Karien Stronks

Publications (130)303.23 Total impact

• Article: Smoking initiation, continuation and prevalence in deprived urban areas compared to non-deprived urban areas in The Netherlands.

  Mirte A G Kuipers, Marleen Wingen, Karien Stronks, Anton E Kunst
  [show abstract] [hide abstract]
  ABSTRACT: Previous studies have shown that smoking prevalence is higher in deprived areas than in affluent areas. We aimed to determine whether smoking initiation or continuation contributes most to inequalities in current smoking, and in which population subgroups these area differences were largest. Therefore, we assessed the relationship between area deprivation and current smoking, initiation and continuation in urban areas, in subgroups defined by gender, generation and educational level. Cross-sectional data of 20,603 Dutch adults (18 years and over) living in 963 urban areas in The Netherlands were obtained from the annual national health survey (2003-2009). Three interrelated smoking outcomes were used: current smoking (smokers/total population), initiation (ever-smokers/total population) and continuation (smokers/ever-smokers). Area deprivation was dichotomised; deprived urban areas (as defined by the Dutch government) and non-deprived urban areas (reference group) were distinguished. Multilevel logistic regression models controlled for individual characteristics (including education and income) and tested for interaction with gender, generation and education. After controlling for individual characteristics, odds for smoking were not significantly higher in deprived areas (current smoking: OR = 1.04 [0.92-1.18], initiation: OR = 1.05 [0.93-1.18], continuation: OR = 1.03 [0.88-1.19]). For smoking initiation, significant differences between deprived areas and other areas remained in younger generations (OR = 1.19 [1.02-1.38]) and higher educated (OR = 1.23 [1.04-1.45]) respondents. For continuation and current smoking, after controlling for individual characteristics, no associations were found in any subgroups. In conclusion, area deprivation appears to be independently related to smoking initiation in, respectively, higher educated and younger generations. These results suggest that initiatives to reduce area-level inequalities in smoking should focus on preventing smoking initiation in deprived areas.
  Social Science [?] Medicine 06/2013; 87:132-7. · 2.70 Impact Factor
• Source

  Available from: Hans AM van Oers

  Article: Change in Neighborhood Traffic Safety: Does It Matter in Terms of Physical Activity?

  Birthe Jongeneel-Grimen, Wim Busschers, Marie¨ l Droomers, Hans A. M. van Oers, Karien Stronks, Anton E. Kunst
  [show abstract] [hide abstract]
  ABSTRACT: Background: There is limited evidence on the causality of previously observed associations between neighborhood traffic safety and physical activity (PA). This study aims to contribute to this evidence by assessing the extent to which changes over time in neighborhood traffic safety were associated with PA. Methods: Data were accessed from the national survey Netherlands Housing Research for 2006 and 2009. The two samples of in total 57,092 Dutch residents aged 18–84 years lived in 320 neighbourhoods. Using multi-level hurdle models, the authors assessed whether the odds of being physically active and the mean hours of PA among active people (in 2009) were related to the levels of neighborhood traffic safety (in 2006) and hanges in the levels of neighborhood traffic safety (between 2006 and 2009). Next, we examined if these associations varied according to gender, age, and employment status. Results: Higher levels of neighborhood traffic safety were associated with higher odds of being active (OR 1.080 (1.025– 1.139)). An increase in levels of neighborhood traffic safety was associated with increased odds of being active (OR 1.060 (1.006–1.119)). This association was stronger among women, people aged 35 to 59, and those who were gainfully employed. Neither levels of traffic safety nor changes in these levels were associated with the mean hours of PA among people who were physically active (OR 0.997 (0.975–1.020); OR 1.001 (0.978–1.025), respectively). Conclusion: Not only levels of neighborhood traffic safety, but also increases in neighborhood traffic safety were related to increased odds of being active. This relationship supports claims for a causal relationship between neighborhood traffic safety and PA.
  PLoS ONE 05/2013; 8(5):e62525. · 4.09 Impact Factor
• Article: Unravelling the impact of ethnicity on health in Europe: the HELIUS study.

