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Introduction As smoking prevalence has decreased, there has been debate about “hardening” (smokers are more resistant to established tobacco control measures) or “softening” (smokers are more responsive to interventions) of the remaining smoking population. Despite growing evidence to reject the “hardening” hypothesis, there is lack of long-term population-based studies to test this hypothesis by educational level. Aims and Methods Repeated cross-sectional population-based surveys during 1978–2014 and in 2018 were utilized. The target population consisted of ~5000 25–64-year-old Finns annually. The data included 109 257 respondents of which 53 351 ever-smoking individuals were included in the analyses. Response rates varied between 84% and 43%. Five hardening indicators considering smoking frequency, intensity and smoking cessation were used as the dependent variables. The main independent variable was study year (time). Statistical analyses were based on regression models using restricted cubic splines by educational level. Results Contrary to the hardening hypothesis, hardening indicators showed softening over time among all educational groups. However, educational groups differed from each other. Compared with the highly educated, the quit ratio was lower, number of cigarettes per day (CPD) was higher, the proportions of daily smokers among current smokers and heavy smokers among daily smokers were higher among the less educated. Conclusions In accordance with growing evidence, also the Finnish smoking population has “softened” over time. Although the change has been predominantly in the same direction for all educational groups, the rate of change has been stronger among the highly educated, highlighting the continued burden of smoking among the less educated. Implications Even though “softening” of smoking has occurred, lighter smoking also poses health risks. Therefore, tobacco control policies and cessation services should be developed and targeted to a greater extent also for people who smoke less than daily and for those who smoke fewer CPD. Furthermore, interventions should focus on special requirements of the lower educational groups to promote health equity.

Objective To estimate the effects of excess body mass and leisure time physical activity on the incidence and persistence of chronic pain. Design A prospective cohort study. Methods As a part of the Finnish Helsinki Health Study, we included three cohorts of employees of the City of Helsinki (18,562 observations) and defined incident chronic pain as having pain in any part of the body for more than three months at follow-up in participants without chronic pain at baseline (N = 13,029 observations). Persistent chronic pain was defined as having pain for more than three months at both baseline and follow-up (N = 5,533 observations). Results Overweight (adjusted odds ratio [OR] = 1.18, 95% confidence interval [CI] = 1.06–1.31) and obesity (OR = 1.65, 95% CI = 1.45–1.88) increased the incidence of chronic pain. Moreover, overweight (OR = 1.16, 95% CI = 1.02–1.32) and obesity (OR = 1.48, 95% CI = 1.26–1.74) increased the risk of persistent chronic pain. Vigorous leisure time physical activity reduced the incidence of chronic pain (OR = 0.85, 95% CI = 0.75–0.96). Physical activity did not influence the risk of persistent chronic pain. Furthermore, overweight/obesity modified the effect of leisure time physical activity on incident chronic pain. Inactive overweight or obese participants were at the highest risk of chronic pain (OR = 1.71, 95% CI = 1.40–2.09), while the OR dropped to 1.44 (95% CI = 1.19–1.75) in moderately active overweight or obese participants and to 1.20 (95% CI = 0.97–1.47) in highly active overweight or obese participants. Conclusions Obesity not only increases the risk of developing chronic pain, but also increases the risk of persistent pain, while leisure time physical activity reduces the risk of developing chronic pain.

