Scandinavian Journal of Public Health

Aims: The study examined readiness to change the level of physical activity in leisure time among physically inactive adults, the sociodemographic, lifestyle-related and social factors associated with readiness to change, and finally the various kinds of help to become more physically active required by people who are ready to change and by those not ready to change. Materials and methods: Data were derived from the national representative Danish Health Interview Survey 2005 and included 9,160 physically inactive persons between 16 and 79 years of age. Data were analysed using multiple logistic regression and multiple correspondence analysis. Results: In all, 52 % of the physically inactive respondents stated they were ready to change their level of physical activity. Men had higher odds of being ready to change than women. Readiness to change decreased with age and increased with increasing levels of education. Those ready to change led an active and social lifestyle characterized by considerable health-oriented engagement, while the opposite characterised those not ready to change. Those ready to change wanted help to become more physically active in the form of e.g. opportunities for physical activity at work or help and support from the family. Those not ready to change wanted help from a general practitioner or did not want help at all. Conclusions: Those ready to change and those not ready to change were characterized by very different sociodemographic, lifestyle-related and social factors. This knowledge will benefit prevention initiatives and elucidates the necessity of targeting the initiatives.

Aims: Although childhood obesity is becoming increasingly prevalent, treatment options are limited and the continued development of effective treatment strategies is necessary. It is equally important to explore involvement of other resources in society, such as sports associations. This study was designed to investigate the possibility of reducing the degree of obesity in obese children by focusing on physical activity as an intervention. Methods: Seventy-six children (40 boys) aged 8—12 years (mean age 10.5 years, mean body mass index (BMI) 28.9, standard deviation (SD) 3.0; mean BMI z-score 3.24, SD 0.49) were invited to participate in a one-week sports camp and six-month support system. After the camp a sports coach from a local sports club supported the child during participation in a chosen sport for six months. Weight, height, body composition (using dual energy x-ray absorptiometry and magnetic resonance imaging), and lifestyle (using a questionnaire) were measured at baseline and after 12 months. Data were pooled from two camps, one with a self-selected control group and one randomized controlled trial. Results: Twelve months after the camp the intervention group had a significant decrease in BMI z-score (baseline BMI z-score 3.22; follow up 3.10, p = 0.023). The control group also reduced their BMI z-score (baseline BMI z-score 3.27; follow up 3.18, p = 0.022). No differences were found in baseline values, follow-up values, or changes in BMI z-score between groups, nor between boys and girls. Conclusions: The focus on physical activity as an intervention had no effect on degree of obesity when compared with a waiting list control group.

Background: Understanding how exercise influences health is important in designing public health interventions. At present, evidence suggests that there is a positive relationship between exercise and health. However, whether this relationship is partly due to the stress-moderating impact of exercise has been less frequently investigated although more and more people are taxed by stressful life circumstances. Methods: A comprehensive review of studies testing the potential of exercise as a stress-buffer was conducted (including literature from 1982 to 2008). The findings are based on a narrative review method. Specific criteria were taken into account to evaluate causality of the evidence. Results: About half of the studies reported at least partly supportive results in the sense that people with high exercise levels exhibit less health problems when they encounter stress. The causality analyses show that stress-moderation effects were consistently found in different samples and with different methodological approaches. Although more support results from cross-sectional studies, exercise-based stress-buffer effects were also found in prospective, longitudinal and quasi-experimental investigations. Conclusions: This review underscores the relevance of exercise as a public health resource. Recommendations are provided for future research. More prospective and experimental studies are needed to provide insight into how much exercise is necessary to trigger stress-buffer effects. Furthermore, more information is warranted to conclude which sort of exercise has the strongest impact on the stress-illness-relationship.

Aims: To investigate the mortality among social assistance recipients, who are among the most marginalized people in Norway. Cause-specific mortality was analysed in an attempt to explain the excess mortality. Previous research has suggested that social disadvantage leads to higher mortality from all causes, whereas others have found substantial variation when studying separate causes. The impact of the various causes will influence policy recommendations. Methods: Data were compiled through linking between Norwegian administrative records. The entire population born between 1935 and 1974 (2,297,621 people) was followed with respect to social assistance and death from 1993 to 2003. Cause-specific, age-standardized mortality rates for social assistance recipients and the rest of the population were calculated, and both the absolute (rate difference) and relative (rate ratio) rates were measured. Results: The rate ratio for total mortality was 3.1 for men and 2.5 for women for the comparison between social assistance recipients and the general population. The mortality among social assistance recipients was higher for all causes, but the magnitude differed considerably, depending on the cause. The rate ratio for men ranged from 1.2 for non-smoking-related cancer to 18.8 for alcohol- and drug-related causes. Alcohol-and drug-related and violent causes together contributed to half of the excess mortality for men and one-third for women. Conclusions: The mortality of this socially disadvantaged group was considerably higher than that of the general population, and this difference reflected mainly drug-related causes.

