Does job strain mediate the effect of socioeconomic group on smoking behaviour? The impact of different health policies in Denmark and Sweden.

AIMS: The aim was to compare the impact of socioeconomic groups (SEG) on the risk of being a daily smoker or quitter, and to investigate whether the potentially mediating effect of psychosocial working conditions was similar in the Danish and the Swedish populations. METHODS: The study populations consisted of 10,049 employed participants, aged 18-64 years, 51% women, randomly selected from the general populations in the Oresund region, 1999-2000. Odds ratios (OR) for daily-smokers and "non-quitters'' were computed for two age-groups and two SEGs in gender specific models, stratified by country. The association between SEG, current smoking, quitting, and influence at work, job demand and jobstrain, respectively, was tested by means of logistic regression. RESULTS: The contextual determinants defined by country had a different effect on smoking prevalence among men and women and among age groups. Low influence and job strain seemed to have an effect on smoking among Danish women, but not among Swedish women. The OR of being a daily smoker were higher in men than women among younger Danes, but higher in women than men among Swedes. The prevalence of low influence, high demand and job strain was higher and more socially skewed among the Swedes, but did not mediate the effect of SEG on smoking behaviour. CONCLUSIONS: The smoking prevalence was lower and the quit-rates higher among Swedes than Danes. Both countries had social differences in smoking that in absolute terms were rather similar, but in relative terms were higher in Sweden. The mediating effect of psychosocial working conditions was lacking. The determinants of smoking behaviours must be found somewhere else in the social and cultural context.

The effect of non-response on estimates of health care utilisation: linking health surveys and registers.

BACKGROUND: Non-response in health surveys may lead to bias in estimates of health care utilisation. The magnitude, direction and composition of the bias are usually not well known. When data from health surveys are merged with data from registers at the individual level, analyses can reveal non-response bias. Our aim was to estimate the composition, direction and magnitude of non-response bias in the estimation of health care costs in two types of health interview surveys. METHODS: The surveys were (1) a national personal interview survey of 22 484 Danes (2) a telephone interview survey of 5000 Danes living in Funen County. Data were linked with register information on health care utilisation in hospitals and primary care. Health care utilisation was estimated for respondents and non-respondents, and the difference was explained by a decomposition method of bias components. RESULTS: The surveys produced the same pattern of non-response, but with slight differences in non-response bias. Response rates for the interview and telephone surveys were 75 and 69%, respectively. Refusal was the most frequent reason for non-response (22 and 20% of those sampled, respectively), whereas illness, non-contact, and other reasons were less frequent. Respondents used 3-6% less health care than non-respondents at the aggregate level, but the opposite was true for some specific types of health care. Non-response due to illness was the main contributor to non-response bias. CONCLUSIONS: Different types of non-response have different bias effects. However, the magnitude of the bias encourages the continued use of interview health surveys.

Higher smoking prevalence in urban compared to non-urban areas: time trends in six European countries.

We investigated differences in smoking prevalence between urban and non-urban area of residence in six Western European countries (Sweden, Finland, Denmark, Germany, Italy and Spain), and smoking prevalence trends over the period 1985-2000. In most countries, smoking prevalence was highest in urban areas, and increased with urbanization. Urban/non-urban inequalities were most pronounced among individuals with low education levels, and also among females. There were no significant differences in annual rate of change in smoking prevalence between non-urban and urban areas.

Influence of lifestyle, health, and work environment on smoking cessation among Danish nurses followed over 6 years.

BACKGROUND: The purpose of this study was to examine the influence of lifestyle, health, and work environment on smoking cessation among Danish nurses age 45-66 years over a 6-year period from 1993-1999. METHODS: Data derive from the Danish Nurse Cohort Study; a prospective cohort established in 1993 when all Danish female nurses 45+ years old and members of the Danish Nurses Association were mailed a questionnaire. The cohort was followed up 6 years later in 1999. In total, 12,980 responded to questions concerning smoking status in both the 1993 and 1999 surveys. This study deals with the 4713 women (36%) who reported smoking at baseline. Smoking cessation was based on self-report. RESULTS: At follow-up in 1999, 24% reported that they no longer smoked. Low prior tobacco consumption at baseline, high fresh fruit consumption, high blood pressure, working day shifts, having low physical job strain, perceiving influence on one's own work, and partner's socio-economic status (as measured by most recent occupation) were associated with successful smoking cessation. CONCLUSION: The findings from this study highlight the importance of various factors, including lifestyle, health status, and aspects of one's work environment, on successful efforts at smoking cessation.

Use of complementary and alternative medicine in the Scandinavian countries.

OBJECTIVE: To describe the prevalence of use of complementary and alternative medicine (CAM) in Norway, Denmark and Stockholm County. DESIGN, SETTING, AND SUBJECTS: In Norway, a national representative sample of 1000 participants completed telephone interviews regarding their CAM use in 1997 (response rate 51). In Denmark, a national representative sample of 16 690 participants completed questionnaires and interviews regarding their health and morbidity in 2000 (response rate 74). In Stockholm County, a randomly selected sample of 1001 participants completed telephone interviews about their CAM use in 2000 (response rate 63). RESULTS: Prevalence of ever-use of CAM was 34% in Norway, 45% in Denmark, and 49% in Stockholm. Use of CAM is associated with poor self-reported health in all three studies, and with visits to a medical doctor in Denmark and Norway. More women than men, and more with higher education, reported use of CAM. Most frequently used CAM therapy was homeopathy in Norway, reflexology in Denmark, and massage in Stockholm County. CONCLUSIONS: Use of CAM is common in the Scandinavian countries, and there are national differences regarding therapy preferences. Many individuals use both CAM and conventional health services.

The validity of self-reported fractures among Danish female nurses: comparison with fractures registered in the Danish National Hospital Register.

BACKGROUND: The authors compared self-reported non-spine fractures obtained from a cohort of Danish female nurses with fracture diagnoses registered in the Danish National Hospital Register (DNHR). METHOD: The self-reported fracture history was obtained from a questionnaire and was related to fracture information registered with the DNHR by means of the unique person identification code of Danish citizens. A total of 166 self-reported hip fractures, 391 self-reported wrist fractures, and 121 self-reported upper arm fractures were available for the comparison. The self-reported fractures were initially compared with the anatomic specific fracture diagnoses registered in the DNHR. Second, the comparison also included fracture diagnoses of adjacent skeletal sites (unspecific fracture diagnoses). RESULTS: The positive predictive value of a positive report of hip fracture was 89%. Inclusion of unspecific registered hip fractures increased the positive predictive value to 94%. The same figures for wrist fractures were 75% and 84%, respectively, and for upper arm fractures 54% and 83%, respectively. The predictive value of a negative report of hip fracture was 99.5%. The fracture year was correctly reported in 76% of the hip fracture cases, 81% of the wrist fracture cases, and 82% of the upper arm fracture cases. Predictors of false-positive report of fractures were young age ( < 60 years), report of indoor falls in the previous year, and use of hormone replacement therapy (HRT). CONCLUSION: The authors conclude that self-report of hip, wrist, or upper arm fractures among Danish nurses is relatively accurate but varies by the site of fracture. False positive reports of fracture introduce only modest bias fracture risk estimates and tend to dilute the association between exposures and fracture.