in the Netherlands, and how these interventions are organized, implemented and funded. RESULTS In the US, a systematic approach for disease prevention is recommended for 15 drug or behavioural interventions. In the Netherlands, six of these (e.g. counselling excessive alcohol consumption) are offered only to patients who present themselves with complaints or questions. In the US, systematic early detection is recommended for 26 diseases. In the Netherlands, for eleven of those, no early detection programme has been implemented (e.g. hypertension). In the Netherlands, all interventions have a basis for funding. CONCLUSION Firstly, it is recommended that consensus will be reached in the Netherlands about which preventive interventions should be systematically offered to whom. Secondly, strengthening prevention implies the systematic identification of those who might benefit from interventions, especially in case of drug and behavioural ones. Thirdly, our analysis points to the importance of funding that aligns with a programmatic approach.
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Affiliation(s)
| | | | | | - Karien Stronks
- Amsterdam UMC, afd. Public and Occupational Health, Amsterdam
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Ruijsbroek A, Wong A, den Hertog F, Droomers M, van den Brink C, Kunst AE, van Oers HAM, Stronks K. Do inhabitants profit from integrating a public health focus in urban renewal programmes? A Dutch case study. PLoS One 2022; 17:e0270367. [PMID: 35749511 PMCID: PMC9232143 DOI: 10.1371/journal.pone.0270367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Urban renewal traditionally involves policy sectors such as housing, transport, and employment, which potentially can enhance the health of residents living in deprived areas. Additional involvement of the public health sector might increase the health impact of these urban renewal activities. This study evaluates the health impact of an additional focus on health, under the heading of Healthy District Experiments (HDE), within districts where an urban renewal programme was carried out. Methods We evaluated changes in health outcomes before the start of the HDE and after implementation, and compared these changes with health changes in control areas, e.g. districts from the urban renewal programme where no additional HDE was implemented. Additionally, we gathered information on the content of the experiments to determine what types of activities have been implemented. Results The additional activities from the HDE were mostly aimed at strengthening the health care in the districts and at promoting physical activity. When we compared the prevalence in general health, mental health, overweight, obesity, smoking, and physical activity during the study period between the HDE districts and control districts, we found no significant differences in the rate of change. The study is limited by a small sample size and the cross-sectional nature of the data. These and other limitations are discussed. Conclusion We found no evidence for a beneficial health impact of the activities that were initiated with a specific focus on health, within a Dutch urban renewal programme. Specific attention for network management and the integration of such activities in the wider programme, as well as an allocated budget might be needed in order to sort a health impact.
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Affiliation(s)
- Annemarie Ruijsbroek
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- * E-mail:
| | - Albert Wong
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Frank den Hertog
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mariël Droomers
- Department of Public Health, Municipality of Utrecht, Utrecht, The Netherlands
| | - Carolien van den Brink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Anton E. Kunst
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans A. M. van Oers
- Tranzo, Faculty of Social Sciences, University of Tilburg, Tilburg, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Collard D, Stronks K, Harris V, Coyer L, Brinkman K, Beudel M, Bokhizzou N, Douma RA, Elbers P, Galenkamp H, Wolde MT, Prins M, van den Born BJH, Agyemang C. Ethnic Differences in Coronavirus Disease 2019 Hospitalization and Hospital Outcomes in a Multiethnic Population in the Netherlands. Open Forum Infect Dis 2022; 9:ofac257. [PMID: 35783684 PMCID: PMC9129177 DOI: 10.1093/ofid/ofac257] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Evidence from the United States and United Kingdom suggests that ethnic minority populations are at an increased risk for developing severe coronavirus disease 2019 (COVID-19); however, data from other West-European countries are scarce. Methods We analyzed data from 1439 patients admitted between February 2020 and January 2021 to 4 main hospitals in Amsterdam and Almere, the Netherlands. Differences in the risk for hospitalization were assessed by comparing demographics to the general population. Using a population-based cohort as reference, we determined differences in the association between comorbidities and COVID-19 hospitalization. Outcomes after hospitalization were analyzed using Cox regression. Results The hospitalization risk was higher in all ethnic minority groups than in those of Dutch origin, with age-adjusted odds ratios ranging from 2.2 (95% confidence interval [CI], 1.7-2.6) in Moroccans to 4.5 (95% CI, 3.2-6.0) in Ghanaians. Hypertension and diabetes were similarly associated with COVID-19 hospitalization. For all other comorbidities, we found differential associations. Intensive care unit admission and mortality during 21-day follow-up after hospitalization was comparable between ethnicities. Conclusions The risk of COVID-19 hospitalization was higher in all ethnic minority groups compared to the Dutch, but the risk of adverse outcomes after hospitalization was similar. Our results suggest that these inequalities may in part be attributable to comorbidities that can be prevented by targeted public health prevention measures. More work is needed to gain insight into the role of other potential factors such as social determinants of health, which might have contributed to the ethnic inequalities in COVID-19 hospitalization.
