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Educational inequalities in sports participation remain a public health issue in the Netherlands. Combining structurally based resources from Pierre Bourdieu's theory of capital with Amartya Sen's conceptualization of individual agency may offer new insights into the complex mechanisms that drive these inequalities. Specifically, we posited that the way individuals are able to exercise their agency within the structurally based economic, social, and cultural resources they have access to may help explain educational inequalities in sports participation. Data from two waves of the GLOBE study (2014, 2021) were used to test whether two sequential mediators, structurally based resources followed by individual agency, help explain the relationship between educational level and sports participation. Adults aged 25 and older residing in Eindhoven, the Netherlands self-reported highest attained educational level, structurally based resources (economic, social, and embodied cultural capital), individual agency (self-control, perceived choice, and reflexivity), and sports participation. A sequential mediation analysis using structural equation modelling was used to test the direct effect of education on sports participation, the sequential indirect effect through both mediators, and partial indirect effects through each mediator individually. Educational level was positively associated with sports participation. The hypothesized sequential mediation pathway was not supported; educational level was positively associated with structurally based resources and structurally based resources were positively associated with individual agency, but individual agency was not related to sports participation. Though not through individual agency, structurally based resources helped explain educational inequalities in sports participation. Having access to more economic, social, and cultural resources may empower individuals by increasing their agency. This increased agency was not associated with sports participation, which could be because sports participation is not universally valued as a goal. The conceptualization and operationalization of individual agency in the context of sports participation warrants more research. We found that structurally based resources helped explain a substantial portion of educational inequalities in sport, so we propose that policies alleviating more than just economic barriers to sports participation, but also social and cultural barriers, may help reduce educational inequalities in sports participation in the Netherlands. [ABSTRACT FROM AUTHOR]

Background: Interest in applying a complex systems approach to understanding socioeconomic inequalities in health is growing, but an overview of existing research on this topic is lacking. In this systematic scoping review, we summarize the current state of the literature, identify shared drivers of multiple health and health behavior outcomes, and highlight areas ripe for future research. Methods: SCOPUS, Web of Science, and PubMed databases were searched in April 2023 for peer-reviewed, English-language studies in high-income OECD countries containing a conceptual systems model or simulation model of socioeconomic inequalities in health or health behavior in the adult general population. Two independent reviewers screened abstracts and full texts. Data on study aim, type of model, all model elements, and all relationships were extracted. Model elements were categorized based on the Commission on Social Determinants of Health framework, and relationships between grouped elements were visualized in a summary conceptual systems map. Results: A total of 42 publications were included; 18 only contained a simulation model, 20 only contained a conceptual model, and 4 contained both types of models. General health outcomes (e.g., health status, well-being) were modeled more often than specific outcomes like obesity. Dietary behavior and physical activity were by far the most commonly modeled health behaviors. Intermediary determinants of health (e.g., material circumstances, social cohesion) were included in nearly all models, whereas structural determinants (e.g., policies, societal values) were included in about a third of models. Using the summary conceptual systems map, we identified 15 shared drivers of socioeconomic inequalities in multiple health and health behavior outcomes. Conclusions: The interconnectedness of socioeconomic position, multiple health and health behavior outcomes, and determinants of socioeconomic inequalities in health is clear from this review. Factors central to the complex system as it is currently understood in the literature (e.g., financial strain) may be both efficient and effective policy levers, and factors less well represented in the literature (e.g., sleep, structural determinants) may warrant more research. Our systematic, comprehensive synthesis of the literature may serve as a basis for, among other things, a complex systems framework for socioeconomic inequalities in health. [ABSTRACT FROM AUTHOR]

