Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: A systematic review

International Journal of Behavioral Nutrition and Physical Activity

Frank J van Lenthe²  Alex Burdorf²  Anton E Kunst³  Johannes Brug⁴  Katrina Giskes¹  Carlijn BM Kamphuis²  Marielle A Beenackers² 

[1] School of Medicine, University of Sydney, Sydney, Australia;Department of Public Health, Erasmus MC, Rotterdam, Netherlands;Department of Public Health, AMC, University of Amsterdam, Amsterdam, Netherlands;Department of Epidemiology & Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands

关键词: Europe;    Systematic review;    Physical activity;    Inequalities;    Socioeconomic;   

Others  :  811733
DOI  :  10.1186/1479-5868-9-116

 received in 2012-02-28, accepted in 2012-09-04,  发布年份 2012

【 摘 要 】

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.

【 授权许可】

   
2012 Beenackers et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE: Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008, 358:2468-2481.
• [2]Stirbu I, Kunst AE, Bopp M, Leinsalu M, Regidor E, Esnaola S, Costa G, Martikainen P, Borrell C, Deboosere P, et al.: Educational inequalities in avoidable mortality in Europe. J Epidemiol Community Health 2010, 64:913-920.
• [3]Stringhini S, Sabia S, Shipley M, Brunner E, Nabi H, Kivimaki M, Singh-Manoux A: Association of socioeconomic position with health behaviors and mortality. JAMA 2010, 303:1159-1166.
• [4]Menvielle G, Boshuizen H, Kunst AE, Dalton SO, Vineis P, Bergmann MM, Hermann S, Ferrari P, Raaschou-Nielsen O, Tjønneland A, et al.: The role of smoking and diet in explaining educational inequalities in lung cancer incidence. J Natl Cancer Inst 2009, 101:321-330.
• [5]Huisman M, Kunst AE, Mackenbach JP: Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control 2005, 14:106-113.
• [6]McLaren L: Socioeconomic status and obesity. Epidemiol Rev. 2007, 29:29-48.
• [7]Roskam AJ, Kunst AE, Van Oyen H, Demarest S, Klumbiene J, Regidor E, Helmert U, Jusot F, Dzurova D, Mackenbach JP: Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries. Int J Epidemiol 2010, 39:392-404.
• [8]Seidell JC: Epidemiology of obesity. Semin Vasc Med 2005, 5:3-14.
• [9]Molarius A, Seidell JC, Sans S, Tuomilehto J, Kuulasmaa K: Educational level, relative body weight, and changes in their association over 10 years: an international perspective from the WHO MONICA Project. Am J Public Health 2000, 90:1260-1268.
• [10]Branca F, Nikogosian H, Lobstein T: Challenge of Obesity in the WHO European Region and the Strategies for Response. Denmark: World Health Organization; 2007.
• [11]Giskes K, Avendaňo M, Brug J, Kunst AE: A systematic review of studies on socioeconomic inequalities in dietary intakes associated with weight gain and overweight/obesity conducted among European adults. Obes Rev 2010, 11:413-429.
• [12]Centers for Disease Control and Prevention: Physical activity and health: a report of the Surgeon General. Washington DC: U.S. Department of Health and Human services; 1996.
• [13]Warburton DE, Nicol CW, Bredin SS: Health benefits of physical activity: the evidence. Can Med Assoc J 2006, 174:801-809.
• [14]Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, et al.: Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995, 273:402-407.
• [15]Allender S, Foster C, Boxer A: Occupational and nonoccupational physical activity and the social determinants of physical activity: results from the Health Survey for England. J Phys Act Health 2008, 5:104-116.
• [16]Popham F, Mitchell R: Relation of employment status to socioeconomic position and physical activity types. Prev Med 2007, 45:182-188.
• [17]Geyer S, Hemström Ö, Peter R, Vågerö D: Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. J Epidemiol Community Health 2006, 60:804-810.
• [18]Galobardes B, Lynch J, Smith GD: Measuring socioeconomic position in health research. Br Med Bull 2007, 81–82:21-37.
• [19]Rose D: Official Social Classifications in the UK. Social Research Update 1995, 9:1.
• [20]Eikemo TA, Huisman M, Bambra C, Kunst AE: Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries. Sociol Health Illn 2008, 30:565-582.
• [21]Ferrera M: The 'Southern Model' of Welfare in Social Europe. Journal of European Social Policy 1996, 6:17-37.
• [22]Ball K, Crawford D: Socioeconomic status and weight change in adults: a review. Soc Sci Med 2005, 60:1987-2010.
• [23]Van Dyck D, Cardon G, Deforche B, Sallis JF, Owen N, De Bourdeaudhuij I: Neighborhood SES and walkability are related to physical activity behavior in Belgian adults. Prev Med 2010, 50:S74-S79.
• [24]Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P: International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003, 35:1381-1395.
• [25]Taylor HL, Jacobs DR Jr, Schucker B, Knudsen J, Leon AS, Debacker G: A questionnaire for the assessment of leisure time physical activities. J Chronic Dis 1978, 31:741-755.
