Anna Månsdotter

Parental share in public and domestic spheres: a population study on gender equality, death, and sickness

Study objective: Examine the relation between aspects of gender equality and population health based on the premise that sex differences in health are mainly caused by the gender system. Setting/participants: All Swedish couples (98 240 people) who had their first child together in 1978. Design: The exposure of gender equality is shown by the parents’ division of income and occupational position (public sphere), and parental leave and temporary child care (domestic sphere). People were classified by these indicators during 1978–1980 into different categories; those on an equal footing with their partner and those who were traditionally or untraditionally unequal. Health is measured by the outcomes of death during 1981–2001 and sickness absence during 1986–2000. Data are obtained by linking individual information from various national sources. The statistical method used is multiple logistic regressions with odds ratios as estimates of relative risks. Main results: From the public sphere is shown that traditionally unequal women have decreased health risks compared with equal women, while traditionally unequal men tend to have increased health risks compared with equal men. From the domestic sphere is indicated that both women and men run higher risks of death and sickness when being traditionally unequal compared with equal. Conclusions: Understanding the relation between gender equality and health, which was found to depend on sex, life sphere, and inequality type, seems to require a combination of the hypotheses of convergence, stress and expansion.

The association between masculinity rank and mortality patterns: a prospective study based on the Swedish 1969 conscript cohort

Background: Being male constitutes a risk factor for early death, and this may be connected to concepts of masculinity. The objective of the present study was to investigate the association between masculinity rank during late adolescence and mortality patterns in a cohort of 49 321 Swedish men tested for compulsory military training in 1969. Methods: The measure of masculinity consisted of a five-grade ranking from the conscription information that comprised leisure interests and occupational preferences. Information on all-cause mortality, alcohol-related mortality, suicide, mortality from other violent causes and mortality from cardiovascular disease was collected from national registers for 1970–2003. The analyses were performed using Cox proportional hazard models with hazard ratios as estimates of relative risk. Results: For all-cause mortality, the crude relative risks versus ordinary masculinity were: lowest masculinity 1.98 (95% CI 1.71 to 2.31), low masculinity 1.38 (95% CI 1.24 to 1.53), high masculinity 0.90 (95% CI 0.81 to 1.01) and highest masculinity 0.78 (95% CI 0.62 to 0.97). After adjustments for childhood class, smoking, alcohol drinking, blood pressure, short stature, psychiatric disorder, low intelligence and contact with police or childcare authorities, conscripts who were ranked lowest on masculinity had a remaining increased relative risk of all-cause mortality (1.49; 95% CI 1.28 to 1.75) and suicide (1. 79; 95% CI 1.31 to 2.43). For mortality from violent causes other than suicide, no statistically significant associations were demonstrated. Conclusions: Earlier research has proposed that masculinity may hold both positive and negative aspects regarding lifetime health. The major conclusion here is that being ranked less masculine is associated with higher mortality.

Pioneers and laggards : Is the effect of gender equality on health dependent on context?

This study combines data at individual and area level to examine interactions between equality within couples and gender equality in the municipality in which individuals live. The research question is whether the context impacts on the association between gender equality and health. The material consists of data on 37,423 men and 37,616 women in 279 Swedish municipalities, who had their first child in 1978. The couples were classified according to indicators of their level of gender equality in 1980 in the public sphere (occupation and income) and private sphere (child care leave and parental leave) compared to that of their municipality. The health outcome is compensated days from sickness insurance during 1986-1999 with a cut-off at the 85% percentile. Data were analysed using logistic regression with the overall odds as reference. The results concerning gender equality in the private sphere show that among fathers, those who are equal in an equal municipality have lower levels of sick leave than the average while laggards (less equal than their municipality) and modest laggards have higher levels. In the public sphere, pioneers (more equal t han their municipality) fare better than the average while laggards fare worse. For mothers, those who are traditional in their roles in the public sphere are protected from high levels of sick leave, while the reverse is true for those who are equal. Traditional mothers in a traditional municipality have the lowest level of sick leave and pioneers the highest. These results show that there are distinct benefits as well as disadvantages to being a gender pioneer and/or a laggard in comparison to your municipality. The associations are markedly different for men and women.

