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IntroductionThis study investigates (1) whether mental health problems among individuals aged 12–15 years impact (a) high school dropout (ages 16–20 years) and (b) having a ‘neither in employment nor in education or training’ (NEET) period (ages 21–26 years); (2) the process of mediation and interaction by high school dropout in the association between mental health problems and NEET; and (3) whether these associations differ based on (non-)employment and mental health problems of parents.MethodsLongitudinal register data were used (n=196 227). Log-linear regression analyses were used to assess the association between reimbursed medication for mental health problems and high school dropout or NEET period for at least 12 months. Causal mediation analysis was used to assess the mediation and interaction effects of high school dropout in the association between mental health problems and NEET. Stratified analyses were performed based on parental employment and mental health status.ResultsMental health problems were strongly associated with high school dropout (RR 1.96, 95% CI 1.88; 2.04) and NEET (RR 2.44, 95% CI 2.35; 2.52). High school dropout had a small mediating effect in the relationship between mental health problems and NEET. Individuals with parents with mental health problems or non-employment more often experienced high school dropout and being NEET, but the mediating effect of dropout on NEET was lower in these individuals.ConclusionPreventing mental health problems early in the lifecourse is of paramount importance to promote educational outcomes and employment participation, but high school dropout only plays a marginal role in this relationship.

What has been largely overlooked, however, is the fact that these approaches are only valid in linear models and rely on the assumption that there is no interaction between exposure and mediator on the outcome (6). [...]because the importance of controlling for mediator-outcome confounders was never mentioned in Baron & Kenny, many studies have neglected to account for potential confounding factors of the mediator-outcome relationship. [...]whereas a total effect can always be decomposed into a natural direct and indirect effect, controlled direct effects are estimated for every level of the mediator (which may differ substantially depending on the magnitude of the interaction effect between exposure and mediator). An alternative approach in mediation analysis is to quantify controlled direct effects that only rely on assumptions (i) and (iii): no uncontrolled exposure-outcome confounding and no uncontrolled mediator-outcome confounding. [...]some have argued that controlled direct effects are much more policy-relevant because they estimate the proportion of the total effect of the exposure on the outcome that could be eliminated by a specific intervention on the mediator (13, 14). [...]sensitivity analysis is helpful to assess the robustness of the results to potential violations of the underlying assumptions.

Music is a promising (adjunctive) treatment for both acute and chronic pain, reducing the need for pharmacological analgesics and their side effects. Yet, little is known about the effect of different types of music. Hence, we investigated the efficacy of five music genres (Urban, Electronic, Classical, Rock and Pop) on pain tolerance. In this parallel randomized experimental study, we conducted a cold pressor test in healthy volunteers ( n  = 548). The primary outcome was pain tolerance, measured in seconds. No objective (tolerance time) or subjective (pain intensity and unpleasantness) differences were found among the five genres. Multinomial logistic regression showed that overall genre preference positively influenced pain tolerance. In contrast, the music genres that participants thought would help for pain relief did not. Our study was the first to investigate pain tolerance at genre level and in the context of genre preference without self-selecting music. In conclusion, this study provides evidence that listening to a favored music genre has a significant positive influence on pain tolerance, irrespective of the kind of genre. Our results emphasize the importance of individual music (genre) preference when looking at the analgesic benefits of music. This should be considered when implementing music in the clinical setting.

Prior research has indicated that residents who perceive their neighborhood as more cohesive have better mental and physical health than those with lower perceived neighborhood social cohesion. However, because most studies are based on cross-sectional data, it remains unclear whether improving the perceptions of social cohesion leads to better health over time. This study applied random effects within-between models to examine the within-individual and between-individual associations of perceived neighborhood social cohesion and poor self-assessed health (SAH) in a cohort of Dutch adults with 17-year follow-up. We also tested whether such associations varied by age, educational level, and gender. The results of pooled analyses indicated that higher perceived neighborhood social cohesion was associated with better SAH [odds ratio (OR): 0.72; 95% confidence interval (CI): 0.65, 0.80], but did not find conclusive evidence that within-individual changes in perceived neighborhood social cohesion were associated with SAH (OR: 0.96; 95% CI: 0.89, 1.04). We also did not observe any moderating effects for age, educational level, or gender. This study provides some evidence that improving social cohesion in neighborhoods may be a beneficial health promotion strategy.

