Does the socioeconomic positioned neighbourhood matter? Norwegian adolescents’ perceptions of barriers and facilitators for physical activity

Background and aims: A higher proportion of adolescents from lower socioeconomic position families tend to be less physically active than their counterparts from higher socioeconomic position families. More research is needed to understand the causes of these differences, particularly the influence of the neighbourhood environment. This qualitative study aims to explore how adolescents and their parents from higher and lower socioeconomic neighbourhoods perceive the social, organisational and physical environment influencing adolescents’ physical activity behaviours. Method: We conducted six semi-structured focus groups with 35 13–14-year-olds and eight interviews with some of their parents. The interviewees were recruited from one higher and two lower socioeconomic neighbourhoods in Oslo, Norway. Theme-based coding was used for analysis, and the results discussed in light of an ecological framework. Results: The results indicate that factors like social norms in a neighbourhood could shape adolescents’ physical activity behaviour, and a social norm of an active lifestyle seemed to be an essential facilitator in the higher socioeconomic neighbourhood. Higher availability of physical activity and high parental engagement seemed to facilitate higher physical activity in this neighbourhood. In the lower socioeconomic neighbourhoods, the availability of local organised physical activity and volunteer engagement from parents varied. Programmes from the municipality and volunteer organisations seemed to influence and be essential for adolescents’ physical activity behaviour in these neighbourhoods. Conclusions: The results illustrate the complexity of behaviour and environment interaction, and a limitation in explaining the phenomenon by focusing primarily on the individual level rather than an ecological perspective.

A decade of socioeconomic inequality in type 2 diabetes area-level prevalence: an unshakeable status quo?

Aims: It is well known that there is a socioeconomic gradient in the prevalence of many chronic diseases, including type 2 diabetes (T2DM). We present a simple assessment of the macro-level association between area socioeconomic disadvantage and the area-level prevalence of T2DM in Danish municipalities and the development in this relationship over the last decade. Methods: We used readily available public data on the socioeconomic composition of municipalities and T2DM prevalence to illustrate this association and report the absolute and relative summary measures of socioeconomic inequality over the time period 2008–2018. Results: The results show a persistent relationship between municipality socioeconomic disadvantage and T2DM prevalence across all analyses, with a modelled gap in T2DM prevalence between the most and least disadvantaged municipalities, the slope index of inequality, of 1.23 [0.97;1.49] in 2018. Conclusions: These results may be used to indicate areas with specific needs, to encourage systematic monitoring of socioeconomic gradients in health, and to provide a descriptive backdrop for a discussion of how to tackle these socioeconomic and geographic inequalities, which seem to persist even in the context of the comprehensive welfare systems in Scandinavia.

Psychosocial job conditions and biomarkers of cardiovascular disease: A cross-sectional study in the Swedish CArdioPulmonary bioImage Study (SCAPIS)

Aims: The aim of this study was to investigate associations between psychosocial work exposure and the presence of biological and imaging biomarkers of cardiovascular disease. Methods: This cross-sectional study was conducted in a sub-cohort of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Psychosocial exposure was evaluated with the job demand–control model, and analysed according to the standard categorization: high strain, active, passive and low strain (reference). Biomarkers (blood pressure, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, coronary artery calcification (CAC) and metabolic syndrome) were measured, or derived through measurements, from clinical examinations. Gender-specific prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated with regression models and adjusted for age, education, smoking, physical activity, general life stress and body mass index (BMI). Results: The analyses included 3882 participants (52.5% women). High strain (high demands–low control) was linked to increased PR for low HDL cholesterol in women, adjusted for all covariates (PR 1.76; 95% CI 1.25–2.48). High strain was also related to moderately increased PR for metabolic syndrome in men, after adjustments for all covariates except BMI (PR 1.25; 95% CI 1.02–1.52). In addition, passive work (low demands–low control) was associated with diastolic hypertension in women (fully adjusted: PR 1.29; 95% CI 1.05–1.59). All relationships between psychosocial factors and LDL cholesterol or CAC (both genders), or hypertension (men), were non-significant. Conclusions: Poor psychosocial job conditions was associated with the presence of low HDL cholesterol and diastolic hypertension in women, and metabolic syndrome in men. These findings contribute to the knowledge of potential pathways between stressful work and coronary heart disease.

