Intentions to retire, life dissatisfaction and the subsequent risk of disability retirement

BACKGROUND AND AIMS

To examine the predictive value of intentions to retire early on the process of disability retirement and the contribution of life dissatisfaction to the association between intentions to retire early and disability retirement.

METHODS

A cohort of 6484 employees over 40 years and working for the City of Helsinki was followed from 2000 to 2004. At baseline, the participants had responded to a questionnaire. Information on disability retirement was obtained from the Local Government Pensions Institution and the State Treasury. We calculated age and gender adjusted incidence rates and estimated Cox regression models.

RESULTS

During the follow-up 232 (3.6%) participants were granted a disability pension. Clear predictive value of disability retirement was found for strong intentions to retire early (age and gender adjusted hazard ratio HR 6.55, 95% CI 4.64-9.26) and for life dissatisfaction (dissatisfaction with subjective well-being, HR 5.31, 4.11-6.87). After adjusting for life dissatisfaction, the HR for those with strong intentions to retire early attenuated to 3.86 (2.66-5.62). After simultaneous adjustments for various risk factors the associations of intentions to retire early and dissatisfaction with subjective well-being with disability retirement attenuated, but remained statistically significant.

CONCLUSIONS

The impact of intentions and subjective experience of well-being as measured by life dissatisfaction to the process of disability retirement should be recognized. Intentions to retire and life dissatisfaction should be considered as suitable measures when identifying people with elevated risk of disability retirement.

Associations of multiple socio-economic circumstances with physical functioning among Finnish and British employees

BACKGROUND

To further increase our understanding of socio-economic health inequalities, we need studies considering multiple socio-economic circumstances and comparing different cultural contexts. This study compared the associations of past and present socio-economic circumstances with physical functioning between employees from Finland and Britain.

METHODS

Cross-sectional survey data from the Helsinki Health Study (n = 5866) and the Whitehall II Study (n = 3052) were used. Participants were white-collar public sector employees aged 45-60 years. Physical functioning was measured with the SF-36 physical component summary. The socio-economic indicators were parental and own education, childhood and current economic difficulties, occupational class, income, housing tenure.

RESULTS

Childhood and current economic difficulties were independently associated with physical functioning in both cohorts, although in London women childhood difficulties did not reach statistical significance. Own education was independently associated with physical functioning in Helsinki. Occupational class showed associations with physical functioning in both cohorts. These were mainly attenuated by education and income, but in London women there was a strong independent association. The association of income with physical functioning was attenuated by education (Helsinki) and occupational class (London). Parental education and housing tenure showed no consistent associations.

CONCLUSIONS

Past and present economic difficulties were independently associated with physical functioning. The conventional socio-economic indicators showed less consistent associations which were partly mediated through other indicators and modified by the national context. The associations that varied according to the indicators and between the cohorts highlight the importance of considering the multiplicity of socio-economic circumstances and comparing different cultural contexts in further studies.

The effect of pain on sickness absence among middle-aged municipal employees

OBJECTIVES

To study the effects of pain on sickness absence, taking into account physical and psychosocial work load and socio-economic position.

METHODS

Data consisted of City of Helsinki personnel register data on sickness absence and a cross-sectional questionnaire survey which was carried out among employees of the City of Helsinki who reached the age of 40, 45, 50, 55 or 60 years during the years 2000-2002 (n = 8960, response rate 67%). Data sets were combined for those who gave permission for such linkage (78%). The main statistical method was negative binomial regression analysis.

RESULTS

The burden of pain on sickness absence was dependent on the duration of absence: the longer the duration, the higher the burden. Self-certified absence was equally predicted by acute and chronic pain, but medically certified absence was more clearly predicted by chronic pain. Adjustments for a range of work load factors and socio-economic position showed that pain was a relatively independent determinant of subsequent sickness absence, but in particular physical work load and socio-economic position explained a small proportion of the association. Overall, pain accounted for 13% of self-certified absence among women and 8% among men. Corresponding figures were 23% and 25% for medically certified 4-14-day sickness absence and 37% and 30% for absence of over 2 weeks.

CONCLUSIONS

The burden of pain on medically certified sickness absence is considerable. Prevention of pain problems is vital for reducing sickness absence rates.

Home ownership and mortality: a register-based follow-up study of 300,000 Finns

BACKGROUND

This study examined whether living in rented housing is associated with increased all-cause and cause-specific mortality, and whether the association between home ownership and mortality can be explained by household income, occupational class, and educational level.

METHODS

A random sample including every seventh Finn aged 40-80 years at the end of 1997 (N = 308 291) was derived from the population register of Finland. The sample was followed up for mortality until the end of 2003 during which time there were 22,721 deaths.

RESULTS

The hazard ratio for all-cause mortality among renters compared with owner-occupiers was 2.06 (95% CI 1.98 to 2.14) in men and 1.73 (1.65 to 1.81) in women. Adjusting for household income, occupational class, and educational level attenuated the excess mortality among renters by 30% in men and 19% in women. The effect of income was larger among the under 65 year olds than those aged 65 years or over. Excess mortality among renters was particularly high for alcohol-related diseases, respiratory diseases, lung cancer, as well as endocrine, metabolic and nutritional diseases, and infections.

CONCLUSIONS

Renters had higher mortality than owner-occupiers even after adjusting for household income, occupational class, and educational level. Home ownership may indicate material living standards and cumulative wealth that cannot sufficiently be captured by conventional socioeconomic indicators. Analysing home ownership may thus increase understanding of the factors producing inequalities in health.

Job decision latitude as a potential modifier of the contribution of physical workload to poor functioning in middle-aged employees

OBJECTIVES

It was hypothesised that job decision latitude may alleviate the detrimental health effect of physical workload. The objective was to test whether job decision latitude modifies the effect of physically demanding work on poor physical functioning, and whether the effects of physically demanding work and job decision latitude are dependent on occupational social class.

METHODS

Data were derived from the Helsinki Health Study baseline questionnaire survey. The participants were employees of the City of Helsinki, Finland, aged 40-60 years. Functioning was measured by Short Form 36 physical component summary. Logistic regression models were used to analyse the data.

RESULTS

The hypothesised modification of the effect of physical demands at work on physical functioning by job decision latitude could not be demonstrated. The expected interaction effect was observed only for the semi-professional class, and interaction of physical demands, decision latitude and occupational social class was not statistically significant. Furthermore, the effects of physically demanding work as well as low decision latitude were of similar magnitude in all the occupational social classes.

CONCLUSIONS

The results suggest that for the majority of employees the effect of physical workload on physical functioning is independent of job decision latitude or occupational social class in general. Control over work conditions is unlikely to reduce difficulties to cope with physical demands, when the actual physical tasks are not changed.

