Anton Kunst

Amsterdam UMC. Univerisity of Amsterdam

Introduction The Netherlands will ban tobacco sales from supermarkets in 2024 and from petrol stations and small outlets after 2030 (tobacco specialist shops exempted). Previous studies showed that this will reduce outlet availability, density, and proximity in Dutch urban areas. Aims and Methods This study assessed the distribution of tobacco out...

Social and community service organizations (SCSOs) may be a promising new environment to more successfully reach people with a lower socioeconomic position (SEP) for smoking cessation support. However, studies that investigate clients’ perspectives of the suitability of SCSOs as a setting to discuss smoking are scarce. This study aimed to (i) inves...

Background Socioeconomic mortality inequalities are persistent in Europe but have been changing over time. Smoking is a known contributor to inequality levels, but knowledge about its impact on time trends in inequalities is sparse. Methods We studied trends in educational inequalities in smoking-attributable mortality (SAM) and assessed their imp...

Background Patient reported experiences (PREMs) are important indices of quality of care. Similarities in demography between patient and doctor, known as social concordance, can facilitate patient-doctor interaction and may be associated with more positive patient experiences. The aim of this research is to study associations between gender concord...

Background During the COVID-19 pandemic, provision of non-COVID healthcare was recurrently severely disrupted. The objective was to determine whether disruption of non-COVID hospital use, either due to cancelled, postponed, or forgone care, during the first pandemic year of COVID-19 impacted socioeconomic groups differently compared with pre-pandem...

Local governments may play a key role in making outdoor sports clubs smoke free. This study aims to assess the activities, motives, challenges and strategies of Dutch municipalities regarding stimulating outdoor sports clubs to become smoke free. Semi-structured interviews were conducted with 19 policy officers of different municipalities in the Ne...

Introduction Social and Community Service Organizations (SCSOs) are a potential setting to reach and support people with a low socioeconomic position who smoke, yet smoking cessation is not widely supported by SCSO professionals. Aims and Methods This study aims to identify SCSO professionals’ (1) potential activities to support smoking cessation...

Objective Despite a nationwide ban on tobacco sales to people under 18 years of age, adolescents can still buy tobacco products in Amsterdam. This study aimed to understand the influence of the retail environment in adolescents’ activity spaces on their tobacco-purchasing behaviour. Method Interviews were conducted with 13 adolescents (aged 14–19...

Background Previous studies found that tobacco outlets were unevenly distributed by area socioeconomic status (SES). However, evidence from continental Europe is limited. This study aims to assess differences in tobacco outlet presence, density and proximity by area SES in the Netherlands. Methods All tobacco outlets in four Dutch cities (Amsterda...

Introduction Visibility of tobacco products at retail tobacco outlets is associated with smoking initiation. To address this, across 2020–2022 the Netherlands banned tobacco product displays, advertisements and vending machines in the retail environment. Tobacco/vape specialist shops were exempted. This study assessed the impact of these policies o...

Background While it is known that educational inequalities in smoking start during early and middle adolescence, it is unknown how they further develop until adulthood. The aim of this article is to map, in the Portuguese context, how educational inequalities in smoking emerge from pre-adolescence until young adulthood. Methods This study used lon...

Background: Smoking is inversely related to people's Physical Activity Level (PAL). As the behavior of friends may affect the choices and behavior of adolescents, having friends with a high PAL may potentially protect against adolescent smoking. This study aims to assess whether adolescents' smoking is associated with the PAL of their friends. Me...

The coronavirus disease 2019 (COVID-19) pandemic, including the restrictive measures taken to reduce the spread of the virus, negatively affected people's health behavior. We explored whether the pandemic also had an effect on metabolic risk factors for cardiovascular disease (CVD) in women and men. We conducted a natural experiment, using data fro...

Background Across Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term trends in educational inequalities in remaining life expectancy at age 30 (e30), and assessed the contributions...

Introduction: The theory of 'family of nations' posits that countries draw policy lessons predominantly from similar countries. Lesson-drawing in tobacco control has, however, been primarily studied in the 'English-speaking' family. We examined in five diverse North-Western European countries whether the government engages in lesson-drawing regard...

This paper describes a new method to present and interpret linear trends in health inequalities, and presents a proof-of-concept for inequalities in smoking among adolescents in Europe. We estimated the regression line of the assumed linear relationship between smoking prevalence in low and high socioeconomic status (SES) youth over time. Using sim...

Background While it is known that educational inequalities in smoking start during early and middle adolescence, it is unknown how they further develop until adulthood. The aim of this article is to map, in the Portuguese context, how educational inequalities in smoking emerge from pre-adolescence until young adulthood. Methods This study used lon...