  Karien Stronks, Marieke B Snijder, Ron Jg Peters, Maria Prins, Aart H Schene, Aeilko H Zwinderman
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: Populations in Europe are becoming increasingly ethnically diverse, and health risks differ between ethnic groups. The aim of the HELIUS (HEalthy LIfe in an Urban Setting) study is to unravel the mechanisms underlying the impact of ethnicity on communicable and non-communicable diseases.Methods/designHELIUS is a large-scale prospective cohort study being carried out in Amsterdam, the Netherlands. The sample is made up of Amsterdam residents of Surinamese (with Afro-Caribbean Surinamese and South Asian-Surinamese as the main ethnic groups), Turkish, Moroccan, Ghanaian, and ethnic Dutch origin. HELIUS focuses on three disease categories: cardiovascular disease (including diabetes), mental health (depressive disorders and substance use disorders), and infectious diseases. The explanatory mechanisms being studied include genetic profile, culture, migration history, ethnic identity, socio-economic factors and discrimination. These might affect disease risks through specific risk factors including health-related behaviour and living and working conditions. Every five years, participants complete a standardized questionnaire and undergo a medical examination. Biological samples are obtained for diagnostic tests and storage. Participants' data are linked to morbidity and mortality registries. The aim is to recruit a minimum of 5,000 respondents per ethnic group, to a total of 30,000 participants. DISCUSSION: This paper describes the rationale, conceptual framework, and design and methods of the HELIUS study. HELIUS will contribute to an understanding of inequalities in health between ethnic groups and the mechanisms that link ethnicity to health in Europe.
  BMC Public Health 04/2013; 13(1):402. · 2.00 Impact Factor
• Article: Development of a diabetes prevention program for Surinamese South Asians in the Netherlands.

  Mary Nicolaou, Evalina Vlaar, Irene Van Valkengoed, Barend Middelkoop, Karien Stronks, Vera Nierkens
  [show abstract] [hide abstract]
  ABSTRACT: Type 2 diabetes is highly prevalent among South Asian origin groups around the world. Not only is prevalence higher than in other ethnic groups, age at presentation is lower and these groups are more likely to experience complications. Evidence suggests that lifestyle interventions may prevent or delay the onset of diabetes. However, little is known about diabetes prevention in South Asians (SA). DH!AAN is a diabetes prevention program designed for Surinamese SA in The Netherlands. In this paper, we describe the theoretical frameworks and formative research that guided the development and cultural adaptation of DH!AAN. Cultural adaptation was based on analysis of the determinants of diet and physical activity, including socio-cultural factors, within our study population. This led to the incorporation of surface and deep structure elements in the intervention. One-to-one counseling by dieticians using motivational interviewing (MI) was the basis for the intervention. Additionally, we aimed to generate social support by including family members in parts of the intervention and group sessions to address issues relating to traditional food habits. We discuss our reflections on the development process and the choices made in developing this intervention. The results of DH!AAN will provide insight into the use of MI for this population group. Moreover, DH!AAN will provide evidence regarding the feasibility of diabetes prevention among South Asian populations.
  Health Promotion International 04/2013; · 1.94 Impact Factor
• Article: Migration and geographical inequalities in health in the Netherlands: an investigation of age patterns.

  Birthe Jongeneel-Grimen, Mariël Droomers, Karien Stronks, J A M van Oers, Anton E Kunst
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVES: This paper estimates, for six different age groups, whether and how migration influences inequalities in health between deprived and non-deprived neighbourhoods in the Netherlands. METHODS: Data were accessed from the Netherlands Housing Survey 2006. Using multi-level logistic regression analyses, we compared the health of migrants with that of nonmigrants in the area of origin and assessed the role of demographic and socioeconomic characteristics. Next, we assessed the magnitude of health differences between deprived versus non-deprived areas among migrants and non-migrants. RESULTS: For many age groups, migrants into non-deprived areas were healthier and migrants into deprived areas had similar levels of health compared with non-migrant populations in the area of origin. These differences in health were not explained by demographic and socio-economic characteristics. For all ages and for people aged 25-34 years we found smaller area inequalities in health among migrants compared with non-migrants. For most other age groups, about equally large differences were observed. CONCLUSIONS: For most age groups, the results do not provide empirical support to the expectation that migration would enlarge health differences between deprived and non-deprived neighbourhoods.
  International Journal of Public Health 03/2013; · 2.54 Impact Factor
• Article: Health governance by collaboration: a case study on an area-based programme to tackle health inequalities in the Dutch city of the Hague.