Background In January 2018, the legal limit for alcoholic beverages in grocery stores changed from 4.7 to 5.5 % alcohol. The increased availability of stronger beer, cider and ready-to-drink beverages was expected to increase the total amount of 100% alcohol bought. The study aimed to examine how the change in alcohol legislation affected the purchasing of 100% alcohol from grocery stores by comparing the years 2017 and 2018. Methods The study data consisted of 47,066 loyalty card holders of Finland's largest retail chain, who gave their consent and provided background information by an online questionnaire. The data contained the type, volume and alcoholic content of the purchases, from which we calculated the amount of 100% alcohol bought. The mean individual alcohol purchases in the years 2017 and 2018 were compared by age, gender, level of education and household income using repeated measurements ANOVA models. Results There was only a small, non-significant change in the total amount of 100% alcohol between 2017 and 2018 (mean 1.9 l and 2.0 l, respectively, p = 0.220). Lower income was associated with a decrease in total 100% alcohol purchased, whereas higher income groups showed an increase. Increase in 100% alcohol bought as ready-to-drink beverages was seen in all population groups. Conclusions The availability of stronger alcoholic beverages in grocery stores did not result in a notable overall increase in total purchases of 100% alcohol. The increased purchases of alcohol as ready-to-drink beverages were, on the average, compensated for by decreased purchases of alcohol as other beverages. The association of income with total alcohol purchases may indicate the effect of price in consumer behavior. Key messages The raise in the legal limit of alcohol content raised did not result in a significant increase in the total amount of 100% alcohol bought from grocery stores. Alcohol purchased as ready-to-drink beverages increased in all population groups.

Background Mental ill-health in young adults is a major public health and work-life problem. We examined in a quasi-experimental design whether occupational psychologist appointment can reduce subsequent sickness absence due to mental disorders among young Finnish employees. Methods The present study was conducted among 18-39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We used Wald test to compare the differences in sickness absence days due to mental disorders (ICD-10, F-diagnosed) between those treated (occupational psychologist appointment for work ability support) and the non-treated (no psychologist appointment) during a one year follow-up. The full sample (n = 2156, 84% women) consisted of employees with mental disorder diagnosed sickness absence during 2009-2014. To account for the systematic differences between the treated and non-treated, the participants were matched according to their characteristics (age, sex, occupational class, education, previous sickness absence and psychotropic medication). The matched sample included 886 participants. We excluded those with treatment before the treatment screening time (± 3 months to the end of sickness absence period), non-treated with treatment during the follow-up and those that could not be matched (lack of common support). Results In the full sample, the mean of sickness absence days due to mental disorders was 17.7 (95% CI, 11.4, 24.1) days for those treated (n = 240) and 23.2 (95% CI, 20.5, 25.9) days for non-treated (n = 1916), difference being non-significant. The corresponding figures in the matched sample were (16.8, 95% CI, 9.5-24.1) for those treated (n = 195) and (27.8, 95% CI, 22.6-32.9) for non-treated (n = 691), difference being statistically significant (p = 0.02). Conclusions This quasi-experiment suggests that seeing an occupational psychologist to support work ability may be reduce mental health related sickness absence. Key messages We showed that supporting work ability at an early stage may prevent sickness absence due to mental disorders. More efforts to provide early stage support for maintaining work ability may prove useful in reducing sickness absence rates in younger employees.

Introduction Chronic pain is common among employees. Childhood adversities are known determinants of adult health but their association with chronic pain in adulthood is largely unknown. We aimed to examine the associations between childhood adversities and chronic pain among midlife employees. Methods Data on seven childhood adversities and chronic pain (pain having lasted at least 3 months) were derived from the baseline survey of the Helsinki Health Study collected in 2000 to 2002 among 40 to 60-year-old employees of the City of Helsinki in Finland. The study included 8140 employees of whom 80% were women. The analyses were made by logistic regression and the results are presented as odds ratios (OR) and their 95% confidence intervals (CI). Age, gender, father’s education, own education, marital status, working conditions, sleep problems and common mental disorders were included as covariates. Results Economic difficulties in the childhood family (OR 1.60, 95% CI 1.41-1.81), childhood illness (1.74, 1.45-2.08), parental divorce (1.26, 1.07-1.48), parental alcohol problems (1.34, 1.18-1.52) and bullying in school or among peers (1.59, 1.37-1.89) were associated with an increased odds of chronic pain in midlife. Adjusting for father’s education, own education and marital status did not contribute to the associations. Working conditions, sleep problems and common mental disorders slightly attenuated the associations between childhood adversities and chronic pain. Conclusions Childhood adversities associate to chronic pain in midlife. The results suggest that promoting well-being among children might lead to less pain decades after childhood. Key messages Childhood adversities are associated with chronic pain in adulthood. Considering well-being among children might lead to less pain decades after childhood.

