Addi van Bergen

Cumulation of ill health and low agency 121 6 associated with, a particular risk factor, and thus represents the maximum health effect that can be achieved if the risk factor could be eliminated. We compared the RR and PAF of the stratifiers to identify at-risk populations for cardiovascular risk (diabetes, high blood pressure, smoking, obesity and inactivity), cancer, low self-rated health, anxiety and depression symptoms and low personal control, and we explored whether SE captures in a single measure the information that is normally obtained by the four abovementioned social factors. Data from the 2016 Public Health Monitor from four major cities in the Netherlands were used to test the hypotheses. METHODS Data collection The data in this study were collected by the Public Health Services of Amsterdam, Rotterdam, The Hague and Utrecht as part of the Public Health Monitor questionnaire 2016. The population sizes of the four cities ranged from 835 thousand in Amsterdam to 630 thousand, 520 thousand and 340 thousand in Rotterdam, The Hague and Utrecht, respectively. In each city, a stratified sample was drawn from the adult population aged ≥ 19 in non- institutionalised households based on neighbourhood and age category. Subjects were sent an invitation letter and up to three reminders by mail. The average response rate to the survey was 33.2%. Statistics Netherlands (CBS) enriched the monitoring data with administrative information regarding migration background, standardised household income and household composition. Measures Dependent variables - Health. The following measures were included: • cardiovascular disease (CVD) risk factors: self-reported general practitioner (GP) diagnosis of diabetes; self-reported GP diagnosis of high blood pressure; current smoking; obesity (BMI 30 or higher based on self-reported height and weight); and inactivity (not meeting the daily recommended 30 minutes of moderate intensive physical activity on any day of the week). • cancer: self-reported GP diagnoses of cancer; • anxiety and/or depression symptoms: score 30 or higher on the 10-item Kessler Psychological Distress Scale (K10) versus score < 30 [27]; • self-rated health: fair or poor versus good or very good. - Agency. The 7-item Pearlin Mastery Scale was used to measure the extent to which an individual regards his or her life chances as being under his or her personal control rather than fatalistically ruled: low ( < 20) versus high ( > =20) personal control.