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Aims: To investigate the association of six-year cumulative level of socioeconomic neighbourhood disadvantage and population density with subsequent adherence to dietary recommendations, controlling for preceding dietary adherence, in adults in Finland. Methods: Population-based Health and Social Support (HeSSup) study participants from four age groups (20–24, 30–34, 40–44 and 50–54 years at baseline in 1998). Data on diet and alcohol consumption were obtained from the 2003 and 2012 surveys and information on neighbourhoods from Statistics Finland Grid database (n = 10,414 men and women). Participants diet was measured as adherence to Nordic Nutrition recommendation (score range 0–100). Neighbourhood disadvantage was measured by median household income, proportion of those with primary education only and unemployment rate, and population density by the number of adult population between years 2007 and 2012. Linear models were used to assess the associations of neighbourhood characteristics with the score for adherence to dietary recommendations in 2012. Results: Cumulative neighbourhood socioeconomic disadvantage was associated with slightly weaker (1.49 (95% confidence interval (CI) −1.89 to −1.09) point decrease in dietary score) adherence while higher population density was associated with better (0.70 (95% CI 0.38−1.01) point increase in dietary score) adherence to dietary recommendations. These associations remained after controlling for prior dietary habits, sociodemographic, chronic cardio-metabolic diseases, and severe life events. Conclusions: These longitudinal findings support the hypothesis that neighbourhood characteristics affect dietary habits. CC BY 4.0Academy of Finland 321409NordForsk Article first published online: November 25, 2020

Aims: To examine the development of self-assessed and parent proxy-assessed health related quality of life (HRQL) in pre-adolescent schoolchildren. Methods: The population (n = 1,346) consisted of the total cohort of children starting 4th grade (age 10) in 2004 in primary schools in a Finnish city of 175,000 inhabitants. HRQL was assessed using the Pediatric Quality of Life InventoryTM 4.0 (PedsQL TM 4.0). The baseline study was conducted in 2004 (child age 10) and follow-up in a panel setting in 2006 (child age 12). The response rate for the children was 80% (n = 1,094) in 2004 and 85% (n = 1,139) in 2006. The response rate for children having responded both in 2004 and 2006 was 73% (n = 986). For parents of the children, one parent participated in the parents’ survey (n = 999 in 2004, n = 888 in 2006). Results: HRQL scores increased significantly in the two-year follow up (child t = 10.16—5.95, p < 0.0001, parent-proxy t = 6.35—2.76, p < 0.0001—0.006). Correlation between baseline and follow-up assessments was significant (child r = 0.4—0.5, p < 0.0001, parent r = 0.47—0.57, p < 0.0001). The correlation between baseline HRQL and change was negative (child r =−0.67 to −0.56, p < 0.0001, parent r =−0.62 to −0.46, p < 0.0001). Correlation between child and parent assessments increased from baseline (r = 0.20—0.39, p < 0.0001) to follow up (r = 0.3—0.42, p < 0.0001). Conclusions: Child-assessed and parent proxy-assessed HRQL scores increase, suggesting HRQL improves, when children grow from age 10 to age 12. Baseline HRQL may not strongly predict future HRQL in early adolescence. The correlation between child self-assessment and parent proxy-assessment is fragile.

Aims: The purpose of this paper is to contribute to understanding which factors influence health promotion action in primary health care (PHC) on the municipal, i.e. local, level. Methods: A cross-sectional mail survey of all PHC personnel in four municipalities in Finland in 2002. The data were analysed by descriptive statistics, and univariate and multivariate logistic regression analyses. Results: A total of 417 (response rate 57%) healthcare professionals participated in the study; 65% of the personnel working in ambulatory care, 52% working in home care and 44% working in inpatient care were engaged in health promotion action (=higher than median engagement). Factors independently associated with engagement in health promotion were organizational values, reflected in perceived skill discretion and social support from coworkers, and the personnel's competence, reflected in knowledge about the health and living conditions of the population served. Further, the opportunities, reflected in cooperation with partners outside the organization were strongly associated with engagement in health promotion action. Conclusions: The results suggest that working conditions such as possibilities for skill usage, reflection and development as well as collegial support enable higher engagement in health promotion action in PHC. However, access to data on the local population's health and living conditions, in addition to opportunities to cooperate with decision makers and partners in the community turned out to be as important. This should be taken into consideration when striving to reorient health services to health promotion.

Aims: To compare primary healthcare (PHC) provided by an independent not-for-profit organization (INPO) with that provided by two public municipal organizations (MO1 and MO2), in terms of clients' perceptions of performance, acceptance, and trust. Methods: A survey using a pre-tested questionnaire to all clients visiting a health centre (HC) doctor or nurse during one week in 2000 (n=511, 51% response rate) and 2002 (n=275, 47%). The data were analysed by descriptive statistics and cumulative logistic regression analysis. Results: The INPO differed from both publicly provided services in accessibility, consistency of service, and outcomes. Clients reported lower trust in HC provided by public organizations compared with the INPO. Trust was higher if clients also reported experiencing ``very good'' or ``moderate'' organizational access — or if general satisfaction was ``very high'' or ``moderate'' or if they experienced outcomes as ``very good'' or ``moderate'' compared with the ``very poor or low'' situation. Women reported lower trust in HC than men. When the family doctor was included in the same logistic regression model with the service provider, only the family doctor was a significant explanatory variable. Reported acceptance of private alternative service providers among clients was similar between the study organizations. Conclusions: Clients of the INPO generally rated the service more positively than clients of publicly provided services. The results indicate that trust in HC depends more on a family doctor system than a service provider.

