Satu Helakorpi

Development of smoking by birth cohort in the adult population in eastern Finland 1972–97

OBJECTIVE To analyse the dynamics of smoking prevalence, initiation, and cessation in relation to sex, age, birth cohort, study year, and educational level. DESIGN Six independent cross-sectional population surveys repeated every five years between 1972 and 1997. SETTING The provinces of North Karelia and Kuopio in eastern Finland. SUBJECTS Independent random samples of 18 088 men and 19 200 women aged 25–64 years. Those comprising the oldest birth cohort were born in 1913–17 and those in the youngest were born in 1968–72. RESULTS Among men the prevalence of smoking decreased over time, but the cohort effect observed in smoking initiation was obscured by the changes in smoking cessation. Differences between the educational categories were small. Among women the prevalence of smoking increased during the study period. This was mainly caused by the less highly educated, in whom smoking initiation clearly increased in successive birth cohorts, but a more moderate cohort effect was also present among the more highly educated women. CONCLUSIONS In men decreased initiation and increased cessation contributed to the downward trend in smoking prevalence, whereas among women, changes in smoking were mostly caused by augmented initiation in successive birth cohorts. During the study period educational inequalities in smoking widened, as the less highly educated came increasingly to form the smoking population.

Did Finland’s Tobacco Control Act of 1976 have an impact on ever smoking? An examination based on male and female cohort trends

Objective: To examine patterns of ever smoking among Finnish adults by gender and birth cohort from 1978 to 2001, with special emphasis on the possible effects of the 1976 Tobacco Control Act (TCA). Methods: The data were derived from independent, annual cross sectional postal surveys among 15–64 year olds (n = 91 342), average response rate 75%. For the analyses 13 five year birth cohorts from 1916 to 1980 were constructed. Birth cohort variations in ever regular smoking were first examined graphically, and then logistic models were used to test the impact of the TCA. Results: Among men there was a decrease in smoking from older to younger cohorts. For women an increase in smoking was observed between successive cohorts. A clear decline in the prevalence of ever smokers concurrent with the TCA was found among both men and women. Conclusions: The smoking behaviour trends across successive birth cohorts suggest the impact of tobacco policy in decreasing smoking initiation in youth. These findings thus support the acceptability and effectiveness of antismoking and smoke free policy measures in society.

Register-based data indicated nonparticipation bias in a health study among aging people

OBJECTIVES To examine nonparticipation in a survey by linking it with register information and identify potential nonresponse bias of inequalities in health status among aging people. STUDY DESIGN AND SETTING Cross-sectional questionnaire survey with clinical checkups carried out in 2002 among persons born in 1926-1930, 1936-1940, and 1946-1950 in Southern Finland. The sample was linked with register information from Statistics Finland and analyzed in terms of participation and health status as measured by medicine reimbursements. RESULTS Participation in the survey was more frequent among those who were older, female, married or cohabiting, higher educated and nonurban residents, and those with higher income and moderate health. Among nonrespondents, women were less healthy than men, whereas among respondents, the results were reversed. Among nonrespondents, better income was associated with unfavorable health. Poor health was generally more common among nonrespondents than respondents in several subgroups. CONCLUSION Differences in response rates were found in sociodemographic factors, health, and socioeconomic position. Favorable health was generally more frequent among respondents than nonrespondents. In particular, health inequalities by gender and income differed between respondents and nonrespondents. Thus, nonresponse may lead to bias in analyses of health inequalities among aging people.