Abstract Background Why lower socioeconomic groups behave less healthily can only partly be explained by direct costs of behaving healthily. We hypothesize that low income increases the risk of facing financial strain. Experiencing financial strain takes up cognitive ‘bandwidth’ and leads to less self-control, and subsequently results in more unhealthy behaviour. We therefore aim to investigate (i) whether a low income increases the likelihood of experiencing financial strain and of unhealthy behaviours, (ii) to what extent more financial strain is associated with less self-control and, subsequently, (iii) whether less self-control is related to more unhealthy behaviour. Methods Cross-sectional survey data were obtained from participants (25–75 years) in the fifth wave of the Dutch GLOBE study (N = 2812) in 2014. The associations between income, financial strain, self-control and health-behaviour-related outcomes (physical inactivity in leisure-time, obesity, smoking, excessive alcohol intake, and weekly fruit and vegetable intake) were analysed with linear regression and generalized linear regression models (log link). Results Experiencing great compared with no financial strain increased the risk of all health-behaviour-related outcomes, independent of income. Low self-control, as compared with high self-control, also increased the risk of an unhealthy lifestyle. Taking self-control into account slightly attenuated the associations between financial strain and the outcomes. Conclusion Great financial strain and low self-control are consistently associated with unhealthy behaviours. Self-control may partly mediate between financial strain and unhealthy behaviour. Interventions that relieve financial strain may free up cognitive bandwidth and improve health behaviour.

Background Structural nutrition interventions like a sugar tax or a product reformulation are strongly supported among the public health community but may cause a considerable backlash (e.g. inspiring aversion to institutions initiating the interventions among citizens). Such a backlash potentially undermines future health-promotion strategies. This study aims to uncover whether such backlash exists. Methods We fielded a pre-registered randomized, population-based survey experiment among adults from the Longitudinal Internet Studies for the Social Sciences panel (n = 1765; based on a random sampling of the Dutch population register). Participants were randomly allocated to the control condition (brief facts about health-information provision/nudging), or one of two experimental groups (the same facts, expanded with either a proposed sugar tax on or reformulation of sugar-sweetened beverages). Ordinary least squares regression was used to estimate the proposed interventions’ effects on four outcome variables: trust in health-promotion institutions involved; perceptions that these institutions have citizens’ well-being in mind (i.e. benevolence); perceptions that these institutions’ perspectives are similar to those of citizens (i.e. alignment of perspectives); and attitudes toward nutrition information. Results Trust, perceived benevolence and perceived alignment of perspectives were affected negatively by a proposed sugar tax (−0.24, 95% CI −0.38 to −0.10; −0.15, −0.29 to −0.01; −0.15, −0.30 to 0.00) or product reformulation (−0.32, −0.46 to −0.18; −0.24, −0.37 to −0.11; −0.18, 0.33 to −0.03), particularly among the non-tertiary educated respondents. Conclusions Sugar taxes or product reformulations may delegitimize health-promotion institutions, potentially causing public distancing from or opposition to these bodies. This may be exploited by political and commercial parties to undermine official institutions. Trial registration https://osf.io/qr9jy/?view_only=5e2e875a1fc348f3b28115b7a3fdfd90. Registered 3 February 2022.

BackgroundStudies on associations between urban green space and mental health have yielded mixed results. This study examines associations of green space exposures with subjective health and depressed affect of middle-aged and older adults in four European cohorts.MethodsData came from four Western-European and Central-European ageing cohorts harmonised as part of the Mindmap project, comprising 16 189 adults with an average age of 50–71 years. Green space exposure was based on the distance to the nearest green space and the amount of green space within 800 m buffers around residential addresses. Cohort-specific and one-step individual participant data (IPD) meta-analyses were used to examine associations of green space exposures with subjective health and depressed affect.ResultsThe amount of green spaces within 800 m buffers was lowest for Residential Environment and CORonary heart Disease (Paris, 15.0 hectares) and highest for Health, Alcohol and Psychosocial factors In Eastern Europe (Czech Republic, 35.9 hectares). IPD analyses indicated no evidence of an association between the distance to the nearest green space and depressed affect (OR 0.98, 95% CI 0.96 to 1.00) or good self-rated health (OR 1.01, 95% CI 0.99 to 1.02). Likewise, the amount of green space within 800 m buffers did not predict depressed affect (OR 0.98, 95% CI 0.96 to 1.00) or good self-rated health (OR 1.01, 95% CI 0.99 to 1.02). Findings were consistent across all cohorts.ConclusionsData from four European ageing cohorts provide no support for the hypothesis that green space exposure is associated with subjective health or depressed affect. While longitudinal evidence is required, these findings suggest that green space may be less important for older urban residents.

