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Background: An increasing amount of research indicates that positive psychological factors, such as optimism, might be beneficial for cardiovascular health. However, most studies have focused on cardiovascular events. The present study aimed to investigate associations between optimism and subclinical outcomes related to cardiovascular health., Methods: This cross-sectional study used data from SCAPIS Malmö, Sweden, including 6251 randomly selected men and women from the Malmö municipality area, aged 50 to 64 years. Optimism was assessed via the LOT-R questionnaire, but also by using the two subscales of LOT-R, assessing optimism and pessimism separately. Arterial health was assessed as the coronary artery calcium score, ankle-brachial index, and aortic augmentation index. Cardiovascular risk was estimated using the SCORE instrument. Adjustments were made for sociodemographic factors, depression, and cardiovascular risk factors., Results: Those who were most optimistic had lower odds of coronary artery calcification, with an odds ratio of 0.74 (95% confidence interval 0.58, 0.93), compared to those who were least optimistic. Also, higher levels of optimism were associated with a general pattern of lower aortic augmentation index, and with higher ankle-brachial index on both left and right side. For coronary artery calcification associations seemed to be mediated primarily through an absence of pessimism. The associations were reduced after adjustments, but persisted for measures of arterial function., Conclusions: The results indicate that optimism might be health protective with regard to arterial function, but with regard to coronary artery calcification it was rather the absence of pessimism that was of importance., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

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.

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.

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.

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.

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.

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.

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.

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., (© 2014 the Nordic Societies of Public Health.)

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.

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.

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.

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.

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 (OR(adjusted) = 0.19; 95% CI 0.14-0.27) and women (OR(adjusted) = 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.

Objectives: To investigate gender differences in daily smoking prevalence in different age groups in southern Sweden., Methods: The 2004 public-health survey in Skane 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.