• [26]Pereira MA, FitzerGerald SJ, Gregg EW, Joswiak ML, Ryan WJ, Suminski RR, Utter AC, Zmuda JM: A collection of Physical Activity Questionnaires for health-related research. Med Sci Sports Exerc 1997, 29:S1-S205.
• [27]Wendel-Vos GCW, Schuit AJ, Saris WHM, Kromhout D: Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 2003, 56:1163-1169.
• [28]Kwaśniewska M, Kaczmarczyk-Chałas K, Pikala M, Broda , Kozakiewicz K, Pajak A, Tykarski A, Zdrojewski T, Drygas W: Socio-demographic and lifestyle correlates of commuting activity in Poland. Prev Med 2010, 50:257-261.
• [29]Adams J: Prevalence and socio-demographic correlates of "active transport" in the UK: analysis of the UK time use survey 2005. Prev Med 2010, 50:199-203.
• [30]Lissner L, Bengtsson C, Björkelund C, Wedel H: Physical activity levels and changes in relation to longevity. A prospective study of Swedish women. Am J Epidemiol 1996, 143:54-62.
• [31]Drygas W, Kwaśniewska M, Kaleta D, Pikala M, Bielecki W, Głuszek J, Zdrojewski T, Pajak A, Kozakiewicz K, Broda G: Epidemiology of physical inactivity in Poland: prevalence and determinants in a former communist country in socioeconomic transition. Public Health 2009, 123:592-597.
• [32]Kaleta D, Jegier A: Occupational energy expenditure and leisure-time physical activity. Int J Occup Med Environ Health 2005, 18:351-356.
• [33]Holtermann A, Hansen JV, Burr H, Søgaard K, Sjøgaard G: The health paradox of occupational and leisure-time physical activity. Br J Sports Med 2012, 69:485-492.
• [34]Wang Y, Tuomilehto J, Jousilahti P, Antikainen R, Mähönen M, Katzmarzyk PT, Hu G: Occupational, commuting, and leisure-time physical activity in relation to heart failure among finnish men and women. J Am Coll Cardiol 2010, 56:1140-1148.
• [35]Salonen JT, Puska P, Tuomilehto J: Physical activity and risk of myocardial infarction, cerebral stroke and death: a longitudinal study in Eastern Finland. Am J Epidemiol 1982, 115:526-537.
• [36]Hu G, Jousilahti P, Borodulin K, Barengo NC, Lakka TA, Nissinen A, Tuomilehto J: Occupational, commuting and leisure-time physical activity in relation to coronary heart disease among middle-aged Finnish men and women. Atherosclerosis 2007, 194:490-497.
• [37]Hu G, Qiao Q, Silventoinen K, Eriksson JG, Jousilahti P, Lindström J, Valle TT, Nissinen A, Tuomilehto J: Occupational, commuting, and leisure-time physical activity in relation to risk for Type 2 diabetes in middle-aged Finnish men and women. Diabetologia 2003, 46:322-329.
• [38]Steeves JA, Bassett DR Jr, Thompson DL, Fitzhugh EC: Relationships of occupational and non-occupational physical activity to abdominal obesity. Int J Obes 2012, 36:100-106.
• [39]Sisson SB, Camhi SM, Church TS, Martin CK, Tudor-Locke C, Bouchard C, Earnest CP, Smith SR, Newton RL Jr, Rankinen T, Katzmarzyk PT: Leisure time sedentary behavior, occupational/domestic physical activity, and metabolic syndrome in U.S. men and women. Metab Syndr Relat Disord 2009, 7:529-536.
• [40]Stender M, Hense HW, Döring A, Keil U: Physical activity at work and cardiovascular disease risk: results from the MONICA Augsburg study. Int J Epidemiol 1993, 22:644-650.
• [41]Kristal-Boneh E, Harari G, Melamed S, Froom P: Association of physical activity at work with mortality in Israeli industrial employees: the CORDIS study. J Occup Environ Med 2000, 42:127-135.
• [42]Suadicani P, Hein HO, Gyntelberg F: Socioeconomic status and ischaemic heart disease mortality in middle-aged men: importance of the duration of follow-up. The Copenhagen Male Study. Int J Epidemiol 2001, 30:248-255.
• [43]Krause N, Brand RJ, Kaplan GA, Kauhanen J, Malla S, Tuomainen TP, Salonen JT: Occupational physical activity, energy expenditure and 11-year progression of carotid atherosclerosis. Scand J Work Environ Health 2007, 33:405-424.
• [44]Behre CJ, Bergström G, Schmidt CB: Increasing leisure time physical activity is associated with less prevalence of the metabolic syndrome in healthy middle-aged men. Angiology 2011, 62:509-512.
• [45]Savela S, Koistinen P, Tilvis RS, Strandberg AY, Pitkälä KH, Salomaa VV, Miettinen TA, Strandberg TE: Leisure-time physical activity, cardiovascular risk factors and mortality during a 34-year follow-up in men. Eur J Epidemiol 2010, 25:619-625.
