Eira Roos

Multiple socio-economic circumstances and healthy food habits

Objective:To examine associations between seven indicators of socio-economic circumstances and healthy food habits, while taking into account assumed temporal order between these socio-economic indicators.Design and setting:Data were derived from cross-sectional postal questionnaires in 2000–2002. Socio-economic circumstances were assessed by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Healthy food habits were measured by an index consisting of consumption of fresh vegetables, fruit or berries, rye bread, fish and choosing vegetable fats on bread and oil in cooking. Sequential logistic regression models were used, adjusting for age and marital status.Participants:Employees of the City of Helsinki, Finland (n=8960, aged 40–60 years).Results:Healthy food habits were reported by 28% of women and by 17% of men. Own education, occupational class, household income, home ownership and current economic difficulties were associated with healthy food habits. These associations were attenuated but mainly remained after mutual adjustments for the socio-economic indicators. Among women, a pathway was found suggesting that part of the effects of education on food habits were mediated through occupational class.Conclusions:Employees in higher and lower socio-economic positions differ in their food habits, and those in lower positions and economically disadvantaged are less likely to report healthy food habits. Health promotion programmes and food policies should encourage healthier food choices among those in lower socio-economic positions and among those with economic difficulties in particular.Sponsorship:Academy of Finland.

The association of income with fresh fruit and vegetable consumption at different levels of education

This study examined whether the association of household income with fresh fruit and vegetable consumption varies by the level of education. Data were derived from mail surveys carried out during 2000–2002 among 40- to 60-year-old employees of the City of Helsinki (n=8960, response rate 67%). Education was categorized into three levels, and the household income was divided into quartiles weighted by household size. The outcome was consumption of fresh fruit and vegetables at least twice a day (58% among women and 33% among men). Beta-binomial regression analysis was used. Among women, higher income resulted in equally higher consumption of fruit and vegetables at all educational levels, that is, similar among those with low, intermediate and high education. Among men, the pattern was otherwise similar; however, men with intermediate education differed from those with low education. We conclude that the absolute cost of healthy food is likely to have a role across all income groups.

Relative weight and disability retirement: a prospective cohort study.

OBJECTIVES The aims of this study were to examine (i) the association of relative weight with subsequent disability retirement due to any diagnosis and also in two major diagnostic groups (ie, musculoskeletal diseases and mental disorders) and (ii) whether diagnosed diseases, physical and mental functioning, and working conditions explain these associations. METHODS This prospective study comprised a cohort of 6542 middle-aged employees of the City of Helsinki, Finland. Questionnaire data were linked with register data on disability retirements, with a mean follow-up time of 7.8 years. RESULTS Adjusting for age, body mass index (BMI) was associated with all-cause disability retirement among men and women, the highest risk being for the severely obese and the obese [hazard ratio (HR) 3.45, 95% confidence interval (95% CI) 2.53-4.69; HR 1.94, 95% CI 1.52-2.46, respectively]. Adjusting for age, relative weight was also strongly associated with the main retirement diagnoses, especially musculoskeletal diseases among the severely obese (HR 4.76, 95% CI 3.06-7.40) and obese (HR 2.35, 95% CI 1.62-3.39). The association was attenuated when adjusting for self-reported diseases and physical and mental functioning at baseline. Working conditions had negligible effects on the associations. CONCLUSIONS Maintenance of normal weight is likely to reduce the risk of disability retirement. Among obese employees, the focus should be on the improvement of physical functioning and the effective treatment of obesity and its co-morbidities to counteract the heightened risk of disability retirement.