Associations of job strain and working overtime with adverse health behaviors and obesity: evidence from the Whitehall II Study, Helsinki Health Study, and the Japanese Civil Servants Study

Adverse health behaviors and obesity are key determinants of major chronic diseases. Evidence on work-related determinants of these behavioral risk factors is inconclusive, and comparative studies are especially lacking. We aimed to examine the associations between job strain, working overtime, adverse health behaviors, and obesity among 45-60-year-old white-collar employees of the Whitehall II Study from London (n=3,397), Helsinki Health Study (n=6,070), and the Japanese Civil Servants Study (n=2,213). Comparable data from all three cohorts were pooled, and logistic regression analysis was used, stratified by cohort and sex. Models were adjusted for age, occupational class, and marital status. Outcomes were unhealthy food habits, physical inactivity, heavy drinking, smoking, and obesity. In London, men reporting passive work were more likely to be physically inactive. A similar association was repeated among women in Helsinki. Additionally, high job strain was associated with physical inactivity among men in London and women in Helsinki. In London, women reporting passive work were less likely to be heavy drinkers and smokers. In Japan, men working overtime reported less smoking, whereas those with high job strain were more likely to smoke. Among men in Helsinki the association between working overtime and non-smoking was also suggested, but it reached statistical significance in the age-adjusted model only. Obesity was associated with working overtime among women in London. In conclusion, job strain and working overtime had some, albeit mostly weak and inconsistent, associations with adverse health behaviors and obesity in these middle-aged white-collar employee cohorts from Britain, Finland, and Japan.

Children's use of dental services in the five Nordic countries

BACKGROUND

An increase in the use of general practitioner services for children has taken place since the 1980s in the Nordic countries, but little is known about the use of dental services during this time.

AIM

To compare differences in children's use of dental services in the five Nordic countries and to analyse changes over time from the 1980s to the 1990s.

METHODS

The participants were 20 500 children aged 2-17 years from Denmark, Finland, Iceland, Norway and Sweden. Cross-sectional population surveys using random samples comprising 3000 children in each country were conducted in 1984 and 1996. Changes over time in the use of dental services were studied in each country by age, sex, level of parental education and living area.

RESULTS

The prevalence of children's utilisation of dental services varied between 60% and 34% in 1984, and between 42% and 30% in 1996. A clear change towards decreasing utilisation over time (p<0.05) was found in all countries except Finland, where utilisation increased statistically significantly (p<0.05). Odds ratios (1984 _ 1.00) for the changes ranged between 0.66 (95% confidence interval 0.58 to 0.75) in Sweden and 0.71 (0.62 to 0.81) in Iceland, while the corresponding figure was 1.32 (1.16 to 1.48) in Finland. In 1996, children from families with the lowest education in Finland and Norway used dental services more frequently than children from families with higher education.

CONCLUSION

Children's use of dental services decreased significantly in four of the five Nordic countries between the mid-1980s and the mid-1990s.

Negative life events and stability of sense of coherence: A five-year follow-up study of Finnish women and men

A strong sense of coherence (SOC) is found to be associated with good mental health. This study investigated (1) whether negative life events affect level of SOC, (2) whether initial level of SOC modifies the effect of negative life events on SOC, and (3) whether stability of SOC differs between genders. The data were derived from the 15-year Health and Social Support study (N= 17,271). Ordinary linear regression analysis was used. Negative life events decreased the level of SOC among both genders irrespective of the timing of the event. The more recent the life event, the lower the SOC. A strong SOC in 1998 did not protect SOC from declining during follow-up. Specific gender differences were not discovered. SOC was related to negative changes in people's environment. Initially strong SOC was not more stable than initially mediocre or weak SOC. Men and women reacted quite similarly to negative life events.

The sociodemographic patterning of drinking and binge drinking in Estonia, Latvia, Lithuania and Finland, 1994-2002

Background

Despite the relatively low recorded alcohol consumption level, the Baltic countries (Estonia, Latvia and Lithuania) and neighbouring Finland suffer from similar harmful consequences related to the use of alcoholic beverages, including socio-economic inequalities in alcohol related mortality. Comparative evidence is needed to understand harmful drinking patterns and to implement preventive alcohol policies also in the Baltic countries. This study compared heavy and binge drinking by sex, age, education, urbanisation and marital status in the Baltic countries and Finland.

Methods

The data were nationally representative postal surveys conducted in Estonia (n = 6271), Latvia (n = 6106), Lithuania (n = 7966) and Finland (n = 15764) during 1994–2002. The criterion for heavy drinking was at least 15 portions weekly among men, and at least five among women, and for binge drinking at least six portions per one occasion.

Results

Heavy drinking was more common among younger participants in all countries, and in Latvia among the less-educated. Among Finnish men, and among women from all countries except Latvia, the better-educated were more often heavy drinkers. In Latvia and Finland, urban men, and in all countries, urban women, were more often heavy drinkers. Heavy drinking was more common among non-married Lithuanian and Finnish men, and Finnish women. Binge drinking was more common among less-educated Estonian and Latvian men, and among younger and less-educated women in all countries.

Conclusion

Our results support the continued power of traditional drinking habits in the North Eastern part of Europe. In the future the target groups for prevention of excessive drinking should also include young and less-educated women in all four countries studied.

Applying an Equity Lens to Tobacco-Control Policies and Their Uptake in Six Western-European Countries

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

The Effects of Childhood Circumstances, Adult Socioeconomic Status, and Material Circumstances on Physical and Mental Functioning: A Structural Equation Modelling Approach

PURPOSE

We sought to examine the importance of childhood circumstances, adult socioeconomic status, and material circumstances to physical and mental functioning among middle-aged women and men.

METHODS

The data were collected among the employees of the City of Helsinki by mailed questionnaires from 2000 to 2002 (7148 women and 1799 men, response rate 67%). Three latent variables covering childhood circumstances, adult socioeconomic status, and material circumstances were constructed from 10 observed socioeconomic indicators. Direct and indirect effects of the latent variables on physical and mental functioning, measured by the SF-36 component summaries, were examined using structural equation modelling.

RESULTS

Childhood circumstances were not directly associated with either physical or mental functioning but had some effect through socioeconomic status. Low socioeconomic status was associated with poor physical functioning, but mental functioning was poorer among those in higher positions. Material circumstances were associated with physical and especially with mental functioning.

CONCLUSIONS

Low socioeconomic status and material circumstances are both important for physical functioning. However, mental functioning does not necessarily follow a similar socioeconomic pattern and the results are heavily influenced by how socioeconomic position is measured.

Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: evidence from the Helsinki Health Study and the Whitehall II Study

BACKGROUND

Common mental disorders do not always show as consistent socioeconomic gradients as severe mental disorders and physical health. This inconsistency may be due to the multitude of socioeconomic measures used and the populations and national contexts studied. We examine the associations between various socioeconomic circumstances and common mental disorders among middle-aged Finnish and British public sector employees.

METHODS

We used survey data from the Finnish Helsinki Health Study (n = 6028) and the British Whitehall II Study (n = 3116). Common mental disorders were measured by GHQ-12. The socioeconomic indicators were parental education, childhood economic difficulties, own education, occupational class, household income, housing tenure and current economic difficulties. Logistic regression analysis was the main statistical method used.

RESULTS

Childhood and current economic difficulties were strongly associated with common mental disorders among men and women in both the Helsinki and the London cohort. The more conventional indicators of socioeconomic circumstances showed weak or inconsistent associations. Differences between the two cohorts and two genders were small.

CONCLUSIONS

Our findings emphasize the importance of past and present economic circumstances to common mental disorders across different countries and genders. Overall, our results suggest that among employee populations, the socioeconomic patterning of common mental disorders may differ from that of other domains of health.

