Carola T M Schrijvers

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (30)127.63 Total impact

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    ABSTRACT: Background The aims of this study are 1) to investigate the association between maternal educational level and healthy eating behaviour of 11-year-old children (fruit, vegetables and breakfast consumption), and 2) to examine whether factors in the home food environment (parental intake of fruit, vegetables and breakfast; rules about fruit and vegetables and home availability of fruit and vegetables) mediate these associations.Methods Data were obtained from the Dutch INPACT study. In total, 1318 parent¿child dyads were included in this study. Multilevel regression models were used to investigate whether factors of the home food environment mediated the association between maternal educational level and children¿s healthy eating behaviour.ResultsChildren of mothers with a high educational level consumed more pieces of fruit per day (B¿=¿0.13, 95% CI: 0.04-0.22), more grams of vegetables per day (B¿=¿23.81, 95% CI¿=¿14.93-32.69) and were more likely to have breakfast on a daily basis (OR¿=¿2.97, 95% CI: 1.38-6.39) than children of mothers with a low educational level. Home availability, food consumption rules and parental consumption mediated the association between maternal education level and children¿s fruit and vegetable consumption. Parental breakfast consumption mediated the association between maternal education level and children¿s breakfast consumption.Conclusions Factors in the home food environment play an important role in the explanation of socio-economic disparities in children¿s healthy eating behaviour and may be promising targets for interventions.
    International Journal of Behavioral Nutrition and Physical Activity 09/2014; 11(1):113. · 3.58 Impact Factor
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    ABSTRACT: In the present study, we examined the association between maternal education and unhealthy eating behaviour (the consumption of snack and sugar-sweetened beverages (SSB)) and explored environmental factors that might mediate this association in 11-year-old children. These environmental factors include home availability of snacks and SSB, parental rules about snack and SSB consumption, parental intake of snacks and SSB, peer sensitivity and children's snack-purchasing behaviour. Data were obtained from the fourth wave of the INPACT (IVO Nutrition and Physical Activity Child cohorT) study (2011), in which 1318 parent-child dyads completed a questionnaire. Data were analysed using multivariate regression models. Children of mothers with an intermediate educational level were found to consume more snacks than those of mothers with a high educational level (B= 1·22, P= 0·02). This association was not mediated by environmental factors. Children of mothers with a low educational level were found to consume more SSB than those of mothers with a high educational level (B= 0·63, P< 0·01). The association between maternal educational level and children's SSB consumption was found to be mediated by parental intake of snacks and SSB and home availability of SSB. The home environment seems to be a promising setting for interventions on reducing socio-economic inequalities in children's SSB consumption.
    The British journal of nutrition 05/2014; · 3.45 Impact Factor
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    ABSTRACT: There is a higher prevalence of intellectual disability (ID) among homeless people than in the general population. However, little is known about the additional psychosocial problems faced by homeless people with ID. We describe the prevalence of ID in a cohort of homeless people in the Netherlands, and report relationships between ID and psychosocial problems in terms of psychological distress, substance (mis)use and dependence, as well as demographic characteristics in this cohort. This cross-sectional study is part of a cohort study among homeless people in the four major cities of the Netherlands. Data were derived from 387 homeless people who were interviewed and screened for ID six months after the baseline measurement. Multivariate logistic regression analyses and χ(2) tests were performed to analyze relationships between ID, psychosocial problems and demographic characteristics. Of all cohort members, 29.5% had a suspected ID. Participants with a suspected ID had a higher mean age, were more likely to be male and to fall in the lowest category of education than participants without a suspected ID. Having a suspected ID was related to general psychological distress (OR = 1.56, p<0.05), somatization (OR = 1.84, p<0.01), depression (OR = 1.58, p<0.05) and substance dependence (OR = 1.88, p<0.05). No relationships were found between a suspected ID and anxiety, regular substance use, substance misuse and primary substance of use. The prevalence of ID among Dutch homeless people is higher than in the general population, and is related to more psychosocial problems than among homeless people without ID. Homeless people with a suspected ID appear to be a vulnerable subgroup within the homeless population. This endorses the importance of the extra attention required for this subgroup.
