Schrijvers, C.Th.M.

Occupational level of the father and alcohol consumption during adolescence; patterns and predictors (Article)

2003-01-01T00:00:00Z

STUDY OBJECTIVE: This paper describes and attempts to explain the association between occupational level of the father and high alcohol consumption among a cohort of New Zealand adolescents from age 11 to 21. DESIGN: Data were obtained from the longitudinal Dunedin multidisciplinary health and development study. At each measurement wave, those who then belonged to the quartile that reported the highest usual amount of alcohol consumed on a typical drinking occasion were categorised as high alcohol consumers. Potential predictors of high alcohol consumption included environmental factors, individual factors, and educational achievement measured at age 9, 11, or 13. Longitudinal logistic GEE analyses described and explained the relation between father's occupation and adolescent alcohol consumption. SETTING: Dunedin, New Zealand. PARTICIPANTS: About 1000 children were followed up from birth in 1972 until adulthood. MAIN RESULTS: A significant association between fathers' occupation and adolescent alcohol consumption emerged at age 15. Overall adolescents from the lowest occupational group had almost twice the odds of being a large consumer than the highest occupational group. The association between father's occupation and high alcohol consumption during adolescence was explained by the higher prevalence of familial alcohol problems and friends approving of alcohol consumption, lower intelligence scores, and lower parental attachment among adolescents from lower occupational groups. CONCLUSIONS: Socioeconomic background affects adolescent alcohol consumption substantially. This probably contributes to cumulation of disadvantage. Prevention programmes should focus on adolescents from lower socioeconomic groups and make healthier choices the easier choices by means of environmental change.

Determinants of levels and changes of physical functioning in chronically ill persons: results from the GLOBE Study (Article)

2001-01-01T00:00:00Z

STUDY OBJECTIVE: Declines in physical functioning are a common result of chronic illness, but relatively little is known about factors not directly related to severity of disease that influence the occurrence of disability among chronically ill persons. The aim of this study was to assess the effect of a large number of potential determinants (sociodemographic factors, health related behaviour, structural living conditions, and psychosocial factors). DESIGN: Longitudinal study of levels and changes of physical functioning among persons suffering from four chronic diseases (asthma/chronic obstructive pulmonary disease (COPD), heart disease, diabetes, chronic low back pain). In 1991, persons suffering from one or more of these diseases were identified in a general population survey. Self reported disabilities, using a subset of the OECD disability indicator, were measured six times between 1991 and 1997. These data were analysed using generalised estimating equations, relating determinants measured in 1991 to disability between 1991 and 1997, and controlling for a number of potential confounders (age, gender, year of measurement, and type and severity of chronic disease). SETTING: Region of Eindhoven (south eastern Netherlands). PARTICIPANTS: 1784 persons with asthma/COPD, heart disease, diabetes mellitus and/or low back pain. MAIN RESULTS: In a "repeated prevalence" model, statistically significant (p<0.05) and strong associations were found between most of the determinants and the prevalence of disabilities. In a "longitudinal change" model, statistically significant (p<0.05) predictors of unfavourable changes in physical functioning were low income and excessive alcohol consumption, while we also found indications for effects of marital status, degree of urbanisation, smoking, and external locus of control. CONCLUSIONS: Other factors than characteristics of the underlying disease have an important influence on levels and changes of physical functioning among chronically ill persons. Reduction of the prevalence of disabilities in the population not only depends on medical interventions, but may also require social interventions, health education, and psychological interventions among chronically ill persons.

Educational level and decreases in leisure time physical activity: predictors from the longitudinal GLOBE study (Article)

2001-01-01T00:00:00Z

STUDY OBJECTIVE: This study describes educational differences in decreases in leisure time physical activity among an adult, physically active population and additionally attempts to identify predictors of these differences from information on health status and individual and environmental factors. DESIGN: Prospective population based study. Baseline measurement were carried out in 1991 and follow up in 1997. SETTING: South eastern part of the Netherlands. PARTICIPANTS: The study included 3793 subjects who were physically active in 1991 and who participated in the follow up. METHODS: Potential predictors of decreasing physical activity were measured in 1991. Logistic regression analyses were carried out for two age groups (< 45 years; > or = 45 years) separately. MAIN RESULTS: Lower educated respondents experienced statistically significant higher odds to decrease physical activity during follow up, compared with respondents with higher vocational schooling or a university degree. Perceived control was the main predictor of educational differences in decreasing physical activity in both age groups. In the older group, material problems and a poor perceived health experienced by lower educated people additionally predicted educational differences in decreases in physical activity during leisure time. CONCLUSIONS: These findings have important implications for health promotion practice and policy to prevent socioeconomic differences in physical inactivity and health. There is a need for evidence-based interventions that improve perceived control and reduce material problems in lower educated groups.

