Explaining socioeconomic status differences in health behaviors.

Today Carlijn Kamphuis defended her thesis entitled ‘Explaining socioeconomic inequalities in health behaviors: The role of environmental factors’.
Inequalities in health according to income, level of education or other socio-economic status indicators have and are being observed across the world. Poorer and less educated people live shorter lives and have higher risk for a range of diseases and health threats. This is also true in a rather egalitarian country like the Netherlands.
One of the reasons why people from lower socioeconomic status groups are less healthy is the fact that these people on average live less healthy lives. Smoking prevalence, lack of physical activity and un-healthful dietary habits are more prevalent. The next question , of course, is to try to find out why that is the case. This is what Carlijn Kamphuis set out to explore in her doctoral thesis research: why do we find socioeconomic differences in physical activity and dietary habits? Her hypothesis was that contextual, or environmental factors, rather than personal factors are the main determinants. More explicitly, she especially explored whether neighbourhood physical environmental factors were important, i.e. the availability and accessibility of opportunities to be physically active and eat a healthful diet.
The thesis contains a series of papers that have been published in different international scientific journals, including two systematic reviews, qualitative research and quantitative analyses of data from the Globe study.
The results indicate that neighbourhood factors do explain only a small proportion of socioeconomic inequalities in health behaviors. It appears that individual cognitions such as attitudes and intentions, and social environmental factors, such as social modelling and support are more important.

For further reading:

• http://www.ncbi.nlm.nih.gov/pubmed/18791047?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum


• http://www.ncbi.nlm.nih.gov/pubmed/18182936?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum


• http://www.ncbi.nlm.nih.gov/pubmed/17010219?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum


• http://www.ncbi.nlm.nih.gov/pubmed/17381942?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum


• http://www.ncbi.nlm.nih.gov/pubmed/16815073?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
  

Dietary guidelines and the obesity epidemic

In a recent issue of the American Journal of Preventive Medicine (2008;34:234-240; http://www.ncbi.nlm.nih.gov/pubmed/18312812?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum) Paul Marantz, Elisabeth Bird and Michael Alderman from the Department of Epidemiology and Population Health of the Einstein College of Medicine, New York, published a paper in which they call for higher standards for dietary guidelines. Their paper argues that dietary guidelines are often based on indirect and sometimes weak evidence, that resulting guidelines may cause harm instead of health benefits, and that dietary guidelines may better be avoided if not based on adequate evidence. They use the fat reduction guideline as an example. In the 1980s and 90s dietary recommendations in most countries included recommendations to reduce dietary fat intake to less than 30 or 35 percent of total energy intake. The authors argue that this recommendation was not based on firm evidence (i.e. total fat is not an issue, type of fat is more important) and that the recommendation has issued changes in peoples diets and in food production and innovation towards less fat, but also towards more sugar and other carbohydrates, leading to higher calorie intakes, and thus possibly contributing to the obesity epidemic. A comment on their paper by Steven Woolf and Marion Nestle was published in the same issue (http://www.ncbi.nlm.nih.gov/pubmed/18312816?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus).

Local produce and the 100 mile diet

'Normal' farming, with the use of loads of fertilizer, long transport distances from farms to food industry to retail to consumers causes lots of wasted energy and leaves a huge carbon foodprint. I reported here earlier on the 100 mile diet, initiated by Alisa Smith and J.B. MacKinnon, i.e. "local eating for global change" (http://100milediet.org/). The 100 mile diet may be much easier for more people when 'skycraper framing' is applied: vertical farming right in the middle of urban areas.

Vertical framing is a possible means to grow grains, fruits and vegetables and fruits, raise poultry and pork, use their waste as fertilizer, and use city waste water for irrigation. A vertical farm could potentially reduce the fossil-fuel use and emissions associated with farming. Year round growth and harvesting could be possible, and consumers could get real fresh, organic produce near their city homes.

Vertical or skycraper farming (http://www.sciam.com/article.cfm?id=growing-vertical-skyscraper-farming or http://en.wikipedia.org/wiki/Vertical_farming), i.e. a multi-storey building with integrated crop and animal farming, is one of the ideas for Earth 3.0 (http://www.sciam.com/article.cfm?id=introducing-earth-3-point-0), as described in the September 2008 issue of Scientific American. In these Earth 3.0 terms, Earth 1.0 was the earth that existed for billions of years untill well into the 18th century. Earth 2.0 came into existence with the industrial revolution leading to enourmous tehnological achievements and health benefits resulting in longlevity and prosperity for at least the richer part of the world.

