Neighbourhood safety and smoking in population subgroups: The HELIUS study

Erik J. Timmermans*, Eleonore M. Veldhuizen, Marieke B. Snijder, Martijn Huisman, Anton E. Kunst

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


This study examines the associations between neighbourhood safety and three types of smoking behaviour, and whether these associations differ by sex, age, ethnicity and individual-level socio-economic position. Baseline data (2011–2015) from the The HEalthy LIfe in an Urban Setting (HELIUS) study (Amsterdam, the Netherlands) were used. Smoking behaviour was based on self-report. Heavy smoking was defined as smoking ≥10 cigarettes per day. Nicotine dependence was assessed using the Fagerström questionnaire. Geographic Information System techniques were used to construct local residential areas and to examine neighbourhood safety for these areas using micro-scale environmental data. Multilevel logistic regression analyses with 6-digit zip code area as a second level were used to assess the association between neighbourhood safety and smoking. In our study sample of 22,728 participants (18–70 years), 24.0% were current smokers, 13.7% were heavy smokers and 8.1% were nicotine dependent individuals. Higher levels of neighbourhood safety were significantly associated with less heavy smoking (OR = 0.88, 95% CI = 0.78–0.99) and less nicotine dependence (OR = 0.81, 95% CI = 0.69–0.95), but not with less current smoking (OR = 1.01, 95% CI = 0.91–1.11). The associations between neighbourhood safety and the three types of smoking behaviour varied by ethnicity. For instance, higher levels of neighbourhood safety were associated with less current smoking in participants of African Surinamese origin (OR = 0.71, 95% CI = 0.57–0.89), but not in those of Dutch (OR = 1.13, 95% CI = 0.91–1.39), South-Asian Surinamese (OR = 1.22, 95% CI = 0.95–1.55), Turkish (OR = 1.08, 95% CI = 0.84–1.38), Moroccan (OR = 1.53, 95% CI = 1.12–2.10) or Ghanaian (OR = 1.18, 95% CI = 0.47–2.94) origin. Policies that improve neighbourhood safety potentially contribute to less heavy smoking and nicotine dependence.

Original languageEnglish
Pages (from-to)111-118
Number of pages8
JournalPreventive Medicine
Publication statusPublished - 1 Jul 2018


This work was financially supported by the Amsterdam Public Health Research Institute in Amsterdam, the Netherlands. The HEalthy LIfe in an Urban Setting (HELIUS) study is conducted by the Academic Medical Center (AMC) Amsterdam and the Public Health Service (GGD) of Amsterdam. Both organisations provided core support for HELIUS. The HELIUS study is also funded by the Dutch Heart Foundation , the Netherlands Organisation for Health Research and Development (ZonMw), the European Union 7th Framework Programme , and the European Fund for the Integration of non-EU immigrants ( EIF ). We are most grateful to the participants of the HELIUS study and the management team, research nurses, interviewers, research assistants and other staff members who have taken part in gathering the data of this study. Furthermore, we would like to thank the Department of Research and Statistics of the municipality of Amsterdam for providing the data of the Amsterdam Safety Monitor 2013/2014 and the integral demographic and socio-economic registries.

FundersFunder number
Amsterdam Public Health Research Institute in Amsterdam
Dutch Heart Foundation
European Fund
Health Research
Entertainment Industry Foundation
Seventh Framework Programme


    • Environmental epidemiology
    • Geographic Information Systems
    • HELIUS study
    • Neighbourhood safety
    • Population subgroups
    • Smoking


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