Sociodemographic differences in 10-year time trends of emotional and behavioural problems among adolescents attending secondary schools in Amsterdam, The Netherlands.

Societal change in western societies may impact emotional and behavioural problems of adolescents. Firm epidemiological evidence of changes in emotional and behavioural problems during the last decade is lacking. Insight into secular changes in emotional and behavioural problems among adolescents from various sociodemographic groups is crucial for adequate and targeted policy making. Therefore, the purpose of this study was to examine 10-year time trends in emotional and behavioural problems among adolescents, and potential differences in time trends between sociodemographic groups. Analyses were based on annually repeated cross-sectional data including 56,159 multi-ethnic students (13-14 years old) in the second year of various levels of secondary education in Amsterdam, The Netherlands, using the internationally validated Strengths and Difficulties Questionnaire. In general, emotional and behavioural problems increased over a 10-year time period (i.e., relative increase of total difficulties by 19%). This increase was mainly due to an increase in hyperactivity/inattention problems, while peer-relationship problems decreased. Time trends differed somewhat by sex: total difficulties and emotional problems increased in girls but remained fairly stable in boys. In Amsterdam, emotional and behavioural problems in adolescents seemingly increased over time, especially hyperactivity/inattention problems. Further research is needed to clarify the underlying causes. We cannot totally exclude potential confounders underlying our findings. Our findings can inform policies to target health programs at sociodemographic groups at increased risk.

Mortality trends among migrant groups living in Amsterdam.

BACKGROUND: The main aim of this paper is to see to what extent mortality patterns between migrants living in the Netherlands converge. This might be an indicator of health and health care acculturation. METHODS: This is an observational study on the basis of standard mortality registration data collected between 1996 and 2007. Eight ethnic groups living in Amsterdam are examined to see if mortality converges or diverges over time. Trends in mortality are studied using Poisson regression. The life expectancy between groups is compared for three time periods. RESULTS: The data showed that for males and females the life expectancy and death rates improved between 1996-1999 and 2004-2007. Most ethnic groups, both males and females, followed this positive trend. For most indicators the ethnic groups converged in terms of mortality. The data also shows the healthy migrant effect with those in Amsterdam from Dutch origin having a relatively high mortality and low life expectancy. DISCUSSION: In this paper the "healthy migrant effect" can be clearly observed. An important cause is the emigration of the original and relatively affluent and healthy Dutch population to suburban areas. Mortality trends tend to converge between ethnic groups during the period 1997-2000 and 2004-2007. The data presented here shows further that trends in mortality and life expectancy which apply to all ethnic groups are much more powerful as this convergence. One wonders if bridging the mortality gap between groups is of much benefit for minority groups, or that minority groups would benefit more from an overall decrease in mortality. CONCLUSION: Mortality trends that apply to all groups tend to be much stronger compared with trends for individual groups. This shows that dynamics affecting all groups similarly have a considerably stronger effect on mortality outcomes in various ethnic groups compared with possible convergence.

Use of the life table to compare mortality in ethnic groups in Amsterdam, the Netherlands.

BACKGROUND: The life table is a valid and frequently used instrument to compare the mortality of migrant groups. Most analyses are limited to an overview and give only life expectancy; however, further analysis of the life table can give more insight into differences in patterns of mortality between groups. METHODS: A thorough life table analysis was applied to the mortality data of seven ethnic groups by age and gender. RESULTS: Life expectancy is systematically higher in migrants compared with the Dutch citizens of Amsterdam. However, between birth and the age of 40 the probability of death is higher among non-western migrants compared with citizens of western origin. The number of deaths is small among the young. This results in very small differences in survival between the groups; from birth up to the age of 40 the survival rate is 98.7% for citizens of western origin and 98.3% for citizens of non-western origin. In all seven ethnic groups over 90.7% of babies, male and female, survive up to the age of 60. In all female groups the survival is better than in male groups. Males and females aged 0 to 40 from Antillean origin are the only exception. CONCLUSION: Life expectancy is generally higher in non-western than in western groups. Differences in survival between ethnic groups are small up to middle age.