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Affiliation(s)
- Didier Collard
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Vanessa Harris
- Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Global Health, Amsterdam Institute of Global Health and Development, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Kees Brinkman
- Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nejma Bokhizzou
- Internal Medicine, BovenIJ Hospital, Amsterdam, the Netherlands
| | - Renee A Douma
- Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - Paul Elbers
- Department of Intensive Care, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Maria Prins
- Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Bert Jan H van den Born
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Chilunga FP, Coyer L, Collard D, Leenstra T, Galenkamp H, Agyemang C, Prins M, Stronks K. COVID-19 Impacts Across Multiple Life Domains of Vulnerable Socio-Demographic Groups Including Migrants: A Descriptive Cross-Sectional Study. Int J Public Health 2022; 67:1604665. [PMID: 35645705 PMCID: PMC9131879 DOI: 10.3389/ijph.2022.1604665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/20/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: We assessed the impacts of COVID-19 on multiple life domains across socio-demographic groups in Netherlands. Methods: After the first COVID-19 wave, we distributed online questionnaires among 13,031 participants of the multi-ethnic HELIUS cohort. Questionnaires contained questions on changes in income status, healthy behaviors, mental health, and access to non-COVID-19 health care. We then calculated differences in adjusted proportions of participants that reported negative changes across multiple life domains by migration background, age, sex, education, and occupation. Results: 4,450 individuals (35%) responded, of which 4,294 were included. Older populations and men seemed to be less vulnerable to negative changes in multiple life domains during the COVID-19 pandemic as compared to the pre-pandemic period, while populations with a migration background and lower education/occupation groups seemed to be more vulnerable to negative changes. Conclusion: Not all populations vulnerable to SARS-CoV-2 infection and mortality are also more vulnerable to COVID-19 impacts across multiple other life domains. Targeted interventions are needed in socio-demographic groups that are most impacted by COVID-19 in various life domains to prevent a further increase of their already increased risk of chronic diseases after the pandemic.
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Affiliation(s)
- Felix P. Chilunga
- Department of Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Felix P. Chilunga,
| | - Liza Coyer
- Public Health Department, Amsterdam, Netherlands
| | - Didier Collard
- Department of Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | | | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Maria Prins
- Public Health Department, Amsterdam, Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
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van Olden CC, Muilwijk M, Stronks K, van den Born BJ, Moll van Charante EP, Nicolau M, Zwinderma AH, Nieuwdorp M, Groen AK, van Valkengoed IGM. Differences in the prevalence of intermediate hyperglycaemia and the associated incidence of type 2 diabetes mellitus by ethnicity: The HELIUS study. Diabetes Res Clin Pract 2022; 187:109859. [PMID: 35367312 DOI: 10.1016/j.diabres.2022.109859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
AIMS We aimed to describe differences in the prevalence of intermediate hyperglycaemia (IH) between six ethnic groups. Moreover, to investigate differences in the association of the classifications of IH with the incidence of T2DM between ethnic groups. METHODS We included 3759 Dutch, 2826 African Surinamese, 1646 Ghanaian, 2571 Turkish, 2691 Moroccan and 1970 South Asian Surinamese origin participants of the HELIUS study. IH was measured by fasting plasma glucose (FPG) and HbA1c. We calculated age-, BMI and physical-activity-adjusted prevalence of IH by sex, and calculated age and sex-adjusted hazard ratios (HR)for the association between IH and T2DM in each ethnic group. RESULTS The prevalence of IH was higher among ethnic minority groups (68.6-41.7%) than the Dutch majority (34.9%). The prevalence of IH categories varied across subgroups. Combined increased FPG and HbA1c was most prevalent in South-Asian Surinamese men (27.6%, 95 %CI: 24.5-30.9%), and in Dutch women (4.2%, 95 %CI: 3.4-5.1%). The HRs for T2DM for each IH-classification did not differ significantly between ethnic groups. HRs were highest for the combined classification, e.g., HR = 8.1, 95 %CI: 2.5-26.6 in the Dutch. CONCLUSION We found a higher prevalence of IH in ethnic minority versus majority groups, but did not find evidence for a differential association of IH with incident T2DM.
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Affiliation(s)
- C C van Olden
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
| | - M Muilwijk
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - K Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - B J van den Born
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - E P Moll van Charante
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - M Nicolau
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A H Zwinderma
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - M Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A K Groen
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - I G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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Merabet N, Lucassen PJ, Crielaard L, Stronks K, Quax R, Sloot PMA, la Fleur SE, Nicolaou M. How exposure to chronic stress contributes to the development of type 2 diabetes: A complexity science approach. Front Neuroendocrinol 2022; 65:100972. [PMID: 34929260 DOI: 10.1016/j.yfrne.2021.100972] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/24/2021] [Accepted: 12/12/2021] [Indexed: 11/18/2022]
Abstract
Chronic stress contributes to the onset of type 2 diabetes (T2D), yet the underlying etiological mechanisms are not fully understood. Responses to stress are influenced by earlier experiences, sex, emotions and cognition, and involve a complex network of neurotransmitters and hormones, that affect multiple biological systems. In addition, the systems activated by stress can be altered by behavioral, metabolic and environmental factors. The impact of stress on metabolic health can thus be considered an emergent process, involving different types of interactions between multiple variables, that are driven by non-linear dynamics at different spatiotemporal scales. To obtain a more comprehensive picture of the links between chronic stress and T2D, we followed a complexity science approach to build a causal loop diagram (CLD) connecting the various mediators and processes involved in stress responses relevant for T2D pathogenesis. This CLD could help develop novel computational models and formulate new hypotheses regarding disease etiology.
