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Aims: The aim was to investigate associations between the experience of parental separation/divorce in childhood and tobacco smoking in adulthood, adjusting for economic stress in childhood and adulthood and psychological health (General Health Questionnaire GHQ12). Methods : The 2012 public-health survey in Skåne, southern Sweden, is a cross-sectional postal questionnaire population-based study with 28,029 participants aged 18–80 (51.7% response rate). Associations between parental separation/divorce in childhood and tobacco smoking were investigated in multiple logistic regression models, with adjustments for economic stress in childhood and adulthood and psychological health. Results : A 17.6% weighted prevalence of men and 17.1% of women reported tobacco smoking. Significantly higher odds ratios of tobacco smoking were observed for men who had experienced parental separation/divorce in childhood at ages 0–4, 5–9 and 15–18 years and for women with this experience in childhood at ages 0–4, 5–9, 10–14 and 15–18 years, even after inclusion of economic stress in childhood in the final multiple models. No effect modification was observed for parental separation and psychological health and for parental separation and economic stress in childhood with regard to smoking. Conclusions: Experience of parental separation/divorce in childhood was significantly associated with tobacco smoking in adulthood for both sexes. There seems to be no specific critical period. [ABSTRACT FROM AUTHOR]

Aims: Research on the effect of unmet health-care needs on mortality at follow-up is scarce. This study investigated whether unmet health-care needs in 2008 were associated with a higher risk of mortality during a five-year follow-up period in a population in southern Sweden, and whether the association was stronger for particular subgroups of cause of death. Methods: The 2008 public-health survey in Skåne was used as baseline. The survey included variables such as unmet health-care needs, risk behaviours and social and socio-economic variables, and had 28,198 respondents aged 18–80 years. The study was longitudinal. Mortality data for the period 27 August 2008 (start of the survey) to 31 December 2013 were provided by the National Board on Health and Welfare. Analyses were run using Cox proportional hazard models. Mortality was analysed as the total and in subgroups: cardiovascular disease (CVD), cancer and other causes. Results: In the time period studied, 946 (3.4%) people had died. Unmet health-care needs increased the hazard ratios (HRs) of total mortality after adjusting for age, particularly for people aged 65–80 years (HR=1.53; confidence interval 1.24–1.88). Unmet health-care needs were associated with death due to cancer and other causes but not with CVD. Adjusting for self-rated health attenuated the HRs. For the age group 18–64 years, there was no significant association between unmet health-care needs and mortality. Conclusions: Having unmet health-care needs at baseline was significantly associated with increased mortality for all causes, except CVD, in the following five year-period, particularly for people aged 65–80 years. [ABSTRACT FROM AUTHOR]

• More knowledge concerning sexual orientation and suicide ideation and attempts is needed. • This population-based study investigated heterosexual, bisexual, homosexual and other. • A higher prevalence of bisexual and homosexual respondents reported suicide thoughts than heterosexuals. • Bisexuals of both sexes and homosexual men reported higher prevalence of suicide attempt. The aim is to investigate associations between sexual orientation and experience of suicide thoughts and suicide attempts. The 2012 public health survey in Scania, southern Sweden, is a cross-sectional population-based study including 28,029 participants aged 18–80 with 51.7% participation. The associations between sexual orientation and experience of suicide thoughts and attempts were investigated in multiple logistic regressions. A 8.2% proportion of men and 11.3% of women reported suicide thoughts more than a year ago, and 4.0% of men 4.1% of women had experienced such thoughts during the past year. A 2.6% proportion of men and 4.6% of women reported suicide attempt more than a year ago, and 0.6% of men and 0.7% of women during the past year. In the age- and multiple adjusted models, bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide thoughts than heterosexual men and women. Bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide attempt than heterosexual men and women. After multiple adjustments these patterns largely remained. The results indicate that bisexual men and women and homosexual men have an increased risk of experience of suicide thoughts and suicide attempt. [ABSTRACT FROM AUTHOR]

Aims: To investigate if any differences in unmet healthcare needs between persons registered at public and private primary care providers exist in Skåne (southernmost Sweden). Methods: The 2012 public health survey in Skåne was conducted with a postal questionnaire and included 28,029 respondents aged between 18 and 80 years. The study was cross-sectional. If the responder in the last three months had perceived oneself to be in need of medical care by a physician but did not seek it, this was used as a measure of unmet healthcare needs. Differences in unmet healthcare needs in relation to the primary care provider were investigated while adjusting for socioeconomic status and self-rated health in a logistic regression. Results: Differences in unmet healthcare needs were small and non-significant when comparing public and private healthcare providers. Non-manual workers were to a somewhat higher extent using private providers while manual workers showed a reverse pattern. Unmet healthcare needs had decreased slightly since 2008, but so had the response rate. Conclusions: With the current primary care system, no significant differences in unmet healthcare needs seem to exist when comparing public and private providers. It is likely that the providers are similar in their organizational setup, accessibility and doctor-patient continuity. Still more studies need to be done, preferably in a way so that uncertainty about what type of primary care provider the respondent is listed at can be avoided and perhaps using a longer time interval for unmet needs so that more subjects could be included. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate the associations between socioeconomic status (SES) and self-reported unmet health care needs, taking economic stress, generalized trust in other people and trust in the health care system into account. Methods: The 2012 public health survey in Scania was conducted using a postal questionnaire and included 28,029 participants aged 18–80 years. The study was cross-sectional. Associations between SES and unmet health care needs were investigated, adjusting for economic stress and trust in logistic regressions. Results: SES was significantly associated with unmet health care needs. The SES categories of unemployed, on long-term sick leave and unskilled manual workers reported particularly high levels of unmet health care needs. SES differences in unmet needs were attenuated when economic stress and the two dimensions of trust and self-rated health were introduced in multiple analyses. The working population gave a lack of time as the reason for unmet health care needs, whereas those on sick leave or unemployed reported a lack of money. Conclusions: SES differences in self-reported unmet health care needs were observed and these associations were attenuated when economic stress during the past year, generalized trust in other people, trust in the health care system and self-rated health were introduced into the multiple models. [ABSTRACT FROM AUTHOR]

The aim of the present study is to investigate associations between parental separation/divorce during childhood, and self-reported psychological health, adjusting for social capital, social support, civil status and economic stress in childhood. A cross-sectional public health survey was conducted in the autumn of 2012 in Scania, southern Sweden, with a postal questionnaire with 28,029 participants aged 18–80. Associations between parental separation/divorce during childhood and self-reported psychological health (GHQ12) were investigated using logistic regressions. A 16.1% proportion of all men 22.4% of all women reported poor psychological health. Among men, 20.4% had experienced parental separation during childhood until age 18 years, the corresponding prevalence among women was 22.3%. Parental separation/divorce in childhood was significantly associated with poor self-rated psychological health among men who had experienced parental separation/divorce at ages 0–4, and among women with this experience at ages 0–4, 10–14 and 15–18. These significant associations remained throughout the multiple analyses. The results support the notion that the experience of parental separation/divorce in childhood may influence psychological health in adulthood, particularly if it is experienced in the age interval 0–4 years. [ABSTRACT FROM AUTHOR]

The aim is to investigate the associations between economic stress in childhood and adulthood, and low generalized trust in other people, testing two life course hypotheses. The 2008 public health survey in Scania is a cross-sectional postal/mail questionnaire study in which 28,198 persons aged 18-80 participated (55% participation in the original sample). Logistic regressions were used to analyze associations between economic stress in childhood and adulthood, and low generalized trust in other people, adjusting for demographic factors, socioeconomic/occupational status, and emotional and instrumental aspects of social support. A 33.9% proportion of the men and 35.7% of the women reported low trust. Trust was significantly associated with all variables included in the models. Economic stress in childhood remained significantly associated with low trust even when economic stress in adulthood was included in the critical period models. The critical period hypothesis regarding trust was corroborated in the meaning that economic stress in childhood and adulthood were independently associated with low trust. However, it was not corroborated in the meaning that a specific time window had a particularly high association with trust. The accumulation hypothesis was confirmed: increased combined childhood and adulthood exposure to economic stress was significantly associated with low trust in a cumulative way. Economic stress in childhood may be of importance for trust in others in adulthood. [ABSTRACT FROM AUTHOR]