Alcohol consumption in Estonia and Finland: Finbalt survey 1994-2006

BackgroundAlcohol consumption has been regarded as an important contributor to the high premature mortality rates. The objective of this paper was to provide an overview and comparison of alcohol consumption and its socio-demographic determinants among adults in Estonia and Finland.MethodsThe study was based on a 25-64-year-old subsample of nationally representative postal cross-sectional surveys conducted in Estonia (n = 10,340) and Finland (n = 19,672) during 1994-2006. Abstinence, frequency, and the amount of alcohol consumed were examined. Logistic regression models were used to test the socio-demographic differences in alcohol consumption at least once a week. The effect of socio-demographic factors on pure alcohol consumed per week was calculated using linear regression.ResultsThe proportion of abstainers was 1.5 times higher among women than men in both countries. Throughout the study period, the amount of alcohol consumed per week increased for both genders in Estonia and for women in Finland, but was stable for men in Finland. In the final study year, medium risk amount of alcohol consumed per week was nearly 1.5 times higher among men in Estonia than in Finland, but about half that among women in Estonia than in Finland. Compared to ethnic majority in Estonia, alcohol consumption at least once a week was lower among men, but amount of pure alcohol drunk per week was higher among women of ethnic minority. In Finland, alcohol consumption at least once a week was more prevalent among women of ethnic minority, but the amount of pure alcohol drunk per week was lower for both gender groups of ethnic minority. Compared to married/cohabiting respondents, alcohol consumption at least once a week was less pronounced among single respondents in Finland, divorced or separated women in both countries, and widowed respondents in Estonia. Greater amount of alcohol consumed per week was more prevalent among single and divorced or separated respondents in Finland, but only among divorced or separated men in Estonia. Frequency of alcohol consumption was lower among less educated than higher educated respondents in Finland, but not in Estonia. The amount of consumed alcohol per week was higher among less educated men in Estonia, but lower among women with basic education in Finland.ConclusionsAlcohol consumption has increased in Estonia and Finland. National alcohol policies should reflect findings of alcohol epidemiology in order to introduce measures that will reduce alcohol related harm in the population effectively.

International differences in self-reported health measures in 33 major metropolitan areas in Europe

Background: The increasing concentration of populations into large conurbations in recent decades has not been matched by international health assessments, which remain largely focused at the country level. We aimed to demonstrate the use of routine survey data to compare the health of large metropolitan centres across Europe and determine the extent to which differences are due to socio-economic factors. Methods: Multilevel modelling of health survey data on 126 853 individuals from 33 metropolitan areas in the UK, Republic of Ireland, Sweden, Norway, Finland, Spain, Belgium and Germany compared general health, longstanding illness, acute sickness, psychological distress and obesity with the average for all areas, accounting for education and social class. Results: We found some areas (Greater Glasgow; Greater Manchester, Cheshire and Merseyside; Northumberland, Tyne and Wear and South Yorkshire) had significantly higher levels of poor health. Other areas (West Flanders and Antwerp) had better than average health. Differences in individual socio-economic circumstances did not explain findings. With a few exceptions, acute sickness levels did not vary. Conclusion: Health tended to be worse in metropolitan areas in the north and west of the UK and the central belt and south east of Germany, and more favourable in Sweden and north west Belgium, even accounting for socio-economic composition of local populations. This study demonstrated that combining national health survey data covering different areas is viable but not without technical difficulties. Future comparisons between European regions should be made using standardized sampling, recruitment and data collection protocols, allowing proper monitoring of health inequalities.

Marital status, educational level and household income explain part of the excess mortality of survey non-respondents

Survey respondents and non-respondents differ in their demographic and socio-economic position. Many of the health behaviours are also known to be associated with socio-economic differences. We aimed to investigate how much of the excess mortality of survey non-respondents can be explained by the socio-economic differences between respondents and non-respondents. Questionnaire-based adult health behaviour surveys have been conducted in Finland annually since 1978. Data from the 1978 to 2002 surveys, including non-respondents, were linked with mortality data from the Finnish National Cause of Death statistics and with demographic and socio-economic register data (marital status, education and household income) obtained from Statistics Finland. The mortality follow-up lasted until 2006, in which period there were 12,762 deaths (7,994 in men and 4,768 in women) during the follow-up. Total and cause-specific mortality were higher among non-respondents in both men and women. Adjusting results for marital status, educational level and average household income decreased the excess total and cause-specific mortality of non-respondents in both men and women. Of the total excess mortality of non-respondents, 41% in men and 20% in women can be accounted for demographic and socio-economic factors. A part of the excess mortality among non-respondents can be accounted for their demographic and socio-economic characteristics. Based on these results we can assume that non-respondents tend to have more severe health problems, acute illnesses and unhealthy behaviours, such as smoking and excess alcohol use. These can be reasons for persons not taking part in population surveys.