Different measures of body weight as predictors of sickness absence

Aims: Excessive weight is associated with increased sickness absence from work due to obesity-linked health problems. However, it is not known which obesity measure best predicts sickness absence. First, we aimed to compare body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) as predictors of sickness absence spells of various lengths. Second, we aimed to compare BMI based on self-reported and measured weight and height as a predictor of sickness absence to assess the validity of self-reported BMI. Methods: The participants were 5750 employees of the City of Helsinki, aged 40–60 years, who were followed up on average for 4.8 years using the employer’s register. Sickness absence spells were classified as self-certified short (1–3 days), medically certified medium length (4–14 days), and long (>14 days) absence spells. Results: All measures of body weight predicted sickness absence. The relative rates of long sickness absence in the highest quintile as compared to the lowest quintile varied in women from 1.62 (95% CI 1.35–1.94) to 1.89 (95% CI 1.62–2.23) and in men from 1.40 (95% CI 0.76–2.59) to 2.33 (95% CI 1.32–4.11). Differences in the predictive power of BMI and WC were small: both were more strongly associated with sickness absence than WHR. Self-reported BMI performed equally well as measured BMI. Conclusions: BMI – measured or self-reported – is a valid anthropometric indicator of body weight and predictor of obesity-associated health-risks. Its use is feasible for research purposes as well as for the assessment of weight-related risks to work ability.

Working Conditions and Major Weight Gain—A Prospective Cohort Study

ABSTRACT The objective of this study was to examine the associations of working conditions with major weight gain. Three different groups of work-related factors were examined: (i) work arrangements, (ii) physical working conditions, and (iii) psychosocial working conditions. The data are based on the Helsinki Health Study (HHS) questionnaire surveys. A baseline mail survey was made among middle-aged employees of the City of Helsinki in 2000–2002. A follow-up survey was made in 2007. Regression analyses with odds ratios and 95% confidence intervals were calculated. During the 5- to 7-year follow-up, 26% of women and 24% of men gained in weight 5 kg or more. Working conditions were mostly unassociated with weight gain. However, nighttime shift work, physical threat at work, and hazardous exposures at work were moderately associated with weight gain. More attention should be devoted to the prevention of weight gain in general and among risk groups in particular.

Weight change and sickness absence--a prospective study among middle-aged employees.

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 employers 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.

Educational differences in disability retirement among young employees in Helsinki, Finland.

BACKGROUND Disability retirement (DR) among young employees is an increasing problem affecting work life and public health, given the potential major loss of working time. Little is known about educational differences in the risk of DR among young employees, despite the need for such knowledge in targeting preventive measures. We examined the association between education and DR due to any cause and to mental and non-mental causes among young employees. METHODS Personnel register data of the City of Helsinki from the years 2002-2013 for 25-to-34-year-old employees (n= 41225) were linked to register data from the Finnish Centre for Pensions on DR (n= 381), and from Statistics Finland on education. Education was categorised into four hierarchical groups. The mean follow-up time was 5.7 years. Cox regression analysis was used. RESULTS There were 381 DR events and of the events, over 70% were due to mental disorders and 72% were temporary. A consistent educational gradient was found. Those with a basic education were at the highest risk of DR due to any cause (HR 4.64, 95% CI 3.07, 7.02), and to mental (HR 4.79, 95% CI 2.89, 7.94) and non-mental causes (HR 4.32, 95% CI 2.10, 8.91). CONCLUSIONS DR due to any cause, and to mental and non-mental causes, followed a clear educational gradient. Early intervention, treatment and rehabilitation with a view to maintaining work ability are needed among young employees, especially those with low education. Adapting working conditions to their health and work ability may also help to avoid premature exit from work.

Joint associations between smoking and obesity as determinants of premature mortality among midlife employees.

