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Physical Activity in a Multi-Ethnic Population: Measurement and Associations with Cardiovascular Health and Contextual Factors De Munter, J.S.L UvA-DARE (Digital Academic Repository) Physical activity in a multi-ethnic population: measurement and associations with cardiovascular health and contextual factors de Munter, J.S.L. Publication date 2012 Document Version Final published version Link to publication Citation for published version (APA): de Munter, J. S. L. (2012). Physical activity in a multi-ethnic population: measurement and associations with cardiovascular health and contextual factors. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). 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UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:04 Oct 2021 Physical activity in a multi-ethnic population Physical activity in a multi-ethnic population Measurement and associations with cardiovascular health and contextual factors Jeroen de Munter Jeroen de Munter Physical activity in a multi-ethnic population Measurement and associations with cardiovascular health and contextual factors Jeroen de Munter “Physical activity in a multi-ethnic population. Measurement and associations with cardiovascular health and contextual factors.” Thesis, Academic Medical Center, University of Amsterdam ISBN: 978-94-6191-266-4 The studies presented in this thesis were conducted within the department of Public Health of the Academic Medical Center, University of Amsterdam. The department of Public Health participates in the Netherlands School of Health Sciences (NIHES), which was re-acknowledged in 2008 by the Royal Netherlands Academy of Arts and Sciences (KNAW). © Jeroen de Munter Lay-out and cover design: Chris Bor Cover photograph: Jeroen de Munter Printed by: Ipskamp Drukkers BV, Enschede, 2012 No part of this thesis may be reproduced or transmitted in any form by any means without written permission from the author. The studies described in this thesis were funded by the Academic Medical Center in support of a VENI fellowship (grant number 916.76.130) awarded by the Board of the Council for Earth and Life Sciences (ALW) of the Netherlands Organisation for Scientific Research (NWO). Physical activity in a multi-ethnic population Measurement and associations with cardiovascular health and contextual factors ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Amsterdam op gezag van de Rector Magnificus prof. dr. D.C. van den Boom ten overstaan van een door het college voor promoties ingestelde commissie, in het openbaar te verdedigen in de Agnietenkapel op woensdag 13 juni 2012, te 10:00 uur door Jeroen Sebastiaan Laurence de Munter geboren te Amsterdam Promotiecommissie Promotor: prof. dr. K. Stronks Co-promotores: dr. C.O. Agyemang dr. I.G. van Valkengoed Overige Leden: prof. dr. A.P. Verhoeff prof. dr. M.H.W. Frings-Dresen prof. dr. W. van Mechelen prof. dr. J.A.M. van Oers prof. dr. B.J.C. Middelkoop Faculteit der Geneeskunde Financial support by the Dutch Heart Foundation and the department of Public Health of the Academic Medical Center, University of Amsterdam for the publication of this thesis is gratefully acknowledged. To Ella Contents 1. General introduction 9 PART I – Physical Activity in Ethnic Minority Groups 2. Large ethnic variations in recommended physical activity 27 according to activity domains in Amsterdam, the Netherlands PART II – Physical Activity and Health 3. Association of physical activity, smoking, and alcohol intake with 45 cardiovascular disease-related hospital discharge in people of European, South-Asian, or African descent 4. The association of physical inactivity with type 2 diabetes 65 among different ethnic groups 5. Total physical activity might not be a good measure in assessing 75 relationship with HDL cholesterol and triglycerides in a multi- ethnic population: a cross-sectional study PART III – Physical Activity and Context 6. The association of leisure-time physical activity and active 91 commuting with measures of socioeconomic position in a multiethnic population living in the Netherlands: results from the cross-sectional SUNSET study 7. Cross national study of leisure time physical activity in Dutch 109 and English populations with ethnic group comparisons 8. General discussion 131 Summary 149 Samenvatting 155 Acknowledgements 161 About the author 165 Chapters 2-7 are based on the following papers: 2 de Munter JS, van Valkengoed IG, Agyemang C, Kunst AE, Stronks K. Large ethnic variations in recommended physical activity according to activity domains in Amsterdam, the Netherlands. Int J Behav Nutr Phys Act 2010;7:85 3 de Munter JS, Agyemang C, Stronks K, van Valkengoed IG. Association of physical activity, smoking, and alcohol intake with cardiovascular