Social network research has evidenced the role of peer effects in the adoption of behaviours. Little is known, however, about whether policies affect how behaviours are shared in a network. To contribute to this literature, we apply the concept of diffusion centrality to school tobacco policies and adolescent smoking. Diffusion centrality is a meas...

It is unclear to what extent differences in cardiovascular disease (CVD) risk between men and women are explained by differences in smoking, and whether this contribution to risk is consistent across ethnic groups. In this prospective study, we determined the contribution of smoking to differences in CVD incidence between men and women, also in var...

Objectives Smoking may still occur at sports clubs with an outdoor smoke-free policy (SFP). This study aims to map the occurrence of smoking at various sports clubs in the Netherlands and to understand why smoking occurs at some clubs but not at others. Study design This was a qualitative design in the form of semistructured interviews. Methods S...

BACKGROUND Previous studies have observed a higher out-of-hospital cardiac arrest (OHCA) risk among lower socioeconomic groups. However, due to the cross-sectional and ecological designs used in these studies, the magnitude of these inequalities is uncertain. This study is the first to assess the individual-level association between income and OHCA...

Objective We aimed to gain insight into how and to what extent social (i.e. private/group chat) and goal-setting (e.g. rewards) functionalities in digital interventions for health behavior change were used by clients and nurses in a preventive care program for disadvantaged women during or after pregnancy, and which factors influenced usage. Method...

Objectives This study was conducted to examine modification in heat-related mortality in the Netherlands by sociodemographic and geographical factors including socioeconomic position and population density (PD). Design This observational study applied time series analysis on daily mortality counts according to mean daily temperature (°C). Setting...

Background It is not known how differences in COVID-19 deaths by migration background in the Netherlands evolved throughout the pandemic, especially after introduction of COVID-19 prevention measures targeted at populations with a migration background (in the second wave). We investigated associations between migration background and COVID-19 death...

Background It is not known how ethnic differences in COVID-19 deaths in the Netherlands evolved throughout the pandemic, especially after introduction of ethnicity-oriented COVID-19 prevention measures. We investigated associations between ethnicity and COVID-19 deaths across first wave of the pandemic, inter-wave period, and second wave in the Net...

Background Smoke-free policies (SFPs) have proven to be effective in protecting people from exposure to second-hand smoke (SHS) and lowering smoking rates. Our aims were to assess the impact of SFPs in hospitality venues (e.g. bars) on smoking behaviour of young people and to assess the impact of SFPs in the home environment on smoking behaviour an...

Background The Netherlands aims to reduce the availability of tobacco outlets by implementing a sales ban for vending machines (2022) and supermarkets (2024). The government intends to further phase out tobacco sales by petrol stations and small outlets after 2030. This study aims to understand its impact on tobacco outlet availability in the Nethe...

Background Although outdoor smoke-free policies (SFPs) at sports clubs represent an important new area of tobacco control, the majority of sports clubs are not smoke-free. This study aims to assess diffusion patterns of outdoor SFPs at sports clubs in the Netherlands, which may inform national strategies aimed at making all outdoor sports clubs smo...

Background After implementation of a tobacco vending machine ban in 2022 and a supermarket sales ban in 2024, the Dutch government intends to further phase out tobacco sales after 2030 by prohibiting sales in petrol stations and small outlets. This study aims to understand 1) the impact of these policies on tobacco outlet availability, and 2) diffe...

Background Higher family affluence is associated with healthier behaviours in adolescents, but the strength of this association varies across countries. Differences in social mobility at the country-level, i.e. the extent to which adolescents develop a different socioeconomic status (SES) than their parents, may partially explain why the associatio...

Background School staff members’ consistent enforcement of school tobacco policies (STPs) is needed to decrease adolescent smoking and exposure to tobacco smoke. Staff’s confidence, indicating their perceived ability to cope with students’ negative responses, explains variations in staff’s STPs enforcement, yet understanding of the determinants for...

Background: Appropriate referral from primary to secondary care is essential for maintaining a health care system that is accessible and cost-effective. Social concordance can affect the doctor-patient interaction and possibly also referral behaviour. Aim: Investigate the association of gender concordance and age concordance on referral rates in...

Background and aims: Exposure to tobacco products and advertising at the point of sale may be associated with pro-smoking cognitions. However, previous studies on this topic measured exposure based on self-reports, and did not include European countries. The aim of this study was to assess the association between objectively measured exposure to t...

Introduction: Cross-national comparison suggests that the timing of the obesity epidemic differs across socio-economic groups (SEGs). Similar to the smoking epidemic, these differences might be described by the diffusion of innovations theory, which states that health behaviours diffuse from higher to lower SEGs. However, the applicability of the...