Studies of the association between parental separation in childhood and suicide thoughts and attempts are scarce. The aim of this study is to investigate associations between parental separation/divorce during childhood, and ever having had suicide thoughts and ever having made suicide attempt, adjusting for social capital and other covariates. In 2012 a cross-sectional public health survey was conducted in Scania, southern Sweden, with a postal questionnaire with 28,029 participants aged 18–80. Associations between parental separation/divorce during childhood and ever having considered suicide or having made suicide attempt were analysed by logistic regression. Overall, 12.1% of the men and 15.5% of the women had experienced suicide thoughts, and 3.2% of the men and 5.3% of the women had ever tried committing suicide. Among men, 20.4% had experienced parental separation during childhood until age 18, and among women 22.3%. Parental separation/divorce in childhood was with few exceptions significantly associated with ever having had suicide thoughts with the highest odds ratios for those who had experienced parental separation during ages 0–4 years. Parental separation/divorce in childhood was significantly associated with suicide attempts among men who had experienced parental separation/divorce at ages 0–4 and 15–18, and among women at any age 0–18. [ABSTRACT FROM AUTHOR]

Aims: To investigate associations between economic stress in childhood and adulthood, and lack of internal health locus of control (HLC), testing the accumulation and critical period life course hypotheses. Methods: A cross-sectional public health (postal) survey was conducted in Skåne in 2008, based on a random sample with 28,198 participants in the age interval 18–80 years, with 55% participation. Logistic regressions analyzed associations between childhood and current economic stress, and lack of internal HLC. Results: A 33.7% prevalence of men and 31.8% of women lack internal HLC, which was significantly associated with the covariates included. The accumulation hypothesis was partly supported because combined childhood and adulthood economic stress exposures were significantly associated with lack of internal HLC in a graded manner. The critical period hypothesis was not supported since the association between economic stress in childhood and lack of internal HLC was partly significant in the final model, and the association with adult (current) economic stress was also significant. Conclusions: The accumulation hypothesis was partly supported. The critical period hypothesis was not supported since both childhood and current economic stress experience were significantly associated with lack of internal HLC. Economic conditions in childhood as well as adulthood are plausibly of relevance for HLC. [ABSTRACT FROM PUBLISHER]

Abstract: The associations between marital status and poor mental health are investigated, and whether social capital, trust, and economic stress attenuate the associations between marital status and poor mental health. The public health survey in Skåne (southern Sweden) 2008 is a cross-sectional study including 28,198 persons aged 18–80. Logistic regression models investigate associations between marital status and mental health, adjusting for age, country of birth, education, emotional support, instrumental support, trust in others, and economic stress. A 13.8% prevalence of the men and 18.2% of the women had poor mental health. Significantly higher odds ratios of poor mental health for the unmarried, divorced and widows/widowers compared to married/cohabitating remained throughout the analyses. Trust and economic stress only moderately attenuated these associations. [Copyright &y& Elsevier]

Abstract: Objective: Exhaustion is hypothesised to be a risk-factor for coronary heart disease (CHD), but as such its independence from emotional states, in particular depression, has not been established in previous investigations. This study aimed to explore the unique contribution of exhaustion, independent from symptoms of depression and anxiety, to CHD development. Methods: The study sample was 5061 men and 6734 women from the Malmö Shoulder and Neck Study cohort examined in 1993–96. Exhaustion was measured by the SF-36 vitality scale. Symptoms of depression and anxiety were measured by the General Health Questionnaire. 571 first coronary events were ascertained through record linkage until 2005. Cox regression analysis was used to assess the contribution of exhaustion to CHD. Results: In age-adjusted analysis exhaustion predicted coronary events in a non-linear way in both men (HR=1.49, 95% CI 1.06–2.11 in the highest exhaustion category) and women (HR=1.78, 95% CI 1.23–2.58 in the second highest exhaustion category). After adjustment for traditional risk-factors for CHD and socioeconomic status, the effect was attenuated and statistically significant only in women. However, further adjustment for symptoms of depression and anxiety strengthened the association between exhaustion and CHD in men (HR=1.62, 95% CI 1.05–2.50), whereas in women, exhaustion no longer predicted CHD. Conclusion: In age-adjusted analysis, exhaustion predicted CHD in both men and women, but its independence from depression and anxiety was demonstrated only in men. Further studies on the topic are required. A larger focus on potential gender differences should seem warranted in future research. [Copyright &y& Elsevier]

Background: Exhaustion is a concept of interest for both occupational health research and stress-disease theory research. The aim of the present study was to explore associations between chronic stressors, in terms of psychosocial working conditions, and exhaustion in a Swedish middle-aged population sample. Methods: A vocationally active population sample of the Malmö Shoulder and Neck Study cohort, comprising 2555 men and 2466 women between 45 and 64 years of age, was used. Psychosocial working conditions, assessed by means of the demand-control-support model, were measured longitudinally with a 1-year interval. Exhaustion was assessed by the SF-36 vitality scale and measured at follow-up, yielding a cross-sectional study design. Results: Exhaustion was twice as common in women as in men. High psychological job demands, low job control and low job support were independently associated with exhaustion in both men and women. These associations remained after controlling for a variety of potential confounders and mediators, including socio-demographic factors, lifestyle factors, musculoskeletal pain, disease, other work-related factors (including physical workload) and non-work-related factors. High demands in combination with low control (job strain), and job strain combined with low job support (iso-strain), increased the risk for exhaustion. Conclusion: Psychosocial working conditions seem to contribute to exhaustion in middle-aged men and women. Future research should include exploration of exhaustion as a possible mediator between work stress and disease, as well as exploration of other chronic stressors, including non-work-related stressors, regarding their effects on exhaustion in men and women. [ABSTRACT FROM AUTHOR]

Aims: The present study aims to quantify non-participation in the RIKS-HIA register during 2005 and to compare acute myocardial infarction (AMI) patients registered and not registered in RIKS-HIA, in relation to sociodemographic factors, prevalent disease, and 7-day and 30-day survival. Methods: We linked information on sociodemographic characteristics, treatments, morbidity, and mortality from the LOMAS (Longitudinal Multilevel Analysis in Scania) database with the RIKS-HIA register. The study population consisted of individuals younger than 85 years living in Scania by 31 December 2004 who had one or more AMI during 2005 (n = 2968). Results: The 70% of the AMI patients included in the register were generally younger, more often men, generally more healthy, more often had AMI as the main diagnosis, and more often underwent revascularisation procedures than AMI patients not included. Among both men (ORadjusted = 0.19; 95% CI 0.14-0.27) and women (ORadjusted = 0.30; 95% CI 0.20-0.44), registered patients had a lower 30-day mortality than patients not registered in RIKS-HIA. Conclusions: Even though RIKS-HIA conveys a clear quality improvement for the care of patients with acute coronary syndrome in Sweden, it is important to be aware that the register does not include the entire AMI population, but rather a selected and healthier population of AMI patients. This circumstance decreases the external validity of the information obtained from the RIKS-HIA register. Such an effect might be reduced over time and data from 2006 shows an inclusion rate of 76% among AMI patients aged less than 80 years. [ABSTRACT FROM AUTHOR]

Background: There are no previous studies investigating when and where those who die pre-hospitally after an AMI paid their last visit to medical care. Methods and Results: Incidence of AMI, pre-hospital and 28-day case fatality rates were monitored over 13 years of follow-up, in relation to sex-specific quartiles of annual income in all inhabitants aged 40-64 years in Malmö, Sweden. Both incidence and short-term case fatality were inversely related to income. In all, 60-70% of all deaths within 28 days after the AMI were pre-hospital deaths. As compared with the lowest income group, the highest income group had lower odds of pre-hospital death with an age- and time-to-event-adjusted odds ratio of 0.5 (95% CI 0.4-0.8) for men and 0.3 (95% Cl 0.1-0.6) for women. On the other hand, while 72% of those in the lowest two income groups had paid a visit to the medical services during the three months before death, only 59% had done so in the two highest income groups (P<0.05). Conclusions: Poor socioeconomic circumstances increase the risk of pre-hospital death after an AMI. Of the pre-hospital deaths, the proportion who had visited the medical services during the 3 months preceding their AMI was higher among those from tower income groups. However, many of those suffering a pre-hospital death had visited clinics that normally do not treat coronary symptoms. If more patients were identified at an earlier stage this might increase the number of patients reaching hospital alive. [ABSTRACT FROM AUTHOR]

