Asking about condom use: a key to individualized care when screening for chlamydia

Chlamydia trachomatis (CT) infection has been a target for both selective and national screening programmes, and Sweden has an opportunistic approach. A national plan of action states that risk groups should be identified and offered risk reduction counselling. Patients attending a drop-in sexually transmitted infection (STI) clinic reception at the University Hospital, Umeå, Sweden, were invited to complete a questionnaire regarding sociodemographic characteristics, symptoms and sexual risk behaviour; all had a CT test taken. A total of 1305 patients were included, 58% men, mean age 27.8 years. CT prevalence was 11%; 51% of those with CT were ≥25 years old. Only 5% used a condom during the entire sexual intercourse with their last new/temporary partner. Sexually active inconsistent condom users comprised 62% of the study population and contributed to 81% of the chlamydia infections. Asking whether a condom was used could quickly triage patients into groups with a ‘higher risk’ (none or inconsistent use of condoms and at least one new/temporary partners), and ‘lower risk’ (with more consistent condom use, although not always accurate) allowing for individualized care and counselling when screening for chlamydia. Evaluating whether a condom was used throughout the sexual intercourse did not add any useful information.

Large improvements in major cardiovascular risk factors in the population of northern Sweden: the MONICA study 1986-2009

OBJECTIVES

the incidence of cardiovascular disease has declined rapidly in Sweden since the 1980s. We explored changes in major cardiovascular risk factors in northern Sweden between 1986 and 2009.

DESIGN

since 1986, six population surveys have been carried out in northern Sweden using procedures of the World Health Organization MONICA project. The population age range was 25-64 years in 1986 and 1990, and 25-74 years from 1994. Trends were analysed using generalized linear models.

RESULTS

a total of 10586 subjects were included in the surveys. Blood pressure decreased by 4.9/3.9 mmHg in women and 1.8/1.5 mmHg in men aged 25-64 years between 1986 and 2009. In men and women aged 65-74 years, the decrease was 12.6/6.1 mmHg between 1994 and 2009. From 1994, the use of blood pressure-lowering drugs increased, particularly among the older subgroup. The prevalence of smoking halved between 1986 and 2009; 11% of women and 9% of men were smokers in 2009. Cholesterol levels decreased by 0.9 mmol L(-1) in the younger age group (25-64 years), and the use of lipid-lowering agents increased from 1994. Among subjects aged 25-64 years, one in five was obese in 2009, which was twice as many as in 1986, and body mass index (BMI) increased by 1.5 kg m(-2) , corresponding to an increase in weight of 4 kg. There was no further increase in BMI from 2004. The prevalence of diabetes did not change between 1986 and 2009. The proportion that received a university education increased markedly in all age groups, especially in women, during the study period.

CONCLUSIONS

significant improvements were observed in major cardiovascular risk factors in northern Sweden between 1986 and 2009.

Time trends in population cholesterol levels 1986-2004: influence of lipid-lowering drugs, obesity, smoking and educational level. The northern Sweden MONICA study

Background

Self-Rated Health (SRH) correlates with risk of illness and death. But how are different questions of SRH to be interpreted? Does it matter whether one asks: “How would you assess your general state of health?”(General SRH) or “How would you assess your general state of health compared to persons of your own age?”(Comparative SRH)? Does the context in a questionnaire affect the answers? The aim of this paper is to examine the meaning of two questions on self-rated health, the statistical distribution of the answers, and whether the context of the question in a questionnaire affects the answers.

Methods

Statistical and semantic methodologies were used to analyse the answers of two different SRH questions in a cross-sectional survey, the MONICA-project of northern Sweden.

Results

The answers from 3504 persons were analysed. The statistical distributions of answers differed. The most common answer to the General SRH was “good”, while the most common answer to the Comparative SRH was “similar”. The semantic analysis showed that what is assessed in SRH is not health in a medical and lexical sense but fields of association connected to health, for example health behaviour, functional ability, youth, looks, way of life. The meaning and function of the two questions differ – mainly due to the comparing reference in Comparative SRH. The context in the questionnaire may have affected the statistics.