Higher family affluence is associated with healthier behaviours in adolescents, but the strength of this association varies across countries. Differences in social mobility at the country-level, i.e. the extent to which adolescents develop a different socioeconomic status (SES) than their parents, may partially explain why the association between f...

Background Outdoor smoke-free policies (SFPs) at sports clubs can contribute to protecting people from second-hand smoke (SHS). However, in absence of national legislation, it is uncertain whether and how sports clubs decide to adopt an SFP. The aim of this study was to explore the decision-making process at sports clubs in relation to the adoption...

This study aimed to assess educational differences in adolescents’ exposure to tobacco outlets. Data were collected among 312 13-17-year-old non-smoking secondary school students in four Dutch cities. In a smartphone app, exposure (≤10 m from outlet) was measured using GPS and participants reported their educational track (pre-vocational vs. pre-un...

Background Urban renewal traditionally involves policy sectors such as housing, transport, and employment, which potentially can enhance the health of residents living in deprived areas. Additional involvement of the public health sector might increase the health impact of these urban renewal activities. This study evaluates the health impact of an...

Background Previous literature has showed that the likelihood of smoking is higher among offspring with smoking parents. The aim of this cohort study is to investigate during which smoking initiation stages and at what ages adolescents are more likely to be influenced by parental smoking. Methods This study used the EPITeen Cohort, which recruited...

Introduction: Studies on the impact of smoke-free policies (SFPs) on hospitals grounds on on-site smoking are scarce. On 1 October 2019, an SFP was implemented on the grounds of the Amsterdam UMC hospital in the Netherlands, including measures for sustained enforcement. This study assessed the impact of this SFP on smoking prevalence on hospital g...

Previous research found that adult smokers increased their smoking in response to the Covid-19 lockdown in spring 2020. This study explored changes in youth’s smoking during, compared to before, the partial lockdown in the Netherlands in a cross-sectional sample of 287 adolescents. Smoking prevalence increased from 4.5% to 5.2%. Cigarette consumpti...

Introduction The Netherlands aims to implement stricter tobacco control policies targeting the retail environment. This paper is an ex ante policy evaluation of the potential impact of the current tobacco display and advertising ban as well as future tobacco sales bans on tobacco outlet visibility and availability. Methods Between September 2019 a...

IntroductionIn this study we investigate why farmers develop psychosocial problems, how they tend to cope with these, and which barriers they face while seeking for help.Methods In-depth interviews with 16 farmers in an eastern province of the Netherlands have been conducted, and transcripts using inductive coding and thematic analysis were analyse...

Objective Differences in cardiovascular disease (CVD) incidence between men and women have been widely reported. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly explain how these differences arise. In this exploratory study, we examined the associations between selected gender-related char...

Both social causation and health-related selection may influence educational gradients in alcohol use in adolescence and young adulthood. The social causation theory implies that the social environment (e.g. at school) influences adolescents’ drinking behaviour. Conversely, the health-related selection hypothesis posits that alcohol use (along othe...

Background Although outdoor smoke-free policies (SFPs) at sports clubs represent an important new area of tobacco control, the majority of sports clubs are not smoke free. This study aims to assess diffusion patterns of outdoor SFPs at sports clubs in the Netherlands. Methods Using a retrospective, registry-based design, an inventory was made of f...

Background: To address social inequalities in adolescent substance use and consequent disparities in health, it is important to identify the mechanisms of the association between substance use and academic performance. We study the role of health literacy (HL) in the association between academic performance and weekly smoking, monthly alcohol use...

Introduction Political acceptability and successful implementation of tobacco control policies at the point of sale may depend on, among other factors, tobacco retailers’ level of support for these policies. This study quantified the level of support among small tobacco retailers for four point-of-sale tobacco control policies and its association w...

Objective We studied the association between the coronavirus disease 2019 (COVID-19) pandemic, including the restrictive measures, and metabolic risk factors for cardiovascular disease (CVD) in women and men. Next, we analysed whether changes in these metabolic risk factors were mediated by psychological and behavioural mechanisms. Design In this n...

Social causation and health-related selection may contribute to educational differences in adolescents’ attention problems and externalizing behaviour. The social causation hypothesis posits that the social environment influences adolescents’ mental health. Conversely, the health-related selection hypothesis proposes that poor mental health predict...

Background Disruption in circadian rhythms is associated with cardiovascular disease and may play a role in socioeconomic differences in cardiovascular disease prevalence. However, it is unclear whether low SES is associated with a lower diurnal rhythm in autonomic activity markers. We investigated the association between SES and the amplitude of t...