Does a reduction in alcohol use by Dutch high school students relate to higher use of tobacco and cannabis?

BACKGROUND: Substance use of adolescents was investigated in a region around Amsterdam, the Netherlands, in the period 2005-2009. The study was intended to find out to what extent behaviour related to different substances are interrelated and how trends develop in different subgroups. METHODS: Two cross-sectional surveys were conducted among Dutch students in the second and fourth year of secondary school, aged 13-16 [n = 1,854 in 2005; n = 2,088 in 2009] by making use of an online questionnaire including questions about alcohol consumption, tobacco use (smoking behaviour) and cannabis use. Two educational levels were included. RESULTS: Decreases in alcohol consumption, tobacco and cannabis use were found between 2005 and 2009. The strongest decline was seen in alcohol consumption. Last month drinking decreased from 61.8% in 2005 to 36.5% in 2009. Last month binge drinking decreased from 38.7% in 2005 to 24.0% in 2009. Reduced alcohol consumption was found among boys and girls, for all ages and in both educational levels. Changes were strongest among 13-year-olds. Weekly or daily smoking declined between 2005 and 2009 among 13-year-olds, girls and students in the lower schooling level. Last month cannabis use decreased among girls and students in the higher schooling level. In both 2005 and 2009 clustering with alcohol consumption was found for the use of other substances. CONCLUSIONS: Between 2005 and 2009 alcohol consumption strongly decreased among high school students. This may be due to the national prevention campaign which in the same period highlighted the importance of not drinking before the age of 16. The decrease in smoking and cannabis use between 2005 and 2009 may be due to clustering with alcohol consumption. A reduction in the use of alcohol in adolescence did not lead to replacement by tobacco or cannabis use.

The relation between self-reported worry and annoyance from air and road traffic.

Negative perceptions such as fear or worry are known to be an important determinant of annoyance. Annoyance caused by noise and odour has been analysed in relation to worry about safety or health due to environmental hazards, using responses to a health survey. In the survey area high environmental impacts come from air and road traffic. The survey results show a correlation between worry due to the airport or passing aircraft and noise and odour annoyance from aircraft (correlation coefficient (c.c.) close to 0.6). For the relation between worry about a busy street and annoyance from road traffic the correlation is lower (c.c. 0.4-0.5). Worries about different situations, such as living below sea level, close to an airport, busy street or chemical industry, are highly correlated (c.c. 0.5-0.9), also for situations that are not obviously related. Personal factors can also lead to more worry: being female, above 35 years of age, having a high risk for anxiety/depression and being in bad health increase the odds for being worried. The results thus suggest that worry about safety or health is correlated to both personal and environmental factors.

The relation between scores on noise annoyance and noise disturbed sleep in a public health survey.

The relation between responses to survey questions on noise annoyance and self-reported sleep disturbance has been analysed to gain insight in its dependency on noise source or noise type and on individual characteristics. The results show a high correlation between responses (scores 0-10) with Pearson's correlation coefficient close to 0.8 for respondents who report hearing the source. At the same level of annoyance, scooters and neighbours are associated with more sleep disturbance, air and road traffic with less. The relation between Annoyance (A) and Sleep Disturbance (SD) is also significantly related to age, the use of sleeping drugs, and living alone. However, the differences in the A-SD relations with respect to source and characteristic are small. Noise-related sleep disturbance is associated more strongly to noise annoyance than it is to noise exposure. For transportation noise both scores are more often equal when the annoyance score is 7 or higher; this change in scoring behaviour could be an indication for a change to severe annoyance.

The effects of a nationwide program to reduce seclusion in the Netherlands.

