Scandinavian Journal of Public Health最新文献

Background: Smoking is closely linked to socioeconomic status and risk of death. We examined the extent to which educational disparities in mortality can be explained by smoking.

Methods: We analysed data from 513,552 men and women aged 25-69 years, excluding individuals with a history of cardiovascular disease, diabetes or cancer. The educational level was lower (less than 10 years), upper (10-12 years) and higher (13 or more years). We employed the direct method to estimate age-adjusted mortality rates and used the Cox proportional hazards model to calculate hazard ratios, using a higher educational level as the reference level. We ran models among non-smokers with interaction terms, educational level and another variable. Based on Akaike information criterion, we performed stratified analyses by marital status among non-smokers.

Results: The hazard ratio for lower educational level in men was 1.38 (1.31-1.45) in non-smokers and 1.57 (1.49-1.66) in smokers. The figures for women were almost identical. Among non-smoking men, the hazard ratio for lower educational level was 1.28 (1.21-1.35) for the ever married and 2.20 (1.93-2.52) for the unmarried men. In women the figures were the same. For non-smoking men and women combined, the population attributable risk ascribed to upper or lower educational level was 17% for the ever married and 35% for the unmarried.

Conclusions: An educational gradient in mortality persists in the absence of smoking and is more pronounced among the unmarried. Marital status appears to modify the relationship between education and mortality, underscoring the need to consider social and relational factors in health inequality research.

Aims: Using a longitudinal approach, the aim of this study was to examine whether baseline engagement in arts and culture was associated with a decline from 'Good' to 'Poor' health at follow-up.

Methods: Self-rated health (SRH) and engagement in six cultural activities among randomly selected Danish adults (⩾15 years) were assessed using data from the Danish Health and Wellbeing Survey in 2019. One year later, all individuals were invited to complete a follow-up survey questionnaire. SRH was dichotomised into 'Good' (very good/good) and 'Poor' (fair/bad/very bad). The cultural participation index (CPI) was used to measure engagement in arts and culture activities. Each activity was scored from 0 (never) to 4 (at least once a week). The total score across all activities could reach a maximum of 24. Adjusted logistic regression models assessed associations between cultural participation and poor health at 1-year follow-up.

Results: The present study included 3286 individuals who perceived their health as good at baseline who completed both survey waves; 11.2% reported poor health at follow-up. Individuals who attended concerts and musical events at least once every 3 months were less likely to report poor health at follow-up (adjusted odds ratio (OR): 0.50, 95% confidence interval (CI): 0.35-0.71) than individuals who never attend concerts and musical events. Furthermore, a 1-point-higher CPI score was associated with a 0.96 (95% CI: 0.93-0.99) lower (adjusted) OR of reporting poor health at follow-up.Conclusions:This follow-up study extends our understanding of the positive health outcomes from engagement in arts and culture activities.

Aims: This systematic review and meta-analysis aimed to identify sociodemographic, lifestyle, and occupational risk factors for disability retirement among middle-aged workers.

Methods: Searches were conducted in PubMed, Web of Science, PsychInfo, Scopus, and Google Scholar from their inception until February 2025. Observational longitudinal studies involving workers aged 40-64 years were included. Two reviewers independently assessed the methodological quality of the studies. A random-effects meta-analysis was performed, with heterogeneity and publication bias evaluated.

Results: From 13,899 reports, 71 reports from 39 longitudinal studies (N=7,309,799 participants) were included. The meta-analysis found that older workers, women, those with 12 years or less education, and workers in intermediate or low occupational class are at increased risk of all-cause disability retirement. Other high-risk groups include past (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.01-1.15) and current (HR 1.29, 95% CI 1.17-1.41) smokers, individuals who are underweight (HR 1.49, 95% CI 1.00-2.23) or obese (HR 1.54, 95% CI 1.31-1.81), individuals lacking physical activity (HR 1.46, 95% CI 1.04-2.06), and those who consume excessive amounts of alcoholic drinks (HR 1.43, 95% CI 1.18-1.73). Additionally, high workload (HR 1.38, 95% CI 1.23-1.56) and low job control (HR 1.47, 95% CI 1.32-1.63) also contribute to the increased risk.

Conclusions: This meta-analysis highlights the significant impact of being vulnerable groups, lifestyle risk factors, and physical and psychosocial work factors on the risk of disability retirement among middle-aged workers. Targeted interventions to create a supportive work environment and encourage healthy lifestyles are crucial to mitigating the risk of disability retirement.