Associations of work-family conflicts with food habits and physical activity

OBJECTIVE

This study examines the relationship between family-work conflicts with food habits and physical activity, and whether the relationship is dependent on family structure and work-related factors.

DESIGN AND SETTING

Cross-sectional postal surveys were carried out in 2001 and 2002 among employees of the City of Helsinki, Finland, aged 40-60 years (n = 5346, response rate 66%; for women 70% and for men 60%). Dependent variables in logistic regression analyses were nationally recommended food habits and physical activity. Independent variables were work-family conflicts and family-work conflicts. Covariates included age, marital status, number of children, occupational class, working hours, time travelling to work, and physical and mental work load.

RESULTS

Women reporting strong work-family conflicts were more likely to follow recommended food habits (odds ratio (OR) and 95% confidence intervals 1.49 (1.19-1.86)), but this relationship weakened when adjusting for work-related factors (OR 1.20 (0.93-1.55)). Women and men with strong family-work conflicts were less likely to report recommended food habits after adjusting for family structure and work-related factors (women OR 0.75 (0.61-0.92), men OR 0.57 (0.34-0.96)). Women and men with strong work-family conflicts were less likely to follow the recommended amount of physical activity (women OR 0.76 (0.60-0.96), men OR 0.54 (0.34-0.87)). Additionally, women with strong family-work conflicts were less likely to follow the recommended amount of physical activity (OR 0.77 (0.63-0.94)). Adjusting for family and work-related factors did not affect these associations.

CONCLUSIONS

Conflicts between paid work and family life are likely to constitute barriers for a physically active lifestyle and possibly also for healthy food habits. Improving the balance between work and family may provide a route for promoting health-related behaviours.

Body weight and health status: importance of socioeconomic position and working conditions

OBJECTIVE

To examine the association between relative body weight and health status and the potential modifying effects of socioeconomic position and working conditions on this association.

RESEARCH METHODS AND PROCEDURES

The data were derived from three identical cross-sectional surveys conducted in 2000, 2001, and 2002. Respondents to postal surveys were middle-aged employees of the City of Helsinki (7148 women and 1799 men, response rate 67%). BMI was based on self-reported weight and height. Health status was measured by the Short-Form 36 subscales and component summaries.

RESULTS

Body weight was inversely associated with physical health, but in mental health, differences between BMI categories were small and inconsistent. In women, physical health deteriorated monotonically with increasing BMI, whereas in men, poor physical health was found among the obese only. Socioeconomic position did not modify the association between BMI and health. In women, the association between body weight and physical health became stronger with decreasing job control and increasing physical work load, whereas in men, a similar modifying effect was found for high job demands.

DISCUSSION

Body weight was associated with physical health only. Lower levels of relative weight in women than in men may be associated with poor physical health. High body weight combined with adverse working conditions may impose a double burden on physical health.

Pain and health related functioning among employees

STUDY OBJECTIVE

Although employees report high rates of pain, little is known about the effects of pain on health related functioning among them. This study examined the effects of pain on employees' health related functioning by bodily locations of pain, number of painful locations, and whether pain was acute or chronic.

DESIGN

Cross sectional questionnaire survey. Data on pain and health related functioning as measured with the eight subscales of the short form 36 health survey (SF-36) were obtained in the years 2001 and 2002.

SETTING

Municipal employees of the City of Helsinki, Finland.

PARTICIPANTS

All employees who reached the age of 40, 45, 50, 55, and 60 years during each study year. Response rate was 66% (n = 5829).

MAIN RESULTS

Compared with those reporting no pain, those with pain had considerably poorer functioning on all SF-36 subscales. The lowest scores for health related functioning were seen in the physical domain of health, whereas the mental domain was less affected. The association of pain with functioning was practically independent of the bodily location of pain. Whether pain was acute or chronic had only a modest effect on functioning. Widest variation in functioning was found by the number of painful locations.

CONCLUSIONS

Among employees pain complaints, irrespective of the location, are associated with a decreased level of functioning. The number of painful locations is likely to be the most useful measure to identify employees with a high risk of poor functioning.

Higher smoking prevalence in urban compared to non-urban areas: time trends in six European countries

We investigated differences in smoking prevalence between urban and non-urban area of residence in six Western European countries (Sweden, Finland, Denmark, Germany, Italy and Spain), and smoking prevalence trends over the period 1985-2000. In most countries, smoking prevalence was highest in urban areas, and increased with urbanization. Urban/non-urban inequalities were most pronounced among individuals with low education levels, and also among females. There were no significant differences in annual rate of change in smoking prevalence between non-urban and urban areas.

Multiple socio-economic circumstances and healthy food habits

OBJECTIVE

To examine associations between seven indicators of socio-economic circumstances and healthy food habits, while taking into account assumed temporal order between these socio-economic indicators.

DESIGN AND SETTING

Data were derived from cross-sectional postal questionnaires in 2000-2002. Socio-economic circumstances were assessed by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Healthy food habits were measured by an index consisting of consumption of fresh vegetables, fruit or berries, rye bread, fish and choosing vegetable fats on bread and oil in cooking. Sequential logistic regression models were used, adjusting for age and marital status.

PARTICIPANTS

Employees of the City of Helsinki, Finland (n=8960, aged 40-60 years).

RESULTS

Healthy food habits were reported by 28% of women and by 17% of men. Own education, occupational class, household income, home ownership and current economic difficulties were associated with healthy food habits. These associations were attenuated but mainly remained after mutual adjustments for the socio-economic indicators. Among women, a pathway was found suggesting that part of the effects of education on food habits were mediated through occupational class.

CONCLUSIONS

Employees in higher and lower socio-economic positions differ in their food habits, and those in lower positions and economically disadvantaged are less likely to report healthy food habits. Health promotion programmes and food policies should encourage healthier food choices among those in lower socio-economic positions and among those with economic difficulties in particular.

Work-family conflicts and self-rated health among middle-aged municipal employees in finland

Work-family conflicts are common, but their effects on health are not well known. The aim of this study was to examine the associations between work-family conflicts and self-rated health among middle-aged municipal employees. In addition, the effect of social background factors on the association between work-family conflicts and self-rated health were examined. The data were based on cross-sectional postal surveys, which were carried out in 2001 and 2002, among female and male employees of the city of Helsinki, Finland. The participants were aged 40-60, and the response rate for women was 69%, and for men 60%. In the final analysis, 3,443 women and 875 men were included. For men and woman alike, work-to-family and family-to-work conflicts were associated with poor self-rated health. The association remained after adjusting for sociodemographic and socioeconomic factors. This study shows that a better balance between family life and work outside the home would probably have a health promoting effect.

The contribution of musculoskeletal disorders and physical workload to socioeconomic inequalities in health

OBJECTIVES

The objective of the study was to examine whether the association of physical workload with musculoskeletal disorders might explain occupational social class inequalities in self-rated health.

METHODS

Participants of the study were 40-60 years old employees of the City of Helsinki. The data (n = 3740) were derived from several sources, including mail survey designed by the researchers and health check-ups carried out by occupational health care. Prevalence data and logistic regression were used in the analyses.