Conclusions

Health is primarily assessed in terms of its sense-relations (associations) and Comparative SRH and General SRH contain different information on SRH. Comparative SRH is semantically more distinct. The context of the questions in a questionnaire may affect the way self-rated health questions are answered. Comparative SRH should not be eliminated from use in questionnaires. Its usefulness in clinical encounters should be investigated.

Time trends in population cholesterol levels 1986-2004: influence of lipid-lowering drugs, obesity, smoking and educational level. The northern Sweden MONICA study

OBJECTIVES

To explore time trends in population total cholesterol.

DESIGN AND SETTING

Five population-based cross-sectional surveys, 1986-2004 in the northern Sweden MONICA study included 8827 men and women.

RESULTS

Age-adjusted cholesterol level declined in men, 25-64 years old, from 6.38 to 5.78 mmol L(-1) and in women from 6.32 to 5.51 mmol L(-1). Between 1994 and 2004, subjects 65-74 years old were included, and their levels also decreased, in men from 6.35 to 5.76 mmol L(-1) and in women from 7.11 to 6.24 mmol L(-1). The decrease was continuous over surveys and age groups, except in young and middle-aged men where no further decline was found after 1999. Cohorts born 1920-1939 showed decreased cholesterol over the period, whilst no change was noted for those born thereafter. In 2004, one-fourth of men and one-third of women 25-74 years achieved levels below 5.0 mmol L(-1). Subjects with low educational level, body mass index > or =25 or smokers all had higher cholesterol levels which persisted during the 18-year period. In 2004, the 9% who used lipid-lowering drugs are estimated to contribute, at most, to 0.13 mmol L(-1) lower cholesterol in the population.

CONCLUSION

Large decreases in cholesterol levels occurred in the 18-year period. Less smoking may contribute to, and increasing obesity attenuate, this trend whilst lipid-lowering drugs have had little effect until recently. Socio-economic inequalities persist.

Overweight, obesity and fat distribution in 50- to 64-year-old participants in the European Prospective Investigation into Cancer and Nutrition (EPIC)

OBJECTIVE

To describe anthropometric characteristics of participants of the European Prospective Investigation into Cancer and Nutrition (EPIC).

DESIGN

A cross-sectional analysis of baseline data of a European prospective cohort study.

SUBJECTS

This analysis includes study populations from 25 centres in nine European countries. The British populations comprised both a population-based and a 'health-conscious' group. The analysis was restricted to 83 178 men and 163 851 women aged 50-64 years, this group being represented in all centres.

METHODS

Anthropometric examinations were undertaken by trained observers using standardised methods and included measurements of weight, height, and waist and hip circumferences. In the 'health-conscious' group (UK), anthropometric measures were predicted from self-reports.

RESULTS

Except in the 'health-conscious' group (UK) and in the French centres, mean body mass index (BMI) exceeded 25.0 kg m-2. The prevalence of obesity (BMI> or =30 kg m(-2)) varied from 8% to 40% in men, and from 5% to 53% in women, with high prevalences (>25%) in the centres from Spain, Greece, Ragusa and Naples (Italy) and the lowest prevalences (<10%) in the French centres and the 'health-conscious' group (UK). The prevalence of a large waist circumference or a high waist-to-hip ratio was high in centres from Spain, Greece, Ragusa and Naples (Italy) and among women from centres in Germany and Bilthoven (The Netherlands).

CONCLUSIONS

Anthropometric measures varied considerably within the EPIC population. These data provide a strong base for further investigation of anthropometric measures in relation to the risk of chronic diseases, especially cancer.

Early unemployment can contribute to adult health problems: results from a longitudinal study of school leavers

STUDY OBJECTIVE

To investigate the long term effects of early unemployment (a total of more than half a year of unemployment between the ages of 16 and 21) on health behaviour and psychological and somatic symptoms.

DESIGN

A 14 year follow up of a cohort of school leavers was conducted from 1981 to 1995. Information was collected by questionnaires.

SETTING

An industrial town in northern Sweden.

PARTICIPANTS

The original cohort was defined as all pupils in a middle sized municipality in the last year of compulsory school at age 16 (n=1083). The participants were followed up between the ages of 16 and 30. The analysis included 96% of the original sample, 547 men and 497 women

MAIN RESULTS

After controlling for initial health behaviour and symptoms as well as for working class background and late unemployment, early unemployment among young men and women showed a significant explanatory effect on smoking, psychological symptoms and-among men only-somatic symptoms after a follow up of 14 years. No correlation was found between early unemployment and late excess alcohol consumption.