Background: The number of sports facilities, sports clubs, or city parks in a residential neighbourhood may affect the likelihood that people participate in sports and their preferences for a certain sports location. This study aimed to assess whether objective physical and socio-spatial neighbourhood characteristics relate to sports participation and preferences for sports locations.Methods: Data from Dutch adults (N = 1201) on sports participation, their most-used sports location, and socio-demographic characteristics were collected using an online survey. Objective land-use data and the number of sports facilities were gathered for each participant using a 2000-m buffer around their home locations, whereas socio-spatial neighbourhood characteristics (i.e., density, socio-economic status, and safety) were determined at the neighbourhood level. A discrete choice-modelling framework (multinomial probit model) was used to model the associations between neighbourhood characteristics and sports participation and location.Results: Higher proportions of green space, blue space, and the number of sports facilities were positively associated with sports participation in public space, at sports clubs, and at other sports facilities. Higher degrees of urbanization were negatively associated with sports participation at public spaces, sports clubs, and other sports facilities.Conclusions: Those with more green space, blue space or sports facilities in their residential neighbourhood were more likely to participate in sports, but these factors did not affect their preference for a certain sports location. Longitudinal study designs are necessary to assess causality: do active people choose to live in sports-facilitating neighbourhoods, or do neighbourhood characteristics affect sports participation? [ABSTRACT FROM AUTHOR]

Background: The key mechanisms underlying socioeconomic inequalities in dietary intake are still poorly understood, hampering the development of interventions. An important, but sparsely mentioned mechanism is that of 'social distinction', whereby those in a higher socioeconomic position adopt dietary patterns by which they can distinguish themselves from lower socioeconomic groups. We investigated the importance of distinction as a mechanism, by testing the socioeconomic gradient in the consumption of so-called 'superfoods' and the contribution of a well-established indicator of distinction, cultural participation. Methods: Data from participants (25-75 years) of the 2014 survey of the Dutch population-based GLOBE study were used (N = 2812). Multivariable regression models were used to analyse the association between education, income and cultural participation (e.g. visits to museums, opera, theatre, concerts) and the consumption of superfoods (spelt, quinoa and goji berries, chia seeds or wheatgrass). Results: The consumption of superfoods is far more prevalent among higher socioeconomic groups. Adjusting for cultural participation strongly attenuated the educational and income gradient in superfoods consumption, whereas cultural participation remained strongly associated with superfoods consumption. Those in the highest quintile of cultural participation reported the highest consumption of spelt products (OR = 2.97, 95% CI = 2.10;4.18), quinoa (OR = 3.50, 95% CI = 2.12;5.79) and goji berries, chia seeds or wheatgrass (OR = 2.69, 95% CI = 1.73;4.17). Conclusions: The associations between socioeconomic position and the consumption of 'superfoods' seem to be partially driven by a process of social distinction. These findings suggest that distinction may be an important, but currently neglected mechanism in generating socioeconomic inequalities in dietary intake. It deserves a more prominent role in interventions to reduce these inequalities. [ABSTRACT FROM AUTHOR]

Socio-economic groups differ in their material, living, working and social circumstances, which may result in different priorities about their daily-life needs, including the priority to make healthy food choices. Following Maslow's hierarchy of human needs, we hypothesised that socio-economic inequalities in healthy food choices can be explained by differences in the levels of need fulfilment. Postal survey data collected in 2011 (67·2 % response) from 2903 participants aged 20–75 years in the Dutch GLOBE (Gezondheid en Levens Omstandigheden Bevolking Eindhoven en omstreken) study were analysed. Maslow's hierarchy of human needs (measured with the Basic Need Satisfaction Inventory) was added to age- and sex-adjusted linear regression models that linked education and net household income levels to healthy food choices (measured by a FFQ). Most participants (38·6 %) were in the self-actualisation layer of the pyramid. This proportion was highest among the highest education group (47·6 %). Being in a higher level of the hierarchy was associated with a higher consumption of fruits and vegetables as well as more healthy than unhealthy bread, snack and dairy consumption. Educational inequalities in fruit and vegetable intake (B= − 1·79, 95 % CI − 2·31, − 1·28 in the lowest education group) were most reduced after the hierarchy of needs score was included (B= − 1·57, 95 % CI − 2·09, − 1·05). Inequalities in other healthy food choices hardly changed after the hierarchy of needs score was included. People who are satisfied with higher-level needs make healthier food choices. Studies aimed at understanding socio-economic inequalities in food choice behaviour need to take differences in the priority given to daily-life needs by different socio-economic groups into account, but Maslow's pyramid offers little help. [ABSTRACT FROM PUBLISHER]

