Understanding the mechanisms linking holistic housing renovations to health and well-being of adults in disadvantaged neighbourhoods: A realist review.

Holistic housing renovations combine physical housing improvements with social and socioeconomic interventions (e.g. referral to social services, debt counselling, involvement in decision-making, promoting social cohesion). This realist review aimed at understanding underlying mechanisms linking holistic housing renovations to health and well-being of adults in disadvantaged neighbourhoods. Following systematic and iterative searching, and relevance and quality appraisals, 18 scientific articles and reports were analysed. We identified three pathways via which physical housing improvements affect health, four pathways via which social and socioeconomic interventions affect health, and two pathways via which both reinforce each other in their health effects. Our findings are theoretically novel, relevant for those conducting holistic housing renovations, and point towards gaps in the literature.

Environmental, health, wellbeing, social and equity effects of urban green space interventions: A meta-narrative evidence synthesis.

BACKGROUND: As populations become increasingly urbanised, the preservation of urban green space (UGS) becomes paramount. UGS is not just dedicated recreational space such as public parks, but other types of informal green space are important, for example, street trees and roof gardens. Despite the potential from cross-sectional evidence, we know little about how to design new, or improve or promote existing UGS for health, wellbeing, social and environmental benefits, or known influencing factors such as physical activity. OBJECTIVES: To perform a meta-narrative review of the evidence regarding the health, wellbeing, social, environmental and equity effects, or known influencing factors of these outcomes, of UGS interventions. DATA SOURCES: Eight electronic databases were searched ((Medline, PsycINFO, Web of Science (Science and Social Science Citation Indices), PADDI (Planning Architecture Design Database Ireland), Zetoc, Scopus, Greenfiles, SIGLE (System for Information on Grey Literature in Europe)), and reference lists of included studies and relevant reviews were hand searched for further relevant studies. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Eligibility criteria included: (i) evaluation of an UGS intervention; and (ii) health, wellbeing, social or environmental outcome(s), or known influencing factors of these outcomes, measured. Interventions involving any age group were included. Interventions must have involved: (a) physical change to green space in an urban-context including improvements to existing UGS or development of new UGS, or (b) combination of physical change to UGS supplemented by a specific UGS awareness, marketing or promotion programme to encourage use of UGS. STUDY APPRAISAL AND SYNTHESIS METHODS: Following a meta-narrative approach, evidence was synthesised by main intervention approach, including: (i) park-based; (ii) greenways/trails; (iii) urban greening; (iv) large green built projects for environmental purposes. Outcomes such as economic (e.g. cost effectiveness and cost-benefit analyses), adverse effects and unintended consequences were also extracted. Evidence was synthesised following the RAMESES guidelines and publication standards, the PROGRESS-plus tool was used to explore equity impact, and risk of bias/study quality was assessed. The findings from the evidence review were presented at an expert panel representing various disciplines in a workshop and these discussions framed the findings of the review and provide recommendations that are relevant to policy, practice and research. RESULTS: Of the 6997 studies identified, 38 were included. There was strong evidence to support park-based (7/7 studies) and greenway/trail (3/3 studies) interventions employing a dual-approach (i.e. a physical change to the UGS and promotion/marketing programmes) particularly for park use and physical activity; strong evidence for the greening of vacant lots (4/4 studies) for health, wellbeing (e.g. reduction in stress) and social (e.g. reduction in crime, increased perceptions of safety) outcomes; strong evidence for the provision of urban street trees (3/4 studies) and green built interventions for storm water management (6/7 studies) for environmental outcomes (e.g. increased biodiversity, reduction in illegal dumping). Park-based or greenway/trail interventions that did not employ a dual-approach were largely ineffective (7/12 studies showed no significant intervention effect). Overall, the included studies have inherent biases owing to the largely non-randomized study designs employed. There was too little evidence to draw firm conclusions regarding the impact of UGS interventions on a range of equity indicators. LIMITATIONS; CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: UGS has an important role to play in creating a culture of health and wellbeing. Results from this study provide supportive evidence regarding the use of certain UGS interventions for health, social and environmental benefits. These findings should be interpreted in light of the heterogeneous nature of the evidence base, including diverging methods, target populations, settings and outcomes. We could draw little conclusions regarding the equity impact of UGS interventions. However, the true potential of UGS has not been realised as studies have typically under-evaluated UGS interventions by not taking account of the multifunctional nature of UGS. The findings have implications for policymakers, practitioners and researchers. For example, for policymakers the trajectory of evidence is generally towards a positive association between UGS and health, wellbeing, social and environmental outcomes, but any intervention must ensure that negative consequences of gentrification and unequal access are minimised.

Potential environmental determinants of physical activity in adults: a systematic review.