CONCLUSIONS

Early unemployment can contribute to adult health problems. Thus, youth unemployment constitutes a significant public health problem, which to a certain extent remains in adult age.

Adolescent determinants of cardiovascular risk factors in adult men and women

AIMS

To investigate how physical activity, physical performance and sociodemographic characteristics at the age of 16 are related to adult health habits (physical activity, dietary intake, smoking) and biological risk factors for cardiovascular diseases (being overweight, low aerobic fitness, unfavorable levels of serum lipids, high blood pressure).

METHODS

A randomly selected group of 220 male and 205 female students at 16 years of age was tested in 1974, and reinvestigated 18 years later.

RESULTS

The predictive health profiles for adult lifestyle and biological risk factors were different in men and women. Leisure sports activity along with high performance in the nine-minute run among the boys and in the two-hand lift test among the girls were significant predictors of adult physical activity. A positive attitude to aerobic exercise and high performance in the nine-minute run test among the boys and high marks in physical education among the girls decreased the risk of smoking. Leisure sports activities together with body mass index at young ages were the most powerful predictors of adult biological risk factors, but attitudes to sports and educational level were also significant determinants.

CONCLUSION

These results contribute to the knowledge of which factors at young ages may promote adult healthy habits in particular physical activities.

Do high levels of unemployment influence the health of those who are not unemployed? A gendered comparison of young men and women during boom and recession

Research has shown that health among young people, particularly women, deteriorates during a recession compared to a boom. It seems that the trade cycle mainly affects the health of those who are not long-term unemployed. The aim of this study was to analyse the relation between the health of non-unemployed people and the levels of unemployment in society. Two groups of young people aged 21 were surveyed, one in 1986 (the boom group, n = 1083) and one in 1994 (the recession group, n = 898). The non-response rate was 2% in the first and 10% in the second group. Both groups were investigated with a self-administered questionnaire, which included questions about somatic and psychological health, as well as experiences of employment, unemployment, education and labour market programmes. Young men and women generally reported more somatic and psychological symptoms during recession than boom. The only exception was psychological symptoms among men, which was of the same magnitude during both periods. Poorer health during recession was found among women in work and in labour market programmes, as well as among both male and female students. Multiple regression analysis was performed in order to analyse if the occupational-related health effects of the trade cycle remained after controlling for possible moderating factors. The effects of unemployment in society on young people's health may be mediated through pessimism about the future, high demands and financial problems. Lack of control over the work situation may also be an important contributing factor to ill health among women during recession. The trade cycle was correlated with ill health among women only. Possible explanations for poorer health among women during a recession were discussed.

Smoking habits-a question of trend or unemployment? A comparison of young men and women between boom and recession

The increased unemployment rates during the 1990s were followed by decreased cigarette consumption. The aim of this study was to analyse the association between unemployment and smoking habits among young men and women during times of prosperity and recession. Two groups of final-year pupils were surveyed five years after leaving school, at the age of 21, in 1986 (boom) and 1994 (recession). The boom group included 1083 pupils; the recession group 898 pupils. The non-response rate was 2% in the boom group and 10% in the recession group. Daily tobacco use was measured through self-administered questionnaires. Daily cigarette smoking was of a lower magnitude during the recession (9.7% among men and 21.9% among women) compared to the boom (19.8% and 37.8%, respectively). A low level of education, and among women also financial problems and motherhood, were associated with more frequent smoking. Unemployment was associated with tobacco consumption, especially among women and during the boom. Thus, smoking habits were found to be a question of both unemployment and tobacco trends in society.

Do early unemployment and health status among young men and women affect their chances of later employment?

The aim of this 5-year prospective study was to investigate the risk of future unemployment among young people who had experienced early unemployment, and to examine whether this risk was influenced by their health status. A total of 1,083 pupils in the final year of compulsory schooling were included in the cohort. The non-participation rate was 2%. At the time of a five-year follow-up, of those who were unemployed during the first two-year period, 71% of the men and 49% of the women were unemployed, had recent experience of unemployment, or were outside the labour market. The relative risk of being unemployed was 2.39 for men (95% CI 1.85-3.10) and 1.76 for women (95% CI 1.25-2.48) among those who had experienced early unemployment compared with those who had been in Youth Opportunities Programmes (YOP) or in work. Young women in YOP had the same risk of later unemployment as those who had experienced early unemployment, while young men in YOP did not have increased risk. Health status and health behaviour had only a minor influence on the risk of unemployment.