BACKGROUND: From 2006 to 2009, the Dutch government provided €5 m annually for a nationwide program to reduce seclusion in psychiatric hospitals by 10% a year. We aimed to establish whether the numbers of both seclusion and involuntary medication changed significantly after the start of this national program. METHODS: Using Poisson regression to estimate difference in logit slopes, we analyzed data for 1998-2009 from the Dutch Health Care Inspectorate, retrospectively examining the national numbers of seclusion and involuntary medication before and after the start of the program. RESULTS: The difference in slopes of the numbers of seclusion before and after the start of the program was statistically significant (difference 5.2%: p < 0.001). After the start of the program seclusions dropped 2.0% per year. Corrected for the increasing number of involuntary hospitalizations this figure was 4.7% per year. The difference in slopes of the numbers of involuntary medication did not change statistically significant (difference 0.5%, n.s.). After correction for the increasing number of involuntary hospitalizations the difference turned significant (difference 3.3%, p = 0.002). CONCLUSIONS: After the start of the nationwide program the number of seclusions fell, and although significantly changing, the reduction was modest and failed to meet the objective of a 10% annual decrease. The number of involuntary medications did not change; instead, after correction for the number of involuntary hospitalizations, it increased.

Suicide death and hospital-treated suicidal behaviour in asylum seekers in the Netherlands: a national registry-based study.

BACKGROUND: Several suicide and suicidal behaviour risk factors are highly prevalent in asylum seekers, but there is little insight into the suicide death rate and the suicidal behaviour incidence in this population. The main objective of this study is to assess the burden of suicide and hospital-treated non-fatal suicidal behaviour in asylum seekers in the Netherlands and to identify factors that could guide prevention. METHODS: We obtained data on cases of suicide and suicidal behaviour from all asylum seeker reception centres in the Netherlands (period 2002-2007, age 15+). The suicide death rates in this population and in subgroups by sex, age and region of origin were compared with the rate in the Dutch population; the rates of hospital-treated suicidal behaviour were compared with that in the population of The Hague using indirect age group standardization. RESULTS: The study included 35 suicide deaths and 290 cases of hospital-treated suicidal behaviour. The suicide death rate and the incidence of hospital-treated suicidal behaviour differed between subgroups by sex and region of origin. For male asylum seekers, the suicide death rate was higher than that of the Dutch population (N = 32; RR = 2.0, 95%CI 1.37-2.83). No difference was found between suicide mortality in female asylum seekers and in the female general population of the Netherlands (N = 3; RR = 0.73; 95%CI 0.15-2.07). The incidence of hospital-treated suicidal behaviour was high in comparison with the population of The Hague for males and females from Europe and the Middle East/South West Asia, and low for males and females from Africa. Health professionals knew about mental health problems prior to the suicidal behaviour for 80% of the hospital-treated suicidal behaviour cases in asylum seekers. CONCLUSIONS: In this study the suicide death rate was higher in male asylum seekers than in males in the reference population. The incidence of hospital-treated suicidal behaviour was higher in several subgroups of asylum seekers than that in the reference population. We conclude that measures to prevent suicide and suicidal behaviour among asylum seekers in the Netherlands are indicated.

Ethnic variation in validity of the estimated obesity prevalence using self-reported weight and height measurements.

BACKGROUND: We examined ethnic differences between levels of body mass index (BMI) based on self-reported and measured body height and weight and the validity of self-reports used to estimate the prevalence of obesity (BMI≥30 kg/m2) in Turkish, Moroccan, and Dutch people in the Netherlands. Furthermore, we investigated whether BMI levels and the prevalence of obesity in Turkish and Moroccan people with incomplete self-reports (missing height or weight) differ from those with complete self-reports. METHODS: Data on self-reported and measured height and weight were collected in a population-based survey among 441 Dutch, 414 Turks and 344 Moroccans aged 18 to 69 years in Amsterdam, the Netherlands in 2004. BMI and obesity were calculated from self-reported and measured height and weight. RESULTS: The difference between measured and estimated BMI was larger in Turkish and Moroccan women than in Dutch women, which was explained by the higher BMI of the Turkish and Moroccan women. In men we found no ethnic differences between measured and estimated BMI. Sensitivity to detect obesity was low and specificity was high. In participants with available self-reported and measured height and weight, self-reports produced a similar underestimation of the obesity prevalence in all ethnic groups. However, many obese Turkish and Moroccan women had incomplete self-reports, missing height or weight, resulting in an additional underestimation of the prevalence of obesity. Among men (all ethnicities) and Dutch women, the availability of height or weight by self-report did not differ between obese and non obese participants. CONCLUSIONS: BMI based on self-reports is underestimated more by Turkish and Moroccan women than Dutch women, which is explained by the higher BMI of Turkish and Moroccan women. Further, in women, ethnic differences in the estimation of obesity prevalence based on self-reports do exist and are due to incomplete self-reports in obese Turkish and Moroccan women. In men, ethnicity is not associated with discrepancies between levels of BMI and obesity prevalence based on measurements and self-reports. Hence, our results indicate that using measurements to accurately determine levels of BMI and obesity prevalence in public health research seems even more important in Turkish and Moroccan migrant women than in other populations.