Background: Both smoking and obesity increase mortality, however, only few studies have considered premature death. The joint effect of smoking and obesity is less studied. The aim of this study was to examine the joint associations of smoking and obesity with all-cause and cancer mortality among midlife employees. Methods: Baseline mail surveys among employees of the City of Helsinki, Finland, during 2000-2002 include data on smoking (never-, ex-, moderate and heavy), BMI (non-obese, obese), and covariates (N = 8960, response rate 67%). Data were linked with register data on mortality until 2013. The final sample included 6437 employees. Cox proportional hazard models were used. Finally synergistic interaction effect was examined. Results: Adjusting for age and gender, non-obese heavy smokers had an elevated risk of all-cause mortality (HR 2.98, 95% CI 2.05–4.32). The joint association of obesity and smoking with all-cause mortality was stronger (HR 3.46, 95% CI 1.87–6.40), but there was no synergistic interaction (Synergy Index 0.9). Non-obese heavy smokers had an elevated cancer mortality (HR 2.94, 95% CI 1.79–4.82). The joint association of obesity and smoking with cancer mortality was stronger (HR 4.57, 95% CI 2.14–9.76) suggesting a synergistic interaction (Synergy Index 1.6, NS). Ex-smokers’ risk of death was not elevated irrespective of their weight status. Conclusions: Smoking increases the risk of death, and obesity strengthens this association. Quitting smoking, especially among obese people, may reduce premature mortality.

Weight change among normal weight, overweight and obese employees and subsequent diagnosis-specific sickness absence: A register-linked follow-up study

Aims: Obesity and weight change are associated with sickness absence; however, less is known about the diagnoses for sickness absence. We examined the association between stable and changing weight by body mass index groups with sickness absence due to any, musculoskeletal and mental diagnoses among midlife female and male employees. Methods: The Finnish Helsinki Health Study phase 1 survey took place in 2000–2002 (response rate 67%) and phase 2 in 2007 (response rate 83%). Based on self-reported body mass index, we calculated the weight change between phases 1 and 2 (body mass index change ⩾5%). The data were linked with registers of the Social Insurance Institution of Finland, including information on diagnoses (ICD-10) for sickness absence >9 days. We used a negative binom ial model to examine the association with sickness absence among 3140 women and 755 men during the follow-up (2007–2013). Results are presented as rate ratios. Covariates were age, sociodemographic factors, workload, health behaviors and prior sickness absence. Results: Weight-gain (rate ratio range=1.27–2.29), overweight (rate ratio range=1.77–2.02) and obesity (rate ratio range=2.16–2.29) among women were associated with a higher rate of sickness absence due to musculoskeletal diseases, compared to weight-maintaining normal-weight women. Similarly, obesity among men was associated with sickness absence due to musculoskeletal diseases (rate ratio range=1.55–3.45). Obesity among women (rate ratio range=1.54–1.72) and weight gain among overweight men (rate ratio=3.67; confidence interval=1.72–7.87) were associated with sickness absence due to mental disorders. Conclusions: Obesity and weight gain were associated with a higher rate of sickness absence, especially due to musculoskeletal diseases among women. Preventing obesity and weight gain likely helps prevent sickness absence.

Lifestyle and cancer—a joint pairwise association of lifestyle habits with subsequent cancer diagnosis

BACKGROUND Unhealthy behaviours increase cancer risk. However, lifestyle habits co-occur and their joint association with cancer is not known. METHODS A survey among midlife employees included data on lifestyle habits and covariates (N = 8960, response rate 67%, 80% women). The joint variables of lifestyle habits were prospectively linked with register data on cancer diagnosis (mean follow-up time 12.1 years). Cox proportional hazard model was used to calculate hazard ratios (HR), and their 95% confidence intervals. RESULTS Smoking was associated with subsequent cancer risk and the association was strengthened by inactivity (HR 1.94, 1.46-2.59) and unhealthy diet (HR 1.92, 1.43-2.57). Smoking combined with both low (HR 1.70, 1.19-2.41) and moderate (HR 1.68, 1.27-2.23) alcohol consumption was also associated with increased cancer risk, as was unhealthy diet combined with moderate alcohol consumption (HR 1.55, 1.17-2.06) and inactivity (HR 1.44, 1.10-1.88). Inactivity combined with either low (HR 1.44, 1.06-1.96) or moderate (HR 1.47, 1.11-1.95) alcohol use was associated with subsequent cancer risk. CONCLUSIONS Key unhealthy behaviours have additive effects. Preventive measures should be targeted to especially smokers and those having several adverse lifestyle habits.