  Thomas Plochg, Melanie Schmidt, Niek S Klazinga, Karien Stronks
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: Area-based programmes are seen as a promising strategy for tackling health inequalities. In these programmes, local authorities and other local actors collaborate to employ health promoting interventions and policies. Little is known about the underlying processes of collaborative governance. To unravel this black box, we explored how the authority of The Hague, The Netherlands, developed a programme tackling health inequalities drawing on a collaborative mode of governance. METHODS: Case study drawing on qualitative semi-structured interviews and document review. Data were inductively analysed against the concept of collaborative governance. RESULTS: The authority's ambition was to co-produce a programme on tackling health inequalities with local actors. Three stages could be distinguished in the governing process: (i) formulating policy objectives, (ii) translating policy objectives into interventions and (iii) executing health interventions. In the stage of formulating policy objectives, the collaboration led to a reframing of the initial objectives. Furthermore, the translation of the policy objectives into health interventions was rather pragmatic and loosely based on health needs and/or evidence. As a result, the concrete actions that ensued from the programme did not necessarily reflect the initial objectives. CONCLUSION: In a local system of health governance by collaboration, factors other than the stated policy objectives played a role, eventually undermining the effectiveness of the programme in reducing health inequalities. To be effective, the processes of collaborative governance underlying area-based programmes require the attention of the local authority, including the building and governing of networks, a competent public health workforce and supportive infrastructures.
  The European Journal of Public Health 03/2013; · 2.73 Impact Factor
• Article: Examining self-rated health of young Central and Eastern Europeans in the context of other world regions.

  Margot I Witvliet, Onyebuchi A Arah, Karien Stronks, Anton E Kunst
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: Poor health is more prevalent in the East of Europe as compared with the West. This variation is often attributed to Soviet communism. Few studies investigate this health discrepancy within young adults who were children during this period. We studied the health of young adults by examining variations between world regions in general health between generations (18-65+). The individual and contextual mechanisms that might influence their health were also investigated. METHODS: World Health Survey data were analysed on young adults aged 18-34 (n = 91 823) and their elders aged 35+ (n = 132 362) from 59 countries. Main outcome was self-reported general health. Multi-level logistic regression was used to assess associations between general health and regions, while accounting for individual- and country-level socio-economic factors across age ranges. RESULTS: The prevalence of poor health was much higher for young adults in the Former Soviet Union region than in Western Europe, with the Central European region being in-between.This pattern remained even after full adjustments, for the Former Soviet Union citizens [odds ratio 4.26 (95% confidence interval 1.77-10.24)] and for Central Europeans [odds ratio 1.73 (95% confidence interval 0.90-3.32)] as compared with Western Europe. Age-specific analyses showed East-West health differences usually being larger as age increases (up to 65+). This age pattern seemed reversed for the South-West divide. CONCLUSIONS: The East-West health gap seems more pronounced for the Former Soviet Union young adults, rather than Central Europeans. It appears as though young adults from Central Europe might have been somewhat insulated from the ill-health effects of communism.
  The European Journal of Public Health 03/2013; · 2.73 Impact Factor
• Article: Why residents of Dutch deprived neighbourhoods are less likely to be heavy drinkers: the role of individual and contextual characteristics.

  Mirte A G Kuipers, Birthe Jongeneel-Grimen, Mariël Droomers, Marleen Wingen, Karien Stronks, Anton E Kunst
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: Earlier research has shown that residents of Dutch deprived neighbourhoods drink less alcohol than people in other areas. We aimed to assess the role of individual and neighbourhood characteristics in a cross-sectional, nationwide, multilevel study. METHODS: Individual data of 30 117 Dutch adults, living in 1722 neighbourhoods across the Netherlands, were obtained from the 2004 to 2009 national health survey (POLS). Chronic heavy alcohol consumption was measured as ≥14 drinks/week for women and ≥21 for men, and episodic heavy drinking as ≥6 drinks/day at least once a week. Neighbourhood deprivation was dichotomous; deprived districts as selected by the Dutch government versus other areas. Multilevel logistic regression models of the association between deprivation and heavy drinking were corrected for age, gender, household composition, population density and potential predictors ethnicity, socioeconomic status (education, income), neighbourhood-level social cohesion and percentage Muslims. RESULTS: The prevalence of heavy drinking was lower in deprived neighbourhoods than in the rest of the Netherlands. This association was found for both chronic and episodic heavy drinking (OR=0.58 (0.47 to 0.72) and OR=0.57 (0.45 to 0.72), respectively). Adding ethnicity to the model reduced these associations by approximately one half. Socioeconomic composition did not contribute to the relationship. The proportion of Muslims explained a small part, while social cohesion explained even less of the association. Stronger associations were observed for women and older adults than for men and younger adults. CONCLUSIONS: The lower prevalence of heavy drinking occurring in deprived areas is largely explained by the ethnicity of neighbourhood residents.
  Journal of epidemiology and community health 03/2013; · 3.04 Impact Factor
• Article: Screening South Asians for type 2 diabetes and prediabetes: (1) comparing oral glucose tolerance and haemoglobin A1c test results and (2) comparing the two sets of metabolic profiles of individuals diagnosed with these two tests.