Background: Lower educated older persons are at increased risk of becoming frail as compared with higher educated older persons. To reduce educational inequalities in the development of frailty, we investigated whether lifestyle, health and social participation mediate this relationship. Methods: Longitudinal data of 14 082 European community-dwelling persons aged 55 years and older participating in the Survey on Health, Ageing, and Retirement in Europe (SHARE) in 2004 and 2006, were used. Associations of lifestyle (smoking behaviour and alcohol consumption), health (depression, memory function, chronic diseases) and social participation, with educational level and frailty worsening were investigated using regression models. In multinomial logistic regression analysis, mediators were added to models in which educational level was associated with worsening in frailty over 2 years follow-up. Results: In all countries, frailty worsening was more prevalent among lower as compared with higher educated persons, although odds ratios were only statistically significant in five of the 11 countries included [ORs varying from 1.40 (95% CI: 1.06-1.84) to 1.61 (95% CI: 1.21-2.14)]. Except for smoking behaviour and memory function, the factors under study all showed associations with educational level and frailty worsening that met the conditions for mediation. After inclusion of the four relevant mediators, attenuation of odds ratios varied between 4.9 and 31.5%. Conclusion: While lifestyle, health and social participation were associated with frailty worsening over 2 years among European community-dwelling older persons, only small to moderate parts of educational inequalities in frailty worsening were explained by these factors. [ABSTRACT FROM AUTHOR]

Background: Healthiness, price, and convenience are typically indicated as important motives for food choices; however, it is largely unknown to what extent older adults from high and low socioeconomic groups differ in these underlying motives. A discrete choice experiment (DCE) is an innovative way to elicit implicit motives for food choices. Objective: The aim was to investigate differences in food motives between socioeconomic groups by means of a DCE. Design: A DCE was carried out during a face-to-face interview among older adults as part of the Health and Living Conditions in Eindhoven and surrounding cities (GLOBE) cohort study, The Netherlands. Participants (n = 399; mean age: 63.3 y) were offered a series of choice sets about a usual dinner at home and were asked to choose in each choice set between 2 meals and an opt-out choice, with different combinations of attribute levels. We included 5 meal attributes (taste, healthiness, preparation time, travel time to shops, and price) and 3 or 4 levels for each attribute. Data were analyzed by multinomial logit models. Results: Healthiness, taste, price, and travel time to the grocery store proved to significantly influence older adults' meal decisions; preparation time was not significant. Healthiness was the most important attribute for all of the participants. More highly educated participants rated a healthy and less expensive meal to be more important than did less educated participants. Those with a high income rated a meal that was healthy and very tasteful to be more important than did those with a lower income. Conclusions: Healthiness, taste, price, and travel time to grocery shops influenced older adults' meal decisions. Higher socioeconomic groups valued health more than did lower socioeconomic groups. DCEs represent a promising method to gain insight into the relative importance of motives for food choices. This trial was registered at www.isrctn.com as ISRCTN60293770. Am J Clin Nutr 2015;101:768-74. [ABSTRACT FROM AUTHOR]