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Affiliation(s)
- Nadège Merabet
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands; Institute for Advanced Study, University of Amsterdam, Amsterdam 1012 GC, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam 1012 GC, the Netherlands
| | - Paul J Lucassen
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam 1012 GC, the Netherlands; Brain Plasticity Group, Swammerdam Institute for Life Sciences, Faculty of Science, University of Amsterdam, Amsterdam 1098 XH, the Netherlands
| | - Loes Crielaard
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands; Institute for Advanced Study, University of Amsterdam, Amsterdam 1012 GC, the Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands; Institute for Advanced Study, University of Amsterdam, Amsterdam 1012 GC, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam 1012 GC, the Netherlands
| | - Rick Quax
- Institute for Advanced Study, University of Amsterdam, Amsterdam 1012 GC, the Netherlands; Computational Science Lab, University of Amsterdam, Amsterdam 1098 XH, the Netherlands
| | - Peter M A Sloot
- Institute for Advanced Study, University of Amsterdam, Amsterdam 1012 GC, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam 1012 GC, the Netherlands; Computational Science Lab, University of Amsterdam, Amsterdam 1098 XH, the Netherlands; National Centre of Cognitive Research, ITMO University, St. Petersburg, Russian Federation
| | - Susanne E la Fleur
- Department of Endocrinology and Metabolism & Laboratory of Endocrinology, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Metabolism and Reward Group, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, Amsterdam, the Netherlands.
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands; Institute for Advanced Study, University of Amsterdam, Amsterdam 1012 GC, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam 1012 GC, the Netherlands.
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Luna Pinzon A, Stronks K, Dijkstra C, Renders C, Altenburg T, den Hertog K, Kremers SPJ, Chinapaw MJM, Verhoeff AP, Waterlander W. The ENCOMPASS framework: a practical guide for the evaluation of public health programmes in complex adaptive systems. Int J Behav Nutr Phys Act 2022; 19:33. [PMID: 35346233 PMCID: PMC8962023 DOI: 10.1186/s12966-022-01267-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Systems thinking embraces the complexity of public health problems, including childhood overweight and obesity. It aids in understanding how factors are interrelated, and it can be targeted to produce favourable changes in a system. There is a growing call for systems approaches in public health research, yet limited practical guidance is available on how to evaluate public health programmes within complex adaptive systems. The aim of this paper is to present an evaluation framework that supports researchers in designing systems evaluations in a comprehensive and practical way. Methods We searched the literature for existing public health systems evaluation studies. Key characteristics on how to conduct a systems evaluation were extracted and compared across studies. Next, we overlaid the identified characteristics to the context of the Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme evaluation and analyzed which characteristics were essential to carry out the LIKE evaluation. This resulted in the Evaluation of Programmes in Complex Adaptive Systems (ENCOMPASS) framework. Results The ENCOMPASS framework includes five iterative stages: (1) adopting a system dynamics perspective on the overall evaluation design; (2) defining the system boundaries; (3) understanding the pre-existing system to inform system changes; (4) monitoring dynamic programme output at different system levels; and (5) measuring programme outcome and impact in terms of system changes. Conclusions The value of ENCOMPASS lies in the integration of key characteristics from existing systems evaluation studies, as well as in its practical, applied focus. It can be employed in evaluating public health programmes in complex adaptive systems. Furthermore, ENCOMPASS provides guidance for the entire evaluation process, all the way from understanding the system to developing actions to change it and to measuring system changes. By the nature of systems thinking, the ENCOMPASS framework will likely evolve further over time, as the field expands with more completed studies.
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Løvhaug AL, Granheim SI, Djojosoeparto SK, Harrington JM, Kamphuis CBM, Poelman MP, Roos G, Sawyer A, Stronks K, Torheim LE, Twohig C, Vandevijvere S, van Lenthe FJ, Terragni L. The potential of food environment policies to reduce socioeconomic inequalities in diets and to improve healthy diets among lower socioeconomic groups: an umbrella review. BMC Public Health 2022; 22:433. [PMID: 35246074 PMCID: PMC8895543 DOI: 10.1186/s12889-022-12827-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/14/2022] [Indexed: 12/19/2022] Open
Abstract
Socioeconomic inequalities in diets need to be tackled to improve population diets and prevent obesity and diet-related non-communicable diseases. The potential of food environment policies to reduce such inequalities has to date however not been appraised. The objective of this umbrella review was to assess the impact of food environment policies on socioeconomic inequalities in diets and to identify knowledge gaps in the existing literature, using the Healthy Food Environment Policy Index as a conceptual framework. The policies considered in the umbrella review are within six domains: 1) food composition 2) food labelling 3) food promotion 4) food provision 5) food retail 6) food pricing. A systematic search for systematic literature reviews on the effect of food environment policies on dietary-related outcomes across socioeconomic groups and published in English between 2004 and 2019 was conducted. Sixteen systematic literature reviews encompassing 159 primary studies were included, covering food composition (n = 2), food labelling (n = 3), food provision (n = 2), food prices (n = 13) and food in retail (n = 4). Quality assessment using the “Assessing the Methodological Quality of Systematic Reviews” quality rating scale showed that review quality was mainly low or critically low. Results suggest that food taxation may reduce socioeconomic inequalities in diets. For all other policy areas, the evidence base was poor. Current research largely fails to provide good quality evidence on impacts of food environment policies on socioeconomic inequalities in diets. Research to fill this knowledge gap is urgently needed.
