Socioeconomic differences in associations between living in a 20-min neighbourhood and diet, physical activity and self-rated health: Cross-sectional findings from ProjectPLAN.

The 20-min neighbourhood (20MN) concept aims to enable residents to meet daily needs using resources within a 20-min trip from home noting that there is no single definition of what services and amenities are required for daily needs nor what modes of transport constitute a 20 min trip. Whether 20MNs promote better health and whether associations differ by socio-economic status (SES) is unknown. Using cross-sectional data from adults randomly sampled in 2018-19 from Melbourne or Adelaide, Australia, we examined whether associations between neighbourhood type (20MN/non-20MN) and diet, physical activity or self-rated health vary according to individual- or area-level SES. We found no consistent patterns of interactions. The results do not consistently support the often assumed belief that 20MNs support more healthful behaviour and that these relationships vary by SES.

Acute ambulatory blood pressure response to short-term black carbon exposure: The MobiliSense sensor-based study.

Documented relationships between black carbon (BC) exposure and blood pressure (BP) have been inconsistent. Very few studies measured both BC exposure and ambulatory BP across the multiple daily environments visited in the general population, and none adjusted for personal noise exposure, a major confounder. Our study addresses these gaps by considering 245 adults living in the Grand Paris region. Personal exposure to BC was monitored for 2 days using AE51 microaethalometers. Ambulatory BP was measured every 30 min after waking up using Arteriograph 24 monitors (n = 6772). Mixed effect models with a random intercept at the individual level and time-autocorrelation structure adjusted for personal noise exposure were used to evaluate the associations between BC exposure (averaged from 5 min to 1 h before each BP measurement) and BP. To increase the robustness of findings, we eliminated confounding by unmeasured time-invariant personal variables, by modelling the associations with fixed-effect models. All models were adjusted for potential confounders and short-term time trends. Results from mixed models show that a 1-µg/m3 increase in 5-minute averaged BC exposure was associated with an increase of 0.57 mmHg in ambulatory systolic blood pressure (SBP) (95 % CI: 0.30, 0.83) and with an increase of 0.36 mmHg in diastolic blood pressure (DBP) (95 % CI: 0.14, 0.58). The slope of the exposure-response relationship gradually decreased for both SBP and DBP with the increase in the averaging period of BC exposure from 5 min to 1 h preceding each BP measurement. Findings from the fixed-effect models were consistent with these results. There was no effect modification by noise in the associations, across all exposure windows. We found evidence of a relationship between BC exposure and acute increase in ambulatory SBP and DBP after adjustment for personal noise exposure, with potential implications for the development of adverse cardiovascular outcomes.

Personal exposure to concentrations and inhalation of black carbon according to transport mode use: The MobiliSense sensor-based study.

INTRODUCTION: Epidemiological evidence suggests that motorized vehicle users have a higher air pollutant exposure (especially from vehicle exhaust) than active (walking or cycling) transport users. However, studies often relied on insufficiently diverse sample and ignored that minute ventilation has an effect on individuals' inhaled dose. This study examined commuters' breathing zone concentration and inhaled doses of black carbon (BC) when travelling by different transport modes in the Grand Paris region. METHODS: Personal exposure to BC was continuously measured with MicroAethalometer (MicroAeth AE51) portable monitors strapped on participants' shoulder with tube inlet at the level of the neck (breathing zone), and inhaled doses were derived from several methods estimating ventilation [based on metabolic equivalents from accelerometry [METs], heart rate, and breathing rate]. Trip stages and transport modes were assessed from GPS and mobility survey data. Breathing zone concentrations and inhaled doses of BC were compared across transport modes at the trip stage level (n = 7495 for 283 participants) using linear mixed effect models with a random intercept at individual level. RESULTS: Trip stages involving public transport and private motorized transport were associated with a 2.20 µg/m3 (95% CI: 1.99, 2.41) and 2.29 µg/m3 (95% CI: 2.10, 2.48) higher breathing zone concentration to BC than walking, respectively. Trip stages with other active modes had a 0.41 µg (95% CI: 0.25, 0.57) higher inhaled dose, while those involving public transport and private motorized transport had a 0.25 µg (95% CI: -0.35, -0.15) and 0.19 µg (95 %CI: -0.28, -0.10) lower inhaled dose of BC per 30 min than walking. CONCLUSION: The ranking of transport modes in terms of personal exposure was markedly different when breathing zone concentrations and inhaled doses were considered. Future studies should take both into account to explore the relationship of air pollutants in transport microenvironments with physiological response.

