Re-examining the social gradient in health: A study of Dutch men, 1850-1984.

Today, a social gradient in health is clearly visible. Individuals with higher socio-economic statuses tend to live longer lives, and are less likely to be disabled or chronically ill. However, there is debate over when the social gradient emerged: is it a constant across contexts, or a particular feature of certain societies? Often, social gradients are not found in historical contexts. This is perhaps because historical studies use mortality as their sole measure of health, which may not fully reflect the health statuses of the living. Using another health indicator may help to identify whether a social gradient in health was present in historical contexts. One alternative measure of health is body height, a barometer of population health. In this study, we accordingly examined socio-economic status's relationship to both adult mortality and body height. A sample of Dutch men (n=3396), born between 1850 and 1900, was used. Socio-economic status was measured with parental occupational class, and height was measured at age 20. Survival analyses (for mortality at age 20 or later) and linear regressions (for height at age 20) were performed. We found no clear gradient in occupational class's relationship to adult mortality. Regarding height, individuals from elite backgrounds were estimated to be 2.82 cm cm taller (95% CI: 1.41-4.24) than those from unskilled working backgrounds. While a gradient in height was present in earlier birth cohorts, it was not visible among men born between 1885 and 1900. These findings indicate that there was a social gradient in health in the late nineteenth and twentieth centuries, although the gradient perhaps changed based on the indicator and time period being examined. This may mean that the social gradient in health is more persistent over time than it appears when only examining the social gradient in mortality.

Strengthening sense of coherence: Evidence from a physical activity intervention targeting vulnerable adults.

Sense of coherence (SOC), a concept that refers to individuals' abilities to manage, comprehend, and find meaning in their lives and the world around them, has been shown to be an important predictor of health outcomes. While SOC was initially hypothesized to be static after early-adulthood, there is growing evidence that health interventions can strengthen SOC. In this study, we accordingly examined whether SOC could be strengthened among adults in the context of a physical activity intervention. This intervention, Communities on the Move, was conducted in the Netherlands, and was primarily targeted at older adults from socially vulnerable backgrounds. Four cohorts were followed for 18 months each, between 2012 and 2016. The SOC-3 questionnaire was used to collect data on SOC at baseline (T0) and after eighteen months (T3), with information on 117 participants in both of these waves. To assess the change in SOC between T0 and T3, ordered logistic regressions were performed, as well as mixed ordered logistic regressions with random intercepts for group and program location. This study found evidence that SOC significantly changed from T0 to T3. Participants with weak SOC at baseline reported a median one-point stronger SOC at T3 (on a 6-point scale), while those with moderate or strong SOC at baseline reported a median change of zero points between T0 and T3. Further, based on the results of the regression analyses, those with weaker SOC scores were most likely to have stronger SOC at T3: having a weak SOC at baseline was associated with a 76% probability of stronger SOC, and a 4% probability of weaker SOC at T3. These results indicated that SOC may be strengthened in vulnerable older adults, particularly when their SOC is initially low.

Dataset for the model of a municipality competitiveness in relation to the geothermal resources exploitation in Poland.

This dataset corresponds with the manuscript "The impact of geothermal resources on the competitiveness of municipalities: evidence from Poland" [1]. In the paper, the geothermal resources are assumed as a local competitive advantage for the municipalities that exploit them. In order to examine the relation between the exploitation of the geothermal resources and local competitiveness we determine a model of municipality competitiveness in Poland. Concept of the local competitiveness is referred to place-based measures (Lovering [2], Mytelka and Farinelli [3], Plummer and Taylor [4], Kitson et al.[5]) and it is related to the management of local resources (Malecki [6], Turok [7]). Literature review suggests that the local competitiveness is best reflected in the indicators of economic welfare and sustainability (Meyer-Stamer [8], Audretsch et al.[9]). Therefore, we use an expert method to build the model of a municipality competitiveness indicators on the example of Poland. Throughout the Analytical Hierarchy Process (AHP) method engaged experts select the 24 indicators of local competitiveness. This method serves in situations of a problem complexity (Kamenetzky [10], Saaty [11]) and as a multicriteria method in the regional studies (Dinc et al. [12]). Aggregation of the AHP selected indicators yields a synthetic competitiveness index for each of the municipalities that we examine. This index constitutes the model dependent variable in the related research article. This procedure of building municipality competitiveness model sets an example of approaching a complex phenomenon such as the local competitiveness definition. The versatility of this method enables its application into related research cases.