Background: Much research has shown that soy products inhibited various diseases. However, no published studies have examined the effects of consumption of soy and isoflavones on periodontal disease. The aim of this study was to investigate whether soy and isoflavone intake is associated with the prevalence of periodontal disease. Methods: The subjects were 3956 Japanese female students, aged 18 to 22 years, who were taking a dietetic course. Periodontal disease was defined as present when a subject reported diagnosis of the disorder by a dentist. Information on dietary factors was collected using a validated diet history questionnaire. Logistic regression analysis was used to estimate the odds ratios and their confidence intervals of periodontal disease. Adjustment was made for cigarette smoking, toothbrushing frequency, region of residence, and body mass index. Results: The prevalence of periodontal disease was 8.0%. Intake of total soy product and tofu was independently associated with a decreased prevalence of periodontal disease; multivariate odds ratios in comparison of the highest with the lowest quintile were 0.68 and 0.68, respectively (95% confidence intervals = 0.47-0.97 and 0.47-0.98, P for trend = 0.01 and 0.004, respectively). A significant inverse dose-response relationship between the intake of isoflavones and the prevalence of periodontal disease was observed, although the difference in the adjusted odds ratio between the extreme quintiles was of borderline significance (P for trend = 0.04). There were no measurable dose-response relationships between consumption of tofu products, fermented soybeans, boiled soybeans, miso, or miso soup and the prevalence of periodontal disease. Conclusion: Our findings suggest that soy and isoflavone intake may decrease the likelihood of periodontal disease. Further investigations with objective measures for periodontal disease are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Background: The widespread use of relative scales in socioepidemiological studies has recently been criticized. The criticism is based mainly on the fact that the importance of different risk factors in explaining social inequalities in cardiovascular disease (CVD) varies, depending on which scale is used to measure social inequalities. The present study examines the importance of established risk factors, as opposed to low-grade inflammation, in explaining socioeconomic differences in the incidence of CVD, using both relative and absolute scales. Methods: We obtained information on socioeconomic position (SEP), established risk factors (smoking, hypertension, and hyperlipidemia), and low-grade inflammation as measured by high-sensitive (hs) C-reactive protein (CRP) levels, in 4,268 Swedish men and women who participated in the Malmö Diet and Cancer Study (MDCS). Data on first cardiovascular events, i.e., stroke or coronary event (CE), was collected from regional and national registers. Social inequalities were measured in relative terms, i.e., as ratios between incidence rates in groups with lower and higher SEP, and also in absolute terms, i.e., as the absolute difference in incidence rates in groups with lower and higher SEP. Results: Those with low SEP had a higher risk of future CVD. Adjustment for risk factors resulted in a rather small reduction in the relative socioeconomic gradient, namely 8% for CRP (⩾?3 mg/L) and 21% for established risk factors taken together. However, there was a reduction of 18% in the absolute socioeconomic gradient when looking at subjects with CRP-levels < 3 mg/L, and of 69% when looking at a low-risk population with no smoking, hypertension, or hyperlipidemia. Conclusion: C-reactive protein and established risk factors all contribute to socioeconomic differences in CVD. However, conclusions on the importance of "modern" risk factors (here, CRP), as opposed to established risk factors, in the association between SEP and CVD depend on the scale on which social inequalities are measured. The one-sided use of the relative scale, without including a background of absolute levels of disease, and of what causes disease, can consequently prevent efforts to reduce established risk factors by giving priority to research and preventive programs looking in new directions. [ABSTRACT FROM AUTHOR]

Background: In a public health perspective, it is of interest to assess the magnitude of geographical variations in ischaemic heart disease (IHD) mortality and quantify the strength of contextual effects on IHD. Objective: To investigate whether area effects vary according to the individual and contextual characteristics of the population, socioeconomic contextual influences were assessed in different age groups and within territories of differing population densities. Design: Multilevel survival analysis of a 28-year longitudinal database. Participants: 341 048 residents of the Scania region in Sweden, reaching age 50-79 years in 1996, followed up over 7 years. Results: After adjustment for several individual socioeconomic indicators over the adult age, Cox multilevel models indicated geographical variations in IHD mortality and socioeconomic contextual effects on the mortality risk. However, the magnitude of geographical variations and strength of contextual effects were modified by the age of individuals and the population density of their residential area: socioeconomic contextual effects were much stronger among non-elderly than among elderly adults, and much larger within urban territories than within rural ones. As a consequence, among non-elderly residents of urban territories, the socioeconomic contextual effect was almost as large as the effect of individual 20-year cumulated income. Conclusions: Non-elderly residents of deprived urban neighbourhoods constitute a major target for both contextual epidemiology of coronary disease and public health interventions aimed at reducing the detrimental effects of the social environment on IHD. [ABSTRACT FROM AUTHOR]

Abstract: The associations between educational level, preclinical carotid atherosclerosis and incident coronary events (CE), were investigated in a general population sample of 5399 Swedish middle-aged men and women without history of cardiovascular disease (CVD) over a median follow-up of 8.7 years. Presence of carotid plaque (focal intima-media thickness (IMT) >1.2mm) was determined by B-mode ultrasound. In the age- and sex-adjusted model, there was an inverse relationship between educational level and risk of future CE (p for trend=0.002). To explore if there were education differences between groups with similar degrees of preclinical carotid atherosclerosis stratified analyses were made. Those with low educational level without carotid plaque showed a slightly increased hazard rate ratio (HRR), 1.14 (95% CI: 0.65, 1.97), compared to those with high educational level without carotid plaque (reference group). For those with high educational level with carotid plaque the HRR was 1.53 (95% CI: 0.92, 2.55). Having both low educational level and carotid plaque was associated with a HRR of 2.72 (95% CI: 1.72, 4.31). Individuals with plaque generally had more unfavourable cardiovascular risk factor levels, regardless of educational level. However, after risk factor adjustment those with both low education and carotid plaque still had a two-fold increased risk of CE. The results imply that differences in the prevalence of preclinical atherosclerosis seem important in explaining education differences in future coronary morbidity. [Copyright &y& Elsevier]

Abstract: While the persistence of socioeconomic differences in cardiovascular disease (CVD) has been recognized for many years, less is known about whether socioeconomic factors are of importance to CVD before symptoms of the disease appear. In this study the associations among educational level, occupational status and progression of atherosclerosis were investigated in 1016 Swedish middle-aged men and women with signs of subclinical atherosclerosis, i.e., carotid plaque (defined as focal intima-media thickness (IMT) >1.2mm). IMT in the common carotid artery (CCA) and in the carotid bifurcation area, as well as carotid plaque score, was determined by B-mode ultrasound. Results showed only weak associations between educational level, occupational status and age-, sex- and baseline IMT-adjusted progression of IMT in the CCA. However, in the age, sex- and baseline IMT-adjusted analyses, those in unskilled manual occupations showed a significantly higher yearly progression of carotid IMT in the bifurcation area compared to those in high- or medium-level non-manual occupations. Those with primary education tended to show a higher yearly progression of carotid IMT in the bifurcation area compared to those with completed secondary education. After adjustment for risk factors, the magnitude of these associations were somewhat attenuated. Similar patterns of associations were seen for the change of carotid plaque score. We conclude that low socioeconomic status (SES) is associated with progression of atherosclerosis in a middle-aged population with signs of subclinical atherosclerosis. Even though socioeconomic differences in cardiovascular risk factor levels could explain part of the found differences in progression rate in women, the mechanisms involved remain to be further established. [Copyright &y& Elsevier]

Background: There are at least three broad conceptual models for the impact of the social environment on adult disease: the critical period, social mobility, and cumulative life course models. Several studies have shown an association between each of these models and mortality. However, few studies have investigated the importance of the different models within the same setting and none has been performed in samples of the whole population. The purpose of the present study was to study the relation between socioeconomic position (SEP) and mortality using different conceptual models in the whole population of Scania. Methods: In the present investigation we use socioeconomic information on all men (N = 48,909) and women (N = 47,688) born between 1945 and 1950, alive on January, 1st,1990, and living in the Region of Scania, in Sweden. Focusing on three specific life periods (i.e., ages 10-15, 30-35 and 40-45), we examined the association between SEP and the 12-year risk of premature cardiovascular mortality and all-cause mortality. Results: There was a strong relation between SEP and mortality among those inside the workforce, irrespective of the conceptual model used. There was a clear upward trend in the mortality hazard rate ratios (HRR) with accumulated exposure to manual SEP in both men (p for trend < 0.001 for both cardiovascular and all-cause mortality) and women (p for trend = 0.01 for cardiovascular mortality) and (p for trend = 0.003 for all-cause mortality). Inter- and intragenerational downward social mobility was associated with an increased mortality risk. When applying similar conceptual models based on workforce participation, it was shown that mortality was affected by the accumulated exposure to being outside the workforce. Conclusion: There was a strong relation between SEP and cardiovascular and all-cause mortality, irrespective of the conceptual model used. The critical period, social mobility, and cumulative life course models, showed the same fit to the data. That is, one model could not be pointed out as "the best" model and even in this large unselected sample it was not possible to adjudicate which theories best describe the links between life course SEP and mortality risk. [ABSTRACT FROM AUTHOR]