Background Social causation as well as health-related selection may contribute to educational gradients in adolescents' attention problems (AP) and externalizing behaviour (EB). From past studies it is unclear which of these mechanisms predominates, as AP and EB have the potential to disrupt adolescents' educational careers, but may also be affecte...

Background Cardiovascular diseases (CVD) are a major public health problem in men and women worldwide. Differences in CVD incidence between men and women have been widely reported, although explanations for these differences remain unclear. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly e...

Background Cardiovascular diseases (CVD) are a major public health problem in men and women worldwide. Differences in CVD incidence between men and women have been widely reported, although explanations for these differences remain unclear. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly e...

Background Current out-of-hospital cardiac arrest (OHCA) prevention strategies are suboptimal due to the inability to identify subgroups at high risk. Insight into the occurrence of OHCA within general populations may help to target prevention strategies. Case registries suggest that there may be substantial differences in emergency medical service...

Introduction: Parental factors may explain part of the social patterning of smoking among adolescents. This study aims at assessing the association between adolescent smoking and family characteristics (parental education, family wealth, and religion) and the mediating role of parental factors (smoking, control, and permissiveness towards smoking)...

Background This study investigated whether raised chronic stress in low education groups contributes to education differences in cardiovascular disease by altering sympathovagal balance. Methods This study included cross-sectional data of 10,202 participants from the multi-ethnic, population-based HELIUS-study. Sympathovagal balance was measured b...

Background Social causation and health-related selection may contribute to educational gradients in adolescents’ attention problems (AP) and externalizing behaviour (EB). From past studies it is unclear which of these mechanisms predominates, as AP and EB have the potential to interfere with educational performance, but may also be affected by diff...

Background Systemic autoimmune diseases (SAIDs) have chronic trajectories and share characteristics of self-directed inflammation and aspects of clinical expression. Nonetheless, burden-of-disease studies rarely investigate them as a distinct category. This study aims to assess the mortality rate of SAIDs as a group and to evaluate co-occurring cau...

Background Insight into the occurrence of out-of-hospital cardiac arrest (OHCA) within general populations may help to target prevention strategies. Case registries suggest that there may be substantial differences in emergency medical service (EMS)-attended OHCA incidence between men and women, but relative sex differences across ethnic groups and...

Objectives The aim of this study is to explore the beliefs, attitudes and social norms of Dutch adolescents with regard to smoking and sports. In addition, we examine whether there are differences between adolescents at sports clubs with versus without an outdoor smoke-free policy (SFP). Design Qualitative design in the form of focus group intervi...

Background Worldwide, socioeconomic differences in health and use of healthcare resources have been reported, even in countries providing universal healthcare coverage. However, it is unclear how large these socioeconomic differences are for different types of care and to what extent health status plays a role. Therefore, our aim was to examine to...

Introduction European estimates of adolescent smoking cessation are lacking and studies on the role of schools in quit behaviour are scarce. We aimed to describe smoking cessation attempts and success among adolescents in Europe and explored the association with school policy and programmes. Methods We used cross-sectional data from the 2013 and 2...

Introduction While evaluations of indoor smoke-free legislation have demonstrated major public health benefits among adults, their impact on smoking behavior of young people remains unclear. Therefore, we performed a systematic review of the association between smoke-free legislation in hospitality venues and smoking behavior of young people. Meth...

Background Outdoor smoke-free policies (SFPs) at sports clubs have significant potential to reduce adolescent smoking. However, the realization of this potential may be strongly dependent on how these policies are implemented in practice. The aim of this study is to explore the perceptions of key stakeholders at different sports clubs in the Nether...

Introduction: Outdoor smoke-free policies (SFPs) at sports clubs may contribute to the prevention of smoking among adolescents. Adolescents' support for such policy is important to its success. The aim of this study is to explore adolescents' perceptions with regard to an outdoor SFP at sports clubs in the Netherlands. Methods: Focus group discu...

Introduction: In most countries, public health partnerships exist to advance national tobacco control. We assessed characteristics related to tobacco control partnership capacity across Europe. Methods: We developed a tool to assess partnership characteristics related to their theoretical capacity to influence policy. The tool was based on an ex...

Background The relationship between socioeconomic position (SEP) and adolescent physical activity is uncertain, as most evidence is limited to specific settings and a restricted number of SEP indicators. This study aimed to assess the magnitude of socioeconomic differences in adolescent vigorous physical activity (VPA) across various European count...

Background Telephone triage is used to facilitate efficient and adequate acute care allocation, for instance in out-of-hours primary care services (OPCSs). Remote assessment of health problems is challenging and could be impeded by a patient’s ambiguous formulation of his or her healthcare need. Socioeconomically vulnerable patients may experience...