Assessing health outcomes in the aftermath of the great recession: a comparison of Spain and the Netherlands.

BACKGROUND: Across time and space, financial security has been shown to impact health outcomes, with the acute loss of financial security being particularly detrimental. We compare financial security's association with health in Spain and the Netherlands. These countries respectively exemplify low and high levels of financial security, general trends that have been exacerbated by the Great Recession of the 2010s. METHODS: We exploit the Spanish (n = 1001) and Dutch (n = 1010) editions of the European Social Survey 7, conducted in 2014, and condense relevant financial security- and health-related survey questions into latent variables using factor analyses. Using the component loadings as quasi-weightings, we generate one financial security variable and three health variables (mental, physical and social). Then, we run ordinary least squares regressions interacting financial security and nationality, for each of the three health outcomes. RESULTS: In unadjusted models, we find that financial security (p < 0.01) is positively associated with the three health outcomes, while being Spanish relative to being Dutch (p < 0.01) is associated with worse health outcomes. However, the results of the interaction term show that being Spanish relative to being Dutch weakens the relationship between physical health and social health, although not mental health. CONCLUSIONS: We find evidence that financial security's influence on health outcomes may vary in different contexts. This may be an important aspect of determining the Great Recession's influence on health outcomes. Our study is a first step in understanding how the relationships between financial security and health may differ in countries with different experiences of the Great Recession.

Contexts, Mechanisms, and Outcomes That Matter in Dutch Community-Based Physical Activity Programs Targeting Socially Vulnerable Groups.

This article presents a practitioner-based approach to identify key combinations of contextual factors (C) and mechanisms (M) that trigger outcomes (O) in Dutch community-based health-enhancing physical activity (CBHEPA) programs targeting socially vulnerable groups. Data were collected in six programs using semi-structured interviews and focus groups using a timeline technique. Sessions were recorded, anonymized, and transcribed. A realist synthesis protocol was used for data-driven and thematic analysis of CMO configurations. CMO configurations related to community outreach, program sustainability, intersectoral collaboration, and enhancing participants' active lifestyles. We have refined the CBHEPA program theory by showing that actors' passion for, and past experiences with, physical activity programs trigger outcomes, alongside their commitment to socially vulnerable target groups. Project discontinuity, limited access to resources, and a trainer's stand-alone position were negative configurations. The authors conclude that local governance structures appear often to lack adaptive capacity to accommodate multilevel processes to sustain programs.

Health-Related Quality of Life, Self-Efficacy and Enjoyment Keep the Socially Vulnerable Physically Active in Community-Based Physical Activity Programs: A Sequential Cohort Study.