Background: To more efficiently reduce social inequalities in mortality, it is important to establish which causes of death contribute the most to socioeconomic mortality differentials. Few studies have investigated which diseases contribute to existing socioeconomic mortality differences in specific age groups and none were in samples of the whole population, where selection bias is minimized. The aim of the present study was to determine which causes of death contribute the most to social inequalities in mortality in each age group in the whole population of Scania, Sweden. Methods: Data from LOMAS (Longitudinal Multilevel Analysis in Skåne) were used to estimate 12-year follow-up mortality rates across levels of socioeconomic position (SEP) and workforce participation in 975,938 men and women aged 0 to 80 years, during 1991-2002. Results: The results generally showed increasing absolute mortality differences between those holding manual and non-manual occupations with increasing age, while there were inverted u-shaped associations when using relative inequality measures. Cardiovascular diseases (CVD) contributed to 52% of the male socioeconomic difference in overall mortality, cancer to 18%, external causes to 4% and psychiatric disorders to 3%. The corresponding contributions in women were 55%, 21%, 2% and 3%. Additionally, those outside the workforce (i.e., students, housewives, disability pensioners, and the unemployed) showed a strongly increased risk of future mortality in all age groups compared to those inside the workforce. Even though coronary heart disease (CHD) played a major contributing role to the mortality differences seen, stroke and other types of cardiovascular diseases also made substantial contributions. Furthermore, while the most common types of cancers made substantial contributions to the socioeconomic mortality differences, in some age groups more than half of the differences in cancer mortality could be attributed to rarer cancers. Conclusion: CHD made a major contribution to the socioeconomic differences in overall mortality. However, there were also important contributions from diseases with less well understood mechanistic links with SEP such as stroke and less-common cancers. Thus, an increased understanding of the mechanisms connecting SEP with more rare causes of disease might be important to be able to more successfully intervene on socioeconomic differences in health. [ABSTRACT FROM AUTHOR]

The objective was to investigate associations between the General Health Questionnaire with twelve sub-items (GHQ-12) and prospective five-year suicide mortality. The two commonly used GHQ-12 cut-offs (2/3 and 3/4) were analyzed. The 2008 public health survey, which was conducted in the autumn of 2008 in Scania, southern Sweden, is based on a postal questionnaire answered by 28,198 participants, aged 18 to 80. GHQ-12 was assessed from the baseline questionnaire, and five-year prospective register data on causes of death were connected to the baseline survey. In total, 21 persons died from intentional self-inflicted injuries, and twenty of them had complete answers regarding GHQ-12. Hazard rate ratios (HRR) were analyzed in survival (Cox-) regression analyses, adjusted for age, sex, marital status and socioeconomic status (SES). The prevalence of poor psychological health according to GHQ-12 with the 2/3 cut-off was 14% among men and 18% among women, and with the 3/4 cut-off it was 11% among men and 15% among women. The 2/3 cut-off yielded a HRR of 3.02 (1.14–7.98, 95% CI) which decreased to 2.44 (0.92–6.49) when adjusted for marital status and SES, and a 3/4 cut-off HRR of 3.97 (1.51–10.47) which decreased to 3.23 (1.22-1.22-8.56) when adjusted for marital status and SES. The results indicate high effect measures (HRRs) between GHQ12 with both cut offs and five-year suicide mortality. • The General Health Questionnaire (GHQ-12) and suicide mortality were investigated. • This study investigates the two most common GHQ-12 cut-offs and suicide mortality. • The GHQ-12 and suicide were significantly associated independently of cut-off. [ABSTRACT FROM AUTHOR]

Background Studies on sociodemographic differences in sick leave after coronavirus disease 2019 (COVID-19) are limited and research on COVID-19 long-term health consequences has mainly addressed hospitalized individuals. The aim of this study was to investigate the social patterning of sick leave and determinants of longer sick leave after COVID-19 among mild and severe cases. Methods The study population, from the Swedish multi-register observational study SCIFI-PEARL, included individuals aged 18–64 years in the Swedish population, gainfully employed, with a first positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 1 January 2020 until 31 August 2021 (n  = 661 780). Using logistic regression models, analyses were adjusted for sociodemographic factors, vaccination, prior sick leave, comorbidities and stratified by hospitalization. Results In total, 37 420 (5.7%) individuals were on sick leave due to COVID-19 in connection with their first positive COVID-19 test. Individuals on sick leave were more often women, older, had lower income and/or were born outside Sweden. These differences were similar across COVID-19 pandemic phases. The highest proportion of sick leave was seen in the oldest age group (10.3%) with an odds ratio of 4.32 (95% confidence interval 4.18–4.47) compared with the youngest individuals. Among individuals hospitalized due to COVID-19, the sociodemographic pattern was less pronounced, and in some models, even reversed. The intersectional analysis revealed considerable variability in sick leave between sociodemographic groups (range: 1.5–17.0%). Conclusion In the entire Swedish population of gainfully employed individuals, our findings demonstrated evident sociodemographic differences in sick leave due to COVID-19. In the hospitalized group, the social patterning was different and less pronounced. [ABSTRACT FROM AUTHOR]

Aims: To investigate associations between self-injury and involvement in cyberbullying as a bully, victim or bully-victim among mentally distressed adolescents. Methods: Data from the public health survey of children and adolescents in Scania, Sweden 2016 were used. A questionnaire was answered anonymously in school by 9143 students in 9th grade compulsory school (response rate 77%) and 7949 students in 2nd grade of upper secondary school (response rate 73%). Students with past year (broadly defined) mental distress at least 2 weeks in a row (33% of boys and 63% of girls) were asked if they had performed self-injury (i.e. cut, superficially cut or otherwise injured themselves) past year, and those with data on self-injury and cyberbullying were included in the present study (n=6841). Associations between self-injury and cyberbullying were investigated by multiadjusted logistic regression analysis. Results: Among mentally distressed students, self-injury was reported by 11.7% of boys and 25.9% of girls. Age-adjusted analysis showed increasingly higher odds of self-injury among cyberbullies, cybervictims and cyberbully-victims, using non-involved as reference group (OR boys: 1.8, 2.3, 3.0; girls: 2.1, 3.2, 4.8). Associations weakened after adjustment for several potential confounders but remained significant for all cyberbullying groups except male cyberbullies, among whom significance was lost after adjustment for smoking, alcohol and narcotics. Conclusions: Peer victimization in cyber space is associated with self-injury, especially among victims and bully-victims. Decreasing peer victimization is a priority, and school and health professionals need to be aware of the associations between cyberbullying and self-injury among mentally distressed adolescents. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to assess the association between parental self-rated health and recurrent abdominal pain (RAP) in preschool children. Methods: A questionnaire, including questions about sociodemographic and psychosocial factors, lifestyle, parental and child health, was sent to parents of all 4-year-old children in Scania, Sweden. The response rate was 43.6%. The outcome was RAP and the main exposure was parental self-rated health (SRH). Covariates included sociodemographic, lifestyle and psychosocial factors. Logistic regression analyses were used in a five-step model to estimate the odds ratio (OR) and 95% confidence interval (CI) of parental SRH in relation to child RAP. Results: Logistic regression analysis showed higher odds of RAP among children whose parents reported domestic violence, economic worries and poor SRH (mothers OR = 2.1 (95% CI: 1.6, 2.7) and fathers OR = 1.5 (95% CI: 1.1, 2.0)). Adjustment for sociodemographic, lifestyle and psychosocial factors reduced the OR for RAP in the children of mothers with poor SRH (OR = 1.6 (95% CI: 1.2, 2.2)) and fathers with poor SRH (OR = 1.2 (CI 95%: 0.8, 1.7)). Poor SRH was associated with less reading to the child as well as parental perceptions of insufficiency in the interaction with the child. Conclusions: Health professionals have a key position to prevent psychosomatic symptoms in childhood by identifying the living conditions of children with RAP and particularly, to pay attention to parental poor health to identify if support to the family and/or child protection interventions are needed. Health professionals meeting adult patients with poor health should identify whether they are parents and have children who might need information, support and/or protection. [ABSTRACT FROM AUTHOR]