Hazardous alcohol consumption and problem drinking in Norwegian and Russian women and men: The Tromsø Study 2015–2016 and the Know Your Heart study 2015–2018

Aim: Harmful use of alcohol is a worldwide public health concern. Cultural differences may affect responses to questions on alcohol problems, making international comparisons difficult. We aimed to compare self-reported alcohol consumption and problem drinking between Norwegian and Russian populations. Methods: We used data from women and men aged 40–69 years participating in the Tromsø Study seventh survey (Tromsø7, N=17646, participation 65%), Tromsø (2015–2016), Norway, and the Know Your Heart study (KYH, N=4099, participation 51%), Arkhangelsk and Novosibirsk (2015–2018), Russia. Alcohol consumption and problem drinking were measured by the Alcohol Use Disorders Identification Test (AUDIT) via questionnaires (Tromsø7) and interviews (KYH). We compared AUDIT scores and components between populations, by sex. Results: Non-drinking was more commonly reported in KYH compared with Tromsø7 (men 15.5% versus 4.9%, women 13.3% versus 7.3%). In men, hazardous consumption (41.4% versus 31.5%) and problem drinking (24.8% versus 19.6%) was higher in KYH compared with Tromsø7, but opposite for women (6.5% versus 12.0%, and 2.3% versus 5.8%). KYH men were less likely to report problem drinking behaviours than Tromsø7 men, with the exception of needing a drink first thing in the morning (13.2% versus 2.4%). KYH women consistently reported less consumption and problem drinking than Tromsø7 women. Conclusions: We found between-study differences in hazardous drinking, but in men these were lower than suggested by differences in country-level statistics on alcohol consumption and alcohol-related health-harms. Study sample selection, stronger social desirability bias effects in the Russian samples, and cultural differences in responding could have affected the results.

Factors associated with initiation and use of snus among adolescents

Aim: We investigated factors associated with the initiation and continuation of snus use in adolescents in Norway. The associations with adolescents’ own educational plans, the parents’ educational level(s) and tobacco habits were estimated. Methods: In this cross-sectional questionnaire-based study, 1465 patients aged 18–20 years participated. The questionnaire was administered at regular dental examinations in the public dental health service. To assess the association between individual factors and the initiation of tobacco habits, a generalised structural equation model with random effects at the clinic level was used. Binary responses were modelled using multilevel binary logistic regression, while the number of snus boxes used per month was modelled using a multilevel Poisson regression model. Results: Of current (daily and occasional) tobacco users, 85% were snus users, including dual users of both snus and cigarettes. The median age of snus initiation was 16 years. Both parental snus use and smoking were associated with an increased risk of snus initiation, snus use and a higher amount of use. An increased risk of using snus was associated with male gender and with no educational plans or planning for further vocational education. The amount of snus used was higher among current snus users with a prior smoking history and among those planning for further vocational education. Conclusions: These findings may aid in developing and targeting tobacco prevention strategies aimed at young people. Tobacco prevention measures should start at the elementary school level. The strong association with parental tobacco habits underlines the importance of parents’ influence on their children’s tobacco use.

Increasing inequalities in disability-free life expectancy among older adults in Sweden 2002–2014

Background: In an aging society with increasing old age life expectancy, it has become increasingly important to monitor the health development in the population. This paper combines information on mortality and disability and explores educational inequalities in disability-free life expectancy in the aging population in Sweden, and to what extent these inequalities have increased or decreased over time. Methods: A random sample of the Swedish population aged 77 years and above ( n=2895) provided information about disability in the population in the years 2002, 2004, 2011 and 2014. The prevalence of disability was assessed by five items of personal activities of daily living and incorporated in period life tables for the corresponding years, using the Sullivan method. The analyses were stratified by sex and educational attainment. Estimates at ages 77 and 85 years are presented. Results: Disability-free life expectancy at age 77 years increased more than total life expectancy for all except men with lower education. Women with higher education had a 2.7-year increase and women with lower education a 1.6-year increase. The corresponding numbers for men were 2.0 and 0.8 years. The educational gap in disability-free life expectancy increased by 1.2 years at age 77 years for both men and women. Conclusions: While most of the increase in life expectancy was years free from disability, men with lower education had an increase of years with disability. The educational differences prevailed and increased over the period as the gains in disability-free life expectancy were smaller among those with lower education.

Nationwide data on home care and care home residence: presentation of the Swedish Social Service Register, its content and coverage

Aims: All Swedish municipalities are legally obliged to provide publicly funded elder care to individuals in need. The Swedish Social Service Register collects data on such care. It is the only nationwide source of information on care home residency and use of home care but has rarely been used for research. This study aims to present the content and coverage of the Social Service Register and to provide guidance for researchers planning to use these data. Methods: For each month between 2013 and 2020, we examined which of Sweden’s 290 municipalities reported data to the Social Service Register. We calculated proportions of the population (restricted to ages 80–89 years to enable comparison) that were reported to the Social Service Register in each municipality and presented the types and amount of care recorded in the register. Results: The proportion of municipalities reporting to the Social Service Register increased from 82% to 98% during the study period but several municipalities reported fragmentarily and inconsistently, particularly during earlier years. Among municipalities reporting to the Social Service Register, 9% of the population aged 80–89 years resided in care homes and 19% received home care, but the registered amount and types of care varied substantially between municipalities and over time. Conclusions: The Swedish Social Service Register provides valuable data for research on aging and elder care utilisation, but data should be selected and vetted carefully, especially for earlier years. The amount and types of care may not always be comparable between geographical regions and different time periods. In recent years, however, the coverage of the Social Service Register is good.