  Everlina Ma Vlaar, Wanda M Admiraal, Wim B Busschers, Frits Holleman, Vera Nierkens, Barend Jc Middelkoop, Karien Stronks, Irene Gm van Valkengoed
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: The glycated haemoglobin A1c (HbA1c) level may be used for screening for type 2 diabetes and prediabetes instead of a more burdensome oral glucose tolerance test (OGTT). However, among the high-risk South Asian population, little is known about the overlap of the methods or about the metabolic profiles of those disconcordantly diagnosed. METHODS: We included 944 South Asians (18--60 years old), whom we screened with the HbA1c level and the OGTT in The Hague, the Netherlands. We calculated the area under the receiver-operator characteristic curve (AUROC) with a 95% confidence interval of HbA1c using the American Diabetes Association classifications, and determined the sensitivity and specificity with 95% confidence intervals at different thresholds. Moreover, we studied differences in metabolic characteristics between those identified by HbA1c and by the OGTT alone. RESULTS: The overlap between HbA1c and OGTT classifications was partial, both for diabetes and prediabetes. The AUROC of HbA1c for OGTT defined diabetes was 0.86 (0.79--0.93). The sensitivity was 0.46 (0.29--0.63); the specificity 0.98 (0.98--0.99). For prediabetes, the AUROC was 0.73 (0.69--0.77). Each of the 31 individuals with diabetes and 353 with prediabetes identified with the HbA1c level had a high body mass index, large waist circumference, high blood pressure, and low insulin sensitivity, all of which were similar to the values shown by those among the 19 with diabetes or 62 with prediabetes who only met the OGTT criteria, but not the HbA1c criteria. CONCLUSIONS: The HbA1c level identified a partially different group than the OGTT did. However, both those identified with the HbA1c level and those identified with the OGTT alone were at increased metabolic risk.Trial registration: Dutch Trial Register: NTR1499.
  BMC Endocrine Disorders 02/2013; 13(1):8. · 2.16 Impact Factor
• Article: Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study.

  Martine C de Bruijne, Floor van Rosse, Ellen Uiters, Mariël Droomers, Jeanine Suurmond, Karien Stronks, Marie-Louise Essink-Bot
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: Studies in the USA have shown ethnic inequalities in quality of hospital care, but in Europe, this has never been analysed. We explored variations in indicators of quality of hospital care by ethnicity in the Netherlands. METHODS: We analysed unplanned readmissions and excess length of stay (LOS) across ethnic groups in a large population of hospitalized patients over an 11-year period by linking information from the national hospital discharge register, the Dutch population register and socio-economic data. Data were analysed with stepwise logistic regression. RESULTS: Ethnic differences were most pronounced in older patients: all non-Western ethnic groups > 45 years had an increased risk for excess LOS compared with ethnic Dutch patients, with odds ratios (ORs) (adjusted for case mix) varying from 1.05 [95% confidence intervals (95% CI) 1.02-1.08] for other non-Western patients to 1.14 (95% CI 1.07-1.22) for Moroccan patients. The risk for unplanned readmission in patients >45 years was increased for Turkish (OR 1.24, 95% CI 1.18-1.30) and Surinamese patients (OR 1.11, 95% CI 1.07-1.16). These differences were explained partially, although not substantially, by differences in socio-economic status. CONCLUSION: We found significant ethnic variations in unplanned readmissions and excess LOS. These differences may be interpretable as shortcomings in the quality of hospital care delivered to ethnic minority patients, but exclusion of alternative explanations (such as differences in patient- and community-level factors, which are outside hospitals' control) requires further research. To quantify potential ethnic inequities in hospital care in Europe, we need empirical prospective cohort studies with solid quality outcomes such as adverse event rates.
  The European Journal of Public Health 02/2013; · 2.73 Impact Factor
• Article: Smoking Prevalence among Migrants in the US Compared to the US-Born and the Population in Countries of Origin.