Combining sensor tracking with a GPS-based mobility survey to better measure physical activity in trips: public transport generates walking.

BACKGROUND: Policymakers need accurate data to develop efficient interventions to promote transport physical activity. Given the imprecise assessment of physical activity in trips, our aim was to illustrate novel advances in the measurement of walking in trips, including in trips incorporating non-walking modes. METHODS: We used data of 285 participants (RECORD MultiSensor Study, 2013-2015, Paris region) who carried GPS receivers and accelerometers over 7 days and underwent a phone-administered web mobility survey on the basis of algorithm-processed GPS data. With this mobility survey, we decomposed trips into unimodal trip stages with their start/end times, validated information on travel modes, and manually complemented and cleaned GPS tracks. This strategy enabled to quantify walking in trips with different modes with two alternative metrics: distance walked and accelerometry-derived number of steps taken. RESULTS: Compared with GPS-based mobility survey data, algorithm-only processed GPS data indicated that the median distance covered by participants per day was 25.3 km (rather than 23.4 km); correctly identified transport time vs. time at visited places in 72.7% of time; and correctly identified the transport mode in 67% of time (and only in 55% of time for public transport). The 285 participants provided data for 8983 trips (21,163 segments of observation). Participants spent a median of 7.0% of their total time in trips. The median distance walked per trip was 0.40 km for entirely walked trips and 0.85 km for public transport trips (the median number of accelerometer steps were 425 and 1352 in the corresponding trips). Overall, 33.8% of the total distance walked in trips and 37.3% of the accelerometer steps in trips were accumulated during public transport trips. Residents of the far suburbs cumulated a 1.7 times lower distance walked per day and a 1.6 times lower number of steps during trips per 8 h of wear time than residents of the Paris core city. CONCLUSIONS: Our approach complementing GPS and accelerometer tracking with a GPS-based mobility survey substantially improved transport mode detection. Our findings suggest that promoting public transport use should be one of the cornerstones of policies to promote physical activity.

An evaluation of transport mode shift policies on transport-related physical activity through simulations based on random forests.

BACKGROUND: Physical inactivity is widely recognized as one of the leading causes of mortality, and transport accounts for a large part of people's daily physical activity. This study develops a simulation approach to evaluate the impact of the Ile-de-France Urban Mobility Plan (2010-2020) on physical activity, under the hypothesis that the intended transport mode shifts are realized. METHODS: Based on the Global Transport Survey (2010, n = 21,332) and on the RECORD GPS Study (2012-2013, n = 229) from the French capital region of Paris (Ile-de-France), a simulation method was designed and tested. The simulation method used accelerometer data and random forest models to predict the impact of the transport mode shifts anticipated in the Mobility Plan on transport-related moderate-to-vigorous physical activity (T-MVPA). The transport mode shifts include less private motorized trips in favor of more public transport, walking, and biking trips. RESULTS: The simulation model indicated a mean predicted increase of 2 min per day of T-MVPA, in case the intended transport mode shifts in the Ile-de-France Urban Mobility Plan were realized. The positive effect of the transport mode shifts on T-MVPA would, however, be larger for people with a higher level of education. This heterogeneity in the positive effect would further increase the existing inequality in transport-related physical activity by educational level. CONCLUSIONS: The method presented in this paper showed a significant increase in transport-related physical activity in case the intended mode shifts in the Ile-de-France Urban Mobility Plan were realized. This simulation method could be applied on other important health outcomes, such as exposure to noise or air pollution, making it a useful tool to anticipate the health impact of transport interventions or policies.

Estimating the Impact of Health-related Behaviors on Geographic Variation in Cardiovascular Mortality: A New Approach Based on the Synthesis of Ecological and Individual-level Data.