Life-course socioeconomic circumstances in acute, chronic and disabling pain among young employees: a double suffering

Background: Pain is known to be socioeconomically patterned and associated with disability. However, knowledge is scarce concerning life-course socioeconomic circumstances and pain among young adults. Our aim was to examine the associations of childhood and current socioeconomic circumstances with acute pain and chronic pain with low and high disability levels among young Finnish municipal employees. Methods: We analysed questionnaire data retrieved from the Young Helsinki Health Study ( n=4683) covering 18–39-year-old employees of the City of Helsinki, Finland. We included multiple indicators of childhood and current socioeconomic circumstances and examined their associations with acute pain and with chronic pain with low and high disability levels. The level of chronic pain-related disability was assessed by the chronic pain grade questionnaire. Multinomial logistic regression analyses were conducted with stepwise adjustments for sociodemographic, socioeconomic and health-related covariates. Results: Childhood and current socioeconomic disadvantage were associated with acute and chronic pain, particularly with chronic pain with high disability level. The strongest associations after adjustments for covariates remained between chronic pain with high disability level and low educational level (odds ratio (OR) 3.38, 95% confidence interval (CI) 2.18–5.24), manual occupation (OR 3.75, 95% CI 1.92–7.34) and experiencing frequent economic difficulties (OR 3.07, 95% CI 2.00–4.70). Conclusions: Pain is a common complaint that contributes to disability among young employees, particularly the most socioeconomically vulnerable. There is a socioeconomic gradient in both pain chronicity and the level of chronic pain-related disability. Life-course socioeconomic factors should be considered in pain-preventing strategies and in clinical practice.

Changes in mortality trends amongst common diseases during the COVID-19 pandemic in Sweden

Objective: It has been found that COVID-19 increases deaths within common diseases in countries that have implemented strict lockdowns. In order to elucidate the proper national response to a pandemic, the mortality rates within COVID-19 and various diseases need to be studied in countries whose pandemic response differ. Sweden represents a country with lax pandemic restrictions, and we aimed to study the effects of COVID-19 on historical mortality rates within common diseases during 2020. Methods: Regression models and moving averages were used to predict expected premature mortality per the ICD-10 during 2020 using historical data sets. Predicted values were then compared to recorded premature mortality to identify changes in mortality trends. Results: Seasonal increased mortality was found within neurological diseases. Infectious diseases, tumours and cardiac disease mortality rates decreased compared to expected outcome. Conclusions: Changes in mortality trends were observed for several common diseases during the COVID-19 pandemic. Neurological and cardiac conditions, infections and tumours are examples of diseases that were heavily affected by the pandemic. The indirect effects of COVID-19 on certain patient populations should be considered when determining pandemic impact.

Influenza risk groups in Norway by education and employment status

Aims: This study aimed to estimate the size of the risk group for severe influenza and to describe the social patterning of the influenza risk group in Norway, defined as everyone ⩾65 years of age and individuals of any age with certain chronic conditions (medical risk group). Methods: Study data came from a nationally representative survey among 10,923 individuals aged 16–79 years. The medical risk group was defined as individuals reporting one or more relevant chronic conditions. The associations between educational attainment, employment status, age and risk of belonging to the medical risk group were studied with logistic regression. Results: Nearly a fifth (19.0%) of respondents reported at least one chronic condition, while 29.4% belonged to the influenza risk group due to either age or chronic conditions. Being older, having a low educational level (comparing compulsory education to higher education, odds ratio (OR)=1.4, 95% confidence interval (CI) 1.2–1.8 among women, and OR=1.3, 95% CI 1.1–1.7 among men) and a weaker connection to working life (comparing disability pension to working full-time, OR=6.8, 95% CI 5.3–8.7 among women, and OR=6.5, 95% CI 4.9–8.5 among men) was associated with a higher risk of belonging to the medical risk group for severe influenza. Conclusions: This study indicates that the prevalence of medical risk factors for severe influenza is disproportionally distributed across the socio-economic spectrum in Norway. These results should influence both public funding decisions regarding influenza vaccination and communication strategies towards the public and health professionals.