Background Receipt of sickness allowance (SA), which in the Finnish benefit system functions as compensation for loss of income due to over 10-days-long sickness absence, is more prevalent in lower socioeconomic groups. As SA is an earnings-related benefit and higher occupational classes have on average higher previous income, their share of SA expenditure must be higher than their share of SA days would suggest. However, the allocation of SA costs to different socioeconomic groups is not known. The aim of this study was to compare occupational classes in terms of their shares of total paid SA days and SA benefit costs. Methods We used register data covering the total working-age (16-64) employed population of Finland at the end of 2016 (N = 2.2 million), with linked data on paid sickness allowances during 2017. Yearly accumulated sickness allowance days and allowance costs, paid by the Social Insurance Institution of Finland, were calculated for upper and lower non-manual employees, manual workers and self-employed persons. Results Of the total yearly SA days of the employed population, 13% were paid to upper non-manual employees, 40% to lower non-manual employees, 37% to manual workers and 10% to the self-employed (the respective shares of these occupational classes of the employed population were 23%, 36%, 30% and 11 %). The average gross allowance was 77€ per day among upper non-manuals and between 54€ and 60€ in the other groups. Accordingly, upper non-manuals accounted for a larger share of the SA costs compared to their share of SA days: the proportions of costs were 16%, 39%, 36% and 9% in each occupational class, respectively. Conclusions The results show that as the average amount of daily sickness allowance is distributed in an opposite manner compared to the prevalence and length of sickness allowance spells, socioeconomic differences in sickness allowance costs are smaller than differences in the prevalence of sickness allowance. Key messages Upper non-manual employees have a lower prevalence of sickness absence and shorter spells than other occupational groups. Because of higher earnings-related sickness allowance among upper non-manual employees, their share of sickness allowance costs is higher than their share of sickness allowance days.

Background We examined the developmental trajectories of multisite musculoskeletal pain to acquire the developmental patterns of musculoskeletal pain among midlife municipal employees and whether pain trajectories associate with common mental disorders or behaviors. Methods Middle-aged (44 to 67 years) municipal employees from the city of Helsinki were studied. The baseline survey was conducted in 2000-02 (N = 8960) and two follow-up surveys in 2007 (N = 7332) and 2012 (N = 6809). Repeated measurement of musculoskeletal pain in four anatomical sites was obtained. Trajectories of number of pain sites (0-4) were modeled using latent class growth analysis (n = 6527). Common mental disorders were measured using the General Health Questionnaire 12-item version (GHQ-12). Information on behavior factors, morbidity, and the socioeconomic position was obtained from the questionnaire survey. Associations of baseline factors with pain trajectories were assessed by multinomial logistic regression. Results We found four distinct trajectories of the number of pain sites: high (15%), increasing (24%), decreasing (20%) and low (41%). In multivariable multinomial regression model high, increasing and decreasing trajectories were strongly associated with higher odds with both medium and high common mental disorders. However, the magnitude of the association was much higher for high vs. low trajectory group due to medium (OR 3.70, 95% CI 2.81-4.89) and high (OR 5.37, 95% 4.36-6.61) common mental disorders. Mean score of common mental disorders was also highest for high trajectory group. High, increasing and decreasing trajectory group were also associated with poor behavior, having one or more musculoskeletal comorbidities and low socioeconomic position. Conclusions Multisite musculoskeletal pain remain persistent among midlife employees and those high trajectories of musculoskeletal pain are associated with common mental disorders, behavior, and musculoskeletal comorbidities. Key messages Four distinct trajectories of number of pain sites was identified among midlife municipal employees. High common mental disorders and poor behavior, as well as low socioeconomic position and musculoskeletal comorbidities were strongly associated with pain trajectories.