Health hazards of unemployment--only a boom phenomenon? A study of young men and women during times of prosperity and times of recession

BACKGROUND

It has been suggested that high unemployment rates in society may be less harmful to the health of people than low unemployment rates. Therefore, a study was carried out to compare, among young men and women, the relationship between health and long-term unemployment during periods of rapid economic growth 'boom' and economic recession.

METHODS

Two study groups were chosen at age 21 y (5 y after compulsory schooling ended) from an industrial town in northern Sweden. The first group (number 1083) was chosen and surveyed in 1986 (under 'boom' conditions); the second (number 898) was chosen in 1994 (under economic recession conditions). The non-response rate was 2% for the boom group and 10% for the recession group. The main outcome measurements examined were somatic and psychological symptoms.

RESULTS

Health criteria for general health among long-term unemployed young men and women did not differ between the group surveyed in boom conditions and the group surveyed in recession conditions. The only exception was for psychological symptoms, which scored lower among the men in the recession group. Individual unemployment had a high explanatory power for poor health, in particular, psychological ill health.

CONCLUSIONS

When comparing periods of boom and recession there was no difference in somatic and psychological symptoms for those who were long-term unemployed. Thus, the trade cycle appeared to have had no impact on their health.

Smokeless tobacco as a possible risk factor for myocardial infarction: a population-based study in middle-aged men

OBJECTIVES

To explore whether the use of snuff affects the risk of myocardial infarction (MI).

BACKGROUND

Snuff and other forms of smokeless tobacco are widely used in some populations. Possible health hazards associated with the use of smokeless tobacco remain controversial.

METHODS

In a population-based study within the framework of the Northern Sweden center of the World Health Organization Multinational Monitoring of Trend and Determinants in Cardiovascular Disease (WHO MONICA) Project, tobacco habits were compared in 25- to 64-year-old men with first-time fatal or nonfatal MI and referent subjects matched for age and place of living (687 cases, 687 referents).

RESULTS

The unadjusted odds ratio (OR) for MI in regular cigarette smokers as compared with men who never used tobacco was 3.65 (95% confidence interval [CI] 2.67 to 4.99). When nonsmoking regular snuff dippers were compared with never-users of tobacco, the unadjusted OR was 0.96 (0.65 to 1.41). After adjustment for multiple cardiovascular risk factors, the OR was 3.53 (95% CI 2.48 to 5.03) for regular smoking and 0.58 (95% CI 0.35 to 0.94) for regular snuff dipping. Restricting the analyses to fatal cases of myocardial (including sudden death) showed a tendency towards increased risk among snuff dippers 1.50 (95% CI 0.45 to 5.03).

CONCLUSIONS

The risk of MI is not increased in snuff dippers. Nicotine is probably not an important contributor to ischemic heart disease in smokers. A possible small or modest detrimental effect of snuff dipping on the risk for sudden death could not be excluded in this study due to a limited number of fatal cases.

Prediction of physical fitness and physical activity level in adulthood by physical performance and physical activity in adolescence--an 18-year follow-up study

The aim of the study was to investigate relationships between physical fitness and self-reported physical activity in adulthood and to what extent the level of physical fitness and leisure-time physical activity in adulthood can be explained by anthropometric measures, physical performance, physical activity, attitudes to sports activities and socio-demographic characteristics at the age of 16. A group of 157 men and 121 women was tested at the ages of 16 and 34 by means of questionnaires and fitness tests. Physically active men and women had higher estimated VO2 max and performed better in curl ups and bench press than those who were inactive. Performance in physical tests, height, weight and physical activity at the age of 16 contributed best to explain adult physical performance and physical activity. The magnitude of explanation varied between 10% (9-min run test) and 56% (bench press test); it was in general lower in the men than in the women. The various fitness tests and physical activity were explained by different predictors and the predictors also differed between men and women. The findings about attitudes to sports and socio-demographic factors at a young age that influence adult physical activity habits and fitness are very complex and further research is required to identify specific inactivity risks.