A cost-effectiveness analysis of the Chlamydia Monday - A community-based intervention to decrease the prevalence of chlamydia in Sweden

Aims: The study was undertaken to assess the cost-effectiveness of the Chlamydia Monday, 2007. This is a community-based intervention aimed at reducing the prevalence of chlamydia by information and increased availability of testing, treatment and contact tracing in Stockholm. The aim was to analyze the cost-effectiveness by estimating costs, savings and effects on health associated with the intervention, and to determine if cost-effectiveness varies between men and women. Methods: A societal perspective was adopted, meaning all significant costs and consequences were taken into consideration, regardless of who experienced them. A cost-effectiveness model was constructed including costs of the intervention, savings due to avoiding potential costs associated with medical sequels of chlamydia infection, and health gains measured as quality adjusted life years (QALY). Sensitivity analyses were done to explore model and result uncertainty. Results: Total costs were calculated to be 66,787.21; total savings to 30,370.14; and total health gains to 9.852324 QALYs (undiscounted figures). The discounted cost per QALY was 8,346.05 (10,810.77/QALY for women and 6,085.35/QALY for men). Sensitivity analyses included changes in effectiveness, variation of prevalence, reduced risk of sequel progression, inclusion of prevented future production loss and shortened duration for chronic conditions. The cost per QALY was consistently less than 50,000, which is often regarded as cost-effective in a Swedish context. Conclusions: The Chlamydia Monday has been demonstrated by this study to be a cost-effective intervention and should be considered a wise use of society’s resources.

Who takes paternity leave? : A cohort study on prior social and health characteristics among fathers in Stockholm

Progress towards gender equality involves changes in the traditional parental division – female caring and male breadwinning. One aspect is increased parental leave for fathers, which may benefit the health of mothers, children, and fathers themselves. We examined how social and health characteristics (2002) were associated with paternity leave in excess of the ‘father quota’ of 60 days (2003–2006) in the Stockholm Public Health Cohort. Generally, fathers with stable social position, fit lifestyles, and good health had increased chances of paternity leave uptake. Our findings may contribute to identifying target groups for parental leave strategies among fathers; they indicate also that research on gender equality and public health must carefully address the problems of confounding and health-related selection.

Further Thoughts on Gender and Lifetime Health

however, that even though the division of male and female business is a historical fact, the level of gender equality defined as ‘more or less similarity between women and men in every sphere of life’ [4] is not static. The Scandinavian countries have, for example, experienced a dramatic development during the last decades regarding attitudes and practices linked to the division of parental duties by gender. This indicates, whether wished for or not, that the current gaps between old women and old men may well be reduced in the future. In connection to the statement that women give birth to children and are responsible for their later upbringing, I would like to add the ‘caring hypothesis’ for research on public health and gender [7] . This hypothesis holds that childcare, traditionally linked to mothers, protects against risky lifestyles since, for example, heavy drinking interferes with practical and emotional caring for a child, and risk-keen behaviors in general threaten child security. Consequently, men who adopt a concrete caring role are likely to develop more cautious attitudes and behaviors and live longer lives than men who stick to the supporting role of parenthood [8] . Another aspect of the ‘caring hypothesis’ is that caring for others involves concerns (beyond pleasure) which increase the risk of health problems linked to anxiety, tiredness, and the like. Hence, if coming generations of parents take on a more genderequal division of unpaid and paid work, one may assume The common state of the world is that women live longer than men, while men report better health than women [1, 2] . A common belief is that a major cause of these differences is the gender system, i.e. the societal structure organizing human life based on sex [3] . The gender system implies, among other things, that men are supposed to be instrumental, which suits the role of supporting a family, while women are supposed to be expressive, which suits the role of caring for family members [4] . Another highly public health-relevant aspect of the gender system is that health-related attitudes and behaviors are key components in the construction of masculinity versus femininity [5] . For example, men tend to use risky lifestyles for demonstrating masculinity in terms of power and prestige, while women tend to express inferiority and dependence for demonstrating femininity [6] . Hence, it seems odd to question the gender system as an explanatory factor behind the different morbidity and mortality patterns of women and men. In the former issue of Gerontology , Perrig-Chiello and Hutchison [1] set out to examine ‘the complex pattern of roles and values that define what is thought of as ‘masculine’ and ‘feminine’ and its significant impact on healthrelated lifestyles’. In my view, the authors make an excellent review of the various lifetime health prospects of women and men, and its potential biological, social, and behavioral causes. It could have been stated more clearly, Received: August 27, 2009 Accepted: September 16, 2009 Published online: December 31, 2009

How do gender, class and ethnicity interact to determine health status?