Introduction: This cross-sectional study uses an adaptation of a social-ecological model on the hierarchy of walking needs to explore direct associations and interactions of urban-form characteristics and individual psychosocial factors for leisure-time walking. Methods: Questionnaire data (n = 736) from adults (25-74 yr) and systematic field observations within 14 neighborhoods in Eindhoven (the Netherlands) were used. Multilevel logistic regression models were used to relate the urban-form characteristics (accessibility, safety, comfort, and pleasurability) and individual psychosocial factors (attitude, self-efficacy, social influence, and intention) to two definitions of leisure-time walking, that is, any leisure-time walking and sufficient leisure-time walking according to the Dutch physical activity norm and to explore their interactions. Results: Leisure-time walking was associated with psychosocial factors but not with characteristics of the urban environment. For sufficient leisure-time walking, interactions between attitude and several urban-form characteristics were found, indicating that positive urban-form characteristics contributed toward leisure-time walking only in residents with a less positive attitude toward physical activity. In contrast, living in a neighborhood that was accessible for walking was stronger associated with leisure-tune walking among residents who experienced a positive social influence to engage in physical activity compared with those who reported less social influence. Conclusions: This study showed some evidence for an interaction between the neighborhood environment and the individual psychosocial factors in explaining leisure-time walking. The specific mechanism of interaction may depend on the specific combination of psychosocial factor and environmental factor. The lack of association between urban form and leisure-time walking could be partly due to the little variation in urban-form characteristics between neighborhoods. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this longitudinal study is to identify risk groups for disengagement from sports during adolescence. In addition, it will be explored whether cognitive and environmental factors can explain socio-demographic differences in disengagement from sports. Methods: Data were obtained from the Environmental Determinants of Obesity in Rotterdam Schoolchildren study, and 357 adolescents were eligible for analysis. Socio-demographics (gender, ethnicity, education), individual cognitions and neighbourhood perceptions were assessed at baseline (2005/2006), and sports participation at baseline and at follow-up (2007/2008). Two dichotomous outcome variables were constructed: (i) disengagement from sports (yes/no) and (ii) ceased compliance with the fitnorm (i.e. cease engaging in sports ≥3 times/wk) (yes/no). In logistic regression and mediation analyses, we identified socio-demographic differences in the two outcomes. Subsequently, we applied mediation analyses to identify the contribution of cognitive and environmental explanatory factors of the socio-demographic differences. Results: Girls [odds ratio (OR): 2.5, 95% confidence interval (CI): 1.5–4.5] were more likely than boys to disengage from sports. Girls (OR: 2.5, 95% CI: 1.4–4.2), adolescents of non-Western background (OR: 1.8, 95% CI: 1.0–3.0) and those in lower educational levels (OR: 1.7, 95% CI: 1.0–2.9) were more likely to cease compliance with the fitnorm. Perceived neighbourhood safety partly explained gender differences in disengagement from sports (8%). Intention partly explained ethnical (32%) and educational differences (37%) in ceasing compliance with the fitnorm. Conclusions: Girls, lower-educated adolescents and those with a non-Western background showed more pronounced reductions in sports participation and compliance with the fitnorm. Intention and perceived neighbourhood safety could partially explain these differences. [ABSTRACT FROM AUTHOR]

Although physical activity is often believed to be influenced by both environmental and individual factors, little is known about their interaction. This study explores interactions of perceived safety and social neighborhood factors with psychosocial cognitions for leisure-time walking. Cross-sectional data were obtained from residents (age 25–75 years) of 212 neighborhoods in the South-East of the Netherlands, who participated in the Dutch GLOBE study in 2004 (N = 4395, survey response 64.4%). Direct associations of, and interactions between perceived neighborhood safety, social neighborhood factors (social cohesion, social network and feeling at home) and psychosocial cognitions (attitude, self-efficacy, social influence and intention) on two outcomes of leisure-time walking [yes versus no (binary), and among walkers: minutes per week (continuous)] were analyzed in multilevel regression models. The association between attitude and participating in leisure-time walking was stronger in those who felt less at home in their neighborhood. Social influence and attitude were stronger associated with participation in leisure-time walking in those who sometimes felt unsafe in their neighborhood. A positive intention was associated with more minutes walked in those who perceived their neighborhood as unsafe among those who walked. Only limited support was found for interactions between neighborhood perceptions and psychosocial cognitions for leisure-time walking. [ABSTRACT FROM PUBLISHER]