Background Many studies report that foreign-born healthcare workers (HCWs) in high-income countries have an elevated risk of COVID-19. However, research has not yet specifically evaluated the distribution of COVID-19 among foreign-born workers in different healthcare work groups. We examined the risk of COVID-19 infection and hospitalization among foreign-born HCWs in different occupational roles in Sweden. Methods We linked occupational data (2019) of 783 950 employed foreign-born workers (20–65 years) to COVID-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the hazard ratio (HR) with 95% confidence intervals (95% CIs) of COVID-19 infection and hospitalization in eight healthcare occupational groups vs. non-HCWs and assessed whether region of birth modified the association between healthcare occupations and COVID-19. Results All HCWs had a higher risk of COVID-19 outcomes than non-HCWs, but the risk differed by occupational role. Hospital-based assistant nurses had the highest risk (infection: HR 1.78; 95% CI 1.72–1.85; hospitalization: HR 1.79; 95% CI 1.52–2.11); allied HCWs had the lowest risk (infection: HR 1.22; 95% CI 1.10–1.35; hospitalization: HR 0.98; 95% CI 0.59–1.63). The relative hazard of the outcomes varied across foreign-born workers from different regions. For example, the relative risk of COVID-19 infection associated with being a physician compared to a non-HCW was 31% higher for African-born than European-born workers. Conclusions The risk of COVID-19 among foreign-born HCWs differed by occupational role and immigrant background. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help reduce COVID-19 risk among foreign-born HCWs. [ABSTRACT FROM AUTHOR]

Background: Smoking is usually initiated early in life and most adult regular smokers have started smoking before 18 years of age. A younger age at smoking initiation is associated with risk taking behaviours and worse health outcomes regarding psychological and somatic conditions, suggested to be caused by exposure during critical developmental periods. The present study aims to investigate self-rated health among second grade high school boys and girls related to age at smoking initiation (<14 years of age and ≥ 14 years of age) among current and former smokers, compared to never smokers.Methods: Data was derived from the Scania public health survey among children and adolescents in 2012. The study was cross-sectional with retrospective information about first time cigarette smoking experiences among 3245 boys and 3434 girls in second grade of high school. Self-rated health was assessed with the question "How do you rate your general health". Associations of age at smoking initiation, current smoking status and poor self-rated health were investigated with logistic regression models.Results: Crude odds ratios of poor self-rated health were increased for all smoking groups compared to never smokers. Former smoking boys and currently smoking girls with early smoking initiation had the highest odds ratios of poor self-rated health, with odds ratios (OR) 2.4 (95 % confidence interval (CI): 1.5-3.7) and OR 2.9 (95 % CI: 2.3-3.6), respectively. After adjustments for sociodemographic factors, health-related behaviours, psychosocial factors, weight and functional disabilities, the results were attenuated, but remained statistically significant regarding former and current smoking boys with early smoking initiation, OR 2.0 (95 % CI: 1.1-3.7) and OR 1.7 (95 % CI: 1.1-2.4) and for current smoking girls with early and later smoking initiation, OR 2.1 (95 % CI: 1.5-2.8) and OR 1.5 (95 % CI: 1.1-2.0).Conclusion: Boys and girls in second grade of high school with early smoking initiation reported poorer self-rated health than later initiators and never smokers. Poorer self-rated health persisted also after smoking cessation among early initiating boys. Further studies are needed to understand the adverse health effects associated with timing of smoking initiation. [ABSTRACT FROM AUTHOR]

Background: Victimization in cyberspace has emerged as a new public health issue among the young. The main purpose of this study was to analyze associations between cyber victimization defined as cyber harassment (CH) (a somewhat broader concept than cyberbullying) and subjective health complaints (SHC), to study whether these associations were modified by parental/friend support (measured as communication), and to explore the influence of traditional bullying victimization (TBV) on the association between CH and SHC.Methods: The study population consisted of 8544 students in 9th grade (around 15 years old) who participated in the 2012 Scania public health survey of children and adolescents. The survey was a cross-sectional total-population study conducted in school, with a response rate of 83 %. Main and interaction (stress-buffering) effects of social support on the relationship between CH and SCH were investigated by hierarchical multiple linear regression analyses, adjusted for potential confounders, including TBV.Results: The past-year prevalence of CH (once or several times) was 14 % among boys and 20 % among girls. Having been cyber harassed once or several times during the past year was associated with higher levels of SHC, controlling for age, parental occupation, parental origin, daily smoking, intense alcohol consumption, and disability. Among both boys and girls, the associations were stronger for CH occurring several times than for CH occurring only once. Main effects of parental/friend support were seen for both boys and girls, while stress-buffering effects were indicated for boys only. Additional analysis further adjusting for TBV did not change the associations substantially, indicating that CH has an effect of its own on SHC.Conclusion: Intervention programs aimed at improving the quality of peer and family relationships among children and adolescents might reduce the incidence of both cyber harassment and traditional bullying and lower the prevalence of psychosomatic complaints. [ABSTRACT FROM AUTHOR]

The aim was to investigate associations between health locus of control (HLC) and all-cause, cardiovascular (CVD), cancer and other cause mortality. A public health postal questionnaire was distributed in the autumn of 2008 to a stratified random sample of the 18-80 year old adult population in Scania in southernmost Sweden. The participation rate was 54.1%, and 25,517 participants were included in the present study. Baseline 2008 survey data was linked to cause of death register data to create a prospective cohort with 8.3-year follow-up. Associations between health locus of control and mortality were investigated in survival (Cox) regression models. Prevalence of internal HLC was 69.0% and external HLC 31.0% among women. Internal HLC was 67.6% and external HLC 32.4% among men. In the models with women and men combined, external HLC had significantly higher all-cause, CVD, cancer and other cause mortality even after adjustments for sociodemographic factors and chronic disease at baseline, but after the introduction of health-related behaviors, external HLC only displayed higher cancer mortality compared to internal HLC. External HLC displayed higher all-cause, cancer and other cause mortality for men in the final model adjusted for health-related behaviors, but not for women. Other pathways than health-related behaviors may exist for the association between external HLC and cancer mortality, particularly among men. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate differences according to country of birth and parental country of birth, in relation to poor self-rated health (SRH), in Swedish adolescents. Methods: The Scania public health survey among children and adolescents, conducted in 2012, is a cross-sectional study including most pupils in grade 9 (15 years old), including in 32 of 33 municipalities. The participation rate was 83% (9,791 of 11,735). We performed logistic regressions to investigate the association between the students’ country of birth, parental country of birth and poor SRH. Results: Boys born outside Europe had an odds ratio (OR) 2.1 (1.6–2.8) of poor SRH in the unadjusted model, which was reduced to 0.7 (0.4–1.3) in the multiple model, as compared to boys born in Sweden with both or one parent born in Sweden. Boys born in Europe had an OR 0.4 (0.2–0.9) of poor SRH, after multiple adjustments. Girls born in Sweden with both parents born abroad, and girls born outside of Europe had significantly lower ORs of poor SRH in the multiple model. In particular, adjustment for socio-demographic and psychosocial factors reduced the ORs of poor SRH among boys, but did so to a lesser extent among girls. Conclusions: Differences in socio-demographic and psychosocial factors explained the higher odds of poor SRH among boys born outside of Europe. Girls born in Sweden with both parents born abroad, and girls born outside Europe, had significantly lower ORs of poor SRH. Our results indicate that there are gender differences in the factors behind poor self-rated health, according to the country-related background of adolescents in Sweden. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: Carotid intima-media thickness (IMT) is a measure of arterial thickening and a risk predictor for myocardial infarction and stroke. It is unclear whether IMT also predicts atrial fibrillation (AF). We explored the association between IMT and incidence of first AF hospitalization in a population-based cohort. Methods: IMT was measured in 4846 subjects from the general population (aged 46–68 years, 60% women) without a history of AF, heart failure or myocardial infarction. The Swedish in-patient register was used for retrieval of AF cases. IMT was studied in relation to incidence of AF. Results: During a mean follow-up of 15.3 years, 353 subjects (181 men, 172 women, 4.8 per 1000 person-years) were hospitalized with a diagnosis of AF. After adjustment for cardiovascular risk factors, the hazard ratio (HR) for incidence of AF was 1.61 (95% confidence interval (CI): 1.14–2.27) for 4th vs. 1st quartile of IMT in the common carotid artery. This relationship was also independent of occurrence of carotid plaque. The results were similar for IMT in the bifurcation. Conclusion: Carotid IMT was independently associated with incidence of hospitalized AF in this study of middle-aged subjects from the general population. The results suggest that arterial thickening can predict future AF. [Copyright &y& Elsevier]