The main aim of this study was to evaluate intersections of gender (female/male), class (household income), and ethnicity (country of birth) in relation to various measures of psychological and physical health. The study is based on data from the Swedish National Public Health Survey 2006, comprising a randomly-selected sample of 26,305 men and 30,584 women aged 16–84 years. Of these 2147 men and 2916 women were born outside Sweden. Results from the present study show that being female and from an ethnic minority were consistently and statistically significantly associated with poor health outcomes. Men born in Sweden had overall better health than women who had been born in Sweden, who had better health than men born outside Sweden. The worst-off category was women born outside Sweden, particularly those in households with high income levels. Low income was consistently and statistically significantly associated with all measures of poor health outcomes among men but this association was not so clear for women. Based on the findings from the present study, we conclude that the strongest risk factor with regards to health is being from an ethnic minority, then being female and finally, having a low income. This study contributes to knowledge on the complex association between socio-economic factors and health which provides an evidence base for considering gender when formulating strategies to tackle health inequalities. We hope that the present study will inspire further studies that simultaneously evaluate combinations of differing social constructs.

Risk of self-reported Chlamydia trachomatis infection by social and lifestyle factors – A study based on survey data from young adults in Stockholm, Sweden

ABSTRACT Objective To analyse the associations between demographic, socio-economic and lifestyle factors, and the risk of self-reported chlamydial infection among young adults (20–29 years old) in Stockholm, Sweden. Methods This study was based on the Stockholm Public Health Survey of 2006 (N = 4278). Demographic factors (gender, age, and country of birth), socio-economic factors (individual and parental educational levels, individual income level, and employment status), and lifestyle factors (body mass index, mental health, alcohol consumption, and partnership status) were taken into account. Possible associations were analysed by logistic regression. Results The risk of self-reported chlamydial infection decreases with age, is higher among individuals both who personally, and whose parents, were educated to high school level compared to university level education, and is higher among those employed, unemployed or on sick-leave/pre-retired compared to students. The risk of chlamydial infection is also higher among subjects who report greater alcohol consumption, and those who live without a partner. After considering demographic, socio-economic and lifestyle factors, the associations with age, educational level, employment status and alcohol consumption are strong and statistically significant. Conclusion Indicators of risk-taking behaviours, especially in settings with generally little educational ambition or options, should be incorporated in the design of STI prevention strategies.

How does gender equality progress link to alcohol care and death? A registry study of the Swedish parental cohort of 1988/1989

This article examines how gender equality during early parenthood (1988–1991) associates with alcohol-related inpatient care or mortality (1992–2006). We categorised all Swedish couples having had a first child together in 1988–1989 (N=118 595) as traditional, or gender equal, or untraditional based on income and occupational position (bread-winning indicators), parental leave and temporary child care (child-care indicators). Overall, traditional women run lower risk, whereas traditional men and untraditional women (those opposing the traditional division of parenthood responsibilities) run higher risks of alcohol harm than their gender-equal counterparts.

A Cost-Effectiveness Analysis of the Swedish Universal Parenting Program All Children in Focus.

Objective There are few health economic evaluations of parenting programs with quality-adjusted life-years (QALYs) as the outcome measure. The objective of this study was, therefore, to conduct a cost-effectiveness analysis of the universal parenting program All Children in Focus (ABC). The goals were to estimate the costs of program implementation, investigate the health effects of the program, and examine its cost-effectiveness. Methods A cost-effectiveness analysis was conducted. Costs included setup costs and operating costs. A parent proxy Visual Analog Scale was used to measure QALYs in children, whereas the General Health Questionnaire-12 was used for parents. A societal perspective was adopted, and the incremental cost-effectiveness ratio was calculated. To account for uncertainty in the estimate, the probability of cost-effectiveness was investigated, and sensitivity analyses were used to account for the uncertainty in cost data. Results The cost was €326.3 per parent, of which €53.7 represented setup costs under the assumption that group leaders on average run 10 groups, and €272.6 was the operating costs. For health effects, the QALY gain was 0.0042 per child and 0.0027 per parent. These gains resulted in an incremental cost-effectiveness ratio for the base case of €47 290 per gained QALY. The sensitivity analyses resulted in ratios from €41 739 to €55 072. With the common Swedish threshold value of €55 000 per QALY, the probability of the ABC program being cost-effective was 50.8 percent. Conclusion Our analysis of the ABC program demonstrates cost-effectiveness ratios below or just above the QALY threshold in Sweden. However, due to great uncertainty about the data, the health economic rationale for implementation should be further studied considering a longer time perspective, effects on siblings, and validated measuring techniques, before full scale implementation.