[Public health work needs new evaluation models. Primary care projects are more effective than large scale campaigns]

The need both of critical assessment of community intervention programmes and of alternatives to randomised controlled studies is discussed in the article. Examples are drawn from a review recently completed for the Swedish Council on Technology Assessment in Health Care [Statens Beredning för Utvärdering av medicinsk metodik (SBU)], and from the evaluation of a cardiovascular disease prevention programme currently in progress in northern Sweden.

Reduction of selection bias in primary prevention of cardiovascular disease through involvement of primary health care

OBJECTIVE

To examine selection bias in social and health factors in a community intervention programme for the prevention of cardiovascular disease by comparing programme data with both census data and a random sample of the same population.

DESIGN

Cross sectional studies.

SETTING

All 35 primary health care centres in Västerbotten County, Sweden.

SUBJECTS

24,870 individuals who during 1992 and 1993 became 30, 40, 50 or 60 years of age.

MAIN OUTCOME MEASURES

Total income, socio-economic group, employment, education, body mass index (BMI), total cholesterol, systolic and diastolic blood pressure, and daily smoking.

RESULTS

The differences in social characteristics between participants and non-participants were marginal, indicating that the social selection bias was small. However, unemployment, low income, and younger age tended to be associated with somewhat lower preference to participate. The overall pattern of health status, as measured by risk factors, was similar rather than dissimilar. While the participants in the intervention health survey had lower mean total cholesterol, their blood pressure was generally higher compared with the reference random sample.

CONCLUSIONS

The primary health care system in Sweden might serve as a useful base for educational health counselling, at least within a community intervention programme, for all levels of society.

Comparison between two programmes for reducing the levels of risk indicators of heart diseases among male professional drivers

OBJECTIVES

To compare two programmes for reducing the levels of risk indicators of heart diseases among professional drivers. The programmes were focused on changes of lifestyle. The aim of the programmes was to initiate and motivate a process of change within the driver, which in the long term should lead to permanent and sound health habits. One programme was based on health profile assessment and the other was a health examination.

METHODS

Altogether, 102 subjects were investigated (51 allocated to an intervention group and 51 to a reference group). The programme in the intervention group (health profile assessment) was based on revelatory communication, adjusted to the driver and contained individual and group activities. The reference group went through a health examination. In both groups blood pressure, serum lipid concentrations, body mass index, and estimated maximal oxygen uptake were measured and the lifestyle habits were surveyed by questionnaires at the start and at follow ups of 6 and 18 months.

RESULTS

The results showed that in the intervention group the maximal oxygen uptake increased, as did exercise habits and the intention to practice good dietary habits. Variable working hours was the most common obstacle to change a health habit. In the reference group the maximal oxygen uptake increased and the concentration of serum total cholesterol and the number of people who perceived stress and loneliness decreased.

CONCLUSIONS

Both the health profile assessment and the health examination had an effect on the levels of some risk indicators of heart diseases. Both programmes turned out to be useful because of high participation during the entire period and a generally positive attitude among the subjects.

Unemployment as a disease and diseases of the unemployed

There is a causal link between unemployment and the deterioration in health status, but there is also an act of selection so that people with health problems have more problems in getting a new job. Unemployed men, especially the young, increase their alcohol consumption as compared with employed referents. Unemployed persons are smokers to a greater extent than employed persons, and smokers have a higher risk of becoming unemployed. Psychological indicators have been studied well in connection with health effects of unemployment. Losing, or gaining, employment has clear effects on psychiatric symptoms and on well-being. The death rate is increased among unemployed persons.

Determinants of self-reported neck-shoulder and low back symptoms in a general population

STUDY DESIGN

A combined cross-sectional and longitudinal design.

OBJECTIVES

To investigate relation between, on one hand, self-reported neck-shoulder symptoms and, on the other hand, low back symptoms and self-reported work-related physical load, psychosocial factors, and individual characteristics and to study the influence of physical capacity in adolescence on neck-shoulder and low back symptoms in adulthood.

