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Publication Optimizing the implementation of integrated health promotion packages: an analysis in the context of intersectoral health policymaking in 34 Dutch projects of the governmental program Gezonde Slagkracht(Maastricht University, 2023) Grêaux, KimberlyThere are significant public health issues worldwide resulting from non-communicable diseases primarily caused by unhealthy behaviours such as poor diet, prolonged sitting, and excessive alcohol and drug use. A modern approach to addressing these issues seems to be intersectoral health policymaking. This requires collaboration with various partners from different sectors, in addition to public health, to implement integrated health promotion packages targeting both personal and environmental behavioural determinants. These interventions include various change methods (e.g. educational, regulation, or adjustments in the physical environment) situated in various settings (e.g. schools, supermarkets, and community centres). The aim of this research was to contribute to optimizing the implementation of integrated health promotion packages in local intersectoral health policymaking. In total, 34 project leaders and involved policy network partners and implementers of these intervention packages.Publication Breastfeeding and food pattern in overweight children in the Caribbean(Taylor & Francis Online, 2013) Grêaux, Kimberly; Schwiebbe, Luuk; Renders, Carry, M.; Doak, Colleen M.; Visser, Richard; Kist-van Holthe, Joana; Hirasing, Remy, A.Background: As in most countries around the globe, overweight and obesity are a major threat to public health on the Caribbean island of Aruba. Increasing evidence confirms that breastfeeding protects against overweight and obesity. However, little is known about the mechanism underlying the association between breastfeeding and obesity. One possibility is that breastfed infants are better able to control their meal size and intervals than formula-fed infants. This might lead to a healthier diet in later life and protect against overweight and obesity. Objective: To determine the relationship between breastfeeding, food pattern and being overweight in the Caribbean. Methods: In a cross-sectional school-based study in 2004–2005, weight and height were measured by two research assistants in 1776 children aged 6–11 years on Aruba, an island in the Caribbean. BMI was defined according to guidelines by the International Obesity Task Force. Parents completed a questionnaire pertaining to breastfeeding and dietary food pattern. Results: 1451/1776 (81·7%) children were breastfed; 851/1766 (47·9%) children were breastfed for <4 months, 227/1776 (12·8%) for 4–6 months and 373/1776 (21·0%) for ≧6 months. Children who were breastfed for ≧4 months had lower odds (OR 0·32, 95%CI 0·25–0·40) of being overweight including obesity than those who either were not breastfed or who were breastfed for <4 months. Children who were breastfed for ≧4 months were more likely to have a structured food pattern of six eating moments a day (OR 7·43, 95% CI 5·87–9·39, P<0·001) and to have breakfast every day (OR 2·86, 95% CI 2·17–3·78, P<0·001) than those who were not or who were breastfed for <4 months. Conclusions: Breastfeeding for ≧4 months is associated with a structured food pattern (six eating moments a day including a daily breakfast) and carries a strikingly lower risk of overweight in children. Promoting prolonged breastfeeding together with a focus on a subsequent structured food pattern could be a cheap method of preventing overweight.Publication Structural integration and performance of inter-sectoral public health-related policy networks: An analysis across policy phases.(Elsevier, 2017) Peters, D.T.J.M.; Raab, J.; Grêaux, Kimberly; Stronks, K.; Harting, JannekeBackground: Inter-sectoral policy networks may be effective in addressing environmental determinants of health with interventions. However, contradictory results are reported on relations between structural network characteristics (i.e., composition and integration) and network performance, such as addressing environmental determinants of health. This study examines these relations in different phases of the policy process. Methods: A multiple-case study was performed on four public health-related policy networks. Using a snowball method among network actors, overall and sub-networks per policy phase were identified and the policy sector of each actor was assigned. To operationalise the outcome variable, interventions were classified by the proportion of environmental determinants they addressed. Results: In the overall networks, no relation was found between structural network characteristics and network performance. In most effective cases, the policy development sub-networks were characterised by integration with less interrelations between actors (low cohesion), more equally distributed distances between the actors (low closeness centralisation), and horizontal integration in inter-sectoral cliques. The most effective case had non-public health central actors with less connections in all sub-networks. Conclusion: The results suggest that, to address environmental determinants of health, sub-networks should be inter-sectorally composed in the policy development rather than in the intervention development and implementation phases, and that policy development actors should have the opportunity to connect with other actors, without strong direction from a central actor.Publication Tourism and Development in the Senian Context: Does It Help or Hurt SIDS? The Case of Aruba(Science Direct, 2018) Taylor, DonTourism is the lifeblood of many small island independent states and those that are categorized as small non-independent jurisdictions (SNIJs) such as Aruba. The question that this paper proposes to address is whether and how tourism helps or hinders island development. Research has been conducted on the economic effects of tourism in a global context; however, our approach is to look at its effect in one destination, Aruba, and to contextualize this research by situating it among other Caribbean islands. The rationale is that tourism is of more significance to the Caribbean in terms of economic dependence and tourism intensity. Because of the density of tourism in Aruba and its mono-economical development paradigm this makes for an ideal case study.1 Our methodology is based on an ontological review of the relationship between tourism and economic development utilizing a contextualized definition of development that fits within the philosophical position of Amartya Sen. In that context defined not just in terms of GDP growth but the enhanced social welfare of its citizens also in the Senian sense as distance from unfreedom. The concept of unfreedom for purposes of this paper is based on the extent to which there is an inertia to shift paradigms even if the existing paradigm enhances vulnerability, fragility and restricts opportunities to its citizenry. Therefore, despite its impact on the economy in terms of foreign exchange, investments, and employment, there are considerable and pervasive externalities which should be considered in conceptualizing the totality of tourism’s effect on economic and social development. In this essay, we consider Sen’s (2000) definition of development as freedom and situate it in that context and introduce the work of envelopment theory as conceptualized by Sankatsing (2016).Publication Perceptions and implications of implicit gender bias in the hotel sector in Aruba(Emerald Insight, 2024) Jadnanansing, Madhu; DiPietro, Robin; de Droog, MiekePurpose: This study aimed to collect data on the perception of top executive women in the Aruban hotel sector regarding implicit gender bias. Design/methodology/approach: A qualitative study on the metacognitive processes of awareness, evaluation and autocorrection was utilized. Through purposive sampling women in the top two leadership levels in Aruba Hotel and Tourism Association (AHATA) member-hotels were selected. Findings: Results showed that a third of the top female executives experienced implicit gender bias career barriers. Different types of bias were identified such as: judgments regarding pregnancy, unequal pay and obstructions by the male general manager. How the women dealt with this bias depended on the type of bias and their personality. The identification of bias and its effects on the career trajectory were also influenced by characteristics of the work setting such as the size of the hotel and functional area. Research limitations/implications: The research limitations include the chosen scope, the impediment of the generalizability of the findings due to the nature of the study, self-perceived data and possible researcher and respondent bias. Practical implications This study added to the existing body of leadership development literature with a focus on the effects of implicit bias on female leadership advancement. Some specific theoretical concepts that were combined in this study are organizational leadership, metacognition and the unconscious mind. The important role of personality was also confirmed in this study however one element that stood out in the current study was the effect of resilience in overcoming perceived barriers and attaining personal career goals. Suggestions and directions for future research are provided. Originality/value Despite the fact that gender bias was not observed in an explicit form, participants advised to be aware of the existence and effects of the implicit form and to seek education and guidance from female mentors and to remain goal oriented when confronted with this bias. Since female under-representation in senior leadership positions in other economic sectors is not observed this advice serves as a significant practical implication for the development of female leadership in this important sector in Aruba.