    PLoS ONE 01/2014; 9(1):e86112. · 3.53 Impact Factor
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    ABSTRACT: Childhood overweight is a public health problem associated with psychosocial and physical problems. Personality traits, such as impulsivity, may contribute to the development of overweight. This study examines 1) the association between general impulsivity traits (reward sensitivity and disinhibition) and children's weight, 2) the association between impulsivity traits and unhealthy snack consumption, and 3) the potential mediating role of unhealthy snack consumption in the relationship between impulsivity traits and children's weight. Included were 1,377 parent-child dyads participating in the IVO Nutrition and Physical Activity Child cohorT (INPACT). Children had a mean age of 10 years. Parents completed a questionnaire to measure children's unhealthy snack consumption. Children completed a door-opening task to assess reward sensitivity and completed a questionnaire to measure disinhibition. Children's height and weight were measured to calculate their BMI z-scores. Cross-sectional linear regression analyses were performed to test the associations. Disinhibition was positively associated with unhealthy snack consumption but not with BMI z-scores. Reward sensitivity was not related to unhealthy snack consumption or to BMI z-scores. No evidence was found for a mediating effect of unhealthy snack consumption in the relation between impulsivity traits and children's weight. However, disinhibition appears to have a negative influence on children's unhealthy snack consumption. Future research focusing on food-related impulsivity in addition to general impulsivity will provide additional insight into factors that influence children's unhealthy snack consumption and weight.
    PLoS ONE 01/2014; 9(2):e88851. · 3.53 Impact Factor
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    ABSTRACT: This article describes the association of external and psychosocial factors with the stages of change for moderate-intensity physical activity among individuals with generally low socioeconomic positions. A self-administered questionnaire among individuals aged 18-65 years (response rate 60%, n = 2781) in deprived neighborhoods in Eindhoven, The Netherlands, was conducted in September 2000. To identify factors associated with stages of change an ordinal logistic regression model, the "Threshold of Change model (TCM)", was used to analyze the data. Thirty-six percent of the respondents were in the pre-action stages, 15% was in action and 49% in maintenance. Individuals who were, older, lower educated, had low health locus of control, had less knowledge of physical activity issues, and presented other risky health behaviors, were more likely to be in a lower stage of change category. A positive attitude, high self-efficacy expectations, perceiving the physical activity level of others as high, and much social support were associated with the higher stages of change categories. The distribution across the stages of change supports the need to improve physical activity behavior in these deprived neighborhoods. Interventions need to be tailored to the psychosocial, and the external factors that are likely to play a role in the behavioral change process.
    Preventive Medicine 11/2006; 43(4):325-31. · 3.50 Impact Factor
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    ABSTRACT: We investigated the relationship among father's occupational group, daily smoking, and smoking determinants in a cohort of New Zealand adolescents. The longitudinal Multidisciplinary Health and Development Study provided information on adolescents' self-reported smoking behavior and potential predictors of smoking, such as social and material factors, personality characteristics, educational achievement, and individual attitudes and beliefs regarding smoking. Longitudinal logistic generalized estimating equation analyses were used. Adolescents whose fathers were classified in the lowest-status occupational group were twice as likely as those whose fathers occupied the highest-status occupational group to be daily smokers. This high risk of daily smoking among the adolescents from the lowest occupational group was largely predicted by their lower intelligence scores and by the higher prevalence of smoking among fathers and friends. To prevent socioeconomic differences in smoking, school-based interventions should seek to prevent smoking uptake among adolescents, particularly those of lower socioeconomic status. Programs need to provide positive, nonsmoking role models consonant with the culture and norms of lower-socioeconomic-status groups. Adolescents need to acquire resistance skills and protective behaviors against social pressure and influences.
    American Journal of Public Health 05/2005; 95(4):681-8. · 3.93 Impact Factor
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    ABSTRACT: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.
    The European Journal of Public Health 05/2005; 15(2):152-9. · 2.52 Impact Factor
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    Mariël Droomers, Carola T M Schrijvers, Johan P Mackenbach
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    ABSTRACT: At this time, the mechanisms by which socioeconomic differences in smoking develop are not completely understood. In this paper the Theory of Planned Behaviour as a potential explanatory framework for socioeconomic differences in smoking is tested. It was hypothesized that components of the Theory of Planned Behaviour may be unequally distributed over educational groups and therefore contribute to the explanation of socioeconomic differences in smoking. Educational differences in the intention to quit smoking are described and attempts are made to understand these in the light of educational patterns in attitude towards smoking cessation, perceived subjective norm concerning quitting smoking, and self-efficacy. This cross-sectional study was part of the longitudinal GLOBE study on socioeconomic differences in The Netherlands. Components of the Theory of Planned Behaviour were measured in 1997 among 602 Dutch daily smokers. No educational differences in the intention to quit smoking were found. Persons with a more positive attitude towards smoking cessation and a high subjective norm significantly more often intended to quit smoking. But, positive attitude and high subjective norm were not related to education, which explains the lack of educational differences in intention to quit smoking. Higher educated respondents reported significantly higher self-efficacy to refrain from smoking, which, however, was not related to the intention to quit smoking. It is anticipated that, from all components of the Theory of Planned Behaviour, only the direct effect of self-efficacy on behaviour may contribute to educational differences in smoking cessation.