Ethnic differences in total and HDL cholesterol among Turkish, Moroccan and Dutch ethnic groups living in Amsterdam, the Netherlands.

BACKGROUND: High total cholesterol and low HDL (high-density lipoprotein) cholesterol are important determinants of cardiovascular disease. Little is known about dyslipidemia among Turkish and Moroccan migrants, two of the largest ethnic minority groups in several European countries. This study examines ethnic differences in total and HDL cholesterol levels between Dutch, Turkish and Moroccan ethnic groups. METHODS: Data were collected in the setting of a general health survey, in Amsterdam, the Netherlands, in 2004. Total response rate was 45% (Dutch: 46%, Turks: 50%, Moroccans: 39%). From 1,220 adults information on history of hypercholesterolemia, lifestyle and demographic background was obtained via health interviews. In a physical examination measurements of anthropometry and blood pressure were performed and blood was collected. Total and HDL cholesterol were determined in serum. RESULTS: Total cholesterol levels were lower and hypercholesterolemia was less prevalent among the Moroccan and Turkish than the Dutch ethnic population. HDL cholesterol was also relatively low among these migrant groups. The resulting total/HDL cholesterol ratio was particularly unfavourable among the Turkish ethnic group. Controlling for Body Mass Index and alcohol abstinence substantially attenuated ethnic differences in HDL cholesterol levels and total/HDL cholesterol ratio. CONCLUSIONS: Total cholesterol levels are relatively low in Turkish and Moroccan migrants. However part of this advantage is off-set by their relatively low levels of HDL cholesterol, resulting in an unfavourable total/HDL cholesterol ratio, particularly in the Turkish population. Important factors in explaining ethnic differences are the relatively high Body Mass Index and level of alcohol abstinence in these migrant groups.

Prevalence and management of hypertension among Turkish, Moroccan and native Dutch ethnic groups in Amsterdam, the Netherlands: The Amsterdam Health Monitor Survey.

OBJECTIVE: To assess ethnic differences in the prevalence and management of hypertension among Turkish, Moroccan and native Dutch ethnic groups in Amsterdam, the Netherlands. DESIGN: A cross-sectional survey. PARTICIPANTS: A random sample of 1304 adults aged 18 years and over. Of these, 39.2% were Dutch, 33.2% were Turkish and 27.6% were Moroccan. RESULTS: The prevalence of hypertension was lower in Turkish (men 25.8% and women 22.2%) and Moroccan (men 26.1% and women 19.6%) than in Dutch individuals (men 48.8% and women 35.0%). Except for Turkish women, these differences persisted after adjustment for age and body mass index: the odds ratios (95% confidence interval) for being hypertensive were 0.47 (0.30-0.74; P < 0.001) for Turkish men, 0.48 (0.30-0.76; P < 0.001) for Moroccan men and 0.51 (0.28-0.94; P = 0.03) for Moroccan women. Only Moroccan hypertensive women were less likely than Dutch women to be aware of their condition 0.31 (0.11-0.81; P < 0.01) and to be treated 0.32 (0.12-0.88; P < 0.01) for hypertension. There were no differences in hypertension control between the ethnic groups in both men and women. CONCLUSION: The lower prevalence of hypertension among Moroccan men may contribute to the low cardiovascular disease (CVD) mortality reported among this group in the Netherlands. The differential risks in CVD mortality between Moroccan men and women may partly result from the lower hypertension awareness and treatment rates in Moroccan women. Strategies aimed at improving the detection and treatment of hypertension among Moroccan women may improve the sex disparity in cardiovascular mortality between Moroccan men and women in the Netherlands.