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Affiliation(s)
- Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway.
| | - Sabrina Ionata Granheim
- Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences, Hamar, Norway
| | - Sanne K Djojosoeparto
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, Netherlands
| | - Janas M Harrington
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, Netherlands
| | - Gun Roos
- Consumption Research Norway (SIFO), OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Alexia Sawyer
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Cliona Twohig
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | | | - Frank J van Lenthe
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, Netherlands.,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Laura Terragni
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Bolijn R, Kunst AE, Appelman Y, Galenkamp H, Moll van Charante EP, Stronks K, Tan HL, van Valkengoed IG. Prospective analysis of gender-related characteristics in relation to cardiovascular disease. Heart 2022; 108:1030-1038. [PMID: 35197307 DOI: 10.1136/heartjnl-2021-320414] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/26/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Differences in cardiovascular disease (CVD) incidence between men and women have been widely reported. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly explain how these differences arise. In this exploratory study, we examined the associations between selected gender-related characteristics and CVD incidence. METHODS We linked baseline data of 18 058 participants without CVD from the population-based, multiethnic HEalthy LIfe in an Urban Setting study (Amsterdam, the Netherlands) to CVD incidence data, based on hospital admission and death records from Statistics Netherlands in 2013-2018. Using Cox regression analyses, we studied associations of time spent on household work, doing home repairs, primary earner status, type of employment, working in a male-dominated or female-dominated occupation and desire for emotional support with CVD incidence, stratified by sex. Analyses were adjusted for age, ethnicity and socioeconomic status. RESULTS In men, gender-related characteristics were not associated with higher CVD incidence. In women, homemakers had a higher hazard for CVD compared with full-time workers (HR 2.34, 95% CI 1.35 to 4.04), whereas those spending a moderate amount of time on household work had a lower hazard for CVD than those spending little time (HR 0.56, 95% CI 0.34 to 0.95). CONCLUSION Although we found no evidence for associations between gender-related characteristics and CVD incidence in men, being the homemaker and moderate time spent on household work appeared to be associated with CVD incidence in women. Thus, attention to gender-related characteristics might in future help to identify subgroups that may benefit from additional prevention strategies.
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Affiliation(s)
- Renee Bolijn
- Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Anton E Kunst
- Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Yolande Appelman
- Cardiology, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.,General Practice, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Karien Stronks
- Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Hanno L Tan
- Cardiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
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Garton EM, Savaş S, Pell C, Syurina EV, Stronks K, Cesuroglu T. Complex Interventions Deserve Complex Evaluations: A Transdisciplinary Approach to Evaluation of a Preventive Personalized Medicine Intervention. Front Public Health 2022; 10:793137. [PMID: 35186838 PMCID: PMC8854757 DOI: 10.3389/fpubh.2022.793137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/10/2022] [Indexed: 12/04/2022] Open
Abstract
Non-communicable diseases (NCDs) are the largest cause of disability and death globally. The human and financial costs of NCDs have raised questions of sustainability for many health systems. Personalized, preventive health interventions are an innovative way to address NCDs, but it is difficult to measure their effectiveness using standard evaluation methods. This article describes a novel approach to evaluation by coupling transdisciplinary methods with realist theory to design and pilot a health outcomes evaluation for a personalized medicine approach to NCD prevention in Istanbul, Turkey. Research and practice stakeholders contributed to study design, research questions, validation of results, and recommendations through interactive workshops, consistent dialogue, and reflection. They co-created a customized outcome measurement framework and recommendations that promote sustainability and continuous improvement of future evaluations. The participatory methods helped resolve the dichotomy between patient, practitioner, and researcher focus in the evaluation and improved stakeholders' data literacy. This research contributes to the body of evidence advocating for the use of non-standard methods such as transdisciplinary research to evaluate the effectiveness of complex interventions. The results of the pilot evaluation are also presented as a case study.