  Jizzo R Bosdriesz, Nienke Lichthart, Margot I Witvliet, Wim B Busschers, Karien Stronks, Anton E Kunst
  [show abstract] [hide abstract]
  ABSTRACT: Smoking among migrants is known to differ from the host population, but migrants' smoking is rarely ever compared to the prevalence of smoking in their country of origin. The goal of this study is to compare the smoking prevalence among migrants to that of both the US-born population and the countries of origin. Further analyses assess the influence of sex, age at time of entry to the US and education level. Data of 248,726 US-born and migrants from 14 countries were obtained from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) from 2006-2007. Data on 108,653 respondents from the corresponding countries of origin were taken from the World Health Survey (WHS) from 2002-2005. THE PREVALENCE OF SMOKING AMONG MIGRANTS (MEN: 14.2%, women: 4.1%) was lower than both the US-born group (men: 21.4%, women: 18.1%) and countries of origin (men: 39.4%, women: 11.0%). The gender gap among migrants was smaller than in the countries of origin. Age at time of entry to the US was not related to smoking prevalence for migrants. The risk of smoking for high-educated migrants was closer to their US counterparts. The smoking prevalence among migrants is consistently lower than both the country of origin levels and the US level. The theory of segmented assimilation is supported by some results of this study, but not all. Other mechanisms that might influence the smoking prevalence among migrants are the 'healthy migrant effect' or the stage of the smoking epidemic at the time of migration.
  PLoS ONE 01/2013; 8(3):e58654. · 4.09 Impact Factor
• Source

  Available from: Hans AM van Oers

  Article: Change in neighborhood traffic safety: does it matter in terms of physical activity?

  Birthe Jongeneel-Grimen, Wim Busschers, Mariël Droomers, Hans A M van Oers, Karien Stronks, Anton E Kunst
  [show abstract] [hide abstract]
  ABSTRACT: There is limited evidence on the causality of previously observed associations between neighborhood traffic safety and physical activity (PA). This study aims to contribute to this evidence by assessing the extent to which changes over time in neighborhood traffic safety were associated with PA. Data were accessed from the national survey Netherlands Housing Research for 2006 and 2009. The two samples of in total 57,092 Dutch residents aged 18-84 years lived in 320 neighbourhoods. Using multi-level hurdle models, the authors assessed whether the odds of being physically active and the mean hours of PA among active people (in 2009) were related to the levels of neighborhood traffic safety (in 2006) and changes in the levels of neighborhood traffic safety (between 2006 and 2009). Next, we examined if these associations varied according to gender, age, and employment status. Higher levels of neighborhood traffic safety were associated with higher odds of being active (OR 1.080 (1.025-1.139)). An increase in levels of neighborhood traffic safety was associated with increased odds of being active (OR 1.060 (1.006-1.119)). This association was stronger among women, people aged 35 to 59, and those who were gainfully employed. Neither levels of traffic safety nor changes in these levels were associated with the mean hours of PA among people who were physically active (OR 0.997 (0.975-1.020); OR 1.001 (0.978-1.025), respectively). Not only levels of neighborhood traffic safety, but also increases in neighborhood traffic safety were related to increased odds of being active. This relationship supports claims for a causal relationship between neighborhood traffic safety and PA.
  PLoS ONE 01/2013; 8(5):e62525. · 4.09 Impact Factor
• Article: Intimate Partner Violence in Rwanda: The Mental Health of Victims and Perpetrators.