BACKGROUND: Incidence of and mortality from cardiovascular disease (CVD) exhibit a strong geographical pattern, with inhabitants of more affluent neighborhoods showing a substantially lower risk of CVD mortality than inhabitants of deprived neighborhoods. Thus far, there is insufficient evidence as to what extent these differences can be attributed to differences in health-related behaviors. METHODS: Using a Hierarchical Related Regression approach, we combined individual and aggregate (ecological) data to investigate the extent to which small-area variation in CVD mortality in Dutch neighborhoods can be explained by several behavioral risk factors (i.e., smoking, drinking, overweight, and physical inactivity). The proposed approach combines the benefits of both an ecological analysis (in terms of data availability and statistical power) and an individual-level analysis (in terms of identification of the parameters and interpretation of the results). RESULTS: After correcting for differences in age and sex, accounting for differences in the behavioral risk factors reduces income-related inequalities in CVD mortality by approximately 30%. CONCLUSIONS: Direct targeting of the excess prevalence of unhealthy behaviors in deprived neighborhoods is identified as a relevant strategy to reduce inequalities in CVD mortality. Our results also show that the proposed Hierarchical Related Regression approach provides a powerful method for the investigation of small-area variation in health outcomes.

Active transportation and public transportation use to achieve physical activity recommendations? A combined GPS, accelerometer, and mobility survey study.

BACKGROUND: Accurate information is lacking on the extent of transportation as a source of physical activity, on the physical activity gains from public transportation use, and on the extent to which population shifts in the use of transportation modes could increase the percentage of people reaching official physical activity recommendations. METHODS: In 2012-2013, 234 participants of the RECORD GPS Study (French Paris region, median age = 58) wore a portable GPS receiver and an accelerometer for 7 consecutive days and completed a 7-day GPS-based mobility survey (participation rate = 57.1%). Information on transportation modes and accelerometry data aggregated at the trip level [number of steps taken, energy expended, moderate to vigorous physical activity (MVPA), and sedentary time] were available for 7,644 trips. Associations between transportation modes and accelerometer-derived physical activity were estimated at the trip level with multilevel linear models. RESULTS: Participants spent a median of 1 h 58 min per day in transportation (8.2% of total time). Thirty-eight per-cent of steps taken, 31% of energy expended, and 33% of MVPA over 7 days were attributable to transportation. Walking and biking trips but also public transportation trips with all four transit modes examined were associated with greater steps, MVPA, and energy expenditure when compared to trips by personal motorized vehicle. Two simulated scenarios, implying a shift of approximately 14% and 33% of all motorized trips to public transportation or walking, were associated with a predicted 6 point and 13 point increase in the percentage of participants achieving the current physical activity recommendation. CONCLUSIONS: Collecting data with GPS receivers, accelerometers, and a GPS-based electronic mobility survey of activities and transportation modes allowed us to investigate relationships between transportation modes and physical activity at the trip level. Our findings suggest that an increase in active transportation participation and public transportation use may have substantial impacts on the percentage of people achieving physical activity recommendations.

Multi-level influence of school norms on tobacco use in South Africa: an ecometric consideration of group differences.

OBJECTIVES: Tobacco use has been found to be related to contextual-environmental characteristics. This study focuses on the influence of contextual norms on adolescent smoking behavior with consideration of racial differences. METHODS: Data for this study were derived from the South African Community Epidemiology Network on Drug Use survey. Students (n = 1,277) completed a self-administered questionnaire (available in Afrikaans, Xhosa, and English). School-level aggregate measures were developed from the items: whether they thought smoking was wrong, whether they thought they would be seen as "cool" if they smoked, how many of their closest friends smoked, and whether they had repeated a grade level in school. RESULTS: The results of this analysis revealed that after controlling for demographic characteristics, aggregate measures of importance for ever smoking were whether there were school norms of perceiving that smoking was not wrong, perceiving that smoking was cool, and high prevalence of having friends who smoke. Recent smoking was only predicted by attendance at schools with increased levels of academic failure. Black South Africans were less likely to ever smoke than Coloured or White. CONCLUSIONS: This study highlights the saliency of both compositional (academic failure) and ecological (collective perceptions about smoking) characteristics in predicting ever and recent smoking. Collective perceptions of smoking in a predominantly Black school were largely negative. These findings can be used to target school norms regarding tobacco use in Cape Town.

Why socially deprived populations have a faster resting heart rate: impact of behaviour, life course anthropometry, and biology--the RECORD Cohort Study.