Declining AIDS mortality in Amsterdam: contributions of declining HIV incidence and effective therapy.

INTRODUCTION: We aimed to evaluate the impact of highly active antiretroviral therapy (HAART) on AIDS mortality, taking into account earlier HIV incidence patterns. METHODS: Using AIDS Surveillance data (1982-2000), we calculated the observed course of the AIDS epidemic among homosexual men in Amsterdam, The Netherlands. We used the HIV incidence patterns (1980-2000) among homosexual men participating in the hepatitis B vaccine trial and the Amsterdam Cohort Study and those attending the Amsterdam sexual transmitted infections clinic, together with the time from seroconversion to AIDS and death in the pre-HAART era, to estimate the natural course of the AIDS epidemic if HAART had not been introduced. RESULTS: The estimated course of the AIDS epidemic without the benefits of HAART showed a decline in AIDS mortality, but this estimated decline was not as strong as the observed decline. Taking into account the HIV incidence over calendar time, we estimated that 331 deaths among homosexual men were prevented by HAART between 1996 and 2000 in Amsterdam. CONCLUSION: The decline in AIDS mortality was the result of both HAART and a decline in the HIV incidence in the early 1980s. When evaluating the effect of HAART on mortality, changes in HIV incidence must also be considered.

Evaluation of a Mental Health Service for Young Children: Development, Outcome and Satisfaction.

BACKGROUND: Over a 10-year period (1984-1996) a child guidance clinic developed a service in the community for parents with young children with mental health problems. This included support for primary care staff and training courses. The clinical input to the young children developed from a clinic within the child guidance clinic (1984-87), to a specialist clinic for under fives (1990-91) to a service run by a nurse in the community (1994-95), with nurses referring to colleagues only the more complicated cases. METHOD: The work in 1990-91 was compared with the work in 1994-95. The family and clinic scored the outcome of the work, by recording the severity of the problem, separately, on unanchored 5-point Likert scales before and after treatment. For the evaluation in 1994-95 a satisfaction questionnaire was also developed. The cost of running the two different clinics was calculated. RESULTS: The results indicated that there was a slight fall in the effect size for the clinical work in 1994-95, but this method of working was two-thirds of the cost of the previous clinic. The parents were satisfied with both services. The post-contact parental satisfaction questionnaire had face validity, construct validity and internal consistency. CONCLUSIONS: Nurses working on their own in the community can be a cost effective method for working with families with young children. Some families will need to be referred on to specialist teams and more work needs to be done to establish which families and when referral is appropriate. The questionnaire was shown to be a valid and reliable way of assessing family satisfaction.

Life expectancy and mortality differences between migrant groups living in Amsterdam, The Netherlands.

There is an apparent contradiction between the high level of morbidity and the low level of mortality observed in certain groups of migrants living in Europe. This observation should have some consequences for health policy development and the targeting of resources in a city like Amsterdam. In this paper a number of hypotheses to explain the low mortality in migrant groups are discussed. An analysis is made of mortality in Amsterdam using data from the civil registry as to mortality according to age, sex and nationality group of the deceased. Standard demographic techniques such as the standardised mortality ratio (SMR) and life table analysis were employed. Life table analysis shows that life expectancy in Amsterdam is lowest among residents of Dutch descent (73.3 yr for males and 79.1 yr for females) and highest among those of Mediterranean origin (77.6 yr for males and 86.1 yr for females). This appears to contradict previous research based on the SMR, which showed high mortality in migrant groups. To find the cause of this contradiction, the SMR and risk ratios by age are studied. The conclusion of this paper is that on the basis of life table analysis it appears that some immigrant groups living in Amsterdam have a remarkably high life expectancy. Since the SMR is sensitive to demographic differences between groups compared, questions can be raised about previous studies using the SMR. It has been suggested that the high life expectancy in migrant groups is not really caused by good health but by 'spurious' phenomena, such as problems in mortality registration. However, in view of the available data it seems likely that some migrant groups do in fact have high life expectancy, although the morbidity in these groups can be quite high. These findings should inform health-related policy.