The objective of this systematic review of observational studies was to gain insight into potential determinants of various types and intensities of physical activity among adult men and women. Studies were retrieved from Medline, PsycInfo, Embase and Social scisearch. The ANGELO framework was used to classify environmental factors. In total, 47 publications were identified. Social support and having a companion for physical activity were found to be convincingly associated with different types of physical activity [(neighbourhood) walking, bicycling, vigorous physical activity/sports, active commuting, leisure-time physical activity in general, sedentary lifestyle, moderately intense physical activity and a combination of moderately intense and vigorous activity]. Availability of physical activity equipment was convincingly associated with vigorous physical activity/sports and connectivity of trails with active commuting. Other possible, but less consistent correlates of physical activity were availability, accessibility and convenience of recreational facilities. No evidence was found for differences between men and women. In conclusion, supportive evidence was found for only very few presumed environmental determinants. However, most studies used cross-sectional designs and non-validated measures of environments and/or behaviour. Therefore, no strong conclusions can be drawn and more research of better quality is clearly needed.

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

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.

Occupational level of the father and alcohol consumption during adolescence; patterns and predictors.

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.

Educational differences in leisure-time physical inactivity: a descriptive and explanatory study.

In this study we aim to explain educational differences in leisure-time physical inactivity in terms of psychosocial and material factors. Cross-sectional data were obtained from the baseline of the Dutch GLOBE study in 1991, including 2598 men and women, aged 15-74 years. Physical inactivity during leisure time was defined as not participating in any activity, such as sports, gardening, walking or cycling. Psychosocial factors included in the study were coping resources, personality, and stressors. Material factors were financial situation, employment status, and living conditions. Logistic regression models were used to calculate educational differences in physical inactivity. Physical inactivity was more prevalent in lower educational groups. Psychosocial factors related to physical inactivity were locus of control, parochialism, neuroticism, emotional social support, active problem focussing, optimistic and palliative coping styles. Material factors associated with physical inactivity were income, employment status and financial problems. All correlates of physical inactivity were unequally distributed over educational groups, except optimistic and palliative coping. Personality and coping style were the main contributors to the observed educational differences in physical inactivity. That is to say, parochialism, locus of control, neuroticism and active problem focussing explained about half of elevated odds ratios of physical inactivity in the lower educational groups. The material factors, equivalent income and employment status explained about 40% of the elevated odds ratios. Psychosocial and material correlates together reduced the odds ratios of lower educational groups by on average 75%. These results have practical consequences for the design of more effective interventions to promote physical activity. In particular, personality and coping style of risk groups, such as lower educational groups, should be taken into consideration at the future development of these interventions, as well as inequalities in material restrictions related to engaging in physical activity. Supplementary interventions focussing on childhood conditions which, partly, influence both personality and physical inactivity may also contribute to a reduction of socio-economic differences in physical inactivity.

The effect of neighbourhood income and deprivation on pregnancy outcomes in Amsterdam, The Netherlands.

BACKGROUND: Studies suggest that the neighbourhoods in which people live influence their health. The main objective of this study was to investigate the associations of neighbourhood-level income and unemployment/social security benefit on pregnancy outcomes: preterm delivery, small for gestational age (SGA), pregnancy-induced hypertension (PIH) and miscarriage/perinatal death in Amsterdam. METHODS: A random sample of 7883 from 82 neighbourhoods in Amsterdam. Individual-level data from the Amsterdam Born Children and their Development (ABCD) study were linked to data on neighbourhood-level factors. Multilevel logistic regression was used to estimate odds ratios and neighbourhood-level variance. RESULTS: After adjustment for individual-level factors, women living in low-income neighbourhoods (third, second and first quartiles) were more likely than women living in high-income neighbourhoods (fourth quartile) to have SGA births: OR 1.32 (95% CI 1.04 to 1.68), 1.42 (1.11 to 1.82) and 1.62 (1.25 to 2.08) respectively. Women living in the quartile of neighbourhoods with the highest unemployment/social security benefit were more likely than those living in the quartile with the lowest unemployment/social security benefit to have SGA births 1.36 (1.08 to 1.72). The neighbourhood-level variance was significant only for SGA births. No significant associations were found between neighbourhood-level factors and other pregnancy outcomes. CONCLUSION: The findings suggest that neighbourhood income and deprivation are related to SGA births. More research is needed to explore possible mechanisms underlying poor neighbourhood environment and pregnancy outcomes, in particular through stress mechanisms. Such information might be necessary to help improve maternal and fetal health.

Higher mortality in urban neighbourhoods in The Netherlands: who is at risk?