Background: Poor perceived health during childhood may affect an individual's well-being throughout life. In adult studies, sense of coherence (SOC) has been shown to be associated with perceived health. Aims: The aim of this study was to determine which factors with an emphasis on SOC and physical exercise were associated with perceived health among 12-year-old children. Methods: A total of 1,231 12-year-old school children (83%) completed a questionnaire. Most of the 37 questions had multiple-choice types of response. The questions were largely based on those used in the Health Behaviour in School-aged Children (HBSC) study coordinated by the WHO. SOC was determined using the 13-item scale developed by Antonovsky. Factors used in calculating performance at school were marks (given by the teachers, range 4—10, 10 being the best) in mathematics, native language, and first foreign language. Statistical analysis involved the use of logistic regression models and the so-called generalized estimation technique because of the multi-level study design. Results: In a multivariate model adjusted for reported psychosomatic symptoms, insufficient physical exercise was clearly (OR 4.6) associated with poor perceived health. Other variables with significant associations (OR 1.4—1.7) were a mark below 9 in mathematics, belonging to the weakest SOC tertile, reporting of problems of perceived support from teachers, and reporting of various problems involving the class climate. Conclusions: Among the studied variables physical exercise was the most strongly associated with perceived health, even when several social and psychological risk factors were included in the analysis. SOC and variables of social support were also of importance.

Aims: The aim of the study was to examine the use of physician services and the willingness to choose an health centre (HC) doctor rather than an alternative (i.e. private, occupational healthcare, other doctor) by the working age population in four municipalities in Finland. In a Southern municipality primary health care was contracted out to a non-profit organization whereas Eastern, Western and South-Western municipalities mainly provided services themselves. Methods: A mail survey of a random sample of the 15—64-age population was conducted in 2002 (n = 2,000, response rate 62%). Data were analyzed using descriptive statistics as well as bi- and multivariate logistic regression analyses. Results: Of the respondents, 69% had visited an HC doctor during the past year, and of these, more than 40% had also visited another doctor outside the HC. The willingness to choose an HC doctor varied from 40% to 54% and was highest in the Southern municipality. When significantly associated variables — age, working status, perceived stress in life situation, access to an appointment, perceived interpersonal quality, and visits to doctors — were controlled for, the willingness to choose an HC doctor was, compared with the Southern municipality, less popular only in the Western municipality. Conclusions: The tendency to choose an HC doctor rather than an alternative was quite low, probably reflecting lack of attractiveness of HC to patients. However, contracting out service production did not additionally decrease patients’ willingness to choose an HC doctor. More attention should be paid to improving access, interpersonal quality and continuity of care.

Aim: To investigate whether the development of job involvement of primary healthcare (PHC) employees in Southern Municipality (SM), where PHC services were outsourced to an independent non-profit organisation, differed from that in the three comparison municipalities (M1, M2, M3) with municipal service providers. Also, the associations of job involvement with factors describing the psychosocial work environment were investigated. Methods: A panel mail survey 2000—02 in Finland (n=369, response rates 73% and 60%). The data were analysed by descriptive statistics and multivariate linear regression analysis. Results: Despite the favourable development in the psychosocial work environment, job involvement decreased most in SM, which faced the biggest organisational changes. Job involvement decreased also in M3, where the psychosocial work environment deteriorated most. Job involvement in 2002 was best predicted by high baseline level of interactional justice and work control, positive change in interactional justice, and higher age. Also other factors, such as organisational stability, seemed to play a role; after controlling for the effect of the psychosocial work characteristics, job involvement was higher in M3 than in SM. Conclusion: Outsourcing of PHC services may decrease job involvement at least during the first years. A particular service provision model is better than the others only if it is superior in providing a favourable and stable psychosocial work environment.

Background: Despite similar living conditions among the Finnish-speaking majority and the Swedish-speaking minority in Finland, the latter is a more advantaged group e.g. in terms of socioeconomic status and health. This study investigated (1) the level of sense of coherence (SOC), (2) the structure of generalized resistance resources (GRRs), and (3) associations of GRRs with SOC among Finnish- and Swedish-speaking Finns. Methods: The data derived from the Health and Social Support (HeSSup) Study. The sample comprised 22,937 Finnish men and women aged 20—54, including an additional sample from the Swedish-speaking population (n=2,967). The response rate was 40%. Ordinary regression analysis was used. Results: Swedish-speaking women scored 0.9 (p=0.005) and men 0.6 (p=0.05) points higher on SOC scale compared with Finnish-speaking respondents. The minor difference in the SOC level between the language groups was explained by Finnish speakers' worse psychosocial living conditions in childhood and working conditions in adulthood. Only one interaction was found: parents' divorce during childhood was associated with a significant decrease of SOC scores only for Finnish speakers. Otherwise the same GRRs had similar effects on both Finnish- and Swedish-speaking men's and women's SOC. Conclusion: The only key difference between Finnish- and Swedish-speaking Finns concerned the unequal distribution of GRRs. An increase in GRRs among Finnish speakers would probably strengthen their SOC. However, the slightly stronger level of SOC among Swedish-speaking compared with Finnish-speaking Finns is unlikely to explain the possible differences in well-being between the two language groups.