Although studies have shown that resting heart rate (RHR) is predictive of cardiovascular morbidity/mortality, few studies focused on the epidemiology and social aetiology of RHR. Using the RECORD Cohort Study (7158 participants, 2007-2008, Paris region, France), we investigated individual/neighbourhood socioeconomic variables associated with resting heart rate, and assessed which of a number of psychological factors (depression and stress), behaviour (sport-related energy expenditure, medication use, and alcohol, coffee, and tobacco consumption), life course anthropometric factors (body mass index, waist circumference, and leg length as a marker of childhood environmental exposures), and biologic factors (alkaline phosphatase and gamma-glutamyltransferase) contributed to the socioeconomic disadvantage-RHR relationship. Combining individual/neighbourhood socioeconomic factors in a socioeconomic score, RHR increased with socioeconomic disadvantage: +0.9 [95% credible interval (CrI): +0.2, +1.6], +1.8 (95% CrI: +1.0, +2.5), and +3.6 (95% CrI: +2.9, +4.4) bpm for the 3 categories reflecting increasing disadvantage, compared with the lowest disadvantage category. Twenty-one percent of the socioeconomic disadvantage-RHR relationship was explained by sport practise variables, 9% by waist circumference, 7% by gamma-glutamyltransferase, 5% by alkaline phosphatase, and 3% by leg length. Future research should further clarify the mechanisms through which socioeconomic disadvantage influences resting heart rate, as a pathway to social disparities in cardiovascular morbidity/mortality.

Associations between dietary patterns, physical activity (leisure-time and occupational) and television viewing in middle-aged French adults.

Diet and physical activity are considered to be major components of a healthy lifestyle. However, few studies have examined in detail the relationships between specific types of physical activity, sedentary behaviour and diet in adults. The objective of the present study was to assess differential relationships between dietary patterns, leisure-time and occupational physical activities and time spent watching television (TV), as an indicator of sedentary behaviour, in middle-aged French subjects. We performed a cross-sectional analysis using data from 1359 participants in the SUpplémentation en VItamines et Minéraux AntioXydants study, who completed a detailed physical activity questionnaire and at least six 24 h dietary records. Sex-specific dietary patterns were derived using factor analysis; their relationships with leisure-time and occupational physical activities and TV viewing were assessed using ANCOVA, after adjustment for age, educational level and smoking status. Three dietary patterns were identified in each sex. After adjustment for potential confounders, leisure-time physical activity was positively associated with a 'healthy' food pattern in both men (P for trend < 0·01) and women (P for trend < 0·03) and negatively associated with an 'alcohol/meat' pattern in men (P for trend < 0·01). TV viewing was positively associated with a 'convenience' pattern in men and with a 'alcohol-appetiser' pattern in women. In conclusion, identification of relationships between dietary patterns, physical activity and sedentary behaviour can enable identification of different types of lifestyle and should help to target at-risk groups in nutrition prevention programmes.

Investigating the spatial variability in incidence of coronary heart disease in the Gazel cohort: the impact of area socioeconomic position and mediating role of risk factors.

STUDY OBJECTIVE: The aim of the study was to improve understanding of the relationships between contextual socioeconomic characteristics and coronary heart disease (CHD) incidence in France. Several authors have suggested that CHD risk factors (diabetes, hypertension, cholesterol, overweight, tobacco consumption) may partly mediate associations between socioeconomic environmental variables and CHD. Studies have assessed the overall mediating role of CHD risk factors, but have never investigated the specific mediating role of each risk factor, not allowing their specific contribution to the area socioeconomic position-CHD association to be disentangled. DESIGN: After assessing geographical variations in CHD incidence and socioeconomic environmental effects on CHD using a multilevel Cox model, the extent to which this contextual effect was mediated by each of the CHD risk factors was assessed. PARTICIPANTS: Data of the French GAZEL cohort (n=19,808) were used. MAIN RESULTS: After adjustment for several individual socioeconomic indicators, it was found, in men from highly urbanised environments, that CHD incidence increased with decreasing socioeconomic position of the residential environment. After individual-level adjustment, a higher risk of obesity, smoking and cholesterol was observed in the most deprived residential environments. When risk factors were introduced into the model, a modest decrease was observed in the magnitude of the association between the socioeconomic contextual variable and CHD. Risk factors that contributed most to the decrease of the association were smoking and cholesterol. CONCLUSIONS: Classic risk factors, although some of them more than others, mediated a modest part of the association between area socioeconomic position and CHD.

Individual/neighborhood social factors and blood pressure in the RECORD Cohort Study: which risk factors explain the associations?