    The European Journal of Public Health 07/2004; 14(2):194-8. · 2.52 Impact Factor
  • Mariël Droomers, Carola T M Schrijvers, Johan P Mackenbach
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    ABSTRACT: This paper describes educational differences in starting excessive alcohol consumption during 6 1/2 years of follow-up among 1648 initially alcohol-consuming Dutch adults. The longitudinal GLOBE study provides the unique possibility to study explanations for educational differences due to the collection of extensive baseline information on educational level, alcohol consumption, stressors (tension reduction theory) and vulnerability indicators (differential vulnerability theory) in 1991. Alcohol consumption was again assessed in 1997. We report that lower educated people were almost three times more likely to start excessive alcohol consumption during follow-up compared to the highest educated persons. Both educational differences in exposure to stressors (financial problems) and vulnerability (low social support) contributed to the educational differences in starting excessive alcohol consumption and explained 23% of the educational variation in starting excessive alcohol consumption. Remaining educational differences were however still statistically significant. These results are discussed with regard to implications for interventions and possible additional explanatory mechanisms.
    Social Science [?] Medicine 06/2004; 58(10):2023-33. · 2.73 Impact Factor
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    ABSTRACT: The GLOBE study is a prospective cohort study specifically aimed at the explanation of socio-economic inequalities in health in the Netherlands. The returns of the study are reviewed after ten years of follow-up, and the studies' contribution to the development of policy measures to reduce inequalities in health in the Netherlands are described. The study started in 1991 with a baseline postal survey (response rate 70.1% or n=18973, 15-74 years of age). Two sub-samples of respondents to this survey were subsequently interviewed in 1991 (response 79.4% and 72.3%, n=5667). Baseline data collection included measures of socio-economic position, health and possible explanatory factors. Follow-up involved repeated postal surveys and interviews, and routinely collected data on hospital admissions, cancer incidence and mortality by cause of death. Compared with higher socio-economic groups, lower socio-economic groups showed higher prevalence rates of poor self-reported health (perceived general health, health complaints, chronic conditions, disabilities), higher incidence rates of specific conditions (myocardial infarction) and higher rates of all-cause mortality. The higher prevalence of adverse material circumstances, unhealthy behaviour, adverse psychosocial characteristics, and adverse childhood circumstances in the lower socio-economic groups was important in the explanation of socio-economic inequalities in health. Socio-economic differences in health care utilization did not contribute to the explanation. The GLOBE study contributed significantly to the understanding of the explanation of socio-economic inequalities in health in the Netherlands. Study results were a main source of information in the development of policy measures aimed at the reduction of socio-economic inequalities in health in the Netherlands.
    The European Journal of Public Health 04/2004; 14(1):63-70. · 2.52 Impact Factor
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    M Droomers, C T M Schrijvers, S Casswell, J P Mackenbach
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    ABSTRACT: 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. 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. Dunedin, New Zealand. About 1000 children were followed up from birth in 1972 until adulthood. 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. 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.
    Journal of Epidemiology &amp Community Health 10/2003; 57(9):704-10. · 3.39 Impact Factor
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    Carola T M Schrijvers, Hans Bosma, Johan P Mackenbach
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    ABSTRACT: The aim was to study hostility as a factor intermediate in the association between educational level and health. 1997 cross-sectional data from the Dutch GLOBE study (1675 men and 1819 women) was used. The analyses distinguishes between direct effects of hostility on health, and indirect effects, which are through health-related behaviours. The latter indicates that hostile people may be at risk of adverse health, because they engage in unhealthy behaviours. Data were analysed with logistic regression techniques. Among men and women, the odds of less than good health was higher in lower educational groups. A substantial part of the educational gradient in health could be ascribed to the intermediate effects of hostility. Among both men and women, the direct effects of hostility were more important than indirect effects. Results suggest that interventions should be aimed at the prevention of the development of hostility. Additionally, interventions aimed at the reduction of health damaging behaviours among adults may lead to a reduction of socio-economic inequalities in health.
    The European Journal of Public Health 07/2002; 12(2):110-6. · 2.52 Impact Factor
  • Mariël Droomers, Carola T M Schrijvers, Johan P Mackenbach
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    ABSTRACT: This article describes the effect of educational level on the decision to continue smoking among 1,354 initially smoking participants (age > or = 20 years) in the Dutch GLOBE study. The effect of education on continued smoking was explained from baseline information (1991) on smoking characteristics, individual characteristics, and environmental factors. Smoking status was reassessed after 6.5 years. Lower educated smokers more often continued smoking (odds ratio 2.09). Poor perceived health and earlier smoking initiation in lower educated groups were main predictors of educational differences in smoking maintenance. Educational differences in chronic illness, perceived control, neuroticism, and emotional support also contributed to the explanation of educational differences in continued smoking. These results have important implications for intervention programs and policy.