  Femke Verduin, Esther A N Engelhard, Theoneste Rutayisire, Karien Stronks, Willem F Scholte
  [show abstract] [hide abstract]
  ABSTRACT: Exposure to intimate partner violence (IPV) is a common feature of women living in low- and middle-income countries. Several studies have shown a significant association between IPV against women and mental health in both developed and in low- and middle-income countries. In postconflict settings, the relationship between IPV and mental health is likely more complex, given the high levels of violence experienced by the population as a whole. In this cross-sectional study the authors explore the association between IPV and common mental health disorders (CMD), and more specifically, suicidal ideation, among inhabitants of postgenocide Rwanda. The authors use the concept of "mutual partner violence," thereby exploring the association between IPV and CMD in victims, perpetrators, and those who state they are both. Data of 241 married men and women were used. Symptoms suggestive of CMD were established by use of the Self-Reporting Questionnaire (SRQ-20), and physical intimate partner violence was measured using the Conflict Tactics Scale, Short Version (CTS2S). The authors applied multivariate logistic regressions with total SRQ-20 scores (above/below cutoff) and suicidal ideation as the outcome measures and corrected for age and gender. The study findings suggest that reported IPV is associated with CMD (odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 0.92-3.15) and suicidal ideation (OR = 1.6, 95% CI = 0.70-3.53). Those who state to be both victim and perpetrator (OR = 1.75, 95% CI = 0.82-3.72), or only perpetrator (OR = 3.13, 95% CI = 0.49-20.0), are more likely to report mental health problems than victims and people who do not report IPV. In a postconflict situation, perpetrators of IPV may suffer from mental health problems as much as, or even more than, victims. Longitudinal data are needed to clarify the complex relationship between CMD and IPV, especially if outcomes may also be related to other forms of violence experienced in the past.
  Journal of Interpersonal Violence 12/2012; · 1.64 Impact Factor
• Article: Design of a prospective cohort study to assess ethnic inequalities in patient safety in hospital care using mixed methods.

  Floor van Rosse, Martine C de Bruijne, Cordula Wagner, Karien Stronks, Marie-Louise Essink-Bot
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: While US studies show a higher risk of adverse events (AEs) for ethnic minorities in hospital care, in Europe ethnic inequalities in patient safety have never been analysed. Based on existing literature and exploratory research, our research group developed a conceptual model and empirical study to increase our understanding of the role ethnicity plays in patient safety. Our study is designed to (1) assess the risk of AEs for hospitalised patients of non-Western ethnic origin in comparison to ethnic Dutch patients; (2) analyse what patient-related determinants affect the risk of AEs; (3) explore the mechanisms of patient-provider interactions that may increase the risk of AEs; and (4) explore possible strategies to prevent inequalities in patient safety. METHODS: We are conducting a prospective mixed methods cohort study in four Dutch hospitals, which began in 2010 and is running until 2013. 2000 patients (1000 ethnic Dutch and 1000 of non-Western ethnic origin, ranging in age from 45-75 years) are included. Survey data are being used to capture patients' explanatory variables (e.g., Dutch language proficiency, health literacy, socio-economic status (SES)-indicators, and religion) during hospital admission. After discharge, a two-stage medical record review using a standardized instrument is conducted by experienced reviewers to determine the incidence of AEs. Data will be analysed using multilevel multivariable logistic regression. Qualitative interviews with providers and patients will provides insight into the mechanisms of AEs and potential prevention strategies. CONCLUSION: This study uses a robust study plan to quantify the risk difference of AEs between ethnic minority and Dutch patients in hospital care. In addition we are developing an in-depth description of the mechanisms of excess risk for some groups compared to others, while identifying opportunities for more equitable distributions of patient safety for all.
  BMC Health Services Research 12/2012; 12(1):450. · 1.66 Impact Factor
• Source

  Available from: Marie-Louise Essink-Bot

  Article: Interpreting ethnic inequalities in healthcare consumption: a conceptual framework for research.