Abstract: Investigations of mental health in a life course perspective are scarce. The aim is to investigate associations between economic stress in childhood and adulthood, and poor psychological health in adulthood with reference to the accumulation, critical period and social mobility hypotheses in life course epidemiology. The 2008 public health survey in Skåne is a cross-sectional postal questionnaire study. A random sample was invited which yielded 28,198 respondents aged 18–80 (55% participation). Psychological health was assessed with the GHQ12 instrument. Logistic regression models were used to investigate the associations adjusting for age, country of birth, socioeconomic status, emotional support, instrumental support and trust, and stratifying by sex. The accumulation hypothesis was confirmed because combined childhood and adulthood exposures to economic stress were associated with poor psychological health in a graded manner. The social mobility hypothesis was also confirmed. The critical period hypothesis was not confirmed because both childhood and adulthood economic stress remained significantly associated with poor psychological health in adulthood. Economic stress in childhood is associated with mental health in adulthood. [Copyright &y& Elsevier]

Background In Sweden mental ill-health has increased among the young, especially among young women. Our aim was to investigate the association between experience of physical violence during the past year and self rated psychological health among young men and women. Methods The study population consisted of men (n = 2,624) and women (n = 3,569) aged 18-34 years who participated in the 2008 public health survey study in Skåne. The survey was a cross-sectional stratified random sample postal questionnaire study with a 54.1% participation rate. Associations were investigated by logistic regression models. Results The prevalence of poor psychological health was 18.9% among men and 27.7% among women. One in ten men and one in twenty women had experienced physical violence during the past year. Most men were violated in public places, while women were most often violated at home. Women who had experienced violence during the past year showed more than doubled odds of poor psychological health, odds ratio (OR): 2.66 (95% confidence interval (CI): 2.00, 3.53). Such an association could not be seen in men OR: 1.12 (95% CI: 0.85, 1.47). Adjustment for covariates (i.e. age, country of birth, socioeconomic status, economic stress, alcohol risk consumption, emotional support, instrumental support and generalized trust in other people) did not change the association found among women. Conclusion Violated women, but not men, showed nearly doubled odds of poor psychological health after multiple adjustments. There was also a gender difference regarding location of violence. Awareness of gender differences regarding context and mental impact of violence may assist public health workers in reducing the consequences of violence and to design preventive strategies. [ABSTRACT FROM AUTHOR]

Aims To investigate the associations between economic stress in childhood and adulthood and tobacco smoking, with reference to the accumulation, critical period and social mobility hypotheses from life-course epidemiology. Design, settingparticipants and measurements The 2008 public health survey in Skåne, Sweden is a cross-sectional postal questionnaire study based on a random sample which yielded 28 198 participants aged 18-80 years (55% participation). Logistic regression models were used to investigate associations between economic stress in childhood and adulthood and tobacco smoking. Findings A 17.4% prevalence of men and 19.1% of women reported tobacco smoking. Tobacco smoking was more prevalent among middle-aged men and young women, among those born outside Sweden, with low occupational status, low social support, low trust, economic stress in childhood and adulthood. The accumulation hypothesis was confirmed because combined childhood and adulthood exposures to economic stress were associated ( P < 0.001) with tobacco smoking in a graded manner. The critical period hypothesis was not supported because the associations between economic stress in childhood as well as adulthood, respectively, and tobacco smoking were significant ( P = 0.004 and P < 0.001) throughout the analyses. The social mobility hypothesis was confirmed because upward social mobility was associated significantly ( P < 0.001) with lower odds of smoking, while downward social mobility was associated significantly ( P < 0.001) with higher odds of smoking. Conclusions Downward social mobility and economic stress in both childhood and adulthood should be considered as risk factors for tobacco smoking over the life-course. [ABSTRACT FROM AUTHOR]

Objective: To study the association between sexual orientation and self-rated health, including trust, offence, threat of violence, and violence. Design/setting/participants/measurement: The 2008 Public Health Survey in Skåne is a cross-sectional postal questionnaire study. A total of 28,198 persons aged 18–80 years responded (55%). Logistic regressions analysed the association between sexual orientation and self-rated health. Results: 27.4% of all men and 30.0% of all women rated their health as poor. Poor self-rated health was significantly more prevalent in higher age, among immigrants, people with lower education, low social support, low trust, experience of being offended, experience of threat of violence and violence, and bisexual and other orientation. Homosexual and bisexual men and women had higher age-adjusted odds ratios of having felt offended compared to heterosexual respondents. The odds ratios of low trust, threat of violence (men), and experience of violence (women) were significant for respondents with bisexual orientation but not for respondents with homosexual orientation. In the age-adjusted model, no significant association was observed between homosexual orientation and poor self-rated health among women. All other associations between sexual orientation and health were significant in the age-adjusted model but non-significant in the multiple models. Conclusions: Associations between sexual orientation and health disappear after multiple adjustments including trust and experience of offence, threat of violence, and violence. The study suggests that the group with bisexual orientation seems to be more exposed to low social capital (trust), threat of violence, and violence than the group with homosexual orientation. [ABSTRACT FROM PUBLISHER]

Objective: The objective was to investigate the association between experience of violation during the past 3 months and self-rated health, taking trust (social capital), economic stress, and country of birth and parents’ country of birth into account. Design/setting/participants/measurements: The 2008 public health survey in Skåne is a cross-sectional study with 55% response rate. A random sample was approached using a postal questionnaire, and 28,198 persons aged 18–80 responded. Logistic regression models investigated associations between experience of violation during the past 3 months and self-rated health. Results: A 27.4% proportion of the men and 30.0% of the women reported less than good health. Less than good health was significantly higher in older age groups, among persons born outside Sweden, with low education, economic stress, low trust in other people, and experience of violation during the past 3 months. The group with experience of violation at one occasion during the past 3 months had odds ratio 1.76 (95% CI 1.57–1.97) of less than good health among men and odds ratio 1.78 (95% CI 1.62–1.96) among women, while the group with experience of violation two or more times during the past 3 months had odds ratio 4.28 (95% CI 3.36–5.44) among men and 3.54 (95% CI 2.89–4.35) among women in the final multiple analyses. Conclusions: Experience of violation during the past 3 months is significantly associated with less than good health, which is a finding with important policy implications. [ABSTRACT FROM PUBLISHER]

Aims: To investigate the association between socioeconomic status, unemployment and self-rated psychological health, taking economic stress and horizontal trust into account. Design/setting/participants/measurements: The 2008 public health survey in Skåne is a cross-sectional postal questionnaire study with a 55% participation rate. A random sample was invited and 28,198 persons aged 18–80 participated. Logistic regression models were used to investigate associations between socioeconomic status by occupation (SES), labour market connection and self-rated psychological health (GHQ12). The multiple regression analyses included age, country of birth, education, economic stress and generalized (horizontal) trust. Results: 13.8% of the men and 18.2% of the women had poor psychological health. Poor psychological health was more common among the young, among those born abroad, among those with lower education, with economic stress, and low horizontal trust. There were no significant differences between the employed and self-employed groups. However, the people who had retired early, the unemployed and those on long-term sick leave had significantly higher odds ratios of poor psychological health than higher non-manual employees throughout the analyses. Conclusions: There were no differences in psychological health between non-manual employees in higher positions and other employed and self-employed SES groups among men or women. In contrast, the early retired, the unemployed and the category on long-term sick leave had significantly higher odds ratios of poor psychological health among both men and women throughout the multiple analyses. Both economic stress and trust affected this association (i.e., lowered the odds ratios of poor psychological health), but affected by economic stress to a somewhat higher extent. [ABSTRACT FROM PUBLISHER]

Background: Research in recent decades increasingly indicates the importance of conditions in early life for health in adulthood. Only few studies have investigated socioeconomic conditions in both childhood and adulthood in relation to health testing the risk accumulation, critical period, and social mobility hypotheses within the same setting. This study investigates the associations between economic stress in childhood and adulthood, and self-rated health with reference to the accumulation, critical period and social mobility hypotheses in life course epidemiology, taking demographic, social support, trust and lifestyle factors into account. Methods: The public health survey in Skåne (southern Sweden) in 2008 is a cross-sectional postal questionnaire study based on a random sample, in which 28,198 persons aged 18-80 years participated (55% participation). Logistic regression models were used to investigate associations between economic stress in childhood and adulthood, and self-rated health. Results: Three life-course socioeconomic models concerning the association between economic stress and self-rated health (SRH) were investigated. The results showed a graded association between the combined effect of childhood and adulthood economic stress and poor SRH in accordance with the accumulation hypothesis. Furthermore, upward social mobility showed a protecting effect and downward mobility increased odds ratios of poor SRH in accordance with the social mobility hypothesis. High/severe economic stress exposures in both stages of life were independently associated with poor SRH in adulthood. Furthermore, stratifying the study population into six age groups showed similar odds ratios of poor SRH regarding economic stress exposure in childhood and adulthood in all age groups among both men and women. Conclusions: The accumulation and social mobility hypotheses were confirmed. The critical period model was confirmed in the sense that both economic stress in childhood and adulthood had independent effects on poor SRH. However, it was not confirmed in the sense that a particular window in time (in childhood or adulthood) had a specifically high impact on self-rated health. [ABSTRACT FROM AUTHOR]