    Health Psychology 05/2002; 21(3):263-72. · 3.83 Impact Factor
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    ABSTRACT: 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). 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). Region of Eindhoven (south eastern Netherlands). 1784 persons with asthma/COPD, heart disease, diabetes mellitus and/or low back pain. 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. 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.
    Journal of Epidemiology &amp Community Health 09/2001; 55(9):631-8. · 3.39 Impact Factor
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    M Droomers, C T Schrijvers, J P Mackenbach
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    ABSTRACT: 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. Prospective population based study. Baseline measurement were carried out in 1991 and follow up in 1997. South eastern part of the Netherlands. The study included 3793 subjects who were physically active in 1991 and who participated in the follow up. 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. 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. 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.
    Journal of Epidemiology &amp Community Health 09/2001; 55(8):562-8. · 3.39 Impact Factor
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    ABSTRACT: BACKGROUND Many studies found better cancer survival in patients with a high socioeconomic status (SES) than in patients with a low SES. Comorbidity at the time of diagnosis may be more frequent in patients of lower SES, and negatively influences their survival. The authors studied the association between SES and serious comorbidity at the time of diagnosis among newly diagnosed cancer patients in the Netherlands.METHODS Included in the analyses were patients registered in 1993 in the population-based Eindhoven Cancer Registry (southeastern Netherlands) with one of the most common carcinomas: breast (n = 457), lung (n = 442), colorectum (n = 384), prostate (n = 240), and stomach (n = 118). Information regarding comorbidity came from medical records. The SES of the patients was derived from their postal code of residence and stratified into three categories. The risk of being diagnosed with at least one other chronic condition was calculated using logistic regression analyses.RESULTSThe risk of being diagnosed with at least one other chronic condition was higher among patients with a low or intermediate SES than among those with a high SES for the five sites combined as well as for carcinomas of the breast or lung. The gradient was less clear for patients with colorectal carcinoma, whereas no socioeconomic variation in comorbidity was found for patients with carcinomas of the prostate or stomach.CONCLUSIONS Socioeconomic variation in the prevalence of serious comorbidity at the time of diagnosis does exist in some cancer sites, which may explain (partly) the socioeconomic gradient in survival observed in patients with tumors in these sites. Cancer 1997; 80:1482-8. © 1997 American Cancer Society.
    Cancer 11/2000; 80(8):1482 - 1488. · 5.20 Impact Factor
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    ABSTRACT: Body mass index (BMI) differs by socio-demographic variables, but the origin of these associations remains relatively unknown. To investigate the association between socio-demographic variables and the subsequent change in BMI over six years. 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. 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. 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.
    International Journal of Obesity 09/2000; 24(8):1077-84. · 5.22 Impact Factor
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    H Bosma, C Schrijvers, J P Mackenbach
    BMJ Clinical Research 01/2000; 319(7223):1469-70. · 14.09 Impact Factor
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    ABSTRACT: In the debate about the explanation of socio-economic health inequalities one of the important issues is the relative importance of health selection. The aim of this study was to investigate to what extent occupational class mobility and mobility out of and into employment are health-related, and in addition, to estimate the contribution of health-related social mobility to socio-economic health differences in the working population. Data were taken from the Longitudinal Study on Socio-Economic Health Differences in the Netherlands, which started in 1991; follow-up data were collected in 1995. The analysis is based on 2533 persons aged 15-59 at baseline. The influence of health problems in 1991 (perceived general health, health complaints and chronic conditions) on changes in occupational class between 1991 and 1995 was negligible. Neither upward nor downward mobility was affected by health problems. However, health problems in 1991 were significantly associated with a higher risk of mobility out of employment and a lower risk of mobility into employment in 1995. For example, for mobility out of employment among persons that reported at least one chronic condition in 1991, the odds ratio was 1.46. Health-related mobility out of employment substantially influences the estimate of socio-economic health inequalities in the working population (measured by current occupation). For manual workers, as compared to non-manual workers, the odds ratio for a less-than-good perceived general health was underestimated by 34% in 1995. Selective mobility into employment overestimates socio-economic inequalities in health in the working population by 9%. Respondents that moved into and out of employment were healthier than those that remained economically inactive, but their health was worse than of those that remained employed (both manual and non-manual). Implications for health policy are that the prospects for people with health problems to stay in paid employment should be improved.
    Social Science [?] Medicine 09/1999; 49(4):509-18. · 2.73 Impact Factor
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    ABSTRACT: 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.
    Preventive Medicine 08/1999; 29(1):1-10. · 3.50 Impact Factor

Publication Stats

1k Citations
127.63 Total Impact Points

Institutions

  • 2004–2006
    • Erasmus MC
      • Research Group for Public Health
      Rotterdam, South Holland, Netherlands
  • 1994–2005
    • Erasmus Universiteit Rotterdam
      • Department of Public Health (MGZ)
      Rotterdam, South Holland, Netherlands