Bolte, Gabriele

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Bolte, Gabriele

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Bolte, Gabriele

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Mental Health in context : Impact of social structures and the built environment on mental wellbeing and mental distress
(2017-02-14)
Dreger, Stefanie
;
Ravens-Sieberer, Ulrike
;
Zeeb, Hajo
;
Bolte, Gabriele
Introduction: Not only individual factors but also factors of the social and built environment influence mental distress and ill-health and mental wellbeing. This dissertation aimed to gain further insight into the relationship between individually attributed factors of the social and built environment and mental distress and mental wellbeing. The first objective was to investigate prevalences and variations in mental health by characteristics at the individual level. The second objective was to assess the relationship between social structures at the macro level (here the focused factor was on welfare regimes) and mental health. The third objective was to investigate the relationship between factors of the built environment at the meso level (here the focused factor was environmental noise) and mental health. Methods: The three objectives were addressed by four conceptually independent but topic wise interrelated studies: i) material, psychosocial and sociodemographic determinants of mental wellbeing in Europe, ii) socioeconomic determinants of mental distress and mental wellbeing in school children iii) association between gender, welfare regimes and mental wellbeing, and iv) noise and mental distress in school-aged children. Data from the third wave of the European Quality of Life Survey (2011-2012) and the Health Monitoring Units in Bavaria served as the basis for these studies. Odds ratios were calculated using multilevel and multivariate logistic regression analyses. Poisson regression analyses were used to calculate relative risks for the incidences. Results: In adults material, psychosocial and sociodemographic factors were independently associated with low levels of mental wellbeing. In children, the analyses showed that several indicators of familiesa social disadvantage were associated with mental distress, in contrast to mental wellbeing, where only a few factors were associated. At the macro level prevalence of good mental wellbeing was in most instances higher among men compared to women at welfare regime level, with the exception of the Former Soviet Union welfare regime, where women report slightly higher prevalence of good mental wellbeing. Gender inequalities in good mental wellbeing were identified independent of further individual sociodemographic variables and independent of the welfare regimes that people lived in. People in the Former Soviet Union and the Central and Eastern European Countries welfare regimes showed statistically significantly lower chances to report good mental wellbeing compared to the Scandinavian welfare regime. Gender inequalities in good mental wellbeing were not modified by welfare regimes. At the individual level of the built environment, exposure to road traffic noise at day or night was the main risk factor for incident mental health problems in children. Exposure to noise by neighbours day and night also appeared to be a risk factor for some subcategories of the strength and difficulties questionnaire. Both noise from construction work and aircraft noise during the day were not associated with incident mental health problems. Discussion: Findings of this dissertation highlight an association between individual factors, aspects of the social and built environment and mental wellbeing and mental distress. The study of mental wellbeing is relatively young, therefore, especially in this field further studies are needed to confirm and expand the findings of this dissertation. To plan effective prevention and health promotion interventions a thorough understanding of the underlying mechanisms and pathways is needed. Further studies are warranted to gain knowledge on the impact of (further aspects of) the social and built environment on mental wellbeing and mental distress in adults and in children to identify underlying mechanisms and to identify vulnerable groups for targeted preventions.
Dissertation
594 283
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Neighbourhood context and its contribution to urban health inequalities
(2017-07-11)
Schüle, Steffen
;
Moebus, Susanne
;
Zeeb, Hajo
;
Bolte, Gabriele
The neighbourhood environment in which people live has gained increasing attention in epidemiological research. This dissertation investigated relationships between contextual neighbourhood factors and individual health with a focus on the built environment and its contribution to health inequalities on the neighbourhood level. Furthermore, this dissertation developed new approaches and applied new statistical methods to analyse environmental inequalities in an urban context with a particular focus on public green space and its distribution by socioeconomic neighbourhood characteristics. Firstly, in a systematic review multilevel studies which considered both neighbourhood socioeconomic position (SEP) and objectively measured factors of the built environment were assessed in order to disentangle their independent and interactive effects on individual health outcomes and health behaviours. Secondly, two multilevel analyses of cross-sectional data in the city of Munich investigated whether neighbourhood SEP, public playground and park space, and parentally perceived environmental exposures were independently associated with overweight in preschool aged children while simultaneously considering individual child and family factors. Thirdly, two ecological neighbourhood studies in the city of Dortmund and Munich were conducted to assess whether air and noise pollution and public green space were disproportionately distributed by the degree of neighbourhood deprivation. The systematic review identified a great heterogeneity of definitions applied and metrics being used for measuring built and socioeconomic neighbourhood variables. Mostly mixed results across multilevel studies on how built and socioeconomic neighbourhood environments were associated with health and health-related behaviours were found. Furthermore, the review identified several interactions between contextual neighbourhood factors and individual factors, mostly concerning sex or individual SEP. The two multilevel studies showed that in the case of childhood overweight individual factors, such as parental education or parental overweight, were the most important determinants. However, perceived and objective built environmental factors additionally explained overweight variance between neighbourhoods. The two ecological case studies found out that deprived neighbourhoods were more exposed to air pollution and low public green space availability than more affluent neighbourhoods. This dissertation recommends that apart from individual determinants policies and interventions targeting health promotion should consider the neighbourhood environment additionally. Moreover, a socioeconomic unequal distribution of environmental burdens and resources may result in amplifications of health inequalities within cities. There is a need for further studies considering multiple neighbourhood dimensions in order to analyse interactive and mediating pathways between contextual factors and individual health. The development of new approaches and methods for analysing and assessing environmental health inequalities will contribute to the reconnection of urban planning and public health.
Dissertation
426 627
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Partizipation im Wohnumfeld: Benachteiligungsaspekte bei der Teilhabe von sozial benachteiligten Menschen mit Migrationshintergrund an der Gestaltung ihres Wohnumfeldes aus Public Health Perspektive
(2019-04-09)
Hemetek, Ursula
;
Blättner, Beate
;
Bolte, Gabriele
;
Bolte, Gabriele
In urban environments, health inequalities manifest spatially in the formation of "socially deprived areas". Socially disadvantaged groups with migration background are exposed to multiple burdens when their social disadvantages accumulate with health-related spatial disadvantages due to the unequal distribution of contextual factors in the living environment. Simultaneously, the social inequality of participation opportunities contributes to the fact that the same groups are least able to influence these conditions. According to the Salutogenic Model by Aaron Antonovsky (1997), participation, in the sense of personal participation in socially valued decision making, is an essential life experience that determines to what extent people are able to make resistance resources and coping strategies available, which decide upon their health and wellbeing. As a result, health promotion is not solely based on improving health-related conditions from above, but on actively involving residents, especially such of deprived areas, in decision-making processes concerning the development of their living environment. The research question is therefore: How can participation in relevant decisions about healthrelated aspects in the living environment be facilitated for socially disadvantaged groups of people with migration background and thereby improve their health chances? An explorative research design using grounded theory was applied. Two areas that are part of the Soziale Stadt program in Munich were selected as case studies. In and around those areas 23 expert interviews were conducted and evaluated over a period of 18 months. The results show that participation in the program Soziale Stadt is characterized by different understandings of participation along with different participatory practices. Three forms of participation can be distinguished: formal public participation in constructional redevelopment measures, the participation of professional actors in processes of area-development via the area committee, and projects to improve the societal participation of disadvantaged groups through socially integrative projects, focused on education and unemployment. Socially disadvantaged groups with a migration background are target group for the latter. Their participation in decision- making processes concerning the development of their living environment is thus not achieved.
Dissertation
1281 958

Bolte, Gabriele

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