Background: Rising rates of obesity and overweight is an increasing public health problem all over the world. Recent research has shown the importance of early life factors in the development of child overweight. However, to the best of our knowledge there are no studies investigating the potential synergistic effect of early life factors and presence of parental overweight on the development of child overweight. Methods: The study was population-based and cross-sectional. The study population consisted of children who visited the Child Health Care (CHC) centers in Malmö for their 4-year health check during 2003-2008 and whose parents answered a self-administered questionnaire (n = 9009 children). Results: The results showed that having overweight/obese parents was strongly associated with the child being overweight or obese. Furthermore, there was an association between unfavorable early life factors (i.e., mother smoking during pregnancy, presence of secondhand tobacco smoke early in life, high birth weight) and the development of child overweight/obesity at four years of age, while breastfeeding seemed to have a protective role. For example, maternal smoking during pregnancy was associated with an odds ratio (OR) of 1.47 (95% CI: 1.22, 1.76) for overweight and 2.31 (95% CI: 1.68, 3.17) for obesity. The results further showed synergistic effects between parental overweight and exposure to unfavourable early life factors in the development of child overweight. Conclusions: The present study shows the importance of early life factors in the development of child overweight and obesity, and thus puts focus on the importance of early targeted interventions. [ABSTRACT FROM AUTHOR]

Abstract: This longitudinal study investigates the impact of social participation, trust and the combinations of social participation and trust on the incidence of first time acute myocardial infarction (AMI) in the population of Scania, southern Sweden. It is based on the cross-sectional 2000 public-health survey in Scania with a 59% participation rate and 13,604 participants, and prospective morbidity/mortality data collected for three years (January 2000–December 2002). The study cohort was followed prospectively to examine first ever AMI. Hazard rate ratios (HRR) for first time AMI in the social participation, trust and social participation/trust combinations were calculated in a Cox regression model with adjustments for age, sex, education, economic stress, daily smoking, leisure time physical activity, body mass index (BMI), and self-reported health. The prevalence of low social participation was 32.8% among men and 31.5% among women. The prevalence of low trust was 40.0% among men and 44.2% among women. The three-year first time AMI rate was significantly higher among people with higher age, low education, daily smoking, poor self-reported health (among men), low social participation, and the combinations of low social participation/high trust and low social participation/low trust. The results show that low social participation but not trust was significantly associated with first time AMI after adjustment for age and sex. The positive association between low social participation and myocardial infarction remained significant after further adjustments for education, economic stress, daily smoking, physical activity and BMI, and became not significant only after additional adjustment for self-reported health, HRR 1.3 (0.9–2.0). High trust in combination with low social participation as well as low social capital (low trust/low social participation) were significantly associated with AMI, but after multiple adjustments only the low social participation/high trust category remained significant, HRR 1.6 (1.0–2.6). [Copyright &y& Elsevier]

Aims: To investigate subjective health complaints (SHCs) (psychological and somatic, respectively) among disabled and non-disabled adolescents, focusing on the impact of traditional bullying and cyber harassment, and furthermore to report psychological and somatic SHCs across different types of disability. Methods: Data from the public health survey of children and adolescents in Scania, Sweden, 2012 was used. A questionnaire was answered anonymously in school by 9791 students in the 9th grade (response rate 83%), and 7533 of these with valid answers on key questions were included in this study. Associations with daily SHCs were investigated by multi-adjusted logistic regression analyses. Results: Any disability was reported by 24.1% of boys and 22.0% of girls. Disabled students were more exposed to cyber harassment (boys: 20.0%; girls: 28.2%) than non-disabled peers (boys: 11.8%; girls: 18.1%). Exposure to traditional bullying showed the same pattern but with a lower prevalence. Disabled students had around doubled odds of both daily psychological SHCs and daily somatic SHCs in the fully adjusted models. In general, the odds increased with exposure to cyber harassment or traditional bullying and the highest odds were seen among disabled students exposed to both cyber harassment and traditional bullying. Students with ADHD/ADD had the highest odds of daily psychological SHCs as well as exposure to traditional bullying across six disability types. Conclusions: Disabled adolescents report poorer health and are more exposed to both traditional bullying and cyber harassment. This public health issue needs more attention in schools and in society in general. [ABSTRACT FROM AUTHOR]

Epidemiological evidence indicates a protective effect of light to moderate alcohol consumption compared to non-drinking and heavy drinking. Although several mechanisms have been suggested, the effect of alcohol on atherosclerotic changes in vessel walls is unclear. Therefore, we explored the relationship between alcohol consumption and common carotid intima media thickness, a marker of early atherosclerosis in the general population.~Aims~Unassigned~Individual participant data from eight cohorts, involving 37,494 individuals from the USE-IMT collaboration were used. Multilevel age and sex adjusted linear regression models were applied to estimate mean differences in common carotid intima-media thickness (CIMT) with alcohol consumption.~Methods~Unassigned~The mean age was 57.9 years (SD 8.6) and the mean CIMT was 0.75 mm (SD 0.177). About, 40.5% reported no alcohol consumed, and among those who drank, mean consumption was 13.3 g per day (SD 16.4). Those consuming no alcohol or a very small amount (<5 g per day) had significantly lower common CIMT values than those consuming >10 g per day, after adjusting for a range of confounding factors.~Results~Unassigned~In this large CIMT consortium, we did not find evidence to support a protective effect of alcohol on CIMT.~Conclusion~Unassigned [ABSTRACT FROM AUTHOR]

Objective The purpose of the study was to investigate the long-term associations between smoking habits, environmental tobacco smoke exposure (ETS), carotid intima–media thickness (IMT) progression rate, and rate of lumen diameter reduction in the carotid artery during a 16-year follow-up. Another objective was to investigate if an effect of smoking on progression rate could be explained by increased low grade inflammation. Methods The study population included 2992 middle-aged men and women in the 1991–1994 (baseline) and the 2007–2012 (re-examination) investigation of the Malmö Diet and Cancer Study cardiovascular cohort. Associations between smoking, progression of carotid IMT and lumen diameter reduction due to plaque protrusion were assessed by linear regression. Results IMT progression rates and rate of lumen diameter reduction increased from never smokers with no ETS through former, moderate and heavy smokers, even after adjustment for traditional risk factors (e.g., differences in yearly progression rates (mm/year) of maximal IMT in the carotid bifurcation compared to never smokers; former smokers 0.0074 (95% CI: 0.0018–0.0129), moderate smokers 0.0106 (95% CI: 0.0038–0.0175), and heavy smokers 0.0146 (95% CI: 0.0061–0.0230)). Former smokers showed distinct lowering of progression rates after more than five years since smoking cessation. Smoking and former smoking was associated with increased low grade inflammation, however, the effect of smoking on atherosclerotic progression rate remained fairly unchanged after such adjustment. Conclusion The effect of smoking and former smoking on carotid IMT progression rates and change in lumen reduction due to plaque protrusion could not be explained by differences in traditional risk factors or low grade inflammation. [ABSTRACT FROM AUTHOR]

Background: In Sweden mental ill-health has increased among the young, especially among young women. Our aim was to investigate the association between experience of physical violence during the past year and self rated psychological health among young men and women.Methods: The study population consisted of men (n = 2,624) and women (n = 3,569) aged 18-34 years who participated in the 2008 public health survey study in Skåne. The survey was a cross-sectional stratified random sample postal questionnaire study with a 54.1% participation rate. Associations were investigated by logistic regression models.Results: The prevalence of poor psychological health was 18.9% among men and 27.7% among women. One in ten men and one in twenty women had experienced physical violence during the past year. Most men were violated in public places, while women were most often violated at home. Women who had experienced violence during the past year showed more than doubled odds of poor psychological health, odds ratio (OR): 2.66 (95% confidence interval (CI): 2.00, 3.53). Such an association could not be seen in men OR: 1.12 (95% CI: 0.85, 1.47). Adjustment for covariates (i.e. age, country of birth, socioeconomic status, economic stress, alcohol risk consumption, emotional support, instrumental support and generalized trust in other people) did not change the association found among women.Conclusion: Violated women, but not men, showed nearly doubled odds of poor psychological health after multiple adjustments. There was also a gender difference regarding location of violence. Awareness of gender differences regarding context and mental impact of violence may assist public health workers in reducing the consequences of violence and to design preventive strategies. [ABSTRACT FROM AUTHOR]