Background Health inequalities across countries and populations are well established, but little is known about their long-term trends and even less about factors shaping the trends. We examined the magnitude of absolute and relative educational inequalities in self-rated health over 36 years among adult Finns, considering individual covariates and macro-economic fluctuations. Methods Data were derived from representative annual surveys in 1979-2014 among men and women and covered ages 25-64. Nine periods were used (n = 8870-14235). Our health outcome was less-than-good self-rated health and our socioeconomic indicator was completed years of education as a continuous variable. Nine time-variant sociodemographic and health-related covariates were included. Educational inequalities in self-rated health were examined by relative index of inequality (RII) and slope index of inequality (SII). Results Linear trends suggested stable overall development in both relative and absolute health equalities during 36 years. Period specific analyses showed that among men relative and absolute inequalities narrowed immediately after economic recession in Finland in 1993-94, and among women, inequalities narrowed during global financial crisis in 2008-09. Adjusting for covariates reduced the magnitude of inequalities throughout the nine periods, but affected little the period specific patterning of health inequalities. Conclusions Educational inequalities in self-rated health persisted during 36 years in Finland. While among men and women health inequalities narrowed during and after recessions, they widened soon back to the pre-recession level. The perseverance calls for powerful measures to tackle health inequalities, such as preventing unhealthy behaviours, obesity and unemployment in particular among the lower educated. Key messages Health inequalities have persisted in Finland over 36 years, with unhealthy behaviors and unemployment affecting their magnitude. Health inequalities narrowed during economic recessions, but widened soon back to pre-recession level.

Introduction Healthy behaviours are associated with better health in general but less is known about the combined associations of multiple healthy behaviours with mortality risk. We aimed to examine the associations of combined healthy behaviours with mortality risk over a 15-year follow-up among middle-aged employees. Methods Survey data, collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, was linked with complete register data on mortality from Statistics Finland (response rate 67%, written informed consent for register linkages 74%). Healthy behaviours included high leisure-time physical activity, non-smoking, no binge drinking and healthy food habits. Each healthy behaviour were dichotomized and assigned a value of one for healthy and zero for unhealthy. The number of healthy behaviours were summed together (score range 0-4). Cox regression models were fitted, and the follow-up continued until the end of 2015 (n = 6336). Confounders included age, sex, marital status, socioeconomic position and self-rated health. Results Of the respondents, 7% reported four healthy behaviours, 27% three, 34% two, 22% one and 9% no healthy behaviours. A total of 281 deaths occurred during the follow-up. Each healthy behaviour was individually associated with a reduced mortality risk, non-smoking having the strongest and healthy diet the weakest association. The combined association showed that those without any of the healthy behaviours (HR 2.8, 95% CI 1.51-5.29) and those with only one healthy behaviour (HR 1.89, 95% CI 1.04-3.43) had a higher mortality risk than those with four healthy behaviours. Instead, those with at least two healthy behaviours were not at an increased risk of mortality. Conclusions A low number of healthy behaviours predicted mortality among middle-aged employees. Efforts should be made to promote multiple healthy behaviours among the middle-aged to enhance health and prevent premature mortality. Key messages Almost one third of the respondents had no or only one healthy behaviour. A low number of healthy behaviours was associated with an increased risk of mortality.

Background Fruit and vegetable consumption (FVC) and leisure-time physical activity (LTPA) are associated with better health outcomes but less is known about their joint associations with the risk of mortality. We examined the joint associations of FVC and LTPA with premature mortality among midlife and ageing municipal employees, adjusting for key covariates. Methods Survey data collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, were linked with complete register data on mortality from Statistics Finland (4961 women, 1373 men; response rate 67%; written consent for register linkages 74%). FVC was dichotomised into daily or non-daily, and LTPA into high (>14 MET-hours/week including vigorous exercise) or low. Covariates included age, sex, marital status, socioeconomic position, binge drinking, smoking and self-rated health. Cox regression models were fitted. The follow-up continued until the event of death or the end of 2015. Results A total of 281 deaths occurred during the follow-up. The mortality rate was 7.1% in men and 3.7% in women. A gender interaction was found, showing differing associations for women and men. Men with both daily FVC and high LTPA had the lowest mortality risk (HR 0.19, 95% CI 0.06-0.63) after adjusting for covariates. Men with high LTPA and non-daily FVC also had a lower mortality risk (HR 0.51, 95% CI 0.29-0.90) compared to those with non-daily FVC and low LTPA. Women with daily FVC and high LTPA had a lower mortality risk initially, but after adjusting for covariates no statistically significant associations were observed. Conclusions The joint associations of FVC and LTPA with premature mortality differed between women and men. This could be related to gender differences in e.g. the causes of death, and further studies are needed to clarify this. Increasing FVC and LTPA might prevent premature mortality among men. Key messages Fruit and vegetable consumption jointly with physical activity decreased the risk of premature mortality among men only. Further studies are needed to clarify the gender difference which could be related to for example death causes.