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Affiliation(s)
- Elise M. Garton
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Gentest Institute, Istanbul, Turkey
- *Correspondence: Elise M. Garton
| | | | - Christopher Pell
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Elena V. Syurina
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Karien Stronks
- Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Tomris Cesuroglu
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Gentest Institute, Istanbul, Turkey
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43
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Coyer L, Boyd A, Schinkel J, Agyemang C, Galenkamp H, Koopman AD, Leenstra T, van Duijnhoven YT, Moll van Charante EP, van den Born BJH, Lok A, Verhoeff A, Zwinderman AH, Jurriaans S, Stronks K, Prins M. Differences in SARS-CoV-2 infections during the first and second wave of SARS-CoV-2 between six ethnic groups in Amsterdam, the Netherlands: A population-based longitudinal serological study. Lancet Reg Health Eur 2022; 13:100284. [PMID: 34927120 PMCID: PMC8668416 DOI: 10.1016/j.lanepe.2021.100284] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surveillance data in high-income countries have reported more frequent SARS-CoV-2 diagnoses in ethnic minority groups. We examined the cumulative incidence of SARS-CoV-2 and its determinants in six ethnic groups in Amsterdam, the Netherlands. METHODS We analysed participants enrolled in the population-based HELIUS cohort, who were tested for SARS-CoV-2-specific antibodies and answered COVID-19-related questions between June 24-October 9, 2020 (after the first wave) and November 23, 2020-March 31, 2021 (during the second wave). We modelled SARS-CoV-2 incidence from January 1, 2020-March 31, 2021 using Markov models adjusted for age and sex. We compared incidence between ethnic groups over time and identified determinants of incident infection within ethnic groups. FINDINGS 2,497 participants were tested after the first wave; 2,083 (83·4%) were tested during the second wave. Median age at first visit was 54 years (interquartile range=44-61); 56·6% were female. Compared to Dutch-origin participants (15·9%), cumulative SARS-CoV-2 incidence was higher in participants of South-Asian Surinamese (25·0%; adjusted hazard ratio [aHR]=1·66; 95%CI=1·16-2·40), African Surinamese (28·9%, aHR=1·97; 95%CI=1·37-2·83), Turkish (37·0%; aHR=2·67; 95%CI=1·89-3·78), Moroccan (41·9%; aHR=3·13; 95%CI=2·22-4·42), and Ghanaian (64·6%; aHR=6·00; 95%CI=4·33-8·30) origin. Compared to those of Dutch origin, differences in incidence became wider during the second versus first wave for all ethnic minority groups (all p-values for interaction<0·05), except Ghanaians. Having household members with suspected SARS-CoV-2 infection, larger household size, and low health literacy were common determinants of SARS-CoV-2 incidence across groups. INTERPRETATION SARS-CoV-2 incidence was higher in the largest ethnic minority groups of Amsterdam, particularly during the second wave. Prevention measures, including vaccination, should be encouraged in these groups. FUNDING ZonMw, Public Health Service of Amsterdam, Dutch Heart Foundation, European Union, European Fund for the Integration of non-EU immigrants.
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Affiliation(s)
- Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of Infectious Diseases, Amsterdam Infection and Immunity (AII), University of Amsterdam, Amsterdam, Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Janke Schinkel
- Amsterdam UMC, Department of Medical Microbiology, University of Amsterdam, Amsterdam, Netherlands
| | - Charles Agyemang
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Henrike Galenkamp
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Anitra D.M. Koopman
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Tjalling Leenstra
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | | | - Eric P. Moll van Charante
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of General Practice, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Bert-Jan H. van den Born
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Anja Lok
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Center for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Arnoud Verhoeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Department of Epidemiology, Health Promotion & Healthcare Innovation, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Department of Sociology, University of Amsterdam, Amsterdam, Netherlands
| | - Aeilko H. Zwinderman
- Amsterdam UMC, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam, Netherlands
| | - Suzanne Jurriaans
- Amsterdam UMC, Department of Medical Microbiology, University of Amsterdam, Amsterdam, Netherlands
| | - Karien Stronks
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of Infectious Diseases, Amsterdam Infection and Immunity (AII), University of Amsterdam, Amsterdam, Netherlands
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Coyer L, Boyd A, Schinkel J, Agyemang C, Galenkamp H, Koopman ADM, Leenstra T, Moll van Charante EP, van den Born BJH, Lok A, Verhoeff A, Zwinderman AH, Jurriaans S, van Vught LA, Stronks K, Prins M. SARS-CoV-2 antibody prevalence and correlates of six ethnic groups living in Amsterdam, the Netherlands: a population-based cross-sectional study, June-October 2020. BMJ Open 2022; 12:e052752. [PMID: 34992110 PMCID: PMC8739540 DOI: 10.1136/bmjopen-2021-052752] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES It has been suggested that ethnic minorities have been disproportionally affected by the COVID-19. We aimed to determine whether prevalence and correlates of past SARS-CoV-2 exposure varied between six ethnic groups in Amsterdam, the Netherlands. DESIGN, SETTING, PARTICIPANTS Participants aged 25-79 years enrolled in the Healthy Life in an Urban Setting population-based prospective cohort (n=16 889) were randomly selected within ethnic groups and invited to participate in a cross-sectional COVID-19 seroprevalence substudy. OUTCOME MEASURES We tested participants for SARS-CoV-2-specific antibodies and collected information on SARS-CoV-2 exposures. We estimated prevalence and correlates of SARS-CoV-2 exposure within ethnic groups using survey-weighted logistic regression adjusting for age, sex and calendar time. RESULTS Between 24 June and 9 October 2020, we included 2497 participants. Adjusted SARS-CoV-2 seroprevalence was comparable between ethnic Dutch (24/498; 5.1%, 95% CI 2.8% to 7.4%), South-Asian Surinamese (22/451; 4.9%, 95% CI 2.2% to 7.7%), African Surinamese (22/400; 8.3%, 95% CI 3.1% to 13.6%), Turkish (30/408; 7.9%, 95% CI 4.4% to 11.4%) and Moroccan (32/391; 7.2%, 95% CI 4.2% to 10.1%) participants, but higher among Ghanaians (95/327; 26.3%, 95% CI 18.5% to 34.0%). 57.1% of SARS-CoV-2-positive participants did not suspect or were unsure of being infected, which was lowest in African Surinamese (18.2%) and highest in Ghanaians (90.5%). Correlates of SARS-CoV-2 exposure varied across ethnic groups, while the most common correlate was having a household member suspected of infection. In Ghanaians, seropositivity was associated with older age, larger household sizes, living with small children, leaving home to work and attending religious services. CONCLUSIONS No remarkable differences in SARS-CoV-2 seroprevalence were observed between the largest ethnic groups in Amsterdam after the first wave of infections. The higher infection seroprevalence observed among Ghanaians, which passed mostly unnoticed, warrants wider prevention efforts and opportunities for non-symptom-based testing.