Monitoring diet and diet-related chronic disease risk factors in Finland

Health and dietary monitoring has a long history in Finland. The aim of this review is to summarise the main sources of Finnish dietary information including food balance sheets, household budget survey data, questionnaires related to dietary behaviour and risk factors of main chronic diseases as well as dietary surveys. According to these sources, dietary behaviour and food choices have changed considerably during the last decades. For example, the total fat intake (E %) has decreased remarkably from nearly 40 % in the late 1960s to close to 30 % in 2007. Furthermore, the type of fat consumed has changed noticeably due to the increased popularity of oil used in cooking and the large variety of softer spreads available. There has also been a notable decrease in intake of salt, and a multiple increase in the consumption of fruits and vegetables since the 1970s. The future challenges of dietary monitoring include keeping the participation rates in dietary surveys at acceptable levels, controlling under/over-reporting of diet, developing a national monitoring system for children and adapting to international changes and requirements to harmonise dietary monitoring in Europe.

The recent economic recession and self-rated health in Estonia, Lithuania and Finland: a comparative cross-sectional study in 2004–2010

Background The late-2000s financial crisis had a severe impact on the national economies on a global scale. In Europe, the Baltic countries were among those most affected with more than a 20% decrease in per capita gross domestic product in 2008–2009. In this study, we explored the effects of economic recession on self-rated health in Estonia and Lithuania using Finland, a neighbouring Nordic welfare state, as a point of reference. Methods Nationally representative cross-sectional data for Estonia (n=10 966), Lithuania (n=7249) and Finland (n=11 602) for 2004–2010 were analysed for changes in age-standardised prevalence rates of less-than-good self-rated health and changes in health inequalities using logistic regression analysis. Results The prevalence of less-than-good self-rated health increased slightly (albeit not statistically significantly) in all countries during 2008–2010. This was in sharp contrast to the statistically significant decline in the prevalence of less-than-good health in 2004–2008 in Estonia and Lithuania. Health disparities were larger in Estonia and Lithuania when compared to Finland, but decreased in 2008–2010 (in men only). In Finland, both the prevalence of less-than-good health and health disparities remained fairly stable throughout the period. Conclusions Despite the rapid economic downturn, the short-term health effects in Estonia and Lithuania did not differ from those in Finland, although the recession years marked the end of the previous positive trend in self-rated health. The reduction in health disparities during the recession indicates that different socioeconomic groups were affected disproportionately; however, the reasons for this require further research.

Awareness and use of the Heart Symbol by Finnish consumers

OBJECTIVE To study the awareness of the Heart Symbol in different age and educational groups, and changes in the awareness over a 9-year period. In addition, the reported use of products with the symbol was examined. DESIGN A series of annual cross-sectional postal surveys on Health Behaviour and Health among the Finnish Adult Population. SETTING A random sample (n 5000 per annum) from the Finnish population aged 15-64 years, drawn from the National Population Register, received a questionnaire. SUBJECTS Men and women (n 29 378) participating in the surveys in 2000-2009. RESULTS At the early 2000s, 48 % of men and 73 % of women reported to be familiar with the symbol. The corresponding rates were 66 % for men and 91 % for women in 2009. The reported use of products with the symbol increased from 29 % to 52 % in men and from 40 % to 72 % in women. In men, the awareness did not vary by age, whereas older women (45-64 years) were less likely to be aware of the symbol compared with younger women (25-34 years). Men and women with the highest education were best aware of the symbol and more likely to use the products in the early 2000s. The educational differences diminished or disappeared during the study period. CONCLUSIONS The majority of Finnish adults are familiar with the Heart Symbol, and the reported use of such products increased in all age and educational groups, especially among the less educated. The symbol may work as an effective measure to diminish nutrition-related health inequalities.

Economic inequality and population health: looking beyond aggregate indicators

This paper studies the sensitivity of various health indicators to income inequality as measured by regional Gini coefficients, using individual microdata from Finland over the period 1993-2005. There is no overall association between income and health at the regional level. We discovered that, among men, there are no significant associations between income inequality and several measures of health status. Among women or among both sexes combined, there are some indications of associations in the predicted direction between income inequality and physical health, disability retirement, sick leave, and consumption of medicines, but none are robust to different model specifications. Only among the population aged less than 30 there is some indication that mental health is associated with inequality. Our findings confirm that income inequality in small populations (not large enough to measure the overall class pyramid of the society) is often immaterial for health outcomes.