Aims: To examine the effects of Neo-Marxian social class (i.e. measured as relations of control over productive assets) and potential mediators such as labour-market position, work organization, material deprivation and health behaviours upon mortality in Barcelona, Spain. Methods: Longitudinal data from the Barcelona 2000 Health Interview Survey (n = 7526) with follow-up interviews through the municipal census in 2008 (95.97% response rate) were used. Using data on relations of property, organizational power, and education, social classes were grouped according to Wright’s scheme: capitalists, petit bourgeoisie, managers, supervisors, and skilled, semi-skilled and unskilled workers. Results: Social class, measured as relations of control over productive assets, is an important predictor of mortality among working-class positions for men but not for women. Workers (hazard ratio 1.60, 95% confidence interval 1.10—2.35), managers and small employers had a higher risk of death than capitalists. Conclusions: The extensive use of conventional gradient measures of social stratification has neglected sociological measurements of social class conceptualized as relations of control over productive assets. This concept is capable of explaining how social inequalities are generated. To confirm the protective effect of the capitalist class position and the ‘‘contradictory class location hypothesis’’, additional efforts are needed to properly measure class among low-level supervisors, capitalists, managers, and small employers.

Background: In previous research, ill-health and marginalization from the labour market have been pointed out as potential triggers for being marginalized from other spheres of society as well, e.g. economic, political and social, i.e. social exclusion. However, very few studies have examined the consequences of long-term sickness absence. Aim: The research question raised here is therefore to examine the relationship between long-term sickness absence (≥60 days) and social exclusion among individuals. Methods: The logistic regression analyses are based on longitudinal data (n = 3,144) from the Swedish Level of Living Survey linked to register data. Results: The results suggest that both women and men have higher odds of having no excess cash (‘‘cash margins’’) after their long-term sickness absence, compared with people with no such sickness absence. Women seem more likely to have no cash margins combined with being single/unmarried and having no close friends after long-term sickness absence, than do women without such sick-listing. The results indicate a slight mediating effect of employment status on the odds ratios for these economic and social conditions. Conclusions: The present study suggests that long-term sickness absence increases the risk of adverse economic and social conditions among individuals. That these conditions can be seen as indicators of social exclusion is more doubtful.

Aims: The main aim was to examine whether drinking habits including average, binge and problem drinking are associated with self-certified and medically confirmed sickness absence among middle-aged municipal employees. Another aim was to examine whether psychosocial and physical working conditions and work arrangements explain these associations. Methods: The data on drinking habits and working conditions of 5,119 female and 1,390 male middle-aged employees of the City of Helsinki was obtained from postal questionnaires collected in 2000—2002. The data on sickness absence (2000—2005) were derived from the employer’s registers. Poisson regression analysis with self-certified (1—3 days) and medically confirmed (over 3 days) sickness absence spells as outcomes was used in performing the analyses. Results: Heavy average, binge and problem drinking were all associated with an increase in self-certified sickness absence. Both non-drinkers and heavy drinkers had excess medically confirmed sickness absence compared to moderate drinkers. Problem drinking and among women also binge drinking were associated with medically confirmed sickness absence. Psychosocial working conditions slightly attenuated the association of drinking habits and sickness absence mainly among men. Physical working conditions and work arrangements slightly explained medically confirmed sickness absence among male problem drinkers. Conclusions: All studied drinking habits were associated with both self-certified and medically confirmed sickness absence. Thus, a decrease in unhealthy drinking habits among employees is likely to prevent sickness absence. The effects of working conditions were small but psychosocial working conditions slightly explained the associations between drinking habits and sickness absence mainly among men.

Aims: Mental disorders often go undetected in primary care, for persons awarded disability pension, and in sick-leave certificates. No validity tests of instruments for detection and measurement of mental disorders have been performed in long-term sickness absence (LSA). This is the aim of the present study for Common Mental Disorders — Screening Questionnaire (CMD-SQ). Methods: It is validity tested in a well-defined Danish population comprising all persons on continuous sickness absence just exceeding eight weeks. CMD-SQ is composed of SCL-SOM (somatization), Whiteley-7 (illness worry and conviction), SCL-ANX4 (anxiety), SCL-DEP6 (depression), SCL-8 (emotional disorder), and CAGE (alcohol dependency). Results: Of 2,414 incident persons on long-term sickness absence within one year, 1,121 participated in the study by filling in CMD-SQ and a subsample of 337 was diagnosed by a psychiatric examination including Present State Examination. Psychometric properties such as scalability and monotonicity, construct validity, and predictive validity were analyzed. Further change over time was analyzed. SCL-SOM and Whiteley-7 showed slight psychometric and screening statistics whereas a combined scale of SC-ANX4, SCL-DEP6, and SCL-8, called SCL-8AD, showed the best and excellent psychometric and screening statistics. Conclusions: SCL-8AD, a sub-scale of CMD-SQ, is a promising candidate for screening and measurement of mental disorders in long-term sickness absence.