RESULTS

An occupational class gradient was found for musculoskeletal disorders. The gradient in musculoskeletal disorders was largely explained by physical demands at work in both genders. The contribution of physical demands to occupational class gradient in self-rated health was considerable in women, but smaller in men. The contribution of musculoskeletal disorder to the occupational class gradient in self-rated health was weak for both genders.

CONCLUSION

Physical workload is likely to considerably contribute to inequalities in health. Mediation of this effect through musculoskeletal disorder to generic health, however, could not be demonstrated. Different mechanisms are likely to cause inequalities in different health outcomes.

Trends in the magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland during 1994–2004

BACKGROUND

Socioeconomic inequalities in health in the Baltic countries are possibly increasing due to concomitant pressures. This study compared time trends from 1994 to 2004 in the pattern and magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland.

METHODS

The data were gathered from cross-sectional postal surveys of the Finbalt project, conducted every second year since 1994 on adult populations (aged 20-64 years) in Estonia (n=9049), Latvia (n=7685), Lithuania (n=11,634) and Finland (n=18,821). Three self-reported health indicators were used: (i) less than good perceived health, (ii) diagnosed diseases, and (iii) symptoms.

RESULTS

The existing educational inequalities in health in three Baltic countries and Finland remained generally stable over time from 1994 to 2004. Also, the overall prevalence of all three health indicators was generally stable, but in the Baltic countries improvement in perceived health was mainly found among the better-educated men and women. Diagnosed diseases increased in the Baltic countries, except Lithuania, where diseases decreased among the better-educated women. Symptoms increased among the better-educated Estonian and Finnish women.

CONCLUSIONS

The period from 1994 to 2004 of relative stabilization since the worst conditions of the social transition has not been followed by notable changes in self-reported health, and this appears to be the situation across all educational groups in the Baltic countries. While health inequalities did not markedly change, substantial inequalities do remain, and there were indications of favourable developments mainly among the better-educated respondents. The factors contributing towards increasing health inequalities may only be visible in the future.

Genetic and Environmental Factors Affecting Self-Rated Health from Age 16–25: A Longitudinal Study of Finnish Twins

We analyzed genetic and environmental determinants of self-rated health and its change from adolescence to early adulthood. Questionnaires were mailed to Finnish twins born 1975-1979 at ages 16, 17, 18 1/2 and, on average, 25 years of age (N=2465 complete twin pairs). The data were analyzed using quantitative genetic methods for twin data by the Mx statistical package. Heritability of self-rated health was greatest at age 16 (63%, 95% confidence intervals (CI) 56-67%, men and women together) and declined steadily to age 25 (33%, 95% CI 25-41%). The residual variation was due to unshared environments. Health ratings at different ages were modestly correlated (r=0.33-0.61). These correlations were mainly due to genetic factors, but unshared environment also contributed to them. An important challenge for further research is to identify environmental influences contributing to self-rated health independently of, or in interaction with, genetic factors.

The sociodemographic patterning of health in Estonia, Latvia, Lithuania and Finland

BACKGROUND

Public health problems in the Baltic countries are typical of Eastern European transition economies. A common assumption is that the economic transition has been particularly difficult for previously disadvantaged groups, and comparative research on the health differences between sociodemographic groups in the Baltic countries is therefore needed. This study compared associations of health with gender, age, education, level of urbanization and marital status in three Baltic countries and Finland.

METHODS

The data were gathered from cross-sectional postal surveys conducted in 1994, 1996, 1998 and 2000 on adult populations (aged 20-64 years) in Estonia (n = 5052), Latvia (n = 4290), Lithuania (n = 7945) and Finland (n = 12796). Three self-reported health indicators were used: (i) perceived health, (ii) diagnosed diseases and (iii) symptoms.

RESULTS

The prevalence of less-than-good perceived health (average, rather poor or poor) was higher in the Baltic countries (men 66-56%, women 68-64%) than in Finland (men 35%, women 31%). The odds ratios (with 95% confidence intervals) of less-than-good perceived health among the low educated compared to the highly educated in Estonia, Latvia, Lithuania and Finland were 2.03 (1.49-2.77), 2.00 (1.45-2.76), 2.27 (1.78-2.89) and 1.89 (1.61-2.20) among men, and 3.32 (2.43-4.55), 2.77 (2.04-3.77), 2.07 (1.61-2.66) and 1.89 (1.63-2.20) among women, respectively. Diseases and symptoms were also more common among the lower educated men and women in all four countries. However, urbanization and marital status were not consistently related to the health indicators.

CONCLUSIONS

The Baltic countries share a similar sociodemographic patterning of health with most European countries, i.e. the lower educated have worse health. The methodological considerations of this study point out, however, that further research is needed to support public health policies aimed at the most vulnerable population groups.

Work-family conflicts and drinking behaviours among employed women and men

OBJECTIVE

To examine the relationship between work-family conflicts and drinking behaviours among women and men, and to discover whether the relationship remains the same after taking into account family structure and socio-economic status.

METHOD

Cross-sectional surveys were carried out by postal questionnaires in 2001 and 2002 among female and male municipal employees aged 40-60, of Helsinki, Finland; 4228 women and 1043 men participated, with a response rate of 66%. Dependent variables were heavy drinking-for men >12 standard portions per week and for women >9 portions per week; weekly binge drinking including 6 or more portions per occasion; and problem drinking, as measured by the CAGE questionnaire. Independent variables were work-to-family conflicts and family-to-work conflicts. Covariates were age, family structure, education, income, and occupational class.

RESULTS

Work-family conflicts were strongly related to problem drinking among both women and men and also associated with heavy drinking among women. Taking family structure and socio-economic status into account did not markedly change the relationship between work-family conflicts and heavy drinking among women, but strengthened slightly the association with problem drinking among both women and men.

CONCLUSIONS

Work-family conflicts are particularly important issues in problem drinking among men and women and also in heavy drinking among women. Improving the balance between work and family may be a way to prevent problem drinking.

Children's use of general practitioner services in the five Nordic countries

OBJECTIVE

To compare socioeconomic, sociodemographic, and living area differences in children's use of GP services in five Nordic countries from the 1980s to the 1990s and to analyse trends during the period.

DESIGN

Cross sectional population surveys using random samples comprising 3000 children aged 2-17 years were conducted in 1984 and 1996 in five Nordic countries. Time trends in use of GP services were studied in each country by age, sex, parents' highest level of education, and living area.

SETTING

Five Nordic countries, Denmark, Finland, Iceland, Norway, and Sweden in 1984 and 1996.

PARTICIPANTS

A total sample of 15 000 children aged 2-17 years. Altogether 3000 children were selected at random from the national population registers of the national bureaus of statistics in each country.

MAIN OUTCOME

Health services utilisation on the basis of responses to a questionnaire item asking whether the parents had consulted a GP with regard to their children's health during the previous three months.

MAIN RESULTS

The prevalence of children's utilisation of GP services varied from 14% in 1984 in Sweden to 28% in 1996 in Iceland. A clear time trend towards increasing utilisation of GP services (p<0.05) was found in all countries except in Denmark. Odds ratios for time trends (1984 = 1.00) varied from 1.22 (1.02 to 1.46) in Sweden to 1.92 (1.62 to 2.30) in Norway. After adjusting for independent variables, a statistically borderline significant declining utilisation trend (OR = 0.85 (0.70 to 1.03)) was found for Denmark.