Aims: Gambling marketing can increase intentions to gamble, gambling consumption and gambling harms. In Finland, a substantial part of the population is at risk of gambling problems. Currently, the Finnish gambling marketing environment is changing: public health concerns have resulted in recent restrictions in gambling marketing as well as other measures to reduce gambling harm. However, the upcoming licensing system will soon significantly increase the availability and visibility of gambling by liberalising regulations. This study focuses on exposure to marketing and opinions on marketing regulations in a country with a changing regulatory landscape.

Methods: This study presents results of an online survey (N=132) amongst Finnish individuals who gamble regularly, focusing on perceptions and experiences with gambling marketing. The quantitative data are analysed using cross-tabulation and bivariate correlations, and the qualitative data by using thematic content analysis.

Results: Despite recent marketing restrictions, participants were widely exposed to and identified various forms of marketing by both the monopoly and offshore operators. Marketing by offshore providers was described as widespread and aggressive. The monopoly operator actively leveraged public health messaging as a form of marketing. Of the participants, 60.5% indicated wanting stricter marketing regulations or a blanket ban on gambling marketing.

Conclusions: Gambling marketing is ubiquitous in Finland. Those who gamble are widely exposed to different forms of marketing from both the monopoly and offshore providers. The upcoming licensing system is likely to further increase the visibility of marketing. Many consumers prefer stricter regulation owing to public health concerns.

Aims: There is limited research on how family-related events are associated with sustainable working life, which is defined as the absence of long-term periods of unemployment, sickness absence, or disability pension. We aimed to investigate whether family-related events, such as living with children, marriage, or divorce, are associated with sustainable working life. We also examined whether these associations could be explained by health behaviours including physical activity, smoking, and alcohol consumption, as well as by genetic factors and early life environment.

Methods: Registry data and surveys on family-related events, sustainable working life, and health behaviours of 49,611 Swedish twins in 1993-2016 were used. Cox proportional hazards regressions were applied to estimate the associations between family-related events and sustainable working life, while conditional Cox models for twin pairs accounted for confounding genetic factors and early life environment. Further, the analyses were stratified by health behaviours.

Results: The results showed that a change from being single living without children to being married and living with children was associated with a sustainable working life. Moreover, individuals who experienced divorce and single individuals who changed their status of living with children were less likely to experience a sustainable working life. Genetic factors and early life environment played a role in some associations. Those with healthy behaviours were more likely to have sustainable working lives despite changes in family life, compared with those with unhealthy behaviours.

Conclusions: Family formation (i.e. change from being single to getting married and having children) is associated with sustainable working life, whereas divorce seems to decrease the possibility of sustainable working life. Health behaviours, as well as genetic factors and early life environment, also need to be considered with changes in family life to support sustainable working life.

Aim: To describe sociodemographic trends in leisure-time physical activity among Danish adults from 2010 to 2023.

Methods: Data from the Danish Health and Morbidity Survey waves of 2010, 2013, 2017, 2021 and 2023 were used. Around 10,000 individuals (aged ⩾25 years) participated in each wave (response rates ranging from 61% in 2010 to 41% in 2023). Leisure-time physical activity was assessed using a modified version of the Saltin-Grimby Physical Activity Level Scale. Prevalence and adjusted odds ratios (OR) were estimated according to sex, age and educational attainment.

Results: From 2010 to 2021, the prevalence of leisure-time physical activity decreased from 32.5% to 26.1% among men and from 20.1% to 14.9% among women. Notably, the decline was most pronounced between 2017 and 2021 (COVID-19 year) but was followed by an increase in 2023 for both sexes. However, leisure-time physical activity among individuals aged 25-44 years further declined from 2021 to 2023. Throughout the study period, a persistent social inequality in leisure-time physical activity was observed. In 2023, this educational gap widened and the odds ratios for leisure-time physical activity among individuals with higher educational attainment compared with primary education were OR 2.73 (95% confidence interval 1.93-3.88) among men and were OR 2.95 (95% confidence indterval 1.80-4.83) among women.

Conclusions: Leisure-time physical activity among Danish adults declined from 2010 to 2021, with a notable decrease between 2017 and 2021, followed by a partial recovery. Persistent sex, age, and social disparities were observed, with age and social disparities further widening by 2023. This highlights the need for targeted interventions to promote equal participation in physical activity.