Background: Smoking and physical inactivity are linked to mortality, but it is not known whether the association between smoking and mortality is affected by the amount and intensity of physical activity. We examined the joint associations of smoking and physical activity with mortality, while taking key covariates into account. Methods: We linked survey data, collected in 2000–2002 from among 40–60-year-old employees of the City of Helsinki, Finland, with complete register data on all-cause mortality from Statistics Finland ( n = 6390, 79% women, response rate 67%). Smoking, leisure-time physical activity and covariates (sociodemographic factors, problem drinking, body mass index and self-rated health) were measured at baseline. We fitted Cox regression models (hazard ratios, HR, 95% confidence intervals, CI), and the follow-up continued until the end of 2013. No gender interactions were found. Results: A total of 228 deaths occurred during the follow-up. Smokers were at an increased risk of mortality after full adjustments, but the risk was higher among inactive (HR 3.27, 95% CI 2.05–5.22) and moderately active smokers (HR 2.37, 95% CI 1.49–3.79) than among vigorously active non-smokers. The excess risk for vigorously active smokers, or for inactive or moderately active non-smokers, could not be confirmed. Conclusion : The highest mortality risk was found among physically inactive or moderately active smokers. Prevention of smoking and engaging in vigorous physical inactivity among smokers might prevent mortality during working age.

INTRODUCTION Socioeconomic differences in smoking over time and across national contexts are poorly understood. We assessed the magnitude of relative and absolute social class differences in smoking in cohorts from Britain, Finland, and Japan over 5-7 years. METHODS The British Whitehall II study (n = 4350), Finnish Helsinki Health Study (n = 6328), and Japanese Civil Servants Study (n = 1993) all included employed men and women aged 35-68 at baseline in 1997-2002. Follow-up was in 2003-2007 (mean follow-up 5.1, 6.5, and 3.6 years, respectively). Occupational social class (managers, professionals and clerical employees) was measured at baseline. Current smoking and covariates (age, marital status, body mass index, and self-rated health) were measured at baseline and follow-up. We assessed relative social class differences using the Relative Index of Inequality and absolute differences using the Slope Index of Inequality. RESULTS Social class differences in smoking were found in Britain and Finland, but not in Japan. Age-adjusted relative differences at baseline ranged from Relative Index of Inequality 3.08 (95% confidence interval 1.99-4.78) among Finnish men to 2.32 (1.24-4.32) among British women, with differences at follow-up greater by 8%-58%. Absolute differences remained stable and varied from Slope Index of Inequality 0.27 (0.15-0.40) among Finnish men to 0.10 (0.03-0.16) among British women. Further adjustment for covariates had modest effects on inequality indices. CONCLUSIONS Large social class differences in smoking persisted among British and Finnish men and women, with widening tendencies in relative differences over time. No differences could be confirmed among Japanese men or women. IMPLICATIONS Changes over time in social class differences in smoking are poorly understood across countries. Our study focused on employees from Britain, Finland and Japan, and found relative and absolute and class differences among British and Finnish men and women. Key covariates had modest effects on the differences. Relative differences tended to widen over the 4- to 7-year follow-up, whereas absolute differences remained stable. In contrast, class differences in smoking among Japanese men or women were not found. Britain and Finland are at the late stage of the smoking epidemic model, whereas Japan may not follow the same model.