CONCLUSION

Children's use of GP services has increased significantly in four of the five Nordic countries.

Multiple measures of socioeconomic circumstances and common mental disorders

While serious mental disorders typically show socioeconomic differences similar to physical illness-that is, that lower positions imply poorer health-differences for common mental disorders have been inconsistent. We aim to clarify the associations and pathways between measures of socioeconomic circumstances and common mental disorders by simultaneously analysing several past and present socioeconomic measures. The data were derived from middle-aged women and men employed by the City of Helsinki. Cross-sectional surveys were conducted in 2000-2002 among employees who, during each year, reached 40, 45, 50, 55 or 60 years of age. The pooled data include 8970 respondents (80% women; response rate 67%). Common mental disorders were measured by GHQ-12 and the SF-36 mental component summary. Seven socioeconomic measures were included: parental education, childhood economic difficulties, own education, occupational class, household income, home ownership, and current economic difficulties. Logistic regression analysis was used to examine associations between the socioeconomic circumstances and common mental disorders. Past and present economic difficulties were strongly associated with common mental disorders, whereas conventional past and present socioeconomic status measures showed weak or slightly reverse associations. Adjusting for age and gradually for each socioeconomic measure did not affect the main findings, which were very similar for women and men, as well as for both measures of common mental disorders. While the associations of conventional socioeconomic status measures with common mental disorders were weak and inconsistent, our results highlight the importance of past and present economic difficulties to these disorders.

Associations of SF-36 mental health functioning and work and family related factors with intentions to retire early among employees

OBJECTIVE

To examine the associations of mental health functioning (SF-36) and work and family related psychosocial factors with intentions to retire early.

METHODS

Cross sectional survey data (n = 5037) from the Helsinki Health Study occupational cohort in 2001 and 2002 were used. Intentions to retire early were inquired with a question: "Have you considered retiring before normal retirement age?" Mental health functioning was measured by the Short Form 36 (SF-36) mental component summary (MCS). Work and family related psychosocial factors included job demands and job control, procedural and relational justice, conflicts between work and family, and social network size. Multinomial regression models were used to analyse the data.

RESULTS

Poor mental health functioning, unfavourable psychosocial working conditions, and conflicts between work and family were individually related to intentions to retire early. After adjustments for all work and family related factors the odds ratio for low mental health functioning was halved (from OR = 6.05 to 3.67), but nevertheless the association between poor mental health functioning and strong intentions to retire early remained strong.

CONCLUSIONS

These findings highlight not only the importance of low mental health and unfavourable working conditions but also the simultaneous impact of conflicts between work and family to employees' intentions to retire early.

Smoking and SF-36 health functioning

OBJECTIVE

To examine the association between smoking and general health as measured by the Short-Form Health Survey (SF-36) questionnaire.

METHODS

Data derived are from three cross-sectional surveys conducted in 2000, 2001 and 2002. Respondents to the postal surveys were middle-aged employees of the City of Helsinki (1799 men and 7171 women, response rate 67%). Smoking status was divided into current heavy and moderate smokers, ex-smokers and never smokers. Health status was measured by the eight SF-36 subscales and the physical and mental component summaries.

RESULTS

On the physical subscales, current smokers reported poorer health than non-smokers on general health and physical functioning in men. On the mental subscales, current smokers had consistently poorer health than non-smokers. However, often only heavy smokers differed from non-smokers. No differences were found between ex-smokers and never smokers on any subscale or the component summaries of the SF-36.

CONCLUSIONS

Differences between smoking categories were found on some physical and all mental subscales of the SF-36. The differences were slightly larger among men. As heavy smokers more often report limitations with daily activities as well as loss of well-being, these impairments potentially provide valuable incentives for non-smoking to be used in health education messages and interventions.

Associations between working conditions and angina pectoris symptoms among employed women

OBJECTIVE

This study aimed to examine whether psychosocial working conditions are associated with angina pectoris (AP) symptoms in women.

METHODS

Data were derived from postal questionnaires filled in by 40- to 60-year-old women employed by the City of Helsinki, Finland, in 2000 to 2002 (n = 7093, response rate 67%). AP symptoms were measured by the Rose Questionnaire. Logistic regression analyses were carried out to examine AP symptoms as outcome. Independent variables consisted of Karasek's job demands and job control, work fatigue, working overtime, work-related mental and physical strain, the work-home interface, and social support, adjusted for age. Confounding effects of socioeconomic status, health behaviors (smoking, binge drinking, body mass index), and menopause were also examined. Pregnant women were excluded.

RESULTS

AP symptoms were reported by 6% of participants. Work fatigue was strongly associated with AP. In addition, working overtime, low job control, and high physical strain at work were associated with AP. The associations between psychosocial working conditions and AP symptoms were unaffected by health behaviors, socioeconomic status, or menopause.

CONCLUSIONS

Working conditions were associated with the AP symptoms identified by the Rose Questionnaire. Longitudinal studies are needed to disentangle the causal relationships, i.e., whether psychosocial stress is a true risk factor/cause of angina symptoms and cardiovascular disease among women.

Job control, job demands, or social class? The impact of working conditions on the relation between social class and health

BACKGROUND

The aim of the study was to investigate (1) how much of the association between health and social class is accounted by psychosocial working conditions, and (2) whether health is related to working conditions after controlling for social class.

METHODS

The data derive from the surveys of the Helsinki health study, collected in 2000, 2001, and 2002 from 40-60 year old employees working for the City of Helsinki (n=8970, response rate 67%). The study measured occupation based social class and Karasek's demand-control model. The health outcomes were self rated health as less than good and limiting longstanding illness. Age adjusted prevalence percentages and fitted logistic regression models were calculated.

RESULTS

The individual effects of social class and psychosocial working conditions on self rated health and limiting longstanding illness were strong among both men and women. The relation between social class and both health outcomes considerably attenuated when job control was controlled for, but was reinforced when controlling for job demands. Controlling for both job control and job demands attenuated the relation between social class and self rated health and limiting longstanding illness among women, however, was reinforced among men.

CONCLUSIONS

A substantial part of the relation between social class and health could be attributed to job control, however, job demands reinforced the relation. Although the effect of social class is mediated by psychosocial working conditions, both social class and working conditions were related to health after mutual adjustments.

Associations of psychosocial working conditions with self-rated general health and mental health among municipal employees

OBJECTIVES

To examine associations of job demands and job control, procedural and relational organizational fairness, and physical work load with self-rated general health and mental health. In addition, the effect of occupational class on these associations is examined.

METHODS

The data were derived from the Helsinki Health Study baseline surveys in 2001-2002. Respondents to cross-sectional postal surveys were middle-aged employees of the City of Helsinki (n=5.829, response rate 67%). Associations of job demands and job control, organizational fairness and physical work load with less than good self-rated health and poor GHQ-12 mental health were examined.

RESULTS

Those with the poorest working conditions two to three times more, often reported poor general and mental health than those with the best working conditions. Adjustment for occupational class weakened the associations of low job control and physical work load with general health by one fifth, but even more strengthened that of high job demands. Adjustment for occupational class clearly strengthened the associations of job control and physical work load with mental health in men. Mutual adjustment for all working conditions notably weakened their associations with both health measures, except those of job control in men. All working conditions except relational organizational fairness remained independently associated with general and mental health.