Physical inactivity is most commonly found in socially vulnerable groups. Dutch policies target these groups through community-based health-enhancing physical activity (CBHEPA) programs. As robust evidence on the effectiveness of this approach is limited, this study investigated whether CBHEPA programs contribute to an increase in and the maintenance of physical activity in socially vulnerable groups. In four successive cohorts, starting at a six-month interval, 268 participants from 19 groups were monitored for twelve months in seven CBHEPA programs. Data collection was based on repeated questionnaires. Socio-economic indicators, program participation and coping ability were measured at baseline. Physical activity, health-related quality of life and on-going program participation were measured three times. Self-efficacy and enjoyment were measured at baseline and at twelve months. Statistical analyses were based on a quasi-RCT design (independent t-tests), a comparison of participants and dropouts (Mann-Whitney test), and multilevel modelling to assess change in individual physical activity, including group level characteristics. Participants of CBHEPA programs are socially vulnerable in terms of low education (48.6%), low income (52.4%), non-Dutch origin (64.6%) and health-related quality of life outcomes. Physical activity levels were not below the Dutch average. No increase in physical activity levels over time was observed. The multilevel models showed significant positive associations between health-related quality of life, self-efficacy and enjoyment, and leisure-time physical activity over time. Short CBHEPA programs (10-13 weeks) with multiple trainers and gender-homogeneous groups were associated with lower physical activity levels over time. At twelve months, dropouts' leisure-time physical activity levels were significantly lower compared to continuing participants, as were health-related quality of life, self-efficacy and enjoyment outcomes. BMI and care consumption scored significantly higher among dropouts. In conclusion, Dutch CBHEPA programs reach socially vulnerable, but not necessarily inactive, groups in terms of socio-economic and health-related quality of life outcomes. Our findings suggest that CBHEPA programs particularly contribute to physical activity maintenance in socially vulnerable groups, rather than to an increase in physical activity behaviour over time.

Predictors of willingness to pay for physical activity of socially vulnerable groups in community-based programs.

Willingness to pay (WTP) is used to assess individuals' value attribution to health-related quality of life interventions. Little is known about predictors of WTP for sport and physical activity in socially vulnerable groups in community-based physical activity (CBHEPA) programs. This study addresses the questions: What is the WTP for sport and physical activity of participants in CBHEPA programs, expressed in WTPmoney and WTPtime? Which factors predict WTPmoney and WTPtime? From the literature, predictors for WTP for sport and physical activity were identified: (1) personal and socio-economic predictors: income, education, age, and ethnic origin, (2) health-related predictors: perceived health, life satisfaction, sense of coherence, self-efficacy, (3) sport and physical activity-related predictors: duration and frequency of participation, leisure-time sport or physical activity, sport club membership, enjoyment, and membership fee. Data were gathered for WTPmoney and WTPtime (n = 268) in 19 groups in an evaluation study of CBHEPA programs. Ordered probit was used for analyses. WTPmoney was a monthly average of €9.6. WTPtime was on average 17.6 min travel time. Income was found as predictor for both WTPmoney and WTPtime. Other predictors for WTPmoney were: duration and frequency of program participation, enjoyment, and (former) sport club membership. Low income and younger age were found as predictors for WTPtime. Predictors for WTPmoney are related to income and sport and physical activity experiences, for WTPtime to income and age. Short-term program satisfaction is probably more decisive for WTPmoney than long-term perspectives of improving health-related quality of life.

Evaluation design for community-based physical activity programs for socially disadvantaged groups: communities on the move.

BACKGROUND: As interventions are not yet successful in substantially improving physical activity levels of low socioeconomic status groups in the Netherlands, it is a challenge to undertake more effective interventions. Participatory community-based physical activity interventions such as Communities on the Move (CoM) seem promising. Evaluating their effectiveness, however, calls for appropriate evaluation approaches. OBJECTIVE: This paper provides the conceptual model for the development of a context-sensitive monitoring and evaluation approach in order to (1) measure the effectiveness and cost-effectiveness of CoM, and (2) develop an evaluation design enabling the identification of underlying mechanisms which explain what works and why in community-based physical activity programs. METHODS: A cohort design is proposed, based on multiple cases, measuring impact, processes, and changes at each of the distinguished levels. The methods described in this paper will evaluate both short- and long-term effects, costs, and benefits of CoM. RESULTS: Testing of the proposed model began in October 2012 and is on-going. CONCLUSIONS: The design offers a valid research strategy for evaluating the effectiveness of community-based physical activity programs. Internal validity is guaranteed by the use of several verification techniques such as triangulation. The multiple case studies at the program and community levels enhance external validity.