Background: The burden caused by psychiatric disorders on the individual and society has resulted in more studies examining interventions aimed at reducing sickness absence. Aims: To examine if detection of undetected psychiatric disorders in long-term sickness absence (LSA) would improve the rate of return to work. Methods: Over one year all 2,414 incident persons on LSA in a well-defined population were within one week after eight weeks of continuous sickness absence posted the Common Mental Disorders Screening Questionnaire (CMD-SQ) to screen for mental disorders. In a randomized controlled trial (RCT), of 1,121 responding participants, persons with a minimum level of psychiatric symptoms 420 were allocated to the intervention group and 416 to the control group. The intervention was a psychiatric examination including diagnostics with Present State Examination and feedback regarding treatment and rehabilitation to the participants themselves, general practitioners and the social service taking care of the participants’ rehabilitation back to work. Of the 420 in the intervention group 329 (78.3%) participated in the intervention. The outcomes measure was in an intention treat analysis the rate of return to work. Results: The rate of return to work was non-significantly lower for the intervention group than for the control group, except for persons without a psychiatric sick-leave diagnosis who were sick-listed from full time work, who showed a significantly higher rate of return to work in the intervention group. Conclusions: The effect of interventions for return to work depends on socio-demographic characteristics. Further studies are needed regarding interventions to improve return to work.

Aims: This study analyzes decisive measures of efficiency of a test, receiver operating characteristic (ROC) analysis and QROC analysis combined with considerations about clinical, health-economic, and ethical aspects when choosing screening instruments. Methods: Analyses of Common Mental Disorders Screening Questionnaire (CMD-SQ) and its subscales SCL-SOM, Whiteley-7, SCL-ANX4, SCL-DEP6, SCL-8, plus combinations, for early detection of psychiatric disorders, are the subject for this analysis. In all, 46.4% of 2,414 new people with continuous sickness absence for more than eight weeks over one year in a well-defined Danish population of 120,000 inhabitants participated in the study. The study was performed as a two phase study. All 1,121 persons in Phase 1 filled in the CMD-SQ. In Phase 2, a random subsample of Phase 1 on 337, the people were further examined by a psychiatrist using SCAN as gold standard. The analyses were performed as weighted analyses on Phase 2. Results: From 17 analyses it was shown that the efficiency of a test, ROC analyses, and QROC analyses resulted in different optimal scales and cut-points. The random possibility of a positive test or negative test in the population is discussed for efficiency and ROC analyses. QROC analyses correct for this by the relative κ-values as decisive measures. However, QROC analyses may discard tests of value, all depending on the purpose of the test. Conclusions: In supplement to test statistics the capacity of services to follow up on screening, ethics, and health economy are issues that should be considered in deciding what rating scale and cut-point should be adopted.

Aims: To investigate sex differences in the prevalence and extent of overweight and obesity in adolescents aged 14—18 years. Methods: Standardized measurements of height and weight were collected from surveys of adolescents in the same geographical area in 1966—69 (n = 8378) and in 1995—97 (n = 6673). The prevalence rates of overweight and obesity were calculated using criteria approved by the International Obesity Task Force. The extents of overweight and obesity were assessed by computing age- and sex-specific body mass index (BMI) percentiles. Results: In 1995—97, 17.2% met the criteria for either overweight or obesity, as compared with 10.7% in 1966—69. The prevalence of overweight and obesity combined was higher in girls (13.0%) than in boys (8.5%) in 1966—69 (difference 4.5%, 95% confidence interval (CI) 3.1—5.9), while no sex difference was found in 1995—97 (girls 16.9%, boys 17.5%, difference —0.6, 95% CI —2.3—1.1). The increase in overweight was greater in boys (6.2PP, 95% CI 4.7—7.6) than in girls (1.9PP, 95% CI 0.4—3.5), while the sex difference in increased obesity was smaller (boys 2.8PP, 95% CI 2.1—3.4, girls 2.0PP, 95% CI 1.3—2.6). The increase in extent of overweight and obesity was highest in boys. The values of the 85th percentile and the 95th percentile in boys increased by 1.3 and 3.0 BMI units, respectively. The corresponding increases in girls were 0.7 and 1.7 BMI units. Conclusions: A marked sex difference in time trends for both the prevalence and extent of overweight and obesity, with a more pronounced increase in boys than in girls, was demonstrated. This might have implications for preventive strategies.