• [46]Fransson E, De Faire U, Ahlbom A, Reuterwall C, Hallqvist J, Alfredsson L: The risk of acute myocardial infarction: interactions of types of physical activity. Epidemiology 2004, 15:573-582.
• [47]van Lenthe FJ, Brug J, Mackenbach JP: Neighbourhood inequalities in physical inactivity: the role of neighbourhood attractiveness, proximity to local facilities and safety in the Netherlands. Soc Sci Med 2005, 60:763-775.
• [48]Rundle A, Roux AV, Free LM, Miller D, Neckerman KM, Weiss CC: The urban built environment and obesity in New York City: a multilevel analysis. Am J Health Promot 2007, 21:326-334.
• [49]Cockerham WC, Rütten A, Abel T: Conceptualizing contemporary health lifestyles. Sociological Quarterly 1997, 38:321-342.
• [50]Abel T: Cultural capital and social inequality in health. J Epidemiol Community Health 2008, 62:e13.
• [51]Kamphuis CB, van Lenthe FJ, Giskes K, Huisman M, Brug J, Mackenbach JP: Socioeconomic differences in lack of recreational walking among older adults: the role of neighbourhood and individual factors. Int J Behav Nutr Phys Act 2009, 6:1. BioMed Central Full Text
• [52]Kamphuis CB, Van Lenthe FJ, Giskes K, Huisman M, Brug J, Mackenbach JP: Socioeconomic status, environmental and individual factors, and sports participation. Med Sci Sports Exerc 2008, 40:71-81.
• [53]Gidlow C, Johnston LH, Crone D, Ellis N, James D: A systematic review of the relationship between socio-economic position and physical activity. Health Educ J 2006, 65:338-367.
• [54]Martinez-Gonzalez MA, Varo JJ, Santos JL, De Irala J, Gibney M, Kearney J, Martinez JA: Prevalence of physical activity during leisure time in the European Union. Med Sci Sports Exerc 2001, 33:1142-1146.
• [55]Van Tuyckom C, Scheerder J: Sport for All? Insight into stratification and compensation mechanisms of sporting activity in the 27 European Union member states. Sport, Education and Society 2010, 15:495-512.
• [56]Varo JJ, Martínez-González MA, De Irala-Estévez J, Kearney J, Gibney M, Martínez JA: Distribution and determinants of sedentary lifestyles in the European Union. Int J Epidemiol 2003, 32:138-146.
• [57]Mäkinen TE, Sippola R, Borodulin K, Rahkonen O, Kunst A, Klumbiene J, Regidor E, Ekholm O, Mackenbach J, Prättälä R: Explaining educational differences in leisure-time physical activity in Europe: the contribution of work-related factors. Scand J Med Sci Sports 2012, 22:439-447.
• [58]Dickersin K, Min Y-I, Meinert CL: Factors Influencing Publication of Research Results: Follow-up of Applications Submitted to Two Institutional Review Boards. JAMA 1992, 267:374-378.
• [59]van Poppel MN, Chinapaw MJ, Mokkink LB, van Mechelen W, Terwee CB: Physical activity questionnaires for adults: a systematic review of measurement properties. Sports Med 2010, 40:565-600.
• [60]Ståhl T, Rütten A, Nutbeam D, Bauman A, Kannas L, Abel T, Lüschen G, Rodriquez DJ, Vinck J, van der Zee J: The importance of the social environment for physically active lifestyle–results from an international study. Soc Sci Med 2001, 52:1-10.
• [61]Van Tuyckom C, Scheerder J: Sport for all? Social stratification of recreational sport activities in the EU-27. Kinesiologia Slovenica 2008, 14:54-63.
• [62]Van Tuyckom C, Scheerder J: A multilevel analysis of social stratification patterns of leisure-time physical activity among Europeans. Science & Sports 2010, 25:304-311.
• [63]Addor V, Wietlisbach V, Narring F, Michaud PA: Cardiovascular risk factor profiles and their social gradient from adolescence to age 74 in a Swiss region. Prev Med 2003, 36:217-228.
• [64]Bertrais S, Preziosi P, Mennen L, Galan P, Hercberg S, Oppert JM: Sociodemographic and geographic correlates of meeting current recommendations for physical activity in middle-aged French adults: the Supplementation en Vitamines et Mineraux Antioxydants (SUVIMAX) Study. Am J Public Health 2004, 94:1560-1566.
• [65]Chaix B, Chauvin P: Tobacco and alcohol consumption, sedentary lifestyle and overweightness in France: A multilevel analysis of individual and area-level determinants. Eur J Epidemiol 2003, 18:531-538.
• [66]Dragano N, Bobak M, Wege N, Peasey A, Verde PE, Kubinova R, Weyers S, Moebus S, Möhlenkamp S, Stang A, et al.: Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany. BMC Public Health 2007, 7:255. BioMed Central Full Text
• [67]Drieskens S, Van Oyen H, Demarest S, Van der Heyden J, Gisle L, Tafforeau J: Multiple risk behaviour: increasing socio-economic gap over time? Eur J Public Health 2010, 20:634-639.