CONCLUSIONS

All studied working conditions were strongly associated with both general and mental health but the associations weakened after mutual adjustments. Of the two organizational fairness measures, procedural fairness remained independently associated with both health outcomes. Adjustment for occupational class had essentially different effects on the associations of different working conditions and different health outcomes.

Associations of childhood circumstances with physical and mental functioning in adulthood

The aim of this study was to examine the associations of parental education and specific childhood circumstances with adult physical and mental functioning. Self-reported data were collected in 2000, 2001 and 2002 among middle-aged women (n=7,171) and men (n=1,799) employed by the City of Helsinki. Functioning was measured by the physical and mental component summaries of the Short-Form 36 Health Survey (SF-36). The lowest quartile of the scores on each component summary was considered to indicate limited functioning. Adult socio-economic circumstances were measured by their own education. Among women parental education was inversely associated with physical functioning. The association remained after adjusting for specific childhood circumstances but disappeared after adjustment for own education. In contrast, parental education was positively associated with mental functioning among women, and the association remained after adjusting for specific childhood circumstances and the own education. Among women childhood adversities such as own chronic disease, parental mental problems, economic difficulties and having been bullied in childhood were associated with both physical and mental functioning. Parental drinking problems were associated with adult mental functioning among women. Among men, chronic disease, economic difficulties and having been bullied in childhood were associated with physical functioning. Parental mental problems, economic difficulties and having being bullied in childhood were also associated with mental functioning among men. These results suggest that the effect of parental education on physical functioning is mediated through one's own education. The association between parental education and mental functioning and the effects of several specific childhood circumstances may suggest a latency effect. Some evidence of cumulative effects of childhood and adulthood circumstances were found among women in physical functioning. Specific childhood circumstances are therefore important determinants of adult functioning. These circumstances provide detailed information on the association of childhood circumstances with adult functioning over and above parental education.

The social patterning of relative body weight and obesity in Denmark and Finland

BACKGROUND

Relative body weight is typically inversely associated with social status in affluent societies but studies comparing the social patterning of relative body weight and obesity in different countries have only seldom been conducted. The aim of this study was to analyse and compare the social patterning of relative weight and obesity by occupational status, educational attainment and marital status between Danish and Finnish women and men.

METHODS

Data from the Finnish Survey on Living Conditions and the Danish Health and Morbidity Survey, both collected in 1994, were compared. Relative weight was studied by using body mass index (BMI), and those with BMI > or =30 kg/m(2) were regarded as obese. Logistic regression analysis was used to examine the social patterning of obesity in the pooled dataset. Two-variable interaction effects were tested separately.

RESULTS

Compared with their Danish counterparts, Finnish women and men had higher average relative weight and they were more often obese. There were no country differences in the socio-economic patterning of obesity by educational attainment, but a stronger patterning of obesity by occupational status was found among Danish women. Moreover, non-married women in Denmark were more likely to be obese than their married counterparts.

CONCLUSIONS

Finns have higher relative weight and they are more often obese than Danes. The social patterning of obesity was similar in both studied countries but stronger in Denmark.

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education

OBJECTIVE

To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group.

DESIGN

Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points.

SETTING

Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain.

PARTICIPANTS

451 386 non-institutionalised men and women 25-79 years old.

MAIN OUTCOME MEASURES

Smoking status, daily quantity of cigarettes consumed by smokers.

RESULTS

Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups.

CONCLUSIONS

Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

Occupational class inequalities across key domains of health: Results from the Helsinki Health Study

BACKGROUND

Studies comparing socioeconomic inequalities in health using several health indicators are scarce. Therefore, this study aims to compare the shape and magnitude of occupational class inequalities across key domains of health, i.e. the subjective, functional and medical domains. Additionally, we examine whether physical or mental workload will affect these inequalities, and whether these effects are specific to particular health indicators.

METHODS

Cross-sectional survey data from the Helsinki Health Study in 2000 and 2001 were used. Each year employees of the City of Helsinki, reaching 40, 45, 50, 55 and 60 years received a mailed questionnaire. 6243 employees responded (80% women, response rate 68%). The socioeconomic indicator was occupational social class. Nine health indicators were included: self-rated health, pain or ache, GHQ-12 mental well-being, limiting long-standing illness, SF-36 physical and mental health functioning, Rose angina symptoms, circulatory diseases and mental problems. Prevalence percentages, odds ratios and inequality indices from logistic regression analysis were calculated.

RESULTS

Occupational class inequalities were found for self-rated health, pain or ache, limiting long-standing illness, physical health functioning, angina symptoms, and circulatory diseases. Physical or mental workload did not account for these inequalities. Inequalities were non-existent or slightly reversed for GHQ-12 mental well-being, SF-36 mental health functioning and mental problems.

CONCLUSION

Expected occupational class inequalities in health among both women and men were found for global and physical health but not for mental health. The observed inequalities could not be attributed to physical or mental workload.

Socioeconomic position and self-rated health: the contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources

OBJECTIVES

We examined socioeconomic inequalities in self-rated health by analyzing indicators of childhood socioeconomic circumstances, adult socioeconomic position, and current material resources.

METHODS

We collected data on middle-aged adults employed by the City of Helsinki (n=8970; 67% response rate). Associations between 7 socioeconomic indicators and health self-ratings of less than "good" were examined with sequential logistic regression models.

RESULTS

After adjustment for age, each socioeconomic indicator was inversely associated with self-rated health. Childhood economic difficulties, but not parental education, were associated with health independently of all other socioeconomic indicators. The associations of respondents' own education and occupational class with health remained when adjusted for other socioeconomic indicators. Home ownership and economic difficulties, but not household income, were the material indicators associated with health after full adjustment.

CONCLUSIONS

Own education and occupational class showed consistent associations with health, but the association with income disappeared after adjustment for other socioeconomic indicators. The effect of parental education on health was mediated by the respondent's own education. Both childhood and adulthood economic difficulties showed clear associations with health and with conventional socioeconomic indicators.

A comparative study of the patterning of women's health by family status and employment status in Finland and Sweden

The main aim of this study is to compare the patterning of health by family status and employment status among women in Finland and Sweden and to explore whether the patterning of health by family status is influenced by employment status and income. An additional aim was to identify which combinations of family status and employment status are especially disadvantageous for women's health . The data derived from comparable interview surveys carried out in 1994/1995. The analyses were restricted to ages 25-49; 2282 women in Finland and 2685 in Sweden. Firstly, age-adjusted prevalence percentages were presented by family status and employment status. Secondly, the patterning of health by family status and employment status, and the influence of adjusting for income, were studied by logistic regression analysis. The main results showed that women living in couples with children had the best health in both countries. Additional analyses showed that in Finland particularly poor health can be found among women who are simultaneously non-partnered and non-employed, whereas in Sweden poor health can be found among all non-employed groups of women. Income did not explain the poor health among the non-partnered and non-employed. This study confirmed that health is patterned by family status and employment status both among Finnish and Swedish women. It was found that non-employed women without a partner are likely to have poor health. In order to reduce inequalities in health among women, more efforts should be put on promoting health among these groups.