  Marie-Louise Essink-Bot, Majda Lamkaddem, Petra Jellema, Signe Smith Nielsen, Karien Stronks
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: The increasing diversity of the Western-European population demands identification of potential ethnic healthcare inequities. We developed a framework that helps researchers in interpreting ethnic inequalities in healthcare consumption in equity terms. From this framework, we develop recommendations for the design of future studies. METHODS: The framework was developed by analysing three typical studies on ethnic inequalities in healthcare consumption with respect to the potential of interpreting their results as healthcare inequities. RESULTS: Analysing the effects of ethnic variations in healthcare consumption on health outcomes provides important clues about the presence of potential ethnic healthcare inequities. Interpretation of ethnic variations in healthcare consumption as potentially inequitable requires appropriate adjustment for medical need for healthcare, patient preferences and treatment adherence. Because of the central position of medical need, studies need to be disease-specific and based on standardized assessment of risk factors and disease characteristics. A longitudinal study design is necessary to prevent reverse causation. CONCLUSION: The framework shows that ethnic inequalities in healthcare consumption can be justified if healthcare received meets the need for healthcare in all groups and is in accordance with informed patient preferences. It also shows that ethnic equality in healthcare consumption may hide healthcare inequities. We recommend further research on ethnic healthcare inequities using multi-ethnic cohort designs combined with linkage to healthcare registries. We also recommend research to identify clinically relevant ethnic differences in disease profiles and optimization of treatment regimens.
  The European Journal of Public Health 12/2012; · 2.73 Impact Factor
• Article: Sex Differences in the Association Between Serum Ferritin and Fasting Glucose in Type 2 Diabetes Among South Asian Surinamese, African Surinamese, and Ethnic Dutch: The population-based SUNSET study.

  Louise H Dekker, Mary Nicolaou, Daphne L van der A, Wim B Busschers, Lizzy M Brewster, Marieke B Snijder, Karien Stronks, Irene G M van Valkengoed
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE Moderately elevated iron stores below the levels commonly associated with hemochromatosis have been implicated in the etiology of diabetes. Studies suggest that iron status (measured by serum ferritin) differs significantly according to sex, but inconsistent findings have been reported. Our aim is to test the association between serum ferritin and the prevalence of type 2 diabetes and fasting glucose concentrations in a population-based, multiethnic, cross-sectional study including men and women of African Surinamese, South Asian Surinamese, and ethnic Dutch origin.RESEARCH DESIGN AND METHODS We analyzed data on 508 ethnic Dutch, 597 African Surinamese, and 339 South Asian Surinamese aged 35-60 years. Type 2 diabetes was defined as a fasting plasma glucose level ≥7.0 mmol/L or a self-reported diagnosis.RESULTSSerum ferritin was positively associated with type 2 diabetes and fasting glucose, but differences in the associations according to sex were observed. Serum ferritin concentration was positively associated with type 2 diabetes among women in all ethnic groups (odds ratio [OR] ethnic Dutch: 1.07 [95% CI 1.01-1.13]; OR South Asian Surinamese: 1.05 [1.00-1.10]; OR African Surinamese: 1.05 [1.01-1.10]), but not among men. Serum ferritin was also more strongly associated with fasting glucose in women than in men. Moreover, the magnitude of sex differences in the association between serum ferritin and fasting glucose, but not type 2 diabetes, was more pronounced in the African Surinamese group than in the other ethnic groups (P for interaction ≤0.0001).CONCLUSIONS We found a positive association between serum ferritin and type 2 diabetes and fasting glucose in our multiethnic population, which appeared stronger among women than men. Further evaluation of the variation in sex differences between ethnic groups is warranted, particularly among the African Surinamese, to understand the mechanisms behind these sex differences.
  Diabetes care 11/2012; · 8.09 Impact Factor
• Article: Does collaborative research enhance the integration of research, policy and practice? The case of the Dutch Health Broker Partnership.

  Willemijn Krebbekx, Janneke Harting, Karien Stronks
  [show abstract] [hide abstract]
  ABSTRACT: A gap between health services research and practice has been identified: research findings often do not find their way into practice. Our objective was to explore the potential of collaborative research to bridge this gap in one specific area, health promotion, and to determine factors that influence the development of theory-based practice and practice-based theory. This was investigated in an exploratory single-case study. First, we designed an analytical framework for collaborative research. Next, we used this framework to analyse developments in the Dutch Health Broker Partnership, which involved researchers, policymakers and practitioners. Data consisted of transcripts of the meetings of the Partnership over an 18-month period, as well as interviews with its 13 members. The development of theory-based practice and practice-based theory failed to progress beyond the initial stages, although practitioners' actions did become more comprehensive and researchers' thinking became more influenced by practical limitations and local contexts. The heterogeneity of the Partnership facilitated as well as impeded the progress of these developments. Although collaborative research may serve as a tool to narrow the gap between research and practice, discussing the collaborative process and partner heterogeneity among the partners at the outset may be a necessary prerequisite to achieving the full potential of any partnership, which is limited by the ambivalent influence of partner heterogeneity. Collaborative research may, therefore, additionally benefit from continuous cross-domain orchestration and boundary work.
  Journal of Health Services Research & Policy 10/2012; 17(4):219-26. · 1.73 Impact Factor
• Source

  Available from: Wieke Heideman

  Article: DiAlert: a prevention program for overweight first degree relatives of type 2 diabetes patients: results of a pilot study to test feasibility and acceptability.