disease-related hospital discharge in people of European, South-Asian, or African descent. Eur J Prev Cardiolog 2012 Jan 6; doi: 10.1177/2047487311434232 4 Admiraal WM, van Valkengoed IG, de Munter JS, Stronks K, Hoekstra JB, Holleman F. The association of physical inactivity with Type 2 diabetes among different ethnic groups. Diabet Med 2011 Jun;28(6):668-72 5 de Munter JS, van Valkengoed IG, Stronks K, Agyemang C. Total physical activity might not be a good measure in the relationship with HDL cholesterol and triglycerides in a multi-ethnic population: a cross-sectional study. Lipids Health Dis 2011;10:223 6 de Munter JS, Agyemang C, Brewster LM, Stronks K, van Valkengoed IG. The association of leisure-time physical activity and active commuting with measures of socioeconomic position in a multiethnic population living in the Netherlands: results from the cross- sectional SUNSET study. Under review 7 de Munter JS, Agyemang C, van Valkengoed IG, Bhopal R, Zaninotto P, Nazroo J, Kunst AE, Stronks K. Cross national study of leisure time physical activity in Dutch and English populations with ethnic group comparisons. Under revision © Copyrights: European Society of Cardiology (Chapter 3) Chapter 1 General introduction General introduction This thesis is about ethnic differences in physical activity and the association between physical activity and cardiovascular disease (CVD) and CVD-related risk factors across ethnic groups. The general introduction is divided into four main sections. Part 1 describes Chapter 1 the background information of two large ethnic minority groups from Suriname of South Asian and African descent living in the Netherlands, as well as some key concepts of studying health and ethnicity. Part 2 describes ethnic differences in CVD, with a focus on these two large ethnic minority groups from South Asian and African origin compared to European-origin populations. Part 3 describes ethnic differences in physical activity and the relationship between physical activity and CVD. The final section, part 4, describes the conceptual model that guided the analyses as well as the aim and objectives of this thesis, and also gives an overview of the subsequent chapters. Part 1 - Ethnic minority groups in the Netherlands About 11% of the total population of the Netherlands has a non-Western background, which is approximately 1.9 million people in absolute numbers.1 This definition includes people living in the Netherlands who were born in Turkey or in a country in Africa, Latin America, or Asia (with the exception of the former Dutch East Indies (present-day Indonesia) and Japan). The second generation (i.e., children born in the Netherlands but with at least one parent from one of these countries) is also included in this definition of non-Western. The number of people with non-Western backgrounds is expected to increase in the coming years due to continuing immigration.2 About one-fifth of the non-Western population in the Netherlands is made up of people from the Republic of Suriname (the former Dutch Guyana in South America), which makes them one of the largest non-Western groups living in the Netherlands.1 More than half the Surinamese population in the Netherlands lives in one of the four largest Dutch cities: Amsterdam, Rotterdam, The Hague, and Utrecht.3 In contrast to other large ethnic minority groups in the Netherlands (e.g., people from Turkey or Morocco who originally came to the Netherlands as labor migrants), the people from Suriname came to the Netherlands because of the colonial history. Aside from the steady flow of people from Surinamese ethnic groups who settle in the Netherlands every year, two large waves can be identified. The first wave (consisting of about 40,000 people) was around 1975, when Suriname became independent from the Netherlands; this was followed by a second wave around 1980 due to the political situation in Suriname.4 In the Netherlands, country of birth is the primary operationalization of ethnicity. For Suriname, however, country of birth does not capture the heterogeneity in ethnicity in the population in this country. Therefore, for the population from Suriname, additional 11 indicators are necessary to distinguish between the ethnic groups, which include people from Hindustani, Creole, Javanese, and Chinese backgrounds. Most definitions of ethnicity include that ethnic groups should share at least a combination of the following characteristics: similar ancestry, migration history, language, religion, culture, traditions that are passed down from generation to generation, and a feeling of identity. The two largest ethnic groups from Suriname currently living in the Netherlands have ancestral migration histories from West Africa and the Indian subcontinent.
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