• [68]Galobardes B, Costanza MC, Bernstein MS, Delhumeau C, Morabia A: Trends in risk factors for lifestyle-related diseases by socioeconomic position in Geneva, Switzerland, 1993–2000: health inequalities persist. Am J Public Health 2003, 93:1302-1309.
• [69]Meyer K, Rezny L, Breuer C, Lamprecht M, Stamm HP: Physical activity of adults aged 50 years and older in Switzerland. Soz Praventivmed 2005, 50:218-229.
• [70]Nocon M, Keil T, Willich SN: Education, income, occupational status and health risk behaviour. J Public Health 2008, 15:401-405.
• [71]van Oort FV, van Lenthe FJ, Mackenbach JP: Cooccurrence of lifestyle risk factors and the explanation of education inequalities in mortality: results from the GLOBE study. Prev Med 2004, 39:1126-1134.
• [72]Rathmann W, Haastert B, Icks A, Giani G, Holle R, Meisinger C, Mielck A, Group KS: Sex differences in the associations of socioeconomic status with undiagnosed diabetes mellitus and impaired glucose tolerance in the elderly population: the KORA Survey 2000. Eur J Public Health 2005, 15:627-633.
• [73]Ribet C, Lang T, Zins M, Bingham A, Ferrières J, Arveiler D, Amouyel P, Bonenfant S, Chastang JF, Goldberg M, Ducimetière P: Do cardiovascular risk factors in men depend on their spouses' occupational category? Eur J Epidemiol 2001, 17:347-356.
• [74]Scheerder J, Vanreusel B, Taks M, Renson R: Social Sports Stratification in Flanders 1969–1999: Intergenerational Reproduction of Social Inequalities? International Review for the Sociology of Sport 2002, 37:219-245.
• [75]Scheerder J, Vanreusel B, Taks M: Stratification patterns of active sport involvement among adults: Social change and persistence. International Review for the Sociology of Sport 2005, 40:139-162.
• [76]Schneider S, Becker S: Prevalence of physical activity among the working population and correlation with work-related factors: results from the first German National Health Survey. J Occup Health 2005, 47:414-423.
• [77]Verdaet D, Dendale P, De Bacquer D, Delanghe J, Block P, De Backer G: Association between leisure time physical activity and markers of chronic inflammation related to coronary heart disease. Atherosclerosis 2004, 176:303-310.
• [78]De Vries H, Vant Riet J, Spigt M, Metsemakers J, Van den Akker M, Vermunt JK, Kremers S: Clusters of lifestyle behaviors: results from the Dutch SMILE study. Prev Med 2008, 46:203-208.
• [79]Wagner A, Simon C, Evans A, Ducimetière P, Bongard V, Montaye M, Arveiler D, Group PS: Physical activity patterns in 50–59 year men in France and Northern Ireland. Associations with socio-economic status and health behaviour. Eur J Epidemiol 2003, 18:321-329.
• [80]Frömel K, Mitáš J, Kerr J: The associations between active lifestyle, the size of a community and SES of the adult population in the Czech Republic. Health Place 2009, 15:447-454.
• [81]Jurakić D, Pedišić Z, Andrijašević M: Physical activity of Croatian population: cross-sectional study using International Physical Activity Questionnaire. Croat Med J 2009, 50:165-173.
• [82]Kaleta D, Jegier A: Predictors of inactivity in the working-age population. Int J Occup Med Environ Health 2007, 20:175-182.
• [83]Leskošek B, Doupona M, Moćnik R, Jošt B: Sport participation in the Republic of Slovenia and its relation to selected socio-demographic variables./Beteiligung an Sport in der Republik Slowenien und deren Zusammenhang mit den Ausgewaehlten sozio-demographischen Variablen./Relacije sudjelovanja u sportskim aktivnostima u Repbulici Slovenijis izabranim socio-demografskim varijablama. Kinesiology 2002, 34:41-49.
• [84]Mišigoj-Durakoviæ M, Heimer S, Matkoviæ BR, Ružiæ L, Prskalo I: Physical activity of urban adult population: questionnaire study. Croat Med J 2000, 41:428-432.
• [85]Nowak MA: Relationships between the perception of the influence of physical activity on health and women's engagement in exercise or their physical passivity. Polish Journal of Sport & Tourism 2010, 17:179-184.
• [86]Paulik E, Bóka F, Kertész A, Balogh S, Nagymajtényi L: Determinants of health-promoting lifestyle behaviour in the rural areas of Hungary. Health Promot Int 2010, 25:277-288.
• [87]Pomerleau J, McKee M, Robertson A, Vaasc S, Kadziauskiene K, Abaravicius A, Bartkeviciute R, Pudule I, Grinberga D: Physical inactivity in the Baltic countries. Prev Med 2000, 31:665-672.
