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AIMS: Adverse social factors predict increased mortality. This study aimed to assess the influence of social class and marital status on mortality, adding an adult life course perspective. METHODS: In total, 32,907 males and 20,204 females were evaluated based on census data in Malmo, Sweden. Of these subjects, 22,444 males and 10,902 females also took part in health screening. The main outcomes were all-cause and cause-specific mortality rates in subgroups based on social class and marital status, either measured once or repeatedly in adult life. Results were based on a total of 522,807 years of follow-up in men (5,761 deaths) and 239,815 in women (1,354 deaths). RESULTS: Total and cardiovascular mortality were significantly higher in manual male employees with age-adjusted risk ratios (RR) of 1.7 (95% CI 1.5-1.9) and 1.6 (1.3-2.0) in skilled manual workers, and 2.0 (1.7-2.2) and 1.9 (1.6-2.3) in unskilled manual workers, compared with high-level non-manual employees. The differences remained after adjustment for baseline risk factors and prevalent cardiovascular disease, and were similar for women. Increased mortality risk was also documented for subjects who were divorced or unmarried (adjusted for social class), as well as being downward socially mobile or in a permanent low social class (manual) position. CONCLUSIONS: Social class based on occupation, either measured once or repeatedly in adult life, is associated with marked differences in mortality risk in middle-aged subjects. People who remain married/cohabiting or remarry are at lower risk of early death than people who remain unmarried or divorced. [ABSTRACT FROM AUTHOR]

AIMS: This cohort study on urban middle-aged men investigates the association between the use of analgesics and hypnotics, self-rated health (SRH) and disability pension. METHODS: Five birth-year cohorts of middle-aged, urban, Swedish men were invited to a screening programme and were followed for approximately 11 years. RESULTS: Out of all the subjects (n = 5798), 12.4% received a disability pension during follow-up, 27.0% rated their health as less than perfect, 10.6% used analgesics and 2.9% used hypnotics. Compared with non-users of analgesics and hypnotics, the adjusted hazard ratio of disability pension for the simultaneous use of both drugs was 7.0 (95% CI: 4.3, 11.6) and the adjusted odds ratio of poor SRH was 16.5 (6.3, 43.5). Thus, the use of analgesics and hypnotics was positively related to poor SRH and predicted award of a disability pension within an 11-year follow-up. This may reflect that the use of analgesics and hypnotics is a proxy of disease but an independent negative effect on health cannot be excluded. CONCLUSIONS: Information on the use of these drugs could be used to predict the award of a disability pension, such as in different geographical areas or population groups. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Insufficient coping with stress may lead to increased susceptibility for disease and death. Use of anxiolytic-hypnotic drugs has been suggested as a coping strategy, and some opinions have proposed their use as preventive medication. The aim of this study was to estimate if use of anxiolytic-hypnotic drugs counters the increased mortality observed in individuals lacking other coping strategies such as emotional support and social participation. METHODS: A population based cohort study with 10-year (1982/83-1993) survival analysis was performed in 491 men born in 1914, living in the Swedish city of Malmö. RESULTS: Compared with men with a high level of psychosocial coping resources who did not use anxiolytic-hypnotic drugs, men with a low level of psychosocial coping resources had a higher risk of death irrespective whether they used anxiolytic-hypnotic drugs, RR = 1.7 (95% CI 1.1-2.6) or not RR = 1.8 (95%: 1.3-2.5). CONCLUSION: Anxiolytic-hypnotic drugs do not seem to counter increased mortality in elderly men with low psychosocial coping resources. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of this study was to investigate whether psychosocial resources explain socioeconomic differences in smoking cessation and its maintenance. METHODS: A subpopulation of 11,837 individuals from the Malmo Diet and Cancer Study interviewed in 1992-94, age range 45-64 years, was investigated in this cross-sectional study. A multivariate logistic regression model was used to assess relative risks of having stopped smoking, adjusting for age, country of origin, previous/current diseases, and marital status. RESULTS: An odds ratio of 1.9 (1.4-2.5; 95% CI) for men and 2.0 (1.4-2.7; 95% CI) for women of having stopped smoking was found for higher non-manual employees when compared with unskilled manual workers. A decrease in these odds ratios was found when social participation was introduced into the model. The other three social network and social support variables were non-significant. CONCLUSION: High social participation is a predictor of maintenance of smoking cessation. It seems possible to interpret parts of the socioeconomic differences in smoking cessation and its maintenance as a consequence of differing social network resources and social capital between socioeconomic groups. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine aspects of validity of a short self-report inventory, based on physical and psychological symptoms that, according to other studies, are most prevalent in women. It was hypothesized that such symptoms form a single entity, which would be consistent with the view that they represent a proxy for general distress in women. Method: One hundred and one women were approached, all of whom filled in the 'common symptoms in the general population of women' (CSGP) instrument and the multidimensional self-report inventory Symptom Check List 90 (SCL90) for external comparison. The results indicate that the CSGP scale has high internal consistency ([alpha] = 0.80). The strongest correlations were found between the CSGP scale and the SCL90 subscales assessing 'somatization', 'depression' and 'anxiety'. In the factor analysis, the items on the CSGP scale were widely dispersed among the factors represented by the main SCL90 subscales, and therefore could not be considered to represent any particular subscale. Our conclusion is that the CSGP scale seems to assess a single entity. Other researchers suggest that such an entity represent a proxy for general distress in women. This will have implications for the interpretation of the common symptoms represented by the scale, which women report in clinical settings. [ABSTRACT FROM AUTHOR]

Twenty-five in-depth interviews were made with middle-aged persons of both sexes, who had suffered a first myocardial infarction (MI) two months previously. The purpose was to assess the layman's understanding of concepts such as social network, social support and control which are exposures commonly used or suggested for use in quantitative research in the area of social epidemiology. The validity of the instruments and the underlying concepts in assessing such exposures has important implications for the interpretation of the association between psychosocial factors and health or health behavior.The layman's understanding of social network and social support concepts seemed unproblematic, but the concept of control was understood in rather disparate ways among those interviewed. The experience of control/decision latitude in the work environment, seemed to form a model for the overall understanding of control among several of those interviewed and there also seemed to be important differences based on gender. Another impression, was that the individual's level of aspiration might be an important confounder in the assessment of control in population studies. It is therefore suggested that epidemiologcal data should be stratifyed by basic demographic variables like age, sex and social class in analyses including the control variable, to improve the valid use of this type of measure. [ABSTRACT FROM PUBLISHER]