The aim of this study was to examine whether changes in leisure-time physical activity are associated with subsequent common mental disorders. Follow-up survey data were collected from 40 to 60-year-old employees of the City of Helsinki, Finland, at three time points: 2000-2002 (rr 67%), 2007 (rr 83%) and 2012 (rr 79%). We excluded those with common mental disorders at phase 1 (n = 1162) and in total 4681 respondents (81% women) were available for the analyses. Compared with those persistently active, those persistently inactive had an increased risk of subsequent common mental disorders. Promoting leisure-time physical activity may prove useful for preventing common mental disorders.

Background: Obesity is associated with an increased risk of work disability, but studies concerning weight change are few. We examined the associations of weight change with subsequent sickness absence. Methods: Weight status data of 4164 (83% women) employees of the City of Helsinki were gathered from the Helsinki Health Study baseline survey in 2000–2002 and follow-up survey in 2007. Data were linked prospectively with the employer’s sickness absence registers. Employees were categorized according to their baseline Body Mass Index (normal weight, overweight, obese) as well as weight change (weight gainer, weight loser, weight maintainer) between the two surveys. The association of weight change with sickness absence spells was analysed with Poisson regression. Results: Among women, those who maintained normal weight had the lowest risk for sickness absence. Weight loss, weight gain and stable obesity increased the risk for sickness absence spells of all lengths. Adjustments for covariates attenuated the association only slightly. Among men, the achieved results were mostly not statistically significant. Conclusions: Preventing obesity and weight gain is important for employee well-being and work ability. Early support measures in occupational health care could benefit obese employees and those with weight gain to maintain work ability. The association between weight loss and sickness absence should be corroborated in further studies.

Background Mental disorders are common diagnostic causes for longer sickness absence and disability retirement in OECD-countries. Short sickness absence spells are also common, and neither trivial for health and work ability. We studied how prior short sickness absence spells and days are associated with subsequent longer sickness absence due to mental disorders in three age-groups of …

Background: Measures of socio-economic position, such as education, occupational class and income, are well-known determinants of ill-health, injury and sickness absence. The aim was to analyse socio-economic and occupational determinants of work injury absence and their contribution to overall socio-economic inequalities in all-cause sickness absence. Methods: A register-based follow-up study included municipal employees of the City of Helsinki aged 25–59 years in 2004. The number of participants was 16 471 women and 5033 men. The mean follow-up time was 3.0 years. Education, occupational class and individual income were used as measures of socio-economic position. The main outcome was medically confirmed work injury and all-cause sickness absence of ≥4 days. Inequality indices were calculated using Poisson regression analysis. Results: High education, occupational class and individual income were consistently associated with lower work injury absence among both women and men. The inequalities in work injury absence were larger than in all-cause sickness absence, especially among men, but the contribution to overall socio-economic inequalities was limited. Among women, bus drivers, cooks and hospital attendants had the highest rates of work injuries. Among men, youth mentors, firemen and janitors had the highest rates. Conclusions: Our results indicate that relative socio-economic inequalities in work injury absence are larger than in all-cause sickness absence. Prevention of work injuries provides a source of reducing socio-economic inequalities in health, but their effect is not very large. Prevention of work injuries should be targeted to lower white-collar and manual workers and vulnerable occupations.

The Helsinki Health Study cohort was set up to enable longitudinal studies on the social and work related determinants of health and well-being, making use of self-reported as well as objective register data. The target population is the staff of the City of Helsinki, Finland. Baseline data for the cohort were derived from questionnaire surveys conducted in 2000, 2001 and 2002 among employees reaching 40, 45, 50, 55 or 60 years of age in each year. The number of responders at baseline was 8960 (80% women, response rate 67%). Additional age-based health examination data were available. A follow up survey was conducted in 2007 yielding 7332 responders (response rate 83%). Measures of health include health behaviours, self-rated health, common mental disorders, functioning, pain, sleep problems, angina symptoms and major diseases. Social determinants include socio-demographics, socio-economic circumstances, working conditions, social support, and work-family interface. Further register linkages include sickness absence, hospital discharge, prescribed drugs, and retirement updated at the end of 2010. The cohort allows comparisons with the Whitehall II study, London, UK, and the Japanese Civil Servants Study from western Japan. The cohort data are available for collaborative research at Hjelt Institute, Department of Public Health, University of Helsinki, Finland.