• [88]Puska P, Helasoja V, Prättälä R, Kasmel A, Klumbiene J: Health behaviour in Estonia, Finland and Lithuania 1994–1998. Standardized comparison. Eur J Public Health 2003, 13:11-17.
• [89]Shapo L, Pomerleau J, McKee M: Physical inactivity in a country in transition: a population-based survey in Tirana City, Albania. Scand J Public Health 2004, 32:60-67.
• [90]Stelmach W, Kaczmarczyk-Chałas K, Bielecki W, Drygas W: The impact of income, education and health on lifestyle in a large urban population of Poland (Cindi programme). Int J Occup Med Environ Health 2004, 17:393-401.
• [91]Zaletel-Kragelj L, Fras Z, Zakotnik JM: Results of CINDI health monitor surveys in Slovenia as a tool for development of effective healthy nutrition and physical activity intervention programmes. J Public Health 2007, 14:110-118.
• [92]Artazcoz L, Borrell C, Benach J, Cortès I, Rohlfs I: Women, family demands and health: the importance of employment status and socio-economic position. Soc Sci Med 2004, 59:263-274.
• [93]Bolívar J, Daponte A, Rodríguez M, Sánchez JJ: The Influence of Individual, Social and Physical Environment Factors on Physical Activity in the Adult Population in Andalusia, Spain. Int J Environ Res Public Health 2010, 7:60-77.
• [94]Borrell C, Domínguez-Berjón F, Pasarín MI, Ferrando J, Rohlfs I, Nebot M: Social inequalities in health related behaviours in Barcelona. J Epidemiol Community Health 2000, 54:24-30.
• [95]Borrell C, Rue M, Pasarín MI, Rohlfs I, Ferrando J, Fernandez E: Trends in social class inequalities in health status, health-related behaviors, and health services utilization in a Southern European urban area (1983–1994). Prev Med 2000, 31:691-701.
• [96]De Vogli R, Gnesotto R, Goldstein M, Andersen R, Cornia GA: The lack of social gradient of health behaviors and psychosocial factors in Northern Italy. Soz Praventivmed 2005, 50:197-205.
• [97]Gal DL, Santos AC, Barros H: Leisure-time versus full-day energy expenditure: a cross-sectional study of sedentarism in a Portuguese urban population. BMC Public Health 2005, 5:16. BioMed Central Full Text
• [98]Lera-López F, Rapún-Gárate M: Sports Participation versus Consumer Expenditure on Sport: Different Determinants and Strategies in Sports Management. European Sport Management Quarterly 2005, 5:167-186.
• [99]Meseguer CM, Galán I, Herruzo R, Zorrilla B, Rodríguez-Artalejo F: Leisure-time physical activity in a southern European mediterranean country: adherence to recommendations and determining factors. Rev Esp Cardiol 2009, 62:1125-1133.
• [100]Panagiotakos DB, Pitsavos C, Chrysohoou C, Vlismas K, Skoumas Y, Palliou K, Stefanadis C: Dietary habits mediate the relationship between socio-economic status and CVD factors among healthy adults: the ATTICA study. Public Health Nutr 2008, 11:1342-1349.
• [101]Panagiotakos DB, Pitsavos C, Chrysohoou C, Vlismas K, Skoumas Y, Palliou K, Stefanadis C: The effect of clinical characteristics and dietary habits on the relationship between education status and 5-year incidence of cardiovascular disease: the ATTICA study. Eur J Nutr 2008, 47:258-265.
• [102]Pascual C, Regidor E, Astasio P, Ortega P, Navarro P, Domínguez V: The association of current and sustained area-based adverse socioeconomic environment with physical inactivity. Soc Sci Med 2007, 65:454-466.
• [103]Pascual C, Regidor E, Martínez D, Elisa Calle M, Domínguez V: Socioeconomic environment, availability of sports facilities, and jogging, swimming and gym use. Health Place 2009, 15:553-561.
• [104]Pitsavos C, Panagiotakos DB, Lentzas Y, Stefanadis C: Epidemiology of leisure-time physical activity in socio-demographic, lifestyle and psychological characteristics of men and women in Greece: the ATTICA Study. BMC Public Health 2005, 5:37. BioMed Central Full Text
• [105]Santos R, Santos MP, Ribeiro JC, Mota J: Physical Activity and Other Lifestyle Behaviors in a Portuguese Sample of Adults: Results From the Azorean Physical Activity and Health Study. J Phys Act Health 2009, 6:750-759.
• [106]Schröder H, Rohlfs I, Schmelz EM, Marrugat J, for the REGIDOR investigators: Relationship of socioeconomic status with cardiovascular risk factors and lifestyle in a Mediterranean population. Eur J Nutr 2004, 43:77-85.
• [107]Ali SM, Lindström M: Psychosocial work conditions, unemployment, and leisure-time physical activity: A population-based study. Scand J Public Health 2006, 34:209-216.
• [108]Andersen LB, Schnohr P, Schroll M, Hein HO: All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Arch Intern Med 2000, 160:1621-1628.