Influence of material and behavioural factors on occupational class differences in health

OBJECTIVE

To examine material and behavioural factors as explanations for occupational class differences in health, while taking into account the interrelations between these two groups of factors.

METHODS

Data from cross sectional surveys among middle aged women and men employed by the City of Helsinki (n = 6062, response rate 68%) were used. The contribution of four material and seven behavioural factors to occupational class differences in self rated health was examined by logistic regression techniques. After examining the contribution of each material and behavioural factor individually these were combined into two groups, whose independent and shared effects on occupational class differences in health were examined.

RESULTS

In women, each material factor reduced the association between occupational class and health, while only financial difficulties and financial satisfaction were statistically significant in men. Smoking, dietary habits, and relative body weight were the strongest behavioural factors explaining the association in both women and men. When grouped, both material and behavioural factors explained a large part of occupational class differences in health. The direct effect of material factors was larger than their effect through behavioural factors, and the effect of behavioural factors depending on material factors was about half of their independent effect.

CONCLUSIONS

Material and behavioural factors explained more than a half of occupational class differences in self rated health among women and one third among men. The effects of material and behavioural factors were mostly independent of each other, although some part of their contribution was shared, especially in women.

Psychosocial working conditions and weight gain among employees

OBJECTIVE

To study the associations between psychosocial working conditions and weight gain.

DESIGN, SUBJECTS AND MEASUREMENTS

Data from postal questionnaires (response rate 67%) sent to 40- to 60-y-old women (n=7093) and men (n=1799) employed by the City of Helsinki in 2000-2002 were analysed. Weight gain during the previous 12 months was the outcome variable in logistic regression analyses. Independent variables included Karasek's job demands and job control, work fatigue, working overtime, work-related mental strain, social support and the work-home interface. The final models were adjusted for age, education, marital status, physical strain and body mass index.

RESULTS

In the previous 12 months, 25% of women and 19% of men reported weight gain. Work fatigue and working overtime were associated with weight gain in both sexes. Women who were dissatisfied with combining paid work and family life were more likely to have gained weight. Men with low job demands were less likely to have gained weight. All of these associations were independent of each other.

CONCLUSIONS

Few work-related factors were associated with weight gain. However, our study suggests that work fatigue and working overtime are potential risk factors for weight gain. These findings need to be confirmed in prospective studies.

Socio-economic differences in the prevalence of acute, chronic and disabling chronic pain among ageing employees

Pain is a strong predictor of reduced work ability and well-being, but there is little information on the prevalence of and socio-economic differences in acute, chronic and disabling chronic pain among employees. A questionnaire survey conducted in 2000-2002 among employees aged 40, 45, 50, 55 and 60 of the City of Helsinki (N=8970, response rate 67%) included socio-demographic and socio-economic factors and measures of current pain, pain duration and pain-related disability. Pain was acute when lasting a maximum of 3 months and chronic when persisting for more than 3 months. Disabling chronic pain was determined using the disability subscale of Von Korff's Chronic Pain Grade questionnaire. Acute pain was reported by 15% of women, chronic pain by 29% and disabling chronic pain by 7%. The corresponding figures for men were 12, 24 and 5%. Chronic and disabling chronic pain were more common in older age groups among both genders. Among women, those with secondary or basic education were more likely to report chronic or disabling chronic pain than those with higher education, and semi-professionals, routine non-manual employees and manual workers were more likely to report disabling chronic pain than managers. Among men, separated/divorced or widowed men were more likely to report acute pain than married men, and manual workers were more likely to report chronic pain than managers. Chronic pain was relatively common in this population, and those with older age, lower education and occupational class appear to be at excess risk for chronic pain, especially for disabling chronic pain.

Multiple dimensions of socioeconomic position and obesity among employees: The Helsinki Health Study

OBJECTIVE

To examine socioeconomic differences in obesity using several different socioeconomic indicators, ranging from childhood socioeconomic environment and adult socioeconomic status to material resources and economic satisfaction.

RESEARCH METHODS AND PROCEDURES

The data derived from the Helsinki Health Study baseline surveys in 2000 and 2001. Respondents to postal surveys were middle-aged employees of the City of Helsinki (4,975 women and 1,252 men, response rate 68%). Associations between eight socioeconomic indicators and obesity (BMI > or = 30 kg/m(2)), calculated from self-reported data, were examined by fitting a series of logistic regression models.

RESULTS

In women, all socioeconomic indicators except household income and economic satisfaction were associated with obesity. Parental education and childhood economic difficulties, i.e., socioeconomic conditions in childhood, remained associated with obesity after adjusting for all indicators of current socioeconomic position. Indicators of adult socioeconomic status, own education and occupational class, were no longer associated with obesity when childhood socioeconomic conditions were adjusted for. Home ownership and economic difficulties were associated with obesity after full adjustments. In men, the findings paralleled those among women, but few associations reached statistical significance.

DISCUSSION

Obesity was associated with several dimensions of socioeconomic position. Childhood socioeconomic disadvantage was associated with obesity independently of the various indicators of current socioeconomic position. Associations between obesity and both educational level and occupational class disappeared after adjustment for other indicators of socioeconomic position. This suggests that the variation observed in the prevalence of obesity by these key socioeconomic indicators may reflect differences in the related material resources.

Socioeconomic status and smoking: analysing inequalities with multiple indicators

BACKGROUND AND AIMS

Socioeconomic differences in smoking have been well established. While previous studies have mostly relied on one socioeconomic indicator at a time, this study examined socioeconomic differences in smoking by using several indicators that reflect different dimensions of socioeconomic position.

DATA AND METHODS

Data derive from Helsinki Health Study baseline surveys conducted among the employees of the City of Helsinki in 2000 and 2001. The data include 6243 respondents aged 40-60 years (response rate 68%). Six socioeconomic indicators were used: education, occupational status, household income per consumption unit, housing tenure, economic difficulties and economic satisfaction. Their associations with current smoking were examined by fitting sequential logistic regression models.

RESULTS

All socioeconomic indicators were strongly associated with smoking among both men and women. When the indicators were examined simultaneously their associations with smoking attenuated, especially when education and occupational status were considered together, and when income and housing tenure were introduced into the models already containing education and occupational status. After mutual adjustment for all socioeconomic indicators, housing tenure and economic satisfaction remained associated with smoking in men. In women, all indicators except income and economic difficulties were inversely associated with smoking after adjustments.

CONCLUSIONS

Smoking was associated with structural, material as well as perceived dimensions of socioeconomic disadvantage. Attempts to reduce smoking among the socioeconomically disadvantaged need to target several dimensions of socioeconomic position.

Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries

BACKGROUND

Few studies have compared socioeconomic inequalities in the prevalence of both fatal and non-fatal diseases. This paper aims to give the first international overview for several common chronic diseases.

METHODS

Micro-level data were pooled from non-standardized national health surveys conducted in eight European countries in the 1990s. Surveys ranged in size from 3700 to 41 200 participants. The prevalence of 17 chronic disease groups were analysed in relation to education. Standardized prevalence rates and age-adjusted odds ratios (ORs) were calculated.