Background Studies have suggested poorer health in the homosexual and bisexual groups compared to heterosexuals. Tobacco smoking, which is a health-related behavior associated with psychosocial stress, may be one explanation behind such health differences. Social capital, i.e. the generalized trust in other people and social participation/social networks which decreases the costs of social interaction, has been suggested to affect health through psychosocial pathways and through norms connected with health related behaviours, The aim of this study is to investigate the association between sexual orientation and daily tobacco smoking, taking social capital into account and analyzing the attenuation of the logit after the introduction of social participation, trust and their combination in the models. Methods In 2008 a cross-sectional public health survey was conducted in southern Sweden with a postal questionnaire with 28,198 participants aged 18-80 (55% participation rate). This study was restricted to 24,348 participants without internally missing values on all included variables. Associations between sexual orientation and tobacco smoking were analyzed with logistic regression analysis. Results Overall, 11.9% of the men and 14.8% of the women were daily tobacco smokers. Higher and almost unaltered odds ratios of daily smoking compared to heterosexuals were observed for bisexual men and women, and for homosexual men throughout the analyses. The odds ratios of daily smoking among homosexual women were not significant. Only for the "other" sexual orientation group the odds ratios of daily smoking were reduced to not significant levels among both men and women, with a corresponding 54% attenuation of the logit in the "other" group among men and 31.5% among women after the inclusion of social participation and trust. In addition, only the "other" sexual orientation group had higher odds ratios of low participation than heterosexuals. Conclusions Bisexual men and women and homosexual men, but not homosexual women, are daily smokers to a higher extent than heterosexuals. Only for the "other" sexual orientation group the odds ratios of daily smoking were reduced to not significant levels after adjustments for covariates including trust and social participation. [ABSTRACT FROM AUTHOR]

Background: Few studies investigate predictors of intentional self-injury over time in non-clinical samples. By using longitudinal data from the whole population of the county of Scania, Sweden, aged 18 years and over (N = 936 449), we aim to identify risk factors for non-fatal diagnosed intentional self-injury. Groups at risk of repeat episodes of self-injury will be identified. Methods: Information on hospital stays and outpatient specialized care visits registered as intentional self-injury was collected from the Region Skåne Healthcare database in 2007. These injuries were studied in relation to sociodemographic factors, previous disease, substance abuse and psychotropic drug treatment at baseline. Results: There were increased odds of diagnosed intentional self-injury during follow-up in association with being single, of young or middle age, having low income and being born in the Nordic countries. Presence of neurological or psychiatric disease, substance abuse and previous assault-related injury were also strongly associated with future intentional self-injury. The use of psychotropic drugs showed a clear dose–response relationship with intentional self-injury during follow-up. Those diagnosed with self-injury in the 3-year period before baseline had more than 10 times increased odds of a new episode of intentional self-injury. The odds of repeated episodes of self-injury among subjects born in Europe, but outside Sweden, were less than half those seen for subjects born in Sweden. Conclusions: The present study, based on a total general population, expands the knowledge base regarding intentional self-injury in adults, repeat behaviour and its associations with sociodemographic variables, substance use and disease in both men and women. [ABSTRACT FROM AUTHOR]

Background: The past decade has seen a vast increase in empirical research investigating associations between social capital and health outcomes. Literature reviews reveal 'generalized trust' and 'social participation' to be the most robust of the commonly used social capital proxies, both showing positive association with health outcomes. However, this association could be confounded by unmeasured factors, such as the shared environment. Currently, there is a distinct lack of social capital research that takes into account such residual confounding. Methods: Using data from the United Kingdom's British Household Panel Survey (BHPS) (waves thirteen to eighteen, N = 6982), this longitudinal, multilevel study investigates the validity of the association between trust, social participation and self-rated health using a family-based design. As the BHPS samples on entire households, we employed 'mean' and 'difference from the mean' aggregate measures of social capital, the latter of which is considered a social capital measurement that is not biased by the shared environment of the household. We employed Generalized Estimating Equations for all analyses, our two-level model controlling for correlation at the household level. Results: Results show that after adjusting for the shared environment of the household over a six year period, the association between social participation and self-rated health was fully attenuated (OR = 0.97 (95% confidence interval 0.89-1.06)), while the association with trust remained significant (OR = 1.11 (1.02-1.20)). Other health determinants, such as being a smoker, having no formal qualifications and being unemployed maintain their associations with poor self-rated health. Conclusions: The association between social capital (specifically trust and social participation) and self-rated health appear to be confounded by shared environmental factors not previously considered by researchers. However, the association with trust remains, adding to existing empirical evidence that generalized trust may be an independentpredictor of health. [ABSTRACT FROM AUTHOR]

Background: Rising rates of obesity and overweight is an increasing public health problem all over the world. Recent research has shown the importance of early life factors in the development of child overweight. However, to the best of our knowledge there are no studies investigating the potential synergistic effect of early life factors and presence of parental overweight on the development of child overweight.Methods: The study was population-based and cross-sectional. The study population consisted of children who visited the Child Health Care (CHC) centers in Malmö for their 4-year health check during 2003-2008 and whose parents answered a self-administered questionnaire (n = 9009 children).Results: The results showed that having overweight/obese parents was strongly associated with the child being overweight or obese. Furthermore, there was an association between unfavorable early life factors (i.e., mother smoking during pregnancy, presence of secondhand tobacco smoke early in life, high birth weight) and the development of child overweight/obesity at four years of age, while breastfeeding seemed to have a protective role. For example, maternal smoking during pregnancy was associated with an odds ratio (OR) of 1.47 (95% CI: 1.22, 1.76) for overweight and 2.31 (95% CI: 1.68, 3.17) for obesity. The results further showed synergistic effects between parental overweight and exposure to unfavourable early life factors in the development of child overweight.Conclusions: The present study shows the importance of early life factors in the development of child overweight and obesity, and thus puts focus on the importance of early targeted interventions. [ABSTRACT FROM AUTHOR]

Background: Injuries are second to cardiovascular diseases, the main cause of hospital care in Sweden. The aim of the present study was to investigate the associations between medication with psychotropic drugs and injuries from two types of accidents, i.e. falling accidents and transportation accidents, respectively, in the whole population aged ≥18 years in the county of Scania, Sweden. Methods: Injuries from falling accidents and transportation accidents during 2007 were identified from the Region Healthcare database. Exposure to psychotropic medication expressed as defined daily doses (DDDs) during the 18 months before baseline, i.e. 1 January 2007, was identified from the Swedish Medication Register. The results were stratified by sex and three age groups, i.e. 18–34 years, 35–64 years and ≥65. The logistic regression models were adjusted for marital status, country of origin, income, previous disease and previous accidents. Results: Using psychotropic drugs was associated with increased odds for a falling accident in all age groups, however, with a dose–response relationship only among the elderly. Furthermore, using psychotropic drugs was associated with increased odds of transportation accidents in the ages 18–34 years and 35–64 years, respectively, but with a weaker association among the elderly. A similar pattern of association was seen for specific groups of psychotropic drugs: opioids, anti-depressants and anxiolytics/hypnotics/sedatives. Conclusions: In this total population-based study, there were nearly consistent associations between use of psychotropic drugs and injuries from falling accidents and transportation accidents, even after adjustment for previous accidents, previous disease and socio-demographic variables. [ABSTRACT FROM PUBLISHER]

Objectives: To investigate gender differences in daily smoking prevalence in different age groups in southern Sweden. Methods: The 2004 public-health survey in Skåne is a cross-sectional study. A total of 27,757 persons aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the associations between gender and daily smoking according to age. The multivariate analysis was performed to investigate the importance of possible confounders (country of origin, education, snus use, alcohol consumption, leisure-time physical activity, and BMI) on the gender differences in daily smoking in different age groups. Results: 14.9% of the men and 18.1% of the women were daily smokers. Middle-aged respondents were daily smokers to a significantly higher extent than young and old respondents. The prevalence of daily smoking also varied according to other demographic, socioeconomic, health related behaviour, and BMI characteristics. The crude odds ratios of daily smoking were 1.79 (1.42-2.26) among women compared to men in the 18-24 years age group, and 0.95 (0.80-1.12) in the 65-80 years age group. These odds ratios changed to 2.00 (1.49-2.67) and 0.95 (0.76-1.18), respectively, when all confounders were included. Conclusions: For the first time in Sweden women have a higher prevalence of daily smoking than men. The odds ratios of daily smoking are highest among women compared to men in the youngest age group of 18-24 years and the odds ratios decrease with increasing age. The findings point to a serious public health problem. Strategic interventions targeting young women's tobacco smoking are needed. [ABSTRACT FROM AUTHOR]