Aims: Preventive home visits aim at maintaining health, autonomy and functional ability among home-dwelling older people. The effect of preventive home visits on functional ability, healthcare utilisation and mortality has been investigated with ambiguous findings and overall short follow-up. The aim of this study was to investigate the effect of an intervention comprising an educational programme among preventive home visitors and general practitioners on mortality and nursing home admission over 12 years of follow-up among men and women aged 75 or 80 years at baseline. Methods: The intervention was carried out as a cluster randomised controlled trial including 34 municipalities. This study was based on questionnaire data from the trial and follow-up registry data. Outcomes were measured in four consecutive three-year follow-up periods starting in 1999 and analysed through Cox regression analyses. Results: In all periods, a non-significantly lower mortality rate was observed in intervention municipalities. In the first three-year period, there was a non-significantly higher nursing home admission rate in intervention municipalities. In the second three-year period, there was a non-significantly lower nursing home admission rate in intervention municipalities. Conclusions: No statistically significant effect of the intervention on mortality or nursing home admission was seen at long-term follow-up. The evaluation of preventive home visits needs to consider outcomes valued by the healthcare personnel involved and the older people themselves, such as empowerment and self-esteem, rather than relying on easily measured outcomes such as mortality and nursing home admission.

Background: Women often reduce their working hours after childbirth, or, in some cases, exit the workforce altogether. This adjustment affects their immediate economic independence, with implications for their career trajectory and long-term financial stability. We aim to study the patterns of women's work resumption in the first year after childbirth, including the role of sick leave during pregnancy. We further aim to identify the key factors contributing to women's economic independence one year after childbirth. Methods: Drawing on data from Statistics Netherlands and the Dutch Perinatal Registry, we used descriptive analysis to examine the working hour patterns from onset of pregnancy to one year after childbirth. Additionally, multinomial logistic regression assessed how individual and work-related factors related to having employment with economic independence, having employment without economic independence, or having exited the workforce one year after childbirth. Results: Data on 114,722 Dutch employed women who delivered in 2016 showed a notable shift in employment patterns one year after birth: over half reduced their working hours, with 12.2% leaving the workforce entirely. These patterns were particularly pronounced among women with sick leave during pregnancy. Furthermore, factors such as lower education, fewer working hours, and not cohabiting with a partner were associated with being employed but not economically independent after childbirth. Conclusions: Pregnancy and delivery have a durable impact on women's workforce participation, which affects their economic independence. Strategic workplace and family policies might support retaining employment after childbirth and mitigate adverse economic effects, particularly for those with sick leave during pregnancy.

Background/aims: Municipalities in Norway are required to have a district medical officer (DMO) as chief medical advisor and leader of infection control and prevention work. There is great variation between municipalities in how the role is enacted and organized. Before the Covid-19 pandemic many DMOs felt their role to be unclear and invisible in the organization. This study aimed to explore DMOs' experiences during the Covid-19 pandemic and how organizational context mediated these experiences. Methods: We conducted a qualitative study, generating data from three focus groups involving 17 DMOs from three different regions in Norway. Data were analysed using systematic text condensation. Results: All DMOs, regardless of municipal size, position size or infection rate, reported feeling overwhelmed by the responsibility during the pandemic. Their organizational outset, number of tasks, number of enquiries and uncertain foundation for decisions contributed to this experience. Organizational characteristics that promoted DMOs' coping were resource allocation, teamwork, and professional and social support. Conclusions: Our results suggest that municipalities can enhance their crisis management of future infection control crises by establishing an organizational structure around DMOs that facilitates networking, and by developing plans for task delegation and creation of teams to support and alleviate DMOs during a crisis.

Aims: Increasing self-reported mental health problems among adolescents in many countries, accompanied by worsening results in international studies of school achievement, raises questions about how school, learning and mental health interact. The purpose of the present study is to analyse the associations between mental health, early school achievement and subsequent school failure in the final year of compulsory schooling in Sweden. Methods: This study is based on a Swedish representative sample of 9020 children born in 2004, which was drawn in 2014 by Statistics Sweden. Three logistic regression models were analysed: regressing school failure in school year 9 on psychiatric diagnoses, grades in school year 6 and sociodemographic variables. Results: Psychiatric diagnoses and grades in school year 6 are strongly associated with school failure in school year 9. These two variables interact, and their combined effects on school failure is striking. Almost every second student with a psychiatric diagnosis and not achieving passing grades in all subjects in school year 6 fails in school year 9. The corresponding figure is 2% for students with no psychiatric diagnosis and passing grades in all subjects in school year 6. Conclusions: Early identification of signs of risk factors for school failure provides opportunities to prevent mental health problems and to support school achievement. To properly estimate the magnitude of risk factors for failure in school year 9, the interactive effects of psychiatric diagnoses and grades in school year 6 on school failure need to be accounted for.