• [109]Barengo NC, Nissinen A, Pekkarinen H, Halonen P, Tuomilehto J: Twenty-five-year trends in lifestyle and socioeconomic characteristics in Eastern Finland. Scand J Public Health 2006, 34:437-444.
• [110]Bergman P, Grjibovski AM, Hagströmer M, Bauman A, Sjöstrom M: Adherence to physical activity recommendations and the influence of socio-demographic correlates - a population-based cross-sectional study. BMC Public Health 2008, 8:367. BioMed Central Full Text
• [111]Borodulin K, Laatikainen T, Lahti-Koski M, Jousilahti P, Lakka TA: Association of age and education with different types of leisure-time physical activity among 4437 Finnish adults. J Phys Act Health 2008, 5:242-251.
• [112]Cubbin C, Sundquist K, Ahlén H, Johansson SE, Winkleby MA, Sundquist J: Neighborhood deprivation and cardiovascular disease risk factors: protective and harmful effects. Scand J Public Health 2006, 34:228-237.
• [113]Engström L-M: Who is physically active? Cultural capital and sports participation from adolescence to middle age—a 38-year follow-up study. Physical Education & Sport Pedagogy 2008, 13:319-343.
• [114]Häkkinen U, Järvelin MR, Rosenqvist G, Laitinen J: Health, schooling and lifestyle among young adults in Finland. Health Econ 2006, 15:1201-1216.
• [115]Henriksson KM, Lindblad U, Ågren B, Nilsson-Ehle P, Råstam L: Associations between unemployment and cardiovascular risk factors varies with the unemployment rate: the Cardiovascular Risk Factor Study in Southern Sweden (CRISS). Scand J Public Health 2003, 31:305-311.
• [116]Kivimäki M, Lawlor DA, Davey Smith G, Kouvonen A, Virtanen M, Elovainio M, Vahtera J: Socioeconomic position, co-occurrence of behavior-related risk factors, and coronary heart disease: the Finnish Public Sector study. Am J Public Health 2007, 97:874-879.
• [117]Korniloff K, Häkkinen A, Kautiainen H, Koponen H, Peltonen M, Mäntyselkä P, Oksa H, Kampman O, Vanhala M: Leisure-time physical activity and metabolic syndrome plus depressive symptoms in the FIN-D2D survey. Prev Med 2010, 51:466-470.
• [118]Laaksonen M, Lahelma E, Prättälä R: Associations among health-related behaviours: sociodemographic variation in Finland. Soz Praventivmed 2002, 47:225-232.
• [119]Laaksonen M, Talala K, Martelin T, Rahkonen O, Roos E, Helakorpi S, Laatikainen T, Prättälä R: Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years. Eur J Public Health 2008, 18:38-43.
• [120]Lagerros YT, Bellocco R, Adami HO, Nyrén O: Measures of physical activity and their correlates: the Swedish National March Cohort. Eur J Epidemiol 2009, 24:161-169.
• [121]Leijon ME, Stark-Ekman D, Nilsen P, Ekberg K, Walter L, Ståhle A, Bendtsen P: Is there a demand for physical activity interventions provided by the health care sector? Findings from a population survey. BMC Public Health 2010, 10:34. BioMed Central Full Text
• [122]Lindström M, Hanson BS, Östergren PO: Socioeconomic differences in leisure-time physical activity: the role of social participation and social capital in shaping health related behaviour. Soc Sci Med 2001, 52:441-451.
• [123]Lindström M, Isacsson SO, Merlo J: Increasing prevalence of overweight, obesity and physical inactivity: two population-based studies 1986 and 1994. Eur J Public Health 2003, 13:306-312.
• [124]Lindström M, Moghaddassi M, Merlo J: Social capital and leisure time physical activity: a population based multilevel analysis in Malmo, Sweden. J Epidemiol Community Health 2003, 57:23-28.
• [125]Mäkinen T, Borodulin K, Laatikainen T, Fogelholm M, Prättälä R: Twenty-five year socioeconomic trends in leisure-time and commuting physical activity among employed Finns. Scand J Med Sci Sports 2009, 19:188-197.
• [126]Mäkinen T, Kestilä L, Borodulin K, Martelin T, Rahkonen O, Leino-Arjas P, Prättälä R: Occupational class differences in leisure-time physical inactivity - contribution of past and current physical workload and other working conditions. Scand J Work Environ Health 2010, 36:62-70.
• [127]Mäkinen T, Kestilä L, Borodulin K, Martelin T, Rahkonen O, Prättälä R: Effects of childhood socio-economic conditions on educational differences in leisure-time physical activity. Eur J Public Health 2010, 20:346-353.
• [128]Mäkinen TE, Borodulin K, Tammelin TH, Rahkonen O, Laatikainen T, Prättälä R: The effects of adolescence sports and exercise on adulthood leisure-time physical activity in educational groups. Int J Behav Nutr Phys Act 2010, 7:27. BioMed Central Full Text
• [129]Molarius A: The contribution of lifestyle factors to socioeconomic differences in obesity in men and women - A population-based study in Sweden. Eur J Epidemiol 2003, 18:227-234.