Recent studies have started to suggest that, beyond effects of individual socioeconomic profiles, socioeconomic characteristics of residential neighborhoods are independently associated with blood pressure. However, mechanisms involved in these associations remain unknown. To distinguish between different mechanisms, we investigated whether specific risk factors of hypertension (physical inactivity, alcohol consumption, smoking, body mass index, waist circumference, and resting heart rate) intervene as mediators in the associations between individual or neighborhood socioeconomic characteristics and systolic blood pressure. We relied on data from the RECORD Cohort Study (Residential Environment and CORonary heart Disease) on 5941 participants recruited in 2007-2008, aged 30 to 79 years, residing in 1824 neighborhoods in the Paris metropolitan area. Systolic blood pressure increased independently and regularly with both decreasing individual education and decreasing residential neighborhood education. Body mass index/waist circumference and resting heart rate mediated an appreciable share of the associations between education and blood pressure and, adding validity to the finding, were the 2 most significant mediators for the effects of both individual education and neighborhood education. We found that 52% (95% CI: 25% to 79%) of the association between neighborhood education and blood pressure was mediated by body mass index/waist circumference and 20% (95% CI: 5% to 36%) by resting heart rate. Future research will have to clarify the exact mechanisms through which body weight and shape and resting heart rate intervene as mediators in the associations between individual/neighborhood education and blood pressure.

Gender differences in daily smoking prevalence in different age strata: a population-based study in southern Sweden.

OBJECTIVES: To investigate gender differences in daily smoking prevalence in different age groups in southern Sweden. METHODS: The 2004 public-health survey in Skane is a cross-sectional study. A total of 27,757 persons aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the associations between gender and daily smoking according to age. The multivariate analysis was performed to investigate the importance of possible confounders (country of origin, education, snus use, alcohol consumption, leisure-time physical activity, and BMI) on the gender differences in daily smoking in different age groups. RESULTS: 14.9% of the men and 18.1% of the women were daily smokers. Middle-aged respondents were daily smokers to a significantly higher extent than young and old respondents. The prevalence of daily smoking also varied according to other demographic, socioeconomic, health related behaviour, and BMI characteristics. The crude odds ratios of daily smoking were 1.79 (1.42-2.26) among women compared to men in the 18-24 years age group, and 0.95 (0.80-1.12) in the 65-80 years age group. These odds ratios changed to 2.00 (1.49-2.67) and 0.95 (0.76-1.18), respectively, when all confounders were included. CONCLUSIONS: For the first time in Sweden women have a higher prevalence of daily smoking than men. The odds ratios of daily smoking are highest among women compared to men in the youngest age group of 18-24 years and the odds ratios decrease with increasing age. The findings point to a serious public health problem. Strategic interventions targeting young women's tobacco smoking are needed.

Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden.

BACKGROUND: To more efficiently reduce social inequalities in mortality, it is important to establish which causes of death contribute the most to socioeconomic mortality differentials. Few studies have investigated which diseases contribute to existing socioeconomic mortality differences in specific age groups and none were in samples of the whole population, where selection bias is minimized. The aim of the present study was to determine which causes of death contribute the most to social inequalities in mortality in each age group in the whole population of Scania, Sweden. METHODS: Data from LOMAS (Longitudinal Multilevel Analysis in Skåne) were used to estimate 12-year follow-up mortality rates across levels of socioeconomic position (SEP) and workforce participation in 975,938 men and women aged 0 to 80 years, during 1991-2002. RESULTS: The results generally showed increasing absolute mortality differences between those holding manual and non-manual occupations with increasing age, while there were inverted u-shaped associations when using relative inequality measures. Cardiovascular diseases (CVD) contributed to 52% of the male socioeconomic difference in overall mortality, cancer to 18%, external causes to 4% and psychiatric disorders to 3%. The corresponding contributions in women were 55%, 21%, 2% and 3%. Additionally, those outside the workforce (i.e., students, housewives, disability pensioners, and the unemployed) showed a strongly increased risk of future mortality in all age groups compared to those inside the workforce. Even though coronary heart disease (CHD) played a major contributing role to the mortality differences seen, stroke and other types of cardiovascular diseases also made substantial contributions. Furthermore, while the most common types of cancers made substantial contributions to the socioeconomic mortality differences, in some age groups more than half of the differences in cancer mortality could be attributed to rarer cancers. CONCLUSION: CHD made a major contribution to the socioeconomic differences in overall mortality. However, there were also important contributions from diseases with less well understood mechanistic links with SEP such as stroke and less-common cancers. Thus, an increased understanding of the mechanisms connecting SEP with more rare causes of disease might be important to be able to more successfully intervene on socioeconomic differences in health.