Earth 3.0 should combine the prosperity of Earth 2.0 for all with the sustainability of Earth 1.0. With a large majority of the world population living in cities within the next few decades, vertical farming may contribute to a more sustainable and healthy food producion chain.

The technology for vertical farming does exist and the idea has received quite a bit of media attention lately (see http://www.verticalfarm.com/Default.aspx).

Literature and medicine

Last Thursday I attended a symposium on 'addiction'. This symposium in the literature and medicine series focussed on the role of addiction in literature, in poetry, fiction, song lirics et cetera (see http://www.vu.nl/nl/nieuws-agenda/nieuws/2008/jul-sep/expositie-aan-de-ketting-verslaving-en-afkicken.asp). With bright, funny, insightful and sharp contributions of Armand Girbes ( http://armandgirbes.com/), Aafke de Groot, Jelly Brouwers, Arko Oderwald, Stefan Brijs and a musical intermezzo of Rick de Leeuw and Jan Hautekiet, it was a great afternoon. The symposium also introduced the book "Aan de Ketting" ('Chained') on addiction in literature edited by Arko Oderwald, Koos Neuvel and Willem van Tilburg.

Some citations: 'The desire for a cigarette is the desire itself" (Rutger Kopland), and "Addiction is a sanctuary without a roof" (Jelly Brouwers)

A PhD thesis that sheds more light on computer-tailored nutrition education

Last Thursday, Dr. Willemieke Kroeze defended her thesis “Insights in the efficacy of computer-tailored nutrition education” at a public ceremony in Rotterdam, the Netherlands. The studies for her thesis indicate that computer-tailored nutrition education is more effective than generic nutrition education, as long as it incorporates personal, normative and behaviour change feedback. No differences in effectiveness were found between print-delivered and web-based computer-tailored nutrition education, but the print-delivered version was somewhat better appreciated. These effects were, however, based on self-report fat intake measures, and could not be confirmed based on objective measures, i.e. blood lipids.

The studies for this thesis have been published in international scientific journals:
http://www.ncbi.nlm.nih.gov/pubmed/18565463?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/18487136?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/18063650?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/16700634?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/18471932?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

EMGO seminar: visiting professor David Crawford

On September 1, professor David Crawford from the Center of Physical Activity and Nutrition Research (http://www.deakin.edu.au/hmnbs/cpan/) gave a research seminar on environmental drivers of the obesity epidemic. His excellent presentation covered the obesity and overweight prevalence down under among children, adolescents and adults, and the potential physical and social environmental determinants of obesogenic behaviors and unnecessary weight gain. His presentation made clear that the available evidence for environmental drivers of obesogenic behaviors is not that strong. His presentation ended with 4 categories of clear recommendations to bring this research field further. One of his issues was that we may be focussing too much on environmental determinants of obesity while forgetting about more personal factors of importance, and that we need to do more in investigating mediation and interaction between personal and environmental factors as potential determinants of obesogenic behaviors and weight gain.
Dr. Frank van Lenthe from the department of Public Health at Erasmus University Medical Center in Rotterdam (http://www.erasmusmc.nl/MAGE/), the Netherlands provided a first reaction to David Crawford’s presentation. He claimed that we need to focus even more on environmental factors, because good quality research in this field is still lacking.

The VUmc Department of Epidemiology and Biostatistics

On September 1, the new department of Epidemiology & Biostatistics of the VU University Medical Centre will be officially launched. Last week the personnel of the department held an introductory meeting in which the organisation and leadership of the department was presented. This new department is the result of a merger between the departments of Extramural Medicine, with its strong focus on epidemiology in the extramural setting, and the department of Clinical Epidemiology and Biostatistics, with its strong focus on supporting research of the VUmc in clinical settings. With the new department, most expertise on research methodology and statistics within the VUmc is now concentrated within one department. The mission of the new department of E&B is to initiate, conduct and support excellent research in support of the five research themes of the VU University Medical Center (http://www.english.vumc.nl/research/). The department of E&B has three sections: extramural epidemiology, clinical epidemiology and biostatistics, and four main tasks: research, education, methodology development, and methodological and biostatistical support. The logo and the organisation of the new department is presented in the attached pictures.