• [130]Nielsen TL, Wraae K, Brixen K, Hermann AP, Andersen M, Hagen C: Prevalence of overweight, obesity and physical inactivity in 20- to 29-year-old, Danish men. Relation to sociodemography, physical dysfunction and low socioeconomic status: the Odense Androgen Study. Int J Obes 2006, 30:805-815.
• [131]Norman A, Bellocco R, Vaida F, Wolk A: Total physical activity in relation to age, body mass, health and other factors in a cohort of Swedish men. Int J Obes Relat Metab Disord 2002, 26:670-675.
• [132]Novak M, Ahlgren C, Hammarström A: A life-course approach in explaining social inequity in obesity among young adult men and women. Int J Obes 2006, 30:191-200.
• [133]Orsini N, Bellocco R, Bottai M, Pagano M, Wolk A: Correlates of total physical activity among middle-aged and elderly women. Int J Behav Nutr Phys Act 2007, 4:16. BioMed Central Full Text
• [134]Osler M, Gerdes LU, Davidsen M, Brønnum-Hansen H, Madsen M, Jørgensen T, Schroll M: Socioeconomic status and trends in risk factors for cardiovascular diseases in the Danish MONICA population, 1982–1992. J Epidemiol Community Health 2000, 54:108-113.
• [135]Osler M, Clausen JO, Ibsen KK, Jensen GB: Social influences and low leisure-time physical activity in young Danish adults. Eur J Public Health 2001, 11:130-134.
• [136]Osler M, Godtfredsen NS, Prescott E: Childhood social circumstances and health behaviour in midlife: the Metropolit 1953 Danish male birth cohort. Int J Epidemiol 2008, 37:1367-1374.
• [137]Petersen CB, Thygesen LC, Helge JW, Grønbæk M, Tolstrup JS: Time trends in physical activity in leisure time in the Danish population from 1987 to 2005. Scand J Public Health 2010, 38:121-128.
• [138]Piro FN, Næss O, Claussen B: Area deprivation and its association with health in a cross-sectional study: Are the results biased by recent migration? Int J Equity Health 2007, 6:10. BioMed Central Full Text
• [139]Pudaric S, Sundquist J, Johansson SE: Major risk factors for cardiovascular disease in elderly migrants in Sweden. Ethn Health 2000, 5:137-150.
• [140]Pulkki L, Kivimäki M, Elovainio M, Viikari J, Keltikangas-Järvinen L: Contribution of socioeconomic status to the association between hostility and cardiovascular risk behaviors: a prospective cohort study. Am J Epidemiol 2003, 158:736-742.
• [141]Pulkki L, Kivimäki M, Keltikangas-Järvinen L, Elovainio M, Leino M, Viikari J: Contribution of adolescent and early adult personality to the inverse association between education and cardiovascular risk behaviours: prospective population-based cohort study. Int J Epidemiol 2003, 32:968-975.
• [142]Salonen MK, Kajantie E, Osmond C, Forsén T, Ylihärsilä H, Paile-Hyvärinen M, Barker DJ, Eriksson JG: Prenatal and childhood growth and leisure time physical activity in adult life. Eur J Public Health 2010, 21:719-724.
• [143]Schnohr C, Højbjerre L, Riegels M, Ledet L, Larsen T, Schultz-Larsen K, Petersen L, Prescott E, Grønæk M: Does educational level influence the effects of smoking, alcohol, physical activity, and obesity on mortality? A prospective population study. Scand J Public Health 2004, 32:250-256.
• [144]Simonen RL, Videman T, Kaprio J, Levälahti E, Battié MC: Factors associated with exercise lifestyle - A study of monozygotic twins. Int J Sports Med 2003, 24:499-505.
• [145]Sjögren K, Stjernberg L: A gender perspective on factors that influence outdoor recreational physical activity among the elderly. BMC Geriatr 2010, 10:34. BioMed Central Full Text
• [146]Strand BH, Tverdal A: Can cardiovascular risk factors and lifestyle explain the educational inequalities in mortality from ischaemic heart disease and from other heart diseases? 26 year follow up of 50,000 Norwegian men and women. J Epidemiol Community Health 2004, 58:705-709.
• [147]Strandhagen E, Berg C, Lissner L, Nunez L, Rosengren A, Torén K, Thelle DS: Selection bias in a population survey with registry linkage: potential effect on socioeconomic gradient in cardiovascular risk. Eur J Epidemiol 2010, 25:163-172.
• [148]Suadicani P, OleHein H, Gyntelberg F: Lifestyle, social class, and obesity-the Copenhagen Male Study. Eur J Cardiovasc Prev Rehabil 2005, 12:236-242.
• [149]Tammelin T, Näyhä S, Laitinen J, Rintamäki H, Järvelin MR: Physical activity and social status in adolescence as predictors of physical inactivity in adulthood. Prev Med 2003, 37:375-381.