Disentangling contextual effects on cause-specific mortality in a longitudinal 23-year follow-up study: impact of population density or socioeconomic environment?

BACKGROUND: Various studies have investigated urban/rural differences in cause-specific mortality. A separate body of literature has analysed effects of socioeconomic environment on mortality. Almost no studies have attempted to disentangle effects of population density and socioeconomic environment on mortality, beyond the effects of individual characteristics. METHODS: Considering all individuals living in the region of Scania, Sweden, from 1970-93, we performed 10 year mortality follow-ups on (i) individuals aged 55, (ii) individuals aged 65, and (iii) individuals aged 75 years at baseline. Cox multilevel models adjusted for individual factors allowed us to investigate the independent effects of population density and median income in the parish of residence on mortality from ischaemic heart disease (IHD), lung cancer, and chronic obstructive pulmonary disease (COPD) among individuals who had lived in the same parish for at least 10 years prior to mortality follow-up. RESULTS: In females, as in males, after adjustment for individual and contextual socioeconomic status, we found a dose-response association between population density and mortality from lung cancer and COPD in all age groups investigated, and from IHD especially in the youngest age group. Overall, the population density effect was the strongest on lung cancer mortality. Median income had an additional impact only in 2 out of 16 subgroups of age x gender x cause of death. CONCLUSIONS: In our region-wide study conducted at the parish level, contextual disparities in mortality were dominated by the population density effect. However, it may be unwise to conclude that truly contextual effects exist on mortality, before identification of plausible mediating processes through which urbanicity may influence mortality risk.

A multilevel analysis of tobacco use and tobacco consumption levels in France: are there any combination risk groups?

BACKGROUND: Both the predictors for tobacco use and the determinants of the amounts of tobacco consumed by smokers should be taken into account when designing prevention programmes. METHODS: Using a sample of 12,948 individuals representative of the French population in 1999, multilevel models were used to carry out a comparative investigation for the predictors of tobacco use and the determinants of the amount of tobacco consumed by smokers. RESULTS: At the individual level, a combination of risks (higher risk of smoking and larger amounts of tobacco consumed by smokers) was found for males, for individuals with a low level of education and for divorcees. At the level of the area of residence, both the risk of smoking (odds ratio 1.07, 95% confidence interval: 1.01-1.12 for an increase by one standard deviation) and the amount of tobacco consumed among smokers (percentage variation +4%, 95% confidence interval: 0% - +8%) increased with the gross domestic product per capita. CONCLUSION: This study justifies the combined use, in such analyses, of consumption levels for smokers in addition to the risk of smoking, in order to identify the profiles with the highest risk. It was possible to identify various groups with both a high risk of tobacco use and a high level of consumption among smokers, on the basis of individual (male, divorced or less educated) and environmental (living in a high GDP area) factors. The prevention efforts should thus be focused on such groups.

Tobacco and alcohol consumption, sedentary lifestyle and overweightness in France: a multilevel analysis of individual and area-level determinants.

Using a representative sample of the French population, a multilevel analysis allowed us to examine the effect of the level of consumerism, expressed as the gross domestic product (GDP) per capita in the broad area of residence, on the risks of smoking, drinking, sedentary behaviour and overweightness. After adjustment for potential confounders, we found no GDP effect on the odds of being a moderate smoker. Conversely, the risk of being a highly dependent smoker as opposed to a moderate consumer or an abstainer increased with the area-level GDP per capita (OR: 1.13; 95% CI: 1.04-1.23 for an increment of one standard deviation). A similar pattern was found for alcohol consumption: the odds of being a moderate consumer were not related to the GDP per capita, but a positive effect of the GDP on the odds of being an alcohol-dependent drinker as opposed to a moderate consumer or an abstainer was found among women (OR: 1.14; 95% CI: 1.02-1.28). The gap between the sexes with respect to alcohol-dependency therefore appeared to be narrower when the GDP per capita was high. On the other hand, the risk of overweightness was found to increase with the area-level GDP per capita among blue-collar workers only (OR: 1.21; 95% CI: 1.03-1.43). Beyond the well-documented socioeconomic effects operating at both the individual and the local neighbourhood levels, our study suggests that broader areas of residence, through their level of economic development, may also have an independent impact on health-related behaviour.