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Affiliation(s)
- Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Infectious Diseases, Amsterdam UMC, location AMC, Amsterdam Infection and Immunity (AII), University of Amsterdam, Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Janke Schinkel
- Department of Medical Microbiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Anitra D M Koopman
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Tjalling Leenstra
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud Verhoeff
- Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Health Promotion and Healthcare Innovation, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Jurriaans
- Department of Medical Microbiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lonneke A van Vught
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Center for Experimental Molecular Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Infectious Diseases, Amsterdam UMC, location AMC, Amsterdam Infection and Immunity (AII), University of Amsterdam, Amsterdam, The Netherlands
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Muilwijk M, Bolijn R, Galenkamp H, Stronks K, van Charante EM, van Valkengoed IGM. The association between gender-related characteristics and type 2 diabetes risk in a multi-ethnic population: The HELIUS study. Nutr Metab Cardiovasc Dis 2022; 32:142-150. [PMID: 34810065 DOI: 10.1016/j.numecd.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 08/18/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Men and women have different type 2 diabetes mellitus (T2DM) risks, which have been reported across populations of different ethnicity. Where differences in T2DM risk for sex (biological) have been studied, research on gender (socio-cultural) and T2DM risk is lacking. We explored, in a multi-ethnic population, the association of six gender-related characteristics with incident T2DM over 3 years, and the mediation by known risk factors for T2DM. METHODS AND RESULTS We included 9605 women and 7080 men of the multi-ethnic HELIUS study (Amsterdam, the Netherlands). We studied associations between gender-related characteristics and incident T2DM, using Cox regression. After a median of 3.0 years (IQR 2.0; 4.0), 198 (2.1%) women and 137 (1.9%) men developed T2DM. A lower T2DM risk was observed in those not being the primary earner (HR 0.67; 95% CI 0.47; 0.93) and a higher desired level of social support (HR 0.62; 95% CI 0.44; 0.87). Hours spent on household work, home repairs, type of employment and male- or female-dominated occupation were not associated with T2DM incidence. No evidence for effect modification by biological sex or ethnicity was found. Known risk factors of T2DM did not mediate the observed associations. CONCLUSION Gender-related characteristics, not being the primary earner and a higher desired social support were associated with reduced T2DM risk, and this was not mediated by known risk factors for T2DM.
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Affiliation(s)
- Mirthe Muilwijk
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Renee Bolijn
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Karien Stronks
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Eric M van Charante
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Irene G M van Valkengoed
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, the Netherlands
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Abstract
In health promotion research, enthusiasm for patient and public involvement (PPI) is growing. However, a lack of conceptual clarity leads to ambiguities in participatory processes and purposes, and hampers efforts to achieve and evaluate PPI in research. This study provides an overview of its underlying reasons—or rationales—so as to better understand, guide and interpret PPI in research practice. We conducted a critical review to identify typologies of rationales for PPI. We re-categorized the different types of rationales from these typologies based on their content. We illustrated the resulting categories of rationales with examples from a case study on PPI in research on Lyme disease. Five categories of rationales for PPI were identified. The democratic rationale reflects the normative right of citizens to have a voice in research. The consumerist rationale refers to the economic right of stakeholders with interests to have a say. Rooted in social justice, the transformative rationale seeks to empower marginalized groups. The substantive rationale starts from epistemic considerations and aims to improve the quality of knowledge that research generates. The instrumental rationale is of pragmatic origin and refers to improved efficiency and effectiveness of the research. Our overview of categories of rationales can be used as a frame of reference for PPI in health promotion research. Exploring, stating explicitly and reflecting on the underlying reasons for PPI may help to define realistic purposes, select matching approaches and design appropriate evaluation studies. This might also contribute to the conceptualization of PPI.