Explaining educational differences in mortality: the role of behavioral and material factors (Article)

1999-01-01T00:00:00Z

OBJECTIVES: This study examined the role of behavioral and material factors in explaining educational differences in all-cause mortality, taking into account the overlap between both types of factors. METHODS: Prospective data were used on 15,451 participants in a Dutch longitudinal study. Relative hazards of all-cause mortality by educational level were calculated before and after adjustment for behavioral factors (alcohol intake, smoking, body mass index, physical activity, dietary habits) and material factors (financial problems, neighborhood conditions, housing conditions, crowding, employment status, a proxy of income). RESULTS: Mortality was higher in lower educational groups. Four behavioral factors (alcohol, smoking, body mass index, physical activity) and 3 material factors (financial problems, employment status, income proxy) explained part of the educational differences in mortality. With the overlap between both types of factors accounted for, material factors were more important than behavioral factors in explaining mortality differences by educational level. CONCLUSIONS: The association between educational level and mortality can be largely explained by material factors. Thus, improving the material situation of people might substantially reduce educational differences in mortality.

Socioeconomic inequalities in mortality and importance of perceived control: cohort study (Article)

1999-01-01T00:00:00Z

Socioeconomic inequalities in health in the working population: the contribution of working conditions (Article)

1998-01-01T00:00:00Z

BACKGROUND: The aim was to study the impact of different categories of working conditions on the association between occupational class and self-reported health in the working population. METHODS: Data were collected through a postal survey conducted in 1991 among inhabitants of 18 municipalities in the southeastern Netherlands. Data concerned 4521 working men and 2411 working women and included current occupational class (seven classes), working conditions (physical working conditions, job control, job demands, social support at work), perceived general health (very good or good versus less than good) and demographic confounders. Data were analysed with logistic regression techniques. RESULTS: For both men and women we observed a higher odds ratio for a less than good perceived general health in the lower occupational classes (adjusted for confounders). The odds of a less than good perceived general health was larger among people reporting more hazardous physical working conditions, lower job control, lower social support at work and among those in the highest category of job demands. Results were similar for men and women. Men and women in the lower occupational classes reported more hazardous physical working conditions and lower job control as compared to those in higher occupational classes. High job demands were more often reported in the higher occupational classes, while social support at work was not clearly related to occupational class. When physical working conditions and job control were added simultaneously to a model with occupational class and confounders, the odds ratios for occupational classes were reduced substantially. For men, the per cent change in the odds ratios for the occupational classes ranged between 35% and 83%, and for women between 35% and 46%. CONCLUSIONS: A substantial part of the association between occupational class and a less than good perceived general health in the working population could be attributed to a differential distribution of hazardous physical working conditions and a low job control across occupational classes. This suggests that interventions aimed at improving these working conditions might result in a reduction of socioeconomic inequalities in health in the working population.

Socioeconomic inequalities in cancer survival in the Netherlands and Great Britain: small-area based studies usiug cancer registry data (Doctoral Thesis)

1996-01-17T00:00:00Z

Cancer is the second most impOltant cause of death in the Netherlands, as it is in many developed countries. In 1990 about 30% of all deaths in the Netherlands could be ascribed to cancer. I In general, survival from cancer is rather poor but it varies by such characteristics as the organ of origin of the tumour and age of the patient. Socioeconomic status is another factor which has been found to be of prognostic importance for cancer patients.' In general, cancer patients fi'om lower socioeconomic groups have a lower survival rate than patients fi'om higher socioeconomic groups. The subject of this thesis is the association between socioeconomic status and cancer survival in the southeastern Netherlands and the area covered by the South Thames Regional Health Authority (RHA) in South East England. Both a description of and explanations for variation in survival by socioeconomic status in these two areas are given. The studies reported in this thesis, can be placed within a broader framework of research on socioeconomic inequalities in health (paragraph 1.1) as well as within a narrower framework of research on socioeconomic inequalities in cancer (paragraph 1.2). In the final paragraph of this introduction, the aims of the studies reported in this thesis are presented (paragraph 1.3).