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.