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Affiliation(s)
| | - Kasper Kruithof
- Department of Ethics, Amsterdam UMC, University of Amsterdam, Law & Humanities, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Lotte Ruijter
- Department of Public and Occupation Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Karien Stronks
- Department of Public and Occupation Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
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47
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Agyemang C, Richters A, Jolani S, Hendriks S, Zalpuri S, Yu E, Pijls B, Prins M, Stronks K, Zeegers MP. Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2021-007433. [PMID: 34740916 PMCID: PMC8573300 DOI: 10.1136/bmjgh-2021-007433] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/26/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Early literature on the COVID-19 pandemic indicated striking ethnic inequalities in SARS-CoV-2-related outcomes. This systematic review and meta-analysis aimed to describe the presence and magnitude of associations between ethnic groups and COVID-19-related outcomes. Methods PubMed and Embase were searched from December 2019 through September 2020. Studies reporting extractable data (ie, crude numbers, and unadjusted or adjusted risk/ORs) by ethnic group on any of the five studied outcomes: confirmed COVID-19 infection in the general population, hospitalisation among infected patients, and disease severity, intensive care unit (ICU) admission and mortality among hospitalised patients with SARS-CoV-2 infection, were included using standardised electronic data extraction forms. We pooled data from published studies using random-effects meta-analysis. Results 58 studies were included from seven countries in four continents, mostly retrospective cohort studies, covering a total of almost 10 million individuals from the first wave until the summer of 2020. The risk of diagnosed SARS-CoV-2 infection was higher in most ethnic minority groups than their White counterparts in North American and Europe with the differences remaining in the US ethnic minorities after adjustment for confounders and explanatory factors. Among people with confirmed infection, African-Americans and Hispanic-Americans were also more likely than White-Americans to be hospitalised with SARS-CoV-2 infection. No increased risk of COVID-19 outcomes (ie, severe disease, ICU admission and death) was found among ethnic minority patients once hospitalised, except for a higher risk of death among ethnic minorities in Brazil. Conclusion The risk of SARS-CoV-2 diagnosis was higher in most ethnic minorities, but once hospitalised, no clear inequalities exist in COVID-19 outcomes except for the high risk of death in ethnic minorities in Brazil. The findings highlight the necessity to tackle disparities in social determinants of health, preventative opportunities and delay in healthcare use. Ethnic minorities should specifically be considered in policies mitigating negative impacts of the pandemic. PROSPERO registration number CRD42020180085.
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Affiliation(s)
- Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anke Richters
- Department of Research and Development, The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Shahab Jolani
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Stevie Hendriks
- School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | | | - Evan Yu
- Department of Complex Genetics and Epidemiology, Maastricht University, Maastricht, The Netherlands.,Department of Epidemiology & Biostatistics, School of Public Health, Nanjing, People's Republic of China
| | - Bart Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Amsterdam Infection and Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Infectious Diseases, Research and Prevention, Public Health Service (GGD) of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maurice P Zeegers
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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48
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Davidson EM, Krasuska M, Jenum AK, Gill JMR, Beune E, Stronks K, van Valkengoed IGM, Diaz E, Sheikh A. Developing a realist informed framework for cultural adaptation of lifestyle interventions for the prevention of type 2 diabetes in South Asian populations in Europe. Diabet Med 2021; 38:e14584. [PMID: 33838051 DOI: 10.1111/dme.14584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/14/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023]
Abstract
AIMS Selected lifestyle interventions proven effective for White-European populations have been culturally adapted for South Asian populations living in Europe, who are at higher risk of type 2 diabetes. However, a limited theoretical basis underpins how cultural adaptations are believed to augment intervention effectiveness. We undertook a realist review to synthesise existing literature on culturally adapted type 2 diabetes prevention interventions, to develop a framework that shows 'how' cultural adaptation works, for 'whom' and in 'what contexts'. METHODS We followed the stepped methodological approach of realist review. Our work concluded a European-wide project (EuroDHYAN), and core studies were identified from the preceding EuroDHYAN reviews. Data were extracted, coded into themes and synthesised to create 'Context-Mechanism-Outcome' configurations and to generate a refined explanatory framework. RESULTS We identified eight core intervention papers. From this evidence, and supporting literature, we examined the 'Team' domain of cultural adaptation and identified a mechanism of shared cultural identity which we theorised as contributing to strong team-participant relationships. We also identified four key contexts which influenced intervention outcomes: 'research setting' and 'heterogeneous populations' (intrinsic to the intervention) and 'broader environment' and 'socio-cultural stress' (extrinsic barriers). CONCLUSIONS This work instigates research into the mechanisms of cultural adaptation which, if pursued, will allow a more nuanced understanding of how to apply adaptations, and for whom. In practice we recommend greater consideration of heterogeneous and intersecting population characteristics; how intervention design can safeguard sustainability; and how the four key contexts identified influence how, and whether, these interventions work.