Background: Retirement is one of the major transitions in the life course. However, it is poorly understood how health behaviours, such as food habits, might change after retirement. This study aimed to examine whether healthy food habits change after the transition to old age retirement and whether socio-demographic or health-related factors explain the association between retirement, being continuously employed and healthy food habits at follow-up. Methods: The data were derived from the Helsinki Health Study cohort on the staff of the City of Helsinki, Finland. The baseline questionnaire survey data were collected in 2000–02 and the follow-up in 2007. We included only participants who were aged 55–60 years at baseline and entered old age retirement during the follow-up ( n = 1156, 76% women) or remained continuously employed ( n = 1269, 79% women). Food habits from a food frequency questionnaire included eight items formed according to the Finnish and Nordic dietary recommendations. Logistic regression models were fitted to examine the associations between retirement, being continuously employed and healthy food habits at follow-up. Results: Healthy food habits increased more among retired women than those continuously employed ( P = 0.03). At follow-up retired women had healthier food habits than continuously employed women after adjusting for baseline food habits [OR = 1.36 (1.12–1.65)]. Among men, healthy food habits were unassociated with retirement. Conclusion: Transition to old age retirement is likely to have beneficial effects on food habits among women. This helps prevent major diseases and supports better public health among ageing people.

Among aging employees, sleep problems are prevalent, but they may have serious consequences that are poorly understood. This study examined whether sleep problems are associated with subsequent disability retirement. Baseline questionnaire survey data collected in 2000-2002 among employees of the city of Helsinki, Finland, were linked with register data on disability retirement diagnoses by the end of 2008 (n = 457) for those with written consent for such linkages (74%; N = 5,986). Sleep problems were measured by the Jenkins Sleep Questionnaire. Cox regression analysis was used to calculate hazard ratios and 95% confidence intervals for disability retirement. Gender- and age-adjusted frequent sleep problems predicted disability retirement due to all causes (hazard ratio (HR) = 3.22, 95% confidence interval (CI): 2.26, 4.60), mental disorders (HR = 9.06, 95% CI: 3.27, 25.10), and musculoskeletal disorders (HR = 3.27, 95% CI: 1.91, 5.61). Adjustments for confounders, that is, baseline sociodemographic factors, work arrangements, psychosocial working conditions, and sleep duration, had negligible effects on these associations, whereas baseline physical working conditions and health attenuated the associations. Health behaviors and obesity did not mediate the examined associations. In conclusion, sleep problems are associated with subsequent disability retirement. To prevent early exit from work, sleep problems among aging employees need to be addressed.

Background: Our purpose was to assess the direct and indirect contribution of childhood socio-economic conditions to educational differences in leisure-time physical activity among women and men. Methods: Population-based data were derived from a representative sample of Finns aged ≥30 years ( N = 7112) as part of Health 2000 Survey. Multinomial logistic regression analysis was applied. Leisure-time physical activity was divided into inactivity, moderate and high activity. Results: Childhood socio-economic conditions had both a direct and indirect effect through adulthood socio-economic conditions on educational differences in leisure-time physical activity. The direct effect of childhood socio-economic conditions on educational differences in inactivity was stronger than its indirect effects through adulthood socio-economic conditions and other health behaviours and related factors. Adulthood socio-economic conditions had a considerable indirect effect on educational differences in leisure-time physical activity through other adulthood health behaviours and related factors among men. Conclusions: In order to narrow educational differences in leisure-time physical activity, we should secure a childhood environment that enables a physically active lifestyle, support leisure-time physical activity in diverse occupational groups, guarantee equal physical activity possibilities across different educational careers and support those with insufficient material resources.