  Wieke H Heideman, Maartje de Wit, Barend Jc Middelkoop, Vera Nierkens, Karien Stronks, Frank J Snoek
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: Prevalence of type 2 diabetes mellitus is increasing due to lifestyle changes, particularly affecting those genetically at risk. We developed DiAlert as a targeted group-based intervention aimed to promote intrinsic motivation and action planning for lifestyle changes and weight loss in first degree relatives of patients with type 2 diabetes mellitus.The main objective of the pilot of the DiAlert intervention was to assess fidelity, feasibility and acceptability prior to starting the randomized controlled trial. METHODS: Individuals with a family history of type 2 diabetes mellitus were self-identified and screened for eligibility. DiAlert consists of two group sessions. Feasibility, fidelity, acceptability and self-reported perceptions and behavioral determinants were evaluated in a pre-post study using questionnaires and observations. Determinants of behavior change were analyzed using paired-samples t tests and Wilcoxon signed rank tests. RESULTS: DiAlert was delivered to two groups of first degree relatives of patients with type 2 diabetes mellitus (N = 9 and N = 12). Feasibility and fidelity were confirmed. Overall, the DiAlert group sessions were positively evaluated (8.0 on a scale of 1 to 10) by participants. The intervention did not impact perceived susceptibility or worry about personal diabetes risk. Action planning with regard to changing diet and physical activity increased. CONCLUSIONS: DiAlert proved feasible and was well-accepted by participants. Positive trends in action planning indicate increased likelihood of actual behavior change following DiAlert. Testing the effectiveness in a randomized controlled trial is imperative.Trial registrationNetherlands National Trial Register (NTR): NTR2036.
  Trials 09/2012; 13(1):178. · 2.02 Impact Factor
• Article: The effect of exercise on prescription on physical activity and wellbeing in a multi-ethnic female population: A controlled trial.

  Maaike Gj Gademan, Marije Deutekom, Karen Hosper, Karien Stronks
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: In Western countries, individuals from multi-ethnic disadvantaged populations are less physically active than the Western population as a whole. This lack of physical activity (PA) may be one of the factors explaining disparities in health. Exercise on Prescription" (EoP), is an exercise program to which persons are referred by primary care. It has been developed to suit the needs of physically inactive women from diverse ethnic backgrounds living in deprived neighborhoods in the Netherlands. The effectiveness of this program has however, not yet been proven. METHODS: A total of 514 women from diverse ethnic backgrounds were included in this study (192 EoP, 322 control group). Women in the EoP group participated in 18 sessions of supervised PA. The control group received care as usual. At baseline, 6 and 12 months the women attended an interview and a physical examination. Outcome measures were PA, BMI, weight circumference, fat percentage, oxygen uptake, mental well-being, subjective health and use of care. RESULTS: Of the participants 59 % had a low educational level and 90 % of the women were overweight or obese. Compliance was high, only 14 % dropped out during the course of the program. Total PA did not change, PA during leisure time increased at 6 and at 12 months and PA during household activities increased at 12 months (PEoPvsControl < 0.05). EoP had no significant effect on the other outcome variables. CONCLUSIONS: EoP was successful in recruiting its target population and compliance was high. The effect of EoP on PA, health and mental well-being was limited. In this format EoP does not seem to be effective for increasing PA and the health status of non-Western migrant women.Trial registrationDutch Trial register: NTR1294.
  BMC Public Health 09/2012; 12(1):758. · 2.00 Impact Factor
• Article: Integrating Primary Care and Public Health

  Thomas Plochg, Jennifer van den Broeke, Dionne Sofia Kringos, Karien Stronks
  [show abstract] [hide abstract]
  ABSTRACT: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2012.300977
  American Journal of Public Health 08/2012; · 3.93 Impact Factor