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Affiliation(s)
| | | | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Erik Beune
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karien Stronks
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Irene G M van Valkengoed
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Esperanza Diaz
- Department for Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
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49
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van der Wal JM, van Borkulo CD, Deserno MK, Breedvelt JJF, Lees M, Lokman JC, Borsboom D, Denys D, van Holst RJ, Smidt MP, Stronks K, Lucassen PJ, van Weert JCM, Sloot PMA, Bockting CL, Wiers RW. Advancing urban mental health research: from complexity science to actionable targets for intervention. Lancet Psychiatry 2021; 8:991-1000. [PMID: 34627532 DOI: 10.1016/s2215-0366(21)00047-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/30/2022]
Abstract
Urbanisation and common mental disorders (CMDs; ie, depressive, anxiety, and substance use disorders) are increasing worldwide. In this Review, we discuss how urbanicity and risk of CMDs relate to each other and call for a complexity science approach to advance understanding of this interrelationship. We did an ecological analysis using data on urbanicity and CMD burden in 191 countries. We found a positive, non-linear relationship with a higher CMD prevalence in more urbanised countries, particularly for anxiety disorders. We also did a review of meta-analytic studies on the association between urban factors and CMD risk. We identified factors relating to the ambient, physical, and social urban environment and showed differences per diagnosis of CMDs. We argue that factors in the urban environment are likely to operate as a complex system and interact with each other and with individual city inhabitants (including their psychological and neurobiological characteristics) to shape mental health in an urban context. These interactions operate on various timescales and show feedback loop mechanisms, rendering system behaviour characterised by non-linearity that is hard to predict over time. We present a conceptual framework for future urban mental health research that uses a complexity science approach. We conclude by discussing how complexity science methodology (eg, network analyses, system-dynamic modelling, and agent-based modelling) could enable identification of actionable targets for treatment and policy, aimed at decreasing CMD burdens in an urban context.
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Affiliation(s)
- Junus M van der Wal
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands; Department of Public Health, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Claudia D van Borkulo
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Marie K Deserno
- Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands; Centre for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Josefien J F Breedvelt
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; National Centre for Social Research, London, UK; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mike Lees
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Informatics Institute, University of Amsterdam, Amsterdam, Netherlands
| | - John C Lokman
- Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Denny Borsboom
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Damiaan Denys
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ruth J van Holst
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marten P Smidt
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Karien Stronks
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Public Health, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Paul J Lucassen
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Julia C M van Weert
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, Netherlands
| | - Peter M A Sloot
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Institute for Advanced Study, University of Amsterdam, Amsterdam, Netherlands; National Centre for Cognitive Science, ITMO University, St Petersburg, Russia
| | - Claudi L Bockting
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Reinout W Wiers
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
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50
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Bolijn R, Kunst AE, Appelman Y, Galenkamp H, Moll van Charante EP, Stronks K, Tan HL, Van Valkengoed IGM. Prospective analysis of gender-related characteristics in relation to cardiovascular disease. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular diseases (CVD) are a major public health problem in men and women worldwide. Differences in CVD incidence between men and women have been widely reported, although explanations for these differences remain unclear. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly explain how these differences arise. We aimed to establish the associations between selected gender-related characteristics and CVD incidence.
Methods
We linked baseline data of 18,058 participants without CVD from the population-based, multi-ethnic HELIUS study (Amsterdam, the Netherlands) to CVD incidence data, based on hospital admission and death records from Statistics Netherlands in 2013-2018. Using Cox regression analyses, we studied associations of time spent on household work, doing home repairs, primary earner status, type of employment, performing a male-dominated or female-dominated occupation, and desire for emotional support with CVD incidence, overall (with or without adjustment for sex) and stratified by sex. Analyses were adjusted for age, ethnicity, and socioeconomic status.
Results
In the fully adjusted analyses, most gender-related characteristics were not associated with higher CVD incidence, overall and among men. In women, homemakers had a higher hazard for CVD compared to fulltime workers (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.35-4.04), whereas those spending a moderate amount of time on household work had a lower hazard for CVD than those spending little time (HR 0.56, 95% CI 0.34-0.95).
Conclusions
Although most gender-related characteristics were not associated with CVD incidence in men, being the homemaker and time spent on household work were associated with CVD incidence in women. Thus, attention to gender-related characteristics may in future help to identify subgroups that may benefit from additional prevention strategies.
Key messages
Some gender-related characteristics are relevant for cardiovascular disease risk, particularly in women. Attention to gender-related characteristics may in future help to identify subgroups that may benefit from additional prevention strategies.
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Affiliation(s)
- R Bolijn
- Public and Occupational Health, Amsterdam UMC - location AMC, Amsterdam, Netherlands
| | - AE Kunst
- Public and Occupational Health, Amsterdam UMC - location AMC, Amsterdam, Netherlands
| | - Y Appelman
- Cardiology, Amsterdam UMC - location VUmc, Amsterdam, Netherlands
| | - H Galenkamp
- Public and Occupational Health, Amsterdam UMC - location AMC, Amsterdam, Netherlands
| | - EP Moll van Charante
- Public and Occupational Health, Amsterdam UMC - location AMC, Amsterdam, Netherlands
- General Practice, Amsterdam UMC - location AMC, Amsterdam, Netherlands
| | - K Stronks
- Public and Occupational Health, Amsterdam UMC - location AMC, Amsterdam, Netherlands
| | - HL Tan
- Cardiology, Amsterdam UMC - location AMC, Amsterdam, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - IGM Van Valkengoed
- Public and Occupational Health, Amsterdam UMC - location AMC, Amsterdam, Netherlands
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