SUMMARY OF BACKGROUND DATA

Heavy physical work and exposure to vibration constitute risk factors for low back problems, and repetitive and static work are risk factors for neck-shoulder symptoms in many jobs. The interplay between individual factors and work-related psychosocial and physical exposure, however, is not well documented. This study addresses effects of adolescent capacity on this interplay in a general population.

METHODS

A random sample of 425 Swedish students was investigated when the students were 16 years and 34 years of age. Sixty-five percent participated in both examinations; only those who worked > or = 16 hours/week at the follow-up period, 148 men and 90 women, were included in these analyses. Data about musculoskeletal symptoms, work, and sociodemographic and individual characteristics were collected at the age of 34 years; physical performance data were collected at the ages of 16 years and 34 years.

RESULTS

Among the men, self-employment and worry were associated with neck-shoulder symptoms; among the women, monotonous work and high decision latitude were associated with neck-shoulder symptoms. Low back problems were related to monotonous work among men and women and to exposure to vibration among men. Performance in certain fitness tests at the ages of 16 years and 34 years was negatively associated with musculoskeletal symptoms.

CONCLUSIONS

The inverse relationships between performance at the age of 16 years and adult musculoskeletal symptoms may imply benefits of early fitness training.

Unemployment and sexual risk-taking among adolescents

Sexual risk-taking can lead to serious consequences. This study addressed the question of how sexual risk-taking was influenced by unemployment. A cohort of 1060 adolescents were followed from their last term in compulsory school and five years ahead until the age of 21. Sexual risk-taking, defined as unprotected intercourse without wishing to conceive, was studied with the help of a questionnaire at the beginning and at the end of the period. For men there was a positive correlation between the length of unemployment and increase in risk-taking during the period, but for women there was a (statistically non-significant) negative correlation. In a logistic regression analysis, having children also had a significant effect on increased risk-taking among men. Unemployment thus implies increased sexual risk-taking among adolescent men.

Nervous and depressive symptoms in a longitudinal study of youth unemployment--selection or exposure?

One thousand and sixty young people were followed for 5 years from the last term of compulsory school. Unemployment correlated positively with changes in nervous complaints and depressive symptoms, even after controlling for initial psychological health and background factors. There were no pronounced gender differences. Qualitative methods were used to study mediating factors between unemployment and mental health, including lack of self-confidence, self-blame, stress, isolation, lack of control and resignation.

Physical activity pattern in men and women at the ages of 16 and 34 and development of physical activity from adolescence to adulthood

The aim of this study was to investigate gender-related differences in physical activity patterns at the ages of 16 and 34 and to analyse those factors that might contribute to an explanation of physical activity habits in adulthood. A randomly selected group, consisting of 220 boys and 205 girls, was tested in 1974 and reinvestigated in 1992 by means of a questionnaire. Eighty-eight per cent participated in the reinvestigation. At the age of 16 more boys (69%) than girls (51%) participated in some sports activity in their leisure time. The results showed an overall decrease in participation in vigorous physical activity, although participation in light physical activity remained relatively constant. At the age of 34, there was no difference in overall physical activity between men and women, but the men exercised more vigorously (44% vs. 29%). Early experience of physical activity at the age of 16 decreased the risk of becoming inactive in adulthood. At the age of 34 cohabiting for the men, and having children and high socio-economic class for the women, increased the risk of being physically inactive in adulthood, whereas positive beliefs about health effects of exercise decreased the risk for both men and women.

Development of muscular endurance and strength from adolescence to adulthood and level of physical capacity in men and women at the age of 34 years

This study investigated the development of muscular endurance and strength from the age of 16 to the age of 34 and the fitness components at the age of 34 in men and women. A randomly selected group consisting of 220 boys and 205 girls was tested in 1974 and reinvestigated 18 years later. Muscular endurance and strength increased significantly in 4 of the 5 remeasured tests for the men; bench press increased by 58%, two-hand lift by 20%, hand grip by 16% and Sargent jump by 8%. For the women there was a significant increase in bench press and two-hand lift by 25% and 7% respectively, but hand grip and Sargent jump decreased with a few per cent. The hip and trunk flexion test, sit-up, decreased remarkably in both men (58%) and women (78%). At the age of 16 physical capacity was significantly higher in all tests in the men. This was also the situation at the age of 34 except for VO2 max in ml.kg-1.min-1 and muscular endurance in the back muscles. There were no differences in flexibility between men and women except for less flexibility in the hamstring muscles in the men. The result of the balance test was significantly better in the men.