RESULTS

Most diseases showed higher prevalence among the lower education group. Stroke, diseases of the nervous system, diabetes, and arthritis displayed relatively large inequalities (OR > 1.50). No socioeconomic differences were evident for cancer, kidney diseases, and skin diseases. Allergy was more common in the higher education group. Relative socioeconomic differences were often smaller among the 60-79 age group as compared with the 25-59 age group. Cancer was more prevalent among the lower educated in the 25-59 age group, but among the higher educated in the 60-79 age group. For diabetes, hypertension, and heart disease, socioeconomic differences were larger among women as compared with men. Inequalities in heart disease were larger in northern European countries as compared with southern European countries.

CONCLUSION

There are large variations between chronic diseases in the size and pattern of socioeconomic differences in their prevalence. The large inequalities that are found for some specific fatal diseases (e.g. stroke) and non-fatal diseases (e.g. arthritis) require special attention in equity-oriented research and policies.

Gender differences in the association of age with physical workload and functioning

AIMS

To test whether (1) physically demanding work is less frequent for older than younger employees, and whether (2) the association of physically demanding work with decline of physical functioning is stronger for older employees than their younger counterparts. The gender differences in these associations were examined.

METHODS

Subjects of the study were 40-60 year old employees of the City of Helsinki. Data (n = 5802) were collected with mail questionnaires in 2000 and 2001. Functioning was measured with the Role Limitations due to Physical Health Problems scale of the SF36 health questionnaire. Logistic regression models were used to analyse the data.

RESULTS

There was a linear trend of less physically demanding work in older than in younger age groups. This trend was more marked for men than women. Age and physically demanding work were associated with poor functioning. In women the association of physically demanding work with poor functioning tended to be stronger for older than for younger age groups, while the opposite was observed in men.

CONCLUSIONS

Results suggest that physically demanding work causes more ailments in women of high age than men. It is possible that less men than women are still employed in physically demanding occupations at high age, even though direct evidence of exit from physically demanding work cannot be obtained from cross-sectional data. In these data the physically demanding occupations for men and women were largely different. High physical workload among women working in social and health care is likely to contribute to the gender differences.

Trends in socioeconomic inequalities in self-assessed health in 10 European countries

BACKGROUND

Changes over time in inequalities in self-reported health are studied for increasingly more countries, but a comprehensive overview encompassing several countries is still lacking. The general aim of this article is to determine whether inequalities in self-assessed health in 10 European countries showed a general tendency either to increase or to decrease between the 1980s and the 1990s and whether trends varied among countries.

METHODS

Data were obtained from nationally representative interview surveys held in Finland, Sweden, Norway, Denmark, England, The Netherlands, West Germany, Austria, Italy, and Spain. The proportion of respondents with self-assessed health less than 'good' was measured in relation to educational level and income level. Inequalities were measured by means of age-standardized prevalence rates and odds ratios (ORs).

RESULTS

Socioeconomic inequalities in self-assessed health showed a high degree of stability in European countries. For all countries together, the ORs comparing low with high educational levels remained stable for men (2.61 in the 1980s and 2.54 in the 1990s) but increased slightly for women (from 2.48 to 2.70). The ORs comparing extreme income quintiles increased from 3.13 to 3.37 for men and from 2.43 to 2.86 for women. Increases could be demonstrated most clearly for Italian and Spanish men and women, and for Dutch women, whereas inequalities in health in the Nordic countries showed no tendency to increase.

CONCLUSIONS

The results underscore the persistent nature of socioeconomic inequalities in health in modern societies. The relatively favourable trends in the Nordic countries suggest that these countries' welfare states were able to buffer many of the adverse effects of economic crises on the health of disadvantaged groups.

The shape of the relationship between income and self-assessed health: an international study

BACKGROUND

The relationship between income and health is usually thought to be curvilinear, but previous studies have yielded inconsistent results. We therefore examined the shape of the relationship between household equivalent income and self-assessed health in seven European countries.

METHODS

Data were obtained from nationally representative health, level of living, or similar surveys in Belgium, Denmark, England, Finland, France, The Netherlands, and Norway and applied to men and women aged 25 years and older in the 1990s. Smooth nonparametric curves were fitted to the data, as well as a spline regression function with three linear pieces connected by two knots.

RESULTS

A higher household equivalent income is associated with better self-assessed health among men and women in all countries, particularly in the middle-income range. In the higher income ranges, the relationship is generally curvilinear and characterized by less improvement in self-assessed health per unit of rising income. In the lowest income ranges, the relationship is found to be curvilinear in four countries (Belgium, Finland, The Netherlands, and Norway), where the usual deterioration of health associated with lower incomes levels off or even reverses into an improvement.

CONCLUSIONS

Further research is necessary to investigate the background of differences between countries in the shape of the relationship between income and self-assessed health, and should focus on both methodological and substantive explanations. Assuming causality, the results of our study lend some support to the notion of decreasing marginal health returns of a unit increase in income at the higher income ranges.

Neighbourhoods and self rated health: a comparison of public sector employees in London and Helsinki

STUDY OBJECTIVE

Mortality and morbidity vary across neighbourhoods and larger residential areas. Effects of area deprivation on health may vary across countries, because of greater spatial separation of people occupying high and low socioeconomic positions and differences in the provision of local services and facilities. Neighbourhood variations in health and the contribution of residents' characteristics and neighbourhood indicators were compared in London and Helsinki, two settings where inequality and welfare policies differ.

DESIGN

Data from two cohorts were used to investigate associations between self rated health and neighbourhood indicators using a multilevel approach.

SETTING

London and Helsinki.

PARTICIPANTS

From the Whitehall II study (London, aged 39-63) and the Helsinki health study (aged 40-60).

MAIN RESULTS

Socioeconomic segregation was higher in London than in Helsinki. Age and sex adjusted differences in self rated health between neighbourhoods were also greater in London. Independent of individual socioeconomic position, neighbourhood unemployment, proportion of residents in manual occupations, and proportion of single households were associated with health. In pooled data, residence in a neighbourhood with highest unemployment was associated with an odds ratio of less than good self rated health of 1.51 (95% CI 1.30 to 1.75). High rates of single parenthood were associated with health in London but not in Helsinki.

CONCLUSIONS

Neighbourhood socioeconomic context was associated with health in both countries, with some evidence of greater neighbourhood effects in London. Greater socioeconomic segregation in London may have emergent effects at the neighbourhood level. Local and national social policies may reduce, or restrict, inequality and segregation between areas.

Factors contributing to sense of coherence among men and women

BACKGROUND

The purpose of this study was to examine the associations of four key areas of resistance resources (GRR), i.e. childhood living conditions, work and family life, and social relationships, with sense of coherence (SOC) among Finnish men and women. A particular interest was devoted to interactions between sex and GRR.

METHODS

The data derived from a representative personal interview survey collected by Statistics Finland in 1994 (N=8650, response rate 73%). This study included ages 25-64 (N=6506, 49% women). The associations of age, educational attainment, childhood living conditions, work and family, and social relationships with SOC were analysed using ordinary regression analysis.

RESULTS

Among both men and women, psycho-emotional resources rather than socio-economic circumstances were associated with SOC. These resources included the quality of the relationship with partner, social support, quality of work, and childhood living conditions. Although sex differences were small, the association of living without a partner with low SOC was stronger among men than women.

CONCLUSION

SOC is strongly associated with the psycho-emotional resistance resources. In the Finnish context, the SOC scale was largely sex neutral.