Background: Behavioural, material and psychosocial risk factors may explain educational inequalities in general health. To what extent these risk factors have similar or different contributions to educational inequalities in mental health is unknown. Methods: Data were derived from the Norwegian Survey of Level of Living from 2005, comprising 5791 respondents aged ≥25 years. The study objectives were addressed by means of a series of logistic regression analyses in which we examined: (i) educational inequalities in self-reported general and mental health; (ii) the associations between behavioural, material and psychosocial risk factors and general and mental health, controlled for sex, age and education; and (iii) the contribution of risk factors to the observed health gradients. Results: The lower educated were more likely to be in poor health [odds ratio (OR): 3.46 (95% confidence interval, CI: 2.84–4.21)] and to be in poor mental health [OR: 1.41 (95% CI: 1.12–1.78)] than the highest educated. The joint contribution of behavioural, material and psychosocial risk factors explained all the variations of mental health inequalities, whereas these were able to explain ∼40% of the inequalities in general health. Both behavioural and material risk factors contributed substantially to the explanation of general and mental health inequalities, whereas the psychosocial risk factor (i.e. having close persons to communicate with) only seemed to make a larger difference for the explanation of mental health inequalities. Conclusion: Policies and interventions to reduce health inequalities should have a broad focus. Combined strategies should be applied to improve physical activity, decrease smoking and improve material and psychosocial conditions among lower educated groups, to achieve the true potential of reducing inequalities in both general and mental health. [ABSTRACT FROM PUBLISHER]

Background: This study systematically reviewed the evidence pertaining to socioeconomic inequalities in different domains of physical activity (PA) by European region. Methods: Studies conducted between January 2000 and December 2010 were identified by a systematic search in Pubmed, Embase, Web of Science, Psychinfo, Sportdiscus, Sociological Abstracts, and Social Service Abstracts. English-language peer-reviewed studies undertaken in the general population of adults (18-65 years) were classified by domain of PA (total, leisure-time including sport, occupational, active transport), indicator of socioeconomic position (education, income, occupation), and European region. Distributions of reported positive, negative, and null associations were evaluated. Results: A total of 131 studies met the inclusion criteria. Most studies were conducted in Scandinavia (n = 47). Leisure-time PA was the most frequently studied PA outcome (n = 112). Considerable differences in the direction of inequalities were seen for the different domains of PA. Most studies reported that those with high socioeconomic position were more physically active during leisure-time compared to those with low socioeconomic position (68% positive associations for total leisure-time PA, 76% for vigorous leisure-time PA). Occupational PA was more prevalent among the lower socioeconomic groups (63% negative associations). Socioeconomic differences in total PA and active transport PA did not show a consistent pattern (40% and 38% positive associations respectively). Some inequalities differed by European region or socioeconomic indicator, however these differences were not very pronounced. Conclusions: The direction of socioeconomic inequalities in PA in Europe differed considerably by domain of PA. The contradictory results for total PA may partly be explained by contrasting socioeconomic patterns for leisure-time PA and occupational PA. [ABSTRACT FROM AUTHOR]

Background: To improve our understanding of the neighborhood environment - physical activity (PA) relationship, it is of importance to assess associations between neighborhood environmental characteristics and neighborhood-based PA.Methods: Participants' (N = 308; 45-65 years) light PA (LPA) and moderate-vigorous PA (MVPA) within a 400, 800, and 1600 m buffer around adults' homes was measured using accelerometers and GPS-devices. Land use data in ArcGIS provided neighborhood characteristics for the same buffers. Multilevel linear regression models, adjusted for socio-demographic variables and attitude towards PA, were used to assess associations of objective neighborhood characteristics with neighborhood-based LPA and MVPA.Results: LPA was positively associated with the proportions of roads (within a 400 m buffer), and negatively associated with the proportions of recreational areas (within an 800 m buffer), and the proportion of green space (within the 800 m and 1600 m buffers). Multiple characteristics of 400 m buffers were positively associated with MVPA, i.e. proportions of green space, blue space, residences, shops and foodservice industry, sports terrain, and public social-cultural facilities. Also, characteristics of larger buffers were positively associated with MVPA, i.e. the proportions of shops and foodservice industry, sports terrain, and blue space (within an 800 m buffer), and the proportion of public social-cultural facilities (within the 800 m and 1600 m buffers).Conclusions: Objective neighborhood characteristics of smaller as well as larger sized buffers were associated with neighborhood-based LPA and MVPA. Green and blue spaces seem to be of particular importance for PA in the smallest buffer, i.e. in the direct surrounding of adults' homes. [ABSTRACT FROM AUTHOR]