Unemployment and change of tobacco habits: a study of young people from 16 to 21 years of age

In a cohort study of 1080 pupils who were followed for 5 years from when they left compulsory school (from age 16 to age 21 years), smoking habits were found to correlate with unemployment among both boys and girls. Pupils who were smokers in school had a higher risk of becoming unemployed than non-smokers. Irrespective of early smoking, smoking habits developed more unfavourably among unemployed young people than among those with no unemployment during the period studied. The odds ratio of being a smoker at the age of 21 years when unemployed more than 20 weeks during the observation period, compared with those without or with short unemployment, was 2.44 for men and 3.45 for women. When adjusted for the influence of socio-economic background, education, economy and smoking habits at the start of the period, the odds ratio was 1.7 (95% CI 1.01-2.86) for men and 2.0 (1.13-3.53) for women. The adjusted odds ratio for increasing or starting smoking during the period was 1.5 (95% CI 0.89-2.56) for men and 2.0 (1.18-3.35) for women. No significant correlation was found between snuffing and unemployment. Thus, it seems that unemployment is a risk factor for development of tobacco smoking in young people, especially among women.

Epidemiology of school injuries in the northern part of Sweden

The aim of this one-year investigation of school accidents is to obtain more knowledge for preventive work. In the age-group 7-19 years, 547 injuries were registered, mainly at three hospitals. The incidence rate was 25 per 1000 boys and 20 per 1000 girls per year. Most injuries occurred in intermediate and upper secondary school among boys and in upper school among girls. The relative risk of school injury compared with spare-time injury was 1.8 for boys and 2.6 for girls of compulsory school age. Most injuries occurred in sports area (boys: 34%, girls: 46%). The incidence of sports injuries showed no gender differences. The highest incidence rate was found in senior school girls. Twenty-five percent of all injuries were caused by other pupils, intentional violence being one important mechanism. Head injuries were more common among school injuries compared with spare-time injuries.

Risk indicators of ischemic heart disease among male professional drivers in Sweden

Possible risk indicators of ischemic heart disease relevant to the occupation of professional driving were identified in a cohort of 440 professional drivers and 1000 referents from the Swedish countries of Västerbotten and Norrbotten. The subjects were randomly selected. Data on cardiovascular risk indicators were collected from questionnaires, blood pressure measurements, serum lipid levels, height, and weight. The results showed that significantly more drivers than referents were overweight, smokers, and shift workers; were sedentary in their leisure time; and had a work situation characterized by high demands, low decision latitude, and low social support. There were no significant differences concerning blood pressure and serum lipid levels. The odds ratio for having a high score on a cardiovascular risk index was 3.18 (95% confidence interval 2.41-4.20) for the drivers when they were compared with the referents. When adjusted for age, heredity, shift work, educational level, marital status, and working class, the odds ratio was 2.34 (95% confidence interval 1.70-3.21).

Effects of economic change on male morbidity in neighbouring industrial and rural municipalities in northern Sweden

STUDY OBJECTIVE

The aim was to investigate the health effects of economic changes in a rural and industrial community.

DESIGN

This was a historical cohort study with retrospective information on exposure and information on health outcome from a mailed questionnaire (response rate 82.5%).

SETTING

An industrial and a rural community in northern Sweden.

PARTICIPANTS

Participants included all men born in a rural community and a random sample of men born in a neighbouring industrial community 1915-1924 and alive in 1984 (N = 1989).

MAIN RESULTS

Morbidity was higher in the cohort born in the rural municipality in which more profound changes in the socioeconomic structure had occurred. Even when taking such factors as childhood deprivation, migration, socioeconomic status, early retirement, unemployment, and single living into consideration, most of the differences in morbidity in the two municipalities still remained. However, the changes in employment conditions alone do not appear to explain the differences in morbidity that were found.

CONCLUSION

The higher morbidity in the rural community indicates a health effect of the profound economic changes in that community but this difference cannot be explained by crude indicators of exposure to migration, unemployment, and other indicators of economic change.