BackgroundLoneliness is associated with several adverse mental and physical health outcomes in older adults. Previous studies have shown that a variety of individual-level and perceived area-level characteristics are associated with loneliness. This study examined the associations of objectively measured social and physical neighbourhood characteristics with loneliness.MethodsWe used cross-sectional data from 1959 older adults (63–98 years) who participated in the Longitudinal Ageing Study Amsterdam (LASA; wave 2011/12) and the Health and Living Conditions of the Population of Eindhoven and Surroundings study (GLOBE; wave 2014) in the Netherlands. Study-specific loneliness scores were harmonised across both cohort studies and divided into tertiles denoting low, medium and high levels of loneliness. Objectively measured neighbourhood characteristics, including area-level percentages of low educated residents, social security beneficiaries and unoccupied dwellings, average income, crime levels and land use mix, were linked to individual-level data. Multinomial logistic regression analyses were conducted to examine the associations of interest.ResultsThere was no statistical evidence for an association of the included neighbourhood characteristics with loneliness. Although not statistically significant, the observed associations suggested that participants living in neighbourhoods with more heterogeneous land use mix were less likely to have a medium and high level of loneliness than those living in more homogeneous neighbourhoods in terms of land use mix (ORmedium=0.54, 95% CI=0.18–1.67; ORhigh=0.67, 95% CI=0.21–2.11).ConclusionThe results indicate that the included objectively measured social and physical neighbourhood characteristics are not associated with loneliness in old age.

Background Over the past decades, the prevalence of obesity among adults has rapidly increased, particularly in socioeconomically deprived urban neighbourhoods. To better understand the complex mechanisms behind this trend, we created a system map exposing the underlying system driving obesity prevalence in socioeconomically deprived urban neighbourhoods over the last three decades in the Netherlands. Methods We conducted Group Model Building (GMB) sessions with a group of thirteen interdisciplinary experts to develop a Causal Loop Diagram (CLD) of the obesogenic system. Using system-based analysis, the underlying system dynamics were interpreted. Results The CLD demonstrates the food environment, physical activity environment, socioeconomic environment and socio-political environment, and their interactions. We identified the following overarching reinforcing dynamics in the obesogenic system in socioeconomically deprived urban neighbourhoods: (1) adverse socioeconomic conditions and an unhealthy food environment reinforced each other, (2) increased social distance between social groups and adverse socioeconomic conditions reinforced each other and (3) increased social distance between institutions and communities and the normalisation of unhealthy behaviours reinforced each other. These deeper system dynamics further reinforced chronic stress, sedentary behaviour, sleeping problems, unhealthy diets and reduced physical activity over time. In turn, these dynamics led to the emergent result of rising obesity prevalence in socioeconomically deprived urban neighbourhoods over the past decades. Conclusions Our study sheds light on the system dynamics leading to neighbourhoods with an unhealthy food environment, challenging socioeconomic conditions, a widening distance between social groups and an infrastructure that discouraged physical activity while promoting sedentary behaviour. Our insights can form the basis for the development of an integrated approach aimed at reshaping the obesogenic system in socioeconomically deprived urban neighbourhoods.

Governments grapple with garnering public support for the interventions they propose to achieve with respect to environmental sustainability. We depart from the position that interventions for these issues must align with public perspectives to receive support among the population at large. Our study uses 14 focus-group interviews (  = 57) conducted in the Netherlands to inductively explore these perspectives on a wide range of sustainability issues and their interventions. Our sample predominantly comprises individuals who have not completed tertiary education. As extant research suggests, these individuals are less concerned with sustainability issues. We identify three lenses through which our respondents perceived sustainability, namely how it: 1) impacts their personal life ( ); 2) aligns with their community ( ); and 3) raises doubts ( ). They reveal that many respondents are principally engaged with sustainability in ways that they felt had practical repercussions for them or their community. We conclude by instigating a rethinking of inclusive sustainability interventions by sensitizing them to the perspectives individuals have of sustainability issues and interventions, and those of non-tertiary educated individuals in particular.