• [150]Wemme KM, Rosvall M: Work related and non-work related stress in relation to low leisure time physical activity in a Swedish population. J Epidemiol Community Health 2005, 59:377-379.
• [151]Adams J: The mediating role of time perspective in socio-economic inequalities in smoking and physical activity in older English adults. J Health Psychol 2009, 14:794-799.
• [152]Amuzu A, Carson C, Watt HC, Lawlor DA, Ebrahim S: Influence of area and individual lifecourse deprivation on health behaviours: findings from the British Women's Heart and Health Study. Eur J Cardiovasc Prev Rehabil 2009, 16:169-173.
• [153]Bartley M, Fitzpatrick R, Firth D, Marmot M: Social distribution of cardiovascular disease risk factors: change among men in England 1984–1993. J Epidemiol Community Health 2000, 54:806-814.
• [154]Bartley M, Martikainen P, Shipley M, Marmot M: Gender differences in the relationship of partner's social class to behavioural risk factors and social support in the Whitehall II study. Soc Sci Med 2004, 59:1925-1936.
• [155]Chaudhury M, Shelton N: Physical activity among 60-69-year-olds in England: knowledge, perception, behaviour and risk factors. Ageing & Society 2010, 30:1343-1355.
• [156]Ecob R, Macintyre S: Small area variations in health related behaviours; do these depend on the behaviour itself, its measurement, or on personal characteristics? Health Place 2000, 6:261-274.
• [157]Harrison RA, McElduff P, Edwards R: Planning to win: Health and lifestyles associated with physical activity amongst 15,423 adults. Public Health 2006, 120:206-212.
• [158]Heslop P, Smith GD, Macleod J, Hart C: The socioeconomic position of employed women, risk factors and mortality. Soc Sci Med 2001, 53:477-485.
• [159]Hillsdon M, Lawlor DA, Ebrahim S, Morris JN: Physical activity in older women: associations with area deprivation and with socioeconomic position over the life course: observations in the British Women's Heart and Health Study. J Epidemiol Community Health 2008, 62:344-350.
• [160]Lahelma E, Lallukka T, Laaksonen M, Martikainen P, Rahkonen O, Chandola T, Head J, Marmot M, Kagamimori S, Tatsuse T, Sekine M: Social class differences in health behaviours among employees from Britain, Finland and Japan: The influence of psychosocial factors. Health Place 2010, 16:61-70.
• [161]Livingstone MB, Robson PJ, McCarthy S, Kiely M, Harrington K, Browne P, Galvin M, Wareham NJ, Rennie KL: Physical activity patterns in a nationally representative sample of adults in Ireland. Public Health Nutr 2001, 4:1107-1116.
• [162]Lunn PD: The sports and exercise life-course: a survival analysis of recall data from Ireland. Soc Sci Med 2010, 70:711-719.
• [163]Mein GK, Shipley MJ, Hillsdon M, Ellison GT, Marmot MG: Work, retirement and physical activity: cross-sectional analyses from the Whitehall II study. Eur J Public Health 2005, 15:317-322.
• [164]Mullineaux DR, Barnes CA, Barnes EF: Factors affecting the likelihood to engage in adequate physical activity to promote health. J Sports Sci 2001, 19:279-288.
• [165]Mutrie N, Hannah MK: Some work hard while others play hard: The achievement of current recommendations for physical activity levels at work, at home, and in leisure time in the West of Scotland. Int J Health Promot Edu 2004, 42:109-117.
• [166]Myint PK, Luben RN, Welch AA, Bingham SA, Wareham NJ, Khaw KT: Effect of age on the relationship of occupational social class with prevalence of modifiable cardiovascular risk factors and cardiovascular diseases. A population-based cross-sectional study from European Prospective Investigation into Cancer - Norfolk (EPIC-Norfolk). Gerontology 2006, 52:51-58.
• [167]Poortinga W: Associations of physical activity with smoking and alcohol consumption: a sport or occupation effect? Prev Med 2007, 45:66-70.
• [168]Popham F, Mitchell R: Leisure time exercise and personal circumstances in the working age population: longitudinal analysis of the British household panel survey. J Epidemiol Community Health 2006, 60:270-274.
• [169]Popham F: Intergenerational social class stability and mobility are associated with large absolute differences in adult participation in sport and exercise. Br J Sports Med 2010, 44:1184-1185.
• [170]Stamatakis E, Chaudhury M: Temporal trends in adults' sports participation patterns in England between 1997 and 2006: the Health Survey for England. Br J Sports Med 2008, 42:601-608.
• [171]Wardle J, Griffith J: Socioeconomic status and weight control practices in British adults. J Epidemiol Community Health 2001, 55:185-190.
• [172]Wardle J, Steptoe A: Socioeconomic differences in attitudes and beliefs about healthy lifestyles. J Epidemiol Community Health 2003, 57:440-443.
• [173]Watt HC, Carson C, Lawlor DA, Patel R, Ebrahim S: Influence of life course socioeconomic position on older women's health behaviors: findings from the British Women's Heart and Health Study. Am J Public Health 2009, 99:320-327.