Background: Socio-economic position measures, such as education, occupational class and income, are well-known determinants of health. However, previous studies have not paid attention to mutual interrelationships between these socio-economic position measures and medically confirmed sickness absence. Methods: The study is a register-based study. The participants were municipal employees of the City of Helsinki aged 25–59 years in 2003. There were 21 599 women and 5841 men participants. Three socio-economic position measures were used, namely three-level education, four-level occupational class and gross individual income quartiles. Main outcome measure was medically confirmed sickness absence spells of 4 days or longer. Inequality indices were calculated using Poisson regression analysis. R esults: High education, occupational class and individual income were all consistently associated with lower sickness absence rates among both women and men. After mutual adjustment, education and occupational class remained independent determinants of sickness absence. The association of individual income with sickness absence was practically explained by temporally preceding education and occupational class. Conclusions: Our results indicate that education and occupational class—rather than income—are strong determinants of sickness absence. Education, occupational class and income are complementary socio-economic position measures. To better inform sickness absence policy, future studies should aim to establish whether the observed socio-economic differences reflect broader differences in ill-health, lifestyle and working conditions.

Background: To further increase our understanding of socio-economic health inequalities, we need studies considering multiple socio-economic circumstances and comparing different cultural contexts. This study compared the associations of past and present socio-economic circumstances with physical functioning between employees from Finland and Britain. Methods: Cross-sectional survey data from the Helsinki Health Study (n = 5866) and the Whitehall II Study (n = 3052) were used. Participants were white-collar public sector employees aged 45–60 years. Physical functioning was measured with the SF-36 physical component summary. The socio-economic indicators were parental and own education, childhood and current economic difficulties, occupational class, income, housing tenure. Results: Childhood and current economic difficulties were independently associated with physical functioning in both cohorts, although in London women childhood difficulties did not reach statistical significance. Own education was independently associated with physical functioning in Helsinki. Occupational class showed associations with physical functioning in both cohorts. These were mainly attenuated by education and income, but in London women there was a strong independent association. The association of income with physical functioning was attenuated by education (Helsinki) and occupational class (London). Parental education and housing tenure showed no consistent associations. Conclusions: Past and present economic difficulties were independently associated with physical functioning. The conventional socio-economic indicators showed less consistent associations which were partly mediated through other indicators and modified by the national context. The associations that varied according to the indicators and between the cohorts highlight the importance of considering the multiplicity of socio-economic circumstances and comparing different cultural contexts in further studies.

Background: Health behaviours are potential explanatory factors for socioeconomic differences in mortality. We examined the extent to which seven health behaviours covering dietary habits, smoking and physical avtivity, can account for relative differences in cardiovascular and all-cause mortality by educational level. Methods: Health behaviour data derived from nationwide Finnish health behaviour surveys from the years 1979 to 2001. These annually repeated cross-sectional surveys were linked to register-based information on educational level and subsequent mortality from the year of the survey until the end of 2001 (average follow-up time 11.9 years). The analyses included 29 065 men and 31 543 women of whom 4263 died. Cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all-cause mortality was studied. Results: Educational level showed a graded association with all mortality outcomes. Health behaviours explained 54% of the relative difference between primary and higher educational level in CVD mortality among in men and 22% among in women. For all-cause mortality the corresponding figures were 45 and 38%. Smoking, vegetable use and physical activity were the most important health behaviours explaining educational level differences in all mortality outcomes, while the effects of type of fat used on bread, coffee drinking, relative weight and alcohol use were small. Conclusions: Smoking, low vegetable use and physical inactivity explained a substantial part of educational level differences in cardiovascular and all-cause mortality among men and women. Socioeconomic trends in these behaviours are of crucial importance in determining whether socioeconomic mortality differences will widen or narrow in the future.

Background The workforce is ageing rapidly in post-industrial societies. This highlights the importance of understanding factors contributing to physical functioning among ageing employees. The aim of this study was to examine the effect of changes in physical and psychosocial working conditions on physical health functioning among ageing municipal employees. Methods Follow-up survey data were collected from midlife employees of the City …