Alcohol consumption among unemployed youths: results from a prospective study

A prospective study, including all 1083 pupils in the final year of compulsory schooling in a municipality in northern Sweden, was performed. Ninety-seven point nine per cent of the pupils were followed up after five years. They completed a comprehensive self-administered questionnaire including questions on alcohol consumption. Among men a positive correlation between long-standing unemployment (greater than 20 weeks) and alcohol consumption at the beginning and at the end of the study, as well as the change in consumption during the follow-up period was seen. This correlation was still present when earlier alcohol consumption and socioeconomic variables were controlled for. In women there was a positive correlation between unemployment and the level of alcohol consumption, but a negative correlation between unemployment and change in consumption. When controlling for motherhood and alcohol intake at the start of the study the correlation turned positive. Unemployment among women did not seem to affect recruitment to the high consumption group. Our results support the suggestion that unemployment may be a risk indicator for increasing alcohol consumption among young people, particularly in young men.

Men who never married. A socio-medical study in northern Sweden

In a population-based study 50 never-married men aged 40-64 years were compared with 503 similarly aged other men (married, co-habitant, divorced or widowed). The never-married had shorter education than other men, and had been unemployed more often. The never-married mens' emotional relationships were of lower quality. There was modest tendency towards higher blood pressures and higher serum cholesterol levels among the never-married men, but the differences did not reach statistical significance. In conclusion, never-married men were found to be worse off in terms of social support, education, employment status and health knowledge. Differences in health status, however, were small. It is possible that positive factors, not fully elucidated in this study, counterbalance the adverse socio-medical characteristics. Another possibility is that differences will become manifest at an older age which could be surveyed in a follow-up study.

Unemployment and blood pressure in Swedish building labourers

A group of 297 building labourers from the northernmost province of Sweden was monitored for 2 years in order to register health changes associated with unemployment. Blood pressure before and after the observation period was compared with the subjects' experience of unemployment during that period. More than 60% of the men were unemployed during the period studied. At the beginning of the study period no differences in blood pressure levels were observed between groups of subjects who remained employed and those who later became unemployed. However, the blood pressure change during the follow-up period was significantly greater among individuals who were unemployed during the period than among those who were not. Longer periods of unemployment were associated with greater increases in systolic and diastolic blood pressure. The number of symptoms reported at the start of the study and unemployment at the end of the study were also correlated with a greater increase in blood pressure during the study.

Unemployment and cardiovascular risk indicators. Data from the MONICA survey in northern Sweden

We studied the effect of unemployment, or the threat of unemployment, on indicators of cardiovascular risk in a randomly selected cross-sectional sample of the population aged 25-64 years in northern Sweden with interviews and a health examination. In men, unemployment for more than one year correlated significantly with systolic blood pressure, serum cholesterol level, HDL-quotients, cigarette smoking and physical inactivity. In women, unemployment correlated significantly with body mass index, HDL-quotient, cigarette smoking and physical inactivity. Our results support the hypothesis that correlations between unemployment and cardiovascular disease found in other studies could be partly explained by elevated risk indicators due to unemployment.

Youth unemployment and ill health: results from a 2-year follow-up study

A prospective study was started in 1981, including all 1083 pupils in the last year of compulsory school in a municipality in the northern part of Sweden. All pupils were followed up after 2 years. They were investigated with a comprehensive self-administered questionnaire as well as studies of records and interviews with teachers and school nurses. The total non-participation rate in the study was less than 1%. The main results of the study are the following: unemployment leads to increased psychosomatic and psychological symptoms, decreased social activities in clubs, increased abuse of alcohol and narcotics and increased utilization of health care services. The effects of unemployment are somewhat different among girls and among boys. Girls are more exposed to unemployment and unemployment also leads to more negative effects among them. Hidden unemployment has the same effects as unemployment but the effects are less pronounced.

A parent-centred approach to physiotherapy for their handicapped children

A study was made of a parent-centred model for physiotherapy for a group of handicapped children in a sparsely inhabited region in northern Sweden. The parents were responsible for daily therapy, supervised by physiotherapists and occupational therapists. A questionnaire sent to all the parents showed that in 26 of the 39 families who responded the child was receiving daily therapy. Both parents took part in all but three cases, but eight families reported difficulties with the training. The authors conclude that the parents were not overstrained by their high degree of involvement, provided there was close supervision and adequate economic and emotional support.