BACKGROUND: Urban residents have higher mortality risks than rural residents. These urban-rural differences might be more pronounced within certain demographic subpopulations. AIM: To determine urban-rural differences in all-cause and cause-specific mortality within specific demographic subpopulations of the Dutch population. METHOD: Mortality records with information on gender, age, marital status, region of origin and place of residence were available for 1995 through 2000. Neighbourhood data on address density and socioeconomic level were linked through postcode information. Variations in all-cause and cause-specific mortality between urban and rural neighbourhoods were estimated through Poisson regression. Additionally, analyses were stratified according to demographic subpopulation. RESULT: After adjustments for population composition, urban neighbourhoods have higher all-cause mortality risks than rural neighbourhoods (RR = 1.05; CI 1.04 to 1.05), but this pattern reverses after adjustment for neighbourhood socioeconomic level (RR = 0.98; CI 0.97 to 0.99). The beneficial effect of living in an urban environment applies particularly to individuals aged 10-40 years and 80 years and above, people who never married and residents from non-Western ethnic origins. The beneficial effect of urban residence for non-married people is related to their lower cancer and heart disease mortality. The beneficial effect of urban residence for people of non-Western ethnic origin is related to their lower cancer and suicide mortality. CONCLUSION: In The Netherlands, living in an urban environment is not consistently related to higher mortality risks. Young adults, elderly, single and non-Western residents, especially, benefit from living in an urban environment. The urban environment seems to offer these subgroups better opportunities for a healthy life.

Environmental attributes related to walking and bicycling at the individual and contextual level.

OBJECTIVE: The aim of the present paper was to give insight into the practical consequences of using either single-level or multilevel regression analyses on data from research on environmental determinants of physical activity. METHODS: For this purpose, results from single-level and multilevel regression analyses on comparable attributes of the environment were compared using a combination of individual and aggregated data, merged at the neighbourhood level. RESULTS: Using only individual level data, applying multilevel instead of single-level analyses did not substantially influence the results. However, ignoring the multilevel structure of our data by applying single-level in stead of multilevel analyses resulted in statistically significant associations for all the environmental attributes under study. Moreover, using information on environmental attributes at both the individual and the contextual level to adjust associations at one level for the other level showed that associated environmental attributes tend to be associated either at the individual or at the contextual level. CONCLUSIONS: These results stress the importance for reviews and meta-analyses of recording type of measurement and type of analytical strategy used and incorporating them in the review process. Using advanced multilevel designs will still only partly solve the methodological issues involved in studying environmental attributes associated with physical activity, but it will help in disentangling this complex relationship. Therefore, it is recommended that, whenever there is a presumably relevant grouping (context; eg neighbourhoods) in a study, a multilevel approach should at least be considered.

Socio-demographic variables and 6 year change in body mass index: longitudinal results from the GLOBE study.

BACKGROUND: Body mass index (BMI) differs by socio-demographic variables, but the origin of these associations remains relatively unknown. OBJECTIVE: To investigate the association between socio-demographic variables and the subsequent change in BMI over six years. DESIGN: A Dutch prospective cohort study (GLOBE) from which data were used from initially 20-49-year-old subjects (males: n=362; females: n=405). BMI was calculated from self-reported body height and weight data obtained in 1991 and 1997. Socio-demographic variables used were sex, age, educational level and the occupational level of the main breadwinner, family income, marital status, religious affiliation and degree of urbanization and measured in 1991. RESULTS: Cross-sectionally, BMI was higher in males than in females. BMI was positively associated with age and negatively associated with educational level in both sexes, after adjustment for the other socio-demographic variables. A positive association of BMI with family income was found in males and a negative association with occupational level was found in females. During follow-up, BMI increased significantly more in females (from 23.0 (s.d. 3.3) to 24. 2 (s.d. 3.8)) than in males (from 24.3 (s.d. 2.9) to 25.1 (s.d. 3. 5)). With the exception of a significant lesser increase in BMI in initially 30-39-year-old women compared to initially 40-49-year-old women, no other statistically significant associations were found between socio-demographic variables and the 6-year change in BMI. CONCLUSIONS: Cross-sectional differences in BMI by socio-demographic variables are not due to different 6-year changes in BMI for categories of these variables in adulthood. Cross-sectional differences in BMI by educational level are probably established at the end of adolescence.

Educational differences in excessive alcohol consumption: the role of psychosocial and material stressors.

BACKGROUND: Socioeconomic differences in health are determined mainly by socioeconomic differences in unhealthy behavior. Little is known, however, about the mechanisms that account for socioeconomic differences in unhealthy behavior, such as excessive alcohol consumption. In this paper we examined educational differences in excessive alcohol consumption in The Netherlands and whether these may be explained by educational differences in experienced stress and stress-moderating factors. METHODS: Data were obtained from the baseline survey of the Longitudinal Study on Socio Economic Health Differences in 1991. Excessive drinking was defined as drinking more than six glasses on 3 or more days a week or more than four glasses on 5 or more days a week. Socioeconomic status was indicated by educational level. Stressors were divided into psychosocial and material factors. Analyses were performed for women (n = 756) and men (n = 1,006) separately, among drinkers only. RESULTS: Excessive alcohol consumption was more common among lower educational groups. Material stressors, such as financial problems, deprivation, and income, were related to part of the educational gradient in excessive alcohol consumption. Differences in stress-moderating factors were not related to the educational gradient in excessive drinking. CONCLUSIONS: Our results suggest that improvement of material conditions among the lower educational groups